Inspection on 26/07/05 for Viera Gray House

This inspection was carried out on 26th July 2005.

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 12/07/06

Viera Gray House 23/01/06

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 UnaAnnounced 26 July 2005 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 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 G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Viera Gray House Address 27 Ferry Road Barnes London SW14 9PP 020 8748 4563 020 8748 4560 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Richmond Upon thames Churches Housing Trust Ms Elizabeth Wright Care home only (PC) 38 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Dementia over 65 years of age(DE(E)) Physical disability over 65 years of age (PD(E)) Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th February 2005 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. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 26th July 2005 and was unannounced. The Inspection Team included a Pharmacy Inspector. The report of his findings is detailed within Section 2 of this report. The Manager was present for some of the inspection, however she was involved in a series of planned meetings throughout the day and could not spend a great deal of time with the Inspectors. However, senior staff on duty were helpful and liaised with the Inspectors throughout the day. The Inspectors met with service users and staff on duty and were made welcome by all. The Lead Inspector was invited to join service users from one unit for their midday meal. This was well prepared, tasty and an enjoyable social occasion. In general, the Inspection Team observed positive interactions between staff and service users and service users reported that they were happy and well cared for. The Lead Inspector observed some unsatisfactory practices in one unit and these were discussed with senior staff on duty, and are detailed under Section 3 of this report. Thirty-six service users were living at the home at the time of the inspection. One potential service user was visiting the home on the day of the inspection to look around. Comment cards for service users and their representatives were given to staff on duty to distribute at the time of the inspection. Two visitors completed comment cards on the day of the inspection. One, the hairdresser who has visited the home for the past five years, wrote that she had never had any problems, with staff or service users and that the home ran smoothly and efficiently. She wrote that she was made welcome by staff and that she would ‘recommend Viera Gray to anyone’. The other comment card was completed by a visiting district nurse. She reported that the staff and management worked well in partnership with her team and that staff demonstrated a good understanding of service users’ needs. She additionally wrote, ‘A well managed home. Staff are always so helpful and friendly. My clients are well cared for and seem happy at Viera Gray’. Five comment cards were returned to the Inspector following the inspection. Three of these were from health care professionals and two from relatives of service users. Both relatives wrote that they were made welcome at the home, that they were able to visit service users in private, that they were appropriately informed and involved in decision making. Both were satisfied with the overall care. One relative wrote, ‘I am full of praise for the home, staff and care my relative receives. Everyone is so thoughtful and caring and nothing is any trouble.’ The three health care professionals reported that the Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 6 home works in partnership with them, that senior staff were always available and that staff were knowledgeable. One of the GPs who has patients living at the home wrote, ‘a caring environment. Staff always helpful.’ Service users who spoke to the Inspector, spoke positively about the home and the staff. Many reported that staff were kind and helpful. Service users spoke fondly of specific named staff and the work they had undertaken. One service user said, ‘I cannot fault the home’. Shortly before the inspection, Richmond Churches Housing Trust arranged for an independent advocacy organisation to visit the home and meet with service users individually. Service users were asked about their experiences at the home and the services that they received. Thirty service users met with the Advocates. A report from these interviews has been made available to the home, and a copy was provided to the Commission for Social Care Inspection. The report is comprehensive and includes suggestions for change, directly from service users and also from observations made by the Advocate. The report is a useful tool for the home to develop practice and the findings of the quality report and are referred to in this inspection report. What the service does well: What has improved since the last inspection? The home has met the requirements made at the last inspection. Service users reported that the quality of food has improved. Areas of the home have been redecorated. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 7 There has been work with health care professionals to improve staff training and all staff are undertaking training in protection of vulnerable adults. What they could do better: 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 G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 1, 2, 3, 4 & 5 There is a range of information available to potential and new service users to inform them about services and facilities at the home. There is an appropriate procedure for assessment which aims to identify individual needs. Potential service users are able to visit the home and are admitted on a trial stay so that they can make an informed decision about whether they wish to live at the home. The home does not provide intermediate care. EVIDENCE: There is a comprehensive Statement of Purpose and Service User Guide covering the required areas. There have been no changes to these documents since the last inspection. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 10 Information for service users on the complaints procedure, activities and local services, including advocacy organisations, was available on notice boards in communal areas. Licence agreements outlining the terms and conditions of residency are issued to all service users. The Inspector saw examples of signed licence agreements within three service user records examined. Licence agreements include a description of the room and room number, the procedure for changes to fee arrangement and the procedure for termination of the agreement. Pre admission assessments are made by placing authority social workers and senior staff at the home. Examples of these assessments were seen within service user records and were comprehensive. There was evidence of regular reassessments of need and these were appropriately translated into service user plans. All potential service users are invited to visit the home and to spend time with other service users and staff prior to making a decision about moving to the home. On the day of the inspection, one potential service user was visiting the home. The Assistant Manager had met with this person the previous week in hospital and conducted an assessment. Staff were showing the potential service user and their family around the home. All service users are admitted on a six week trial stay period. At the end of this, service users, their representatives and representatives of the home meet to decide whether the placement is appropriate. Evidence of these review meetings were seen to be in place within service user records examined. The home provides a service to people with a range of needs including dementia. Staff have received training relevant to their role and a new programme of training has been organised. It is important that all staff receive a range of training to meet the needs of the service users. Some practice observed by the Inspector would suggest that some staff should receive further training on working with people with dementia. Refer also to Sections 3 & 6. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7, 8, 9, 10 & 11 Individual service user plans are in place and detail a range of needs. There is insufficient information on social needs and individual life histories. Daily care notes made by staff do not adequately evidence individual care given or needs. Health care needs are appropriately recorded and monitored. Personal care needs of service users are either not being met or not being appropriately recorded in some cases. Assessments of risk were in place in some cases, however further areas in need of assessment were identified. There were some concerns identified about the storage, recording and administration of medication. There are appropriate procedures regarding death and dying. EVIDENCE: Individual service user plans are in place for all service users. The Inspector examined seven of these. They were clearly designed and there was evidence of regular review. Information about social interests and personal histories was limited within these plans. One plan stated, ‘encourage to join in with Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 12 activities’, another stated, ‘likes to see their family’. Participation in organised activities is low, refer to Section 3 of this report. Further development of these areas of individual service user plans must take place. A communication book is held on each unit for staff to record comments on each service user to handover between shifts. The information within these was very basic and the majority of statements did not give any practical information on the wellbeing or activity of any of the service users. Statements such as ‘is usual self’, ‘appears fine’ and ‘given personal care’ were regularly the only comment on an individual’s well being. Assessments of risk were seen to be in place for the majority of service users. In two service user plans there was reference to mobility difficulties and service users being unsteady, however no assessment of risk was in place regarding this. There was evidence of review for the majority of risk assessments seen, however one had not been reviewed for over a year. All service users are registered with local GPs and use other health care professionals as required. Staff on duty reported that the home has a good relationship with the local surgeries and in particular with the visiting nurses, who offer additional support at the home. This was confirmed in the comment cards received from these health care professionals as part of the inspection. Senior staff reported that some of the health care professionals who regularly visited the home were offering training to staff. Health care needs are appropriately detailed within service user plans and are monitored on a daily basis. There is a detailed record of all accidents and incidents within the home. The Pharmacy Inspector examined medication procedures, storage, record and administration. Creams in four service users’ rooms and denture cleaning material in two service users’ rooms was stored on the shelf in the en-suite toilets. These items were not stored securely. There are service users in the home with confusion and who can wander unsupervised. No risk assessment was seen. The date of receipt and signature of the person checking in the medication was not recorded for all medication ordered on a monthly basis. In ten instances the amount of medication in stock could not be compared with the amount that should be in stock as the receipt of medication had not been recorded appropriately. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 13 The actual quantity of medication given was not recorded for two service users prescribed medication with a variable dose and one service user prescribed medication to be taken as directed. One service user who received eye drops told the Inspector that the staff administering these varied and that some staff did not administer these appropriately. The Registered Person must ensure that all staff who undertake this are appropriately trained to do so and that their competency is tested. Staff administering eye drops must ensure that they check whether the drops have been given properly with the service user at the time of administration. Personal care needs, including preferences and choices, are recorded within service user plans. Two service users who spoke with the Inspector reported that they were able to rise, retire and bathe when they wished. Records of baths are maintained and were examined for five service users. Two records indicated that service users were offered and received regular baths. However, long gaps between baths were noted in three of the records examined. One service user had not received baths for periods of between eleven and fifteen days. The records for another service user indicated that they had one bath in February, one in March, one in April and another in July. A third record indicated that there were gaps of up to thirty-one days between baths. The senior staff on duty thought that this was probably an error with recording rather than people not being offered baths. The Registered Person must ensure that all service users are able to bathe or shower as often as they wish and that this is recorded within their service user plan. Service users who spoke with the Inspector reported that they were able to make choices about their lives and some stated that they were free to do as they wished. Service users reported that staff were kind and helpful and that relatives could visit when ever they wanted. A number of service users spoke highly of the hairdresser, who offered a good service for reasonable prices. There are appropriate procedures regarding death and care of the dying. Individual preferences and wishes are recorded. Over the past year there have been examples where the home has worked with other health care professionals to offer appropriate palliative care and support for families. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 12, 13, 14 & 15 A small range of organised activities take place, however these would benefit from improvement. Service users are able to receive visitors and access the local community (according to risk assessment). Staff on one unit behaved inappropriately and failed to meet the needs of service users. There is a varied menu offering a choice at mealtimes and service users reported that they enjoyed the food at the home. EVIDENCE: There is a planned programme of activities, however this is limited and service users and staff reported that participation in organised activities is limited. The home does not employ an activities officer and staff on the units take it in turns to facilitate organised activities. On the week of the inspection there was a list of one organised activity each day, from Monday to Friday. These were musical movement, baking, reminiscence, bingo and a sherry morning. On the day of the inspection a group of four service users and a member of staff were baking a cake. Service users involved reported that they enjoyed this type of activity and the staff member was enthusiastic about her role. The service users said that they enjoyed listening to music and socialising whilst Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 15 participating in the cake making. However, all of the group acknowledged that it was a shame that so few service users were involved. Many service users who were not participating in this planned activity spoke with the Inspector. Some reported that they were happy doing their own thing and organised their own social life. However, others said that they did not do much. The home caters for a range of needs and this diversity means that organising activities to suit all may not be possible or appropriate. Service users in one unit were observed doing very little for large periods of time. These people were not engaging in conversation, nor were they participating in any form of activity. Staff on one unit who stated that they sometimes facilitated activities reported that they ‘persuaded’ service users from their unit to participate in these activities. The recent advocates report of the home, like this inspection visit, identified that some service users were dissatisfied with organised activities and participation levels were low. Their consultation with service users led to a number of suggestions being made. The Registered Person should further consult with service users and should implement activities suggested where possible. The social/leisure interest section within service user plans examined gave very little useful information on individual interests and needs in this area. There was only a small number of social histories in place. Without this information staff cannot organise and plan activities which will meet individual needs and levels of participation may reflect the fact that service users simply do not want to take part in the sort of activities being organised. Some service users who reported that they generally organised their own activities, were happy that they could access the local community and participate in social groups of their choosing. Two service users spoke about a Prose and Poetry group organised at the home on a weekly basis. Another service user told the Inspector that they enjoyed an art and craft group. The hairdresser visits the home weekly and service users reported that this was a good service. Service users reported that regular church services at the home were a positive experience. Some service users told the Inspector that they had recently attended organised trips to places of interest. Service users reported that they enjoyed visits from entertainers. There is a library and quiet room in the home, which is well stocked with books and journals. One service user said that they enjoyed using this room, however many service users do not regularly use this facility. The Inspector was told that one service user had expressed an interest in gardening and that tools had been purchased so that they could be supported Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 16 to do this. This is positive and further work to meet individual needs such as this should be supported. The home holds monthly service user meetings and service users reported that these were quite well attended. A monthly newsletter is made available to all service users. A fete was being organised for later in the summer. Service users reported that their family members can visit whenever they want and can participate in their care. The Inspector saw and met with a number of visitors, who looked relaxed and comfortable. Visitors reported that they were made welcome by staff. The Inspector was told of examples of relatives who had continued to be involved in care delivery at the home. One service user reported that staff always offered choices and that they were given appropriate information about events at the home. In general the Inspector observed positive interactions throughout the home and service users being appropriately supported. The Inspector spent time on each unit. On one unit the Inspector was concerned that service users were not appropriately supported. When the Inspector arrived on the unit three service users and two members of staff were present in the main communal area. The staff members spent the majority of time conversing with each other and did not enter into any conversations with the service users. The television was switched on and a programme generally watched by younger people was on. Although the Inspector does not want to make assumptions about the interests of the service users, it seemed unlikely that any of them would have chosen this programme, and certainly none of them showed any interest in watching it. Two more service users joined the group and the staff continued to converse with each other, hardly acknowledging the return of these service users to the unit. One service user had been to the hairdressers, however staff did not comment on this. At one point the two staff members were standing either side of the room and they continued a conversation in raised voices over the heads of the service users. One member of staff on this unit made a cup of tea for one of the service users and gave all other service users a cold drink. Service users were not consulted about this and one service user actually told the member of staff that they did not want a cold drink as they were cold already. The staff member ignored this comment. Tables were not provided for service users to place their drinks. The service user who had said that they did not want the drink put this on the floor as no other surface was available, a staff member picked this up and gave it back to the service user to hold. One of the service users in the unit repeatedly said that they were cold both directly to staff and as a general statement. At no point did any of the staff react to this or offer the service user extra clothing or a warm drink, the service user was simply ignored. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 17 One service user was escorted into the room by a member of staff. The Inspector observed that the staff member did not speak to the service user at any point whilst they were walking along the corridor, entering the room or sitting down. The examples given above were observations made in one of the units and involved the same members of staff. However, this behaviour by staff was unacceptable and indicates a training need. The Registered Person must ensure that staff in all units give appropriate support, attention and care to service users at all times. The Inspector arrived on one unit as service users were finishing their breakfast. Service users were being offered choices and confirmed that this was always the case. Condiments were available for service users to help themselves. Service users who spoke with the Inspector stated that they liked the food. They reported that they were offered a choice at meal times and that they were able to have light snacks during the evening if they wished. A vegetarian choice is available at all meal times. Dishes of butter and other condiments were available at dining tables for service users to help themselves. However, these dishes were then covered and placed in the fridge without labelling. All food stored within the fridge should be appropriately labelled with the date of opening. The reuse, and refrigeration, of these condiment dishes could lead to contamination and the Registered Person should consider decanting condiments into smaller containers, so that they are not repeatedly used. One service user stated that they were not always able to get a cup of tea when they wanted and that they had to wait for set ‘tea’ and ‘coffee’ times. This was discussed with senior staff on duty, who reported that this should not be the case and that the procedure was that service users were able to have drinks as they require. In one unit staff were seen offering all service users a choice of hot drinks. The Inspector was invited to join the service users of one unit for their midday meal. This was well prepared and tasty. Service users who ate with the Inspector reported that they liked the food and that over recent months the quality of food had improved. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 18 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 standard(s) 16, 17 & 18 There is an appropriate complaints procedure, which is accessible to service users. All service users have a representative external to the home. Procedures designed to protect service users 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. Staff on duty reported that all service users have representatives external to the home. There is a range of information on advocacy services available to service users. A local advocacy group visit the home annually and consult with service users about their experiences of living at the home. 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. Behaviour of staff observed in one unit would suggest that these staff need further training and information on what constitutes as abuse. Refer to Section 3 of this report. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 19 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 The environment is suitable and appropriately maintained. Individual and communal space are adequate and are appropriately decorated, furnished and equipped. Some minor maintenance needs were identified. The home was clean throughout. Care staff undertake additional laundry tasks at weekends and the Registered Person must ensure that service users’ needs can be met within existing staff resources. 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. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 20 Over the last year some communal areas and corridors have been repainted. In general the home was in a good state of repair. A small number of minor maintenance needs were observed. These included a curtain rail which had come loose from the wall and a broken drawer in a kitchenette. Service users reported that they liked the garden. Some said that they found it difficult to access, as they had to negotiated several digipad controlled doors and the lift or stairways. This was discussed with a senior member of staff. They reported that they could see how this might be a concern for some service users and that they would encourage staff to offer assistance so that service users knew were aware that they would be helped if they wished to visit the garden. Service users who spoke with the Inspector reported that they liked their rooms and that they were appropriately furnished and equipped. 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. The premises are suitably equipped with adaptations and equipment throughout. A passenger lift accesses all floors. All rooms are equipped with call alarm systems. Corridors and bathrooms are equipped with garb rails. The home was appropriately heated and ventilated throughout. All hot water outlets had been appropriately equipped with temperature control valves. Water temperatures are checked and recorded weekly. Appropriate checks have been made on gas and electrical equipment and wiring. Care staff on duty reported that they undertook a number of domestic duties around the unit in addition to the work of the cleaners. The home was clean and hygienic throughout on the day of the inspection. There is no laundry staff employed at weekends and care staff have to undertake these duties. This situation is undesirable and detracts from the time staff are spending with service users. Consideration should be given to employing laundry staff at weekends. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 21 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staff are employed in sufficient numbers. There is a programme to offer staff training and NVQ opportunities and there has been some positive work with health care professionals to provide training for staff. Further training in understanding dementia, communication and activities needs to take place. There are appropriate procedures for the recruitment of staff. EVIDENCE: Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 22 The staff are allocated to three teams managed by a Team Leader and either an Assistant Manager or the Deputy Manager. There is a clear rota of staff duty hours and clear lines of accountability. Detailed job descriptions are in place for all roles within the home. The Inspector saw examples of signed terms and conditions of employment within the two staff files examined. There is a range of information for staff on there roles and responsibilities. There is a suitable procedure for the handover of information. There is an appropriate procedure for the recruitment and selection of staff. Senior staff who have undertaken recruitment training are able to take part in the interview panel for other staff. The Inspector examined the recruitment records for two members of staff. These included evidence of pre employment checks, references, interview notes and the original application for employment. On the day of the inspection, a new member of staff was being inducted to the home and was working alongside experienced staff. The senior staff on duty presented as organised and assisted in the inspection process as well as organising the shift. Senior staff reported that training from visiting health care professionals had been organised for all staff. This included training in dementia, pressure areas and care of the dying. The training was due to take place shortly after the inspection. The Inspector was told that other health care professionals were being approached to see what training they could offer. Nine staff members were undertaking NVQ Level 2 and five NVQ Level 3 at the time of the inspection. Two members of senior staff are qualified NVQ Assessors. Training records indicated that staff had recently undertaken training in first aid, medication, basic food hygiene and dementia. Dementia training had been general. It is important that staff undertake more in-depth training in this area in order to meet the needs of many of the service users. Observations made by the Inspector indicated that some staff require further training in this area and in communication. Three staff members had undertaken training in meaningful activities. This is an area identified as needing improvement at the home and other staff who facilitate activities should be appropriately trained to do so. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 23 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 & 38 The Manager is appropriately experienced and qualified. There are appropriate procedures for quality assurance and service user consultation. Checks on health and safety are made and recorded. Some risk to health and safety were identified and must be addressed to ensure the safety and wellbeing of service users. EVIDENCE: The Manager has worked at the home for 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. The organisation arranged for an independent advocacy organisation to consult with all service users and produce a report on their findings. The consultation Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 24 took place with Advocates speaking individually with service questioned service users about food, activities, staff, the complaints and other facilities. The report is thorough and representation of the views of service users. The report suggestions for change. users. They environment, gives a good also provides The home does not have dealings with service users’ bank accounts or financial management. However, small amounts of cash are held by the home, where service users request this service. This money is used for hairdressing, small purchases and some activities. The money is held securely. The Inspector examined money held on behalf of three service users and the related records. Records were accurate and information clearly presented. Crockery, cutlery and serving dishes are washed by staff on the units after each meal. The hot water outlets within these kitchenettes are thermostatically controlled to delivery water at around 43°C to minimise the risk of scalding. The Inspector observed one service user making use of the kitchen sink in their unit. As there is a likelihood of service users doing this, and independent living skills in this area should be encouraged if appropriate, it is important that these temperatures do not exceed 43°C. The Registered Person must make contact with the Environmental Health Officer to ask for their advice regarding water temperatures for washing up and if necessary washing up will have to be done in sinks with higher temperatures. Evidence of liaison with the Environmental Health Officer must be forwarded to the Commission for Social Care Inspection. The Inspector saw evidence of regular checks on the health and safety of the environment, first aid, fire equipment and water temperatures. A cleaning product was found stored in one unit under the kitchen sink. The cupboard was not locked and the storage arrangements presented a potential risk to service users. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 25 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 CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x 3 x x 2 Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 26 Yes Are there any outstanding requirements from the last inspection? 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. OP7 15 The Registered Person must ensure that social needs are identified and that, where possible, social/life histories are in place. The Registered Person must ensure that all risks are appropriately assessed, and that all assessments are subject to regular review. The Registered Person must: 1. Ensure that all items of medication and denture cleaning materials are stored securely in accordance with an appropriate risk assessment by 1st August 2005. 2. Ensure that the receipt of all medication is recorded appropriately. 3. Ensure that the administration of all medication is recorded accurately. Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Standard Regulation Requirement Timescale for action 30/09/05 2. OP7 13(4) & (6) 30/09/05 3. OP9 13(2) 01/08/05 29/07/05 29/07/05 Version 1.40 Page 27 4. Ensure that staff are appropriately trained and are competent at administering eye drops. 4. OP10 12(1) The Registered Person must ensure that service users are able to bathe whenever they wish and that this is recorded. The Registered Person must ensure that the activity programme offers a choice of stimulating activities meeting individual and group needs. Activity participation and enjoyment should be recorded, to support continued development of this service. 31/08/05 31/08/05 5. OP12 16(2)(m) & (n) 30/09/05 6. OP14 12 The Registered Person must 31/08/05 ensure that staff offer appropriate support to service users at all time. Behaviour of staff such as that identified in the main body of the report must be challenged and training provided where necessary. The Registered Person must ensure that food stored within units is appropriately labelled with dates of opening. Consideration should be given to decanting condiments into smaller containers to minimise the risk of contamination by repeated use. The Registered Person must ensure that staff a range of training opportunities so that 31/08/05 7. OP15 13(4) & (6) 16(2)(i) 8. OP30 18(1)(c) 31/03/05 Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 28 they can better understand the needs of people with dementia and in relation to activity provision. 9. OP38 13(4) & (6) 16(2)(j) 30/09/05 The Registered Person must make contact with the Environmental Health Officer to ask for their advice regarding water temperatures for washing up and if necessary washing up will have to be done in sinks with higher temperatures. Evidence of liaison with the Environmental Health Officer must be forwarded to the Commission for Social Care Inspection. The Registered Person must ensure that all COSHH products are stored appropriately. 31/08/05 10. OP38 13(4) & (6) 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. OP7 The Registered Person should ensure that entries made in the daily communication books within units appropriately record individual needs and how these have been met. The Registered Person shouold ensure that service users are aware that they may have drinks and refreshments whenever they wish. The Registered Person should ensure that the maintenance needs identified are met. G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 29 Refer to Standard Good Practice Recommendations 2. OP15 3. OP19 Viera Gray House 4. OP19 The Registered Person should esnure that staff offer assistance so that service users can visit the garden when they wish. The Registered Person should ensure that the laundry needs of service users can be met at weekends. 5. OP26 Viera Gray House G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 30 Commission for Social Care Inspection 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 G54-G04 S17396 Viera Gray V235970 260705 Stage 4.doc Version 1.40 Page 31 - 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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