Inspection on 12/07/06 for Viera Gray House

This inspection was carried out on 12th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Viera Gray House 08/10/08

Viera Gray House 09/07/07

Viera Gray House 23/01/06

Viera Gray House 26/07/05

Viera Gray House 24/02/05

Viera Gray House 25/08/04

Viera Gray House 17/02/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Viera Gray House 27 Ferry Road Barnes London SW13 9PP Lead Inspector Sandy Patrick Unannounced Inspection 09:45 12th July 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Viera Gray House Address 27 Ferry Road Barnes London SW13 9PP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8748 4563 02087484560 Richmond upon Thames Churches Housing Trust Ms Elizabeth Wright Care Home 38 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (20), of places Physical disability over 65 years of age (20) Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Viera Gray is a purpose built care home accommodating up thirty-eight older people, including up to eighteen service users with dementia. The home opened in 1992. The home is owned and managed by Richmond upon Thames Churches Housing Trust. The home is divided into four units, each with a sitting and dining area and a small kitchenette. All bedrooms are for single occupancy and have en suite facilities. Each unit has their own bathroom, equipped with specialist mobility baths. There is an attractive and well maintained garden. The home is situated close to local shops and transport links. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The charges for Viera Gray are between £547 – 577 per week. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three days. The first two days of the inspection, 12th and 13th July 2006, the Inspector spent time with residents, staff and visitors and looked at records. The Inspector visited again on the 20th July 2006 to meet with the Manager and discuss the findings of the inspection. The Inspector was made welcome at the home, shared a meal with residents from one unit, sat in on an organised activity and spoke to individuals and groups of residents and staff. As part of the inspection, the CSCI asked the home to distribute surveys to residents, their visitors and staff asking them to give their views on the home. The CSCI also wrote to a number of other professionals who work with the residents. Twelve residents, fourteen visitors, three staff and seven professionals returned completed surveys. All the residents said that they had a contract and most of them said that they had enough information to move to the home, some said that they visited the home. The majority of residents said that they always or usually received the support that they needed, that staff were available and that they listened to them. One person said that sometimes care and support was over looked and that staff did not always help when there was a problem. Others wrote positive comments about the staff support including, ‘the staff are lovely and do all they can to help’ and ‘there is always someone around we can talk to and they are always friendly’. The majority of residents said that they received the medical support they needed. Opinions were mixed on activities and the majority of residents said that they did not participate in organised activities. One person wrote that the home should consult more with residents about activities. All the residents knew who to speak to if they were unhappy about something. Most of the residents said that they liked the food at the home and that the home was always clean and fresh, although one person said that they felt that toilets and bathrooms were not cleaned sufficiently. One person said that they felt the home did not prioritise the needs of residents when dealing with complaints. One person said that they never knew who the staff on duty were as they did not carry ID, and another resident said that they did not know which staff was due to be on duty and they would like to know this. Some of the things which residents wrote about the home were, ‘when I came to see the home I thought it would be very nice and pleasant here, which it is and we receive all the help we need’, ‘Everything is very good and the staff very helpful’, ‘The carers are very kind’ and ‘the gardens are charming and arranged for comfortable sitting in the sunshine’. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 6 The majority of relatives and visitors who completed surveys said that they were made welcome by staff and were kept informed of the residents’ care. They all knew how to make a complaint and the majority were aware of how to access inspection reports. Most wrote that they were generally satisfied with the care at Viera Gray and that they felt residents were happy there. Half of those completing surveys felt that activities could be improved. Some said that they wanted more individual support. Others said that there was a lack of daily stimulation and residents spent time just watching the TV. One person said that they felt residents should be encouraged more to use the garden. One person said that the home ‘organised many one off events throughout the year which creates a community feeling’. One relative felt that complaints were not dealt with appropriately. One person said that it was not always clear who the keyworker was and what their role involved. One person wrote, ‘the staff at all levels are excellent and give every resident the personal touch’ and another person wrote that they felt the senior staff were accessible. The things that relatives wrote that home did well were, providing adequate food and listening to specific food requests, giving good care, very welcoming staff, very calm, giving care with genuine compassion, good maintenance of the home, communication and cleaning. Some of the things that they felt could improve were, more in house activities, better fundraising, improved communication, more opportunities for baths, access to cool drinking water, stimulus for residents with dementia, a more lively environment with more classical music, carpets and general cleaning. Two of the three staff who completed surveys said that they were well supported and received good training. One of the staff said that they did not feel supported or listened to. All three staff described thorough recruitment procedures. One staff member wrote that there should be more in depth assessments of potential residents. They also said that the lack of permanent staff was a problem. All of the professionals who completed surveys said that the staff worked in partnership with them. They said that they demonstrated a good understanding of residents’ needs and acted on specialist advice. One professional wrote that they felt care was tailor made to meet individual needs. A number of professionals said that they felt staffing shortages were a problem. Residents who spoke with the Inspector were generally happy. Specific concerns raised by residents were discussed with the Manager and general concerns are highlighted throughout the report. Residents said that staff were kind and caring. The majority of staff who spoke with the Inspector said that they were happy and well supported. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Assessments of risk must be in place wherever a risk is identified. They need to be more detailed, accurately record action to minimise risk and reflect changes in need. There needs to be improvements to medication storage and record keeping. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 8 The Manager needs to make sure that all staff are supporting residents using safe and approved manual handling techniques. There needs to be further work to look at how activities can be better organised, resourced and run. Staff need to make sure that all residents who do not participate in organised activities have stimulating and fulfilling opportunities to meet their social needs. Residents need to have regular access to their keyworker. Residents and relatives need to have clear information on the responsibilities of the keyworkers. All staff must be supported to have a good understanding of the needs of people with dementia and individual care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are able to visit the home and are given written information. Some residents feel that this information could be improved. There is an appropriate procedure for assessment which aims to identify individual needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which give information on the complaints procedure and the aims and objectives of the home. Some of the residents completing surveys said that they felt they would have liked more information when deciding whether to move to the home. One of the residents who spoke with the Inspector said that they felt the Statement of Purpose and Service User Guide could be improved so that they were more useful and gave better practical information about daily life at Viera Gray. The Manager should consult with residents and see if Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 11 improvements could be made to these documents so that they give the information residents need in an accessible format. Each resident has a contract and terms and conditions for living at the home. These record individual room numbers and details of fees. Copies of contracts are given to the residents and are held by the home. Residents are assessed by senior staff before moving to the home. Prospective residents are invited to visit the home and spend time there before making a decision about whether they wish to move to Viera Gray. All residents are admitted for a trial stay. At the end of this period a review meeting with the resident is held to make sure the home can continue to meet their needs. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The overall quality in this outcome group is adequate. This judgement has been made using evidence including a visit to the service. Some areas need improvement as current practices put residents at risk. Each resident has a care plan giving information on individual needs, these would benefit from more detail in some places. Risks need to be better assessed and recorded. reflected in care plans and risk assessments. Changes in need must be Some medication practices need improving as residents are put at risk from staff not following procedures. Some staff do not practice safe manual handling techniques and residents are put at risk. EVIDENCE: Each resident has a care plan which outlines their needs and interests. These are generally well laid out although some care plans need more information in some areas. Through discussion with staff and looking at other Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 13 documentation, the Inspector found that some information was missing from care plans. For example one resident required same gender carers, but this was not recorded; another resident’s assessment stated that they liked to prepare some of their own snacks however this was not recorded in the care plan and in another care plan the cultural and religious needs of one resident were not recorded. In some care plans the social needs of residents were not recorded or information was very basic. For example one care plan stated ‘sees daughter’, another stated ‘watches TV’ and another stated ‘encourage to join in house activities’. These statements were the only information given about the residents’ social needs and interests. Care plans did not always accurate reflect changes in need. One resident who spoke to the Inspector described how their physical needs had changed over the past year. However, their care plan remained unchanged in areas that would be affected by this. The format used for recording risk assessments is basic and does not allow for adequate information. The Inspector looked at the risk assessments in place for a sample of residents. These were not completed fully and many were just statements which did not identify the risk and in some cases did not identify the action to minimise the risk. Some of the statements were unclear. Risk assessments for different, unrelated activities were recorded on the same sheet. Where there had been changes in need, risk assessments had not been updated. Some care plans referred to risk assessments which were not in place. All residents are registered with local GPs and other health care professionals as required. Some residents said that they did not always know when the dentist and optician were visiting the home. The Manager said that staff try to give information about this and she is going to put this information into the home’s news letter to keep residents better informed. In general people were happy with the medical support they received. Not all residents were and this was discussed with the Manager. The Manager said that she believes the GPs offer a good service and make regular visits to the home. There is an appropriate procedure for medication and all staff administering medication are trained to do so. Medication was locked securely. One resident raised concerns about administration of medication stating that they felt this was not always done appropriately. The Inspector examined medication records and storage in three units. One resident who holds and administers their own medication has had a change in need. The risk assessment in place regarding this activity was very basic and has not been updated to reflect changes in need. There was no risk assessment in place for two residents whose care plans stated that they administered some of their own medication. The allergy section on some medication administration records were not completed and did not record the Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 14 known allergy of one resident. There is a record of staff signatures in each unit. Some of these were incomplete and did not record all signatures as seen on administration records. The amount of medication held at the home did not tally with records in a number of cases. Medication carried forward from one month to another was not recorded on administration records. Six packets of denture tablets and two creams were not labelled or labels were unclear. The dose given for medication which had a variable dose was not recorded. There was no date of opening on a bottle of eye drops which were to be discarded 28 days after opening. There were some gaps on medication administration records which were not completed. Some administration records did not accurately record medication given. One administration record had been changed and information was confusing. Staff had altered the dosage to be given on another administration record. A loose tablet was found in the box of another type of medication. The Registered Person should put in place an appropriate system for auditing and managing medication to prevent reoccurrence of the incidents described. Personal care needs are recorded in care plans. The home has recently been donated a new bath hoist to assist residents who need this. There are no showers for residents at the home. Some of the residents raised this as a concern. At the time of the inspection the Manager was looking at the possibility of installing new shower rooms for residents and was hopeful that this would be approved. Residents told the Inspector that they were offered regular baths. The Inspector saw an example of bad manual handling techniques where two members of staff supported a resident by lifting them under their arm pits. This practice puts the resident and staff at risk. All staff have been trained in manual handling. The Manager must make sure they follow correct procedures. Staff must be retrained if necessary. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The overall quality in this outcome group is adequate. This judgement has been made using evidence including a visit to the service. There have been improvements to activities but further improvements are needed to make sure residents’ individual needs are being met. Group activities need to be better organised, resourced and run so that they are stimulating. Staff support of residents has improved. However, some staff still acted in ways which does not respect the privacy or dignity of residents. Residents are happy with the choice, variety and quality of food. EVIDENCE: There have been steady improvements to activity provision at the home. The Manager asked residents and relatives to complete information on their social interests and needs which is positive. Some families have provided detailed social histories and photo albums to help support staff to understand and talk to residents about their lives and interests. Keyworkers should contact other families and see if they can do this for other residents. Some of the information provided by families about social interests has not been Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 16 transferred to care plans and information in the care plans was very basic in some cases. There has been some improvement to organised activities and now external providers offer exercise classes and art and craft sessions each week. There is also a well established poetry reading group which some residents said they enjoyed very much. The home has a library which is stocked with a variety of books and journals. Some residents said that they liked specific organised activities including the weekly bingo session. There is a weekly trolley shop and residents said that this was a good service. Residents said that the hairdresser, who visits weekly, was very good and reasonably priced. Residents said that special events and birthdays were celebrated. Many of the residents, relatives and other visitors who contacted the CSCI said that they felt activities needed to improve. Some of them offered suggestions of how they felt this should be done. Participation in activities at the home is limited and the staff have started to monitor this. The records of activity monitoring should be used to look at how improvements can be made. The Inspector acknowledges that it is difficult to provide organised activities to meet the diverse range of needs at the home. However, there is no one allocated to coordinate and plan activities and the Inspector saw this was a problem on the days of the inspection. A group activity is planned for each day but this was not well advertised and residents and staff on the units did not know what was happening on the days of the inspection. The Inspector observed part of a quiz on one day of the inspection. This was not well attended and some of the group did not participate at all. The staff member running the group was enthusiastic but was using a box of quiz questions that she said were so old the residents who attended knew all the answers. The Manager said that new resources were being purchased and this is necessary. The planning and delivery of activities is allocated to different staff members each day. The staff on duty said that they did not have time to plan these activities and the allocation is not based on interests or skills but on who is available. One resident told the Inspector that they could no longer participate in activities due to changes in their eyesight. The Manager must make sure residents with disabilities are supported so that they are able to participate in activities if they wish. The Inspector acknowledges that some organised activities are very successful and popular. However there needs to be better coordination, planning and delivery of activities from staff who are skilled in this area. The monitoring must be used effectively to make sure residents needs are being met. One resident said that they were not consulted about activities. On the days of the inspection the majority of residents did not join in with the organised activity. The Inspector asked staff on duty what other residents did. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 17 Staff reported that many of them rested or watched TV. Some staff said that they chatted with residents and offered nail care. They said that some residents organised their own activities and helped with the garden or went out independently. General observations were that staff were more interactive with residents than they had been in the past. Staff were seen sitting and talking to residents and spending time with them. However there were long periods of time when staff were attending to other tasks and residents were left in communal lounges doing very little. This may be their choice but there was no obvious alternative to this and little stimulation apart from the television. The Manager needs to look at how support of residents who do not join in with organised activities can be improved so that they have the opportunity to participate in varied and stimulating activities. The staff said that they had limited resources on the units. The Manager should consider providing units with a range of games (board games, cards, dominos, jigsaws etc) and craft equipment which could be made available for residents to help themselves or for staff to support residents with. The Inspector noted that staff support of residents had improved since the previous inspection. The staff allowed residents to be freer and to walk around the units as they pleased. The staff on duty spent time chatting to residents and offered them choices about drinks, TV channels and snacks. Residents were using the garden. Each resident has a keyworker. At the time if the inspection some of the residents had keyworkers who were based in different units. A number of residents and some staff said that this was a problem as they did not get the opportunities to meet their keyworker on a regular basis. One relative said that it was unclear what the responsibilities of the keyworkers were. The Manager said that she is reviewing the keyworking system in line with changes to the staff structure and hopes that all residents will have a keyworker who works in the unit they live in. This is important and was a clear request from residents who spoke to the Inspector. The home has residents from a variety of different backgrounds and cultures. There is a regular church service and communion held at the home for those who wish to attend. The information recorded on residents’ cultural and religious needs was limited in some cases. The keyworkers should make sure all the cultural and religious needs of residents are being met and are appropriately recorded. There are regular resident meetings and residents said that these are a useful forum for discussion. Minutes of the meeting and copies of the monthly newsletter show that residents are kept informed about changes. There is a flexible visitors policy and most visitors who contacted the CSCI said that they were made welcome at the home. Relatives are able to continue to Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 18 be involved in providing care if they wish. rapport with visitors. The staff on duty had a good The Inspector saw a number of examples of staff entering residents’ bedrooms without knocking or without waiting for an answer after they knocked. The days of the inspection were hot and the staff were good at monitoring how comfortable residents were, offering them drinks and providing fans. Senior staff on duty made regular visits to the units to make sure residents were happy. The majority of residents said that they liked the food at the home and that they were given choices about this. There is a varied menu which offers a choice of main meals and alternatives. Fresh fruit, snacks and drinks were available on the units. The residents said that the Chef speaks to them and asks for their ideas and feedback. The Inspector was invited to join the residents of one unit for a midday meal. Residents were able to help themselves if they wished and participated in clearing tables. The staff chatted to residents and the atmosphere was pleasant. Staff supporting residents generally sat with them but some staff repeatedly left the residents they were helping during the meal and walked away to attend to other tasks. One resident was supported by different staff during the meal. Staff allocated to support residents should remain with them for the duration of the meal. Some staff offered large mouthfuls to residents and the Manager should make sure staff are aware of how to support residents in a way which is safe and respects their dignity and wishes. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. There is an appropriate complaints procedure, which is accessible to residents. All residents have a representative external to the home. Procedures designed to protect residents are in place. EVIDENCE: There is an appropriate complaints procedure, including time scales and reference to the Commission for Social Care Inspection. Copies of the procedure are available within the Service User Guide and on communal notice boards. There is a record of complaints and how these have been dealt with. There is a record of compliments and thank you cards from service users and their relatives. A small number of people felt that complaints had not always been dealt with appropriately. The organisation must make sure procedures are followed appropriately and complainants have the opportunity to discuss the outcome of complaint investigations if they wish. There is evidence of multidisciplinary input in the investigation of some complaints. All residents have representatives external to the home. There is a range of information on advocacy services. A local advocacy group visit the home annually and consult with residents about their experiences of living at the home. This had taken place shortly before the inspection and the report from this was due to be available shortly after this. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 20 The home has adopted the London Borough of Richmond Protection of Vulnerable Adults Procedure. Richmond Upon Thames Churches Housing Trust have their own procedures on abuse and whistle blowing. The Inspector saw evidence that all staff had attended or were due to attend training in protection of vulnerable adults. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents live in a well maintained, safe and pleasant environment. Changes to some areas of the environment would improve some areas, particularly where residents have identified problems which affect their daily lives. EVIDENCE: The home is a purpose built, two storey building in a residential road. The home is set in attractive grounds. The building is well maintained and decorated and is appropriately furnished throughout. The home is divided into four units, each with their own facilities. The building remains in a good state of repair. The Manager reported that the Maintenance worker attends to all minor repairs. Carpets throughout communal areas were being replaced at the time of the inspection. One resident said that their room was being redecorated the following week. Another resident said that their carpet needed replacing. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 22 Two of the residents told the Inspector that their rooms were too hot. The angle of the rooms meant that sunlight made them very hot on the days of the inspection. The Manager said that she is consulting with the residents and has been looking at how the problem could be addressed. Bedrooms all have en suite facilities and have been personalised by residents. Residents are able to bring their own furniture and equipment. Some residents had their own telephone lines and computer connections. There is a bathroom, with a specialist mobility bath, available in each unit at the home. There are no shower facilities allocated to service users. The Manager reported that service users are able to access the staff shower upon request. At the time of the inspection the Manager was liaising with a company with the aim of installing shower rooms for residents at the home. The dining and lounge space in some of the units is limited and staff had to move heavy tables around to accommodate everyone at mealtimes. The Manager said that she is looking at ways to solve this problem. The ornaments and pictures in communal areas are looking old and worn in places. One picture was not correctly positioned in its frame and looked tatty. The Manager should consider renewing ornaments and pictures in consultation with residents. Staff on the units hand wash crockery and cutlery. The organisation should consider installing dishwashers for better hygiene and to so that staff time is not taken away from contact with residents. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The residents are protected by thorough staff recruitment procedures. The staff are well supported and are offered training in a range of areas. Further training and support to help staff to understand dementia is needed. Residents would like more information about the staff who are working, would like less agency staff and want to have better contact with keyworkers. EVIDENCE: Residents who spoke to the Inspector and completed surveys said that staff were kind, caring and attentive. However they were concerned that staff shortages were a problem. Residents said that they did not like having temporary staff. Residents said that they often did not know who was on duty or know all the names of the different staff. Some residents suggested introducing name badges for staff. Some residents said that they would like to see a duty board which would tell them who was going to be working with them over the next few days. The Manager has looked at ways of providing better information about staff but should consider implementing some of the residents’ ideas. Staff and residents said that they felt the staff spent too much time cleaning. The Manager said that she has been working with staff to help them be less Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 24 task orientated and concentrate more on direct care of the residents. Some changes to custom and practice and in house procedures might help staff to spend more time with residents. The organisation has decided to change the staffing structure at the home in response to requests by staff. Some staff will take up new posts and will be given more keyworking responsibilities. This move is positive and is reflective of what staff members have said they would like. The changes had not been implemented but were being discussed with staff at the time of the inspection. Some staff who spoke to the Inspector were confused about what the changes would mean and the Manager should make sure they all have a clear understanding. The Manager hopes that changes in staff structure will help improve keyworking, activities and the day to day running of the home. The staff are supported to undertake NVQ qualifications. The majority of staff said that they were happy and well supported. Staff records show that all staff members have regular individual supervision meetings and annual appraisals. There are also regular team meetings for all staff. A staff meeting to discuss the changes took place on one day of the inspection. The staff at the home have access to a range of training and this is recorded. The Manager said that she had organised for some staff to attend training in person centred planning, dementia, care planning and reflective practice. She hopes that people attending these training sessions will cascade this information to other staff. It is important that all staff have a good understanding of these areas. Some of the language, actions and comments from staff during the Inspection indicated that some staff need to have a better understanding of dementia and individual care. The Manager has worked hard with senior staff to promote better understanding and has attended a dementia workshop, which she said has given her ideas to support the team. Further work in this area is important and will have a direct impact on residents’ quality of life. There are appropriate procedures for the recruitment of staff and staff files evidence appropriate pre employment checks, interviews and inductions. The residents’ meeting minutes indicate that the Manager has kept them informed about why the staff recruitment process takes time. The Trust should consider how residents could be more involved in the recruitment of staff. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The service is well managed and residents, staff, visitors and other professionals are involved in the continuous development of the service. There are systems for quality monitoring and asking residents for their opinions. Residents are safeguarded by appropriate health and safety procedures. EVIDENCE: The Manager has worked at the home for over seven years and worked at other Richmond Upon Thames Churches Housing Trust services before this. She is qualified to NVQ Level 4 and is an NVQ Assessor. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 26 The Manager and senior staff have consistently demonstrated a good knowledge of residents and their individual needs as well as the needs of the home. Senior members of staff are on duty at all times. Residents and staff said that senior staff visited and spent time on the units throughout the day and the Inspector saw examples of this. The organisation arranges for monthly quality inspections of the home and reports of these are sent to the CSCI. A local advocacy group visit the home annually to conduct a quality audit. They meet with all residents and prepare a report of their findings with recommendations. A visit by the group took place shortly before the inspection. The organisation should forward a copy of this report to the CSCI. Residents are expected to make their own arrangements for the management of their financial affairs. However, the home offers a service of holding small amounts of cash on behalf of individual residents. This money is used for the purchase of small items, personal shopping, the hairdresser and any additional expenditure. Residents and their representatives are able to access the records of these finances. The system used for managing these monies is appropriate. Records are organised and show a clear audit trail. Receipts for expenditure are kept. Records required by Regulation were seen to be in place and were appropriately maintained, accurate and accessible. Some of the residents’ ‘main’ files would benefit from archiving and reorganisation. There are regular checks on the health and safety of the home, including fire safety. These are recorded. Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 28 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action The Registered Person must 31/10/06 make sure care plans are accurate, appropriately details and have information on individual social, religious and cultural needs. The Registered Person must 30/09/06 make sure clear and detailed assessments of risk are in place wherever there is an identified risk or restriction. Risk assessments must give information on actions to minimise risks. Assessments must be reviewed following changes in need. The Registered Person should consider using a different format for risk assessments which allows for the required information to be clearly recorded. 2. OP7 13(4) 3. OP9 13(2) The Registered Person must put 31/08/06 in place a system to audit and DS0000017396.V299934.R01.S.doc Version 5.2 Page 30 Viera Gray House manage ensures: medication which 1. Residents are confident that their medication is managed appropriately. 2. Records are accurate. clear and 3. Risk assessments are in place where residents administer their own medication. 4. The allergy section on records is completed and is accurate. (Previous requirement 01.03.06) 5. Variable recorded. doses are 6. All medication is clearly labelled including the date of opening where appropriate. 7. The changes of dosage are clearly recorded on the administration record for all medication. (Previous requirement 01.03.06) 4. OP10 13(5) The Registered Person must 31/08/06 make sure staff follow safe and approved manual handling practices. The Registered Person must 31/10/06 make sure activities are coordinated, planned and delivered in a way that meets the needs of residents. The monitoring which is in place Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 31 5. OP12 16(2)m&n should be used to look at how activities can be improved. New resources need to be purchased for group use and provided to units so that residents can access these at any time. Residents must be supported so that they do not feel their disability prevents them from participating in organised activities. 6. OP10 OP14 12(4) The Registered Person must 31/08/06 make sure staff knock and wait for an answer before entering residents’ rooms. The Registered Person must 31/08/06 make sure staff supporting residents at mealtimes remain with them and offer them food in an appropriate way. The Registered Person must 31/08/06 make sure that all staff have a range of training opportunities so that they can better understand the needs of people with dementia, person centred planning and in relation to activity provision. Previous requirements 31/03/06 & 31/08/06 7. OP10 OP14 12(4) 8. OP30 18(1)(c) Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Manager should consult with residents and see if improvements could be made to the Statement of Purpose and Service User Guide so that they give the information residents need in an accessible format. The Registered Person should consider employing an Activities Officer to oversee and co-ordinate activity provision at the home. 2. OP12 3. OP14 The Registered Person should consider make sure residents have regular access to the keyworker and understand the role of keyworkers. The Registered Person should consider equipping units with dishwashers to improve hygiene and so that staff time is not taken away from residents. The Registered Person should consult with residents about new ornaments and pictures for communal areas. The Registered Person should consult with residents about how best to address the problem of over heating in bedrooms. The Registered Person should consider whether shower facilities can be provided for service users. The Registered Person should consider the best way to make sure residents have room to dine without staff moving furniture around. DS0000017396.V299934.R01.S.doc Version 5.2 Page 33 4. OP19 5. OP19 6. OP19 OP24 7. OP21 8. OP20 Viera Gray House 9. OP27 The Registered Person should consider implementing some of the residents’ ideas about providing information on which staff are on duty. The Registered Person should consider ways in which residents could be more involved in the recruitment of staff. 10. OP29 Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 35 Viera Gray House DS0000017396.V299934.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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