Inspection on 08/10/08 for Viera Gray House

This inspection was carried out on 8th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Viera Gray House 09/07/07

Viera Gray House 12/07/06

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 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Viera Gray House 27 Ferry Road Barnes London SW13 9PP Lead Inspector Sandy Patrick Unannounced Inspection 8th October 2008 09:50 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.V372720.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.V372720.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 020 8748 4580 BWright@rutcht.org.uk 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.V372720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2008 Brief Description of the Service: Viera Gray is a purpose built care home accommodating up thirty-eight older people, including up to eighteen residents 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 fees for Viera Gray House are between £633 - £668 per week. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of the inspection we visited the home on the 8th October 2008. The visit was unannounced. The inspection team included an Expert by Experience, a lay person who helps to find out about whether people at the home are getting good outcomes. We met with people who live there, staff on duty, visitors and the Manager. We looked at the environment and at records. We wrote to people living at Viera Gray, their visitors and staff and asked them to complete surveys about the home. 19 people who live at the home and their families, 10 members of staff and 3 professional visitors completed and returned surveys to us. We spoke to three people on the telephone and asked them about their experiences. We asked the Manager to complete a quality self assessment. We looked at all the information we have received about the home since the last key inspection. This included a visit in July. We did not write a report following this visit but the letter about the visit is available on request. Some of the things people told us about Viera Gray were: ‘The staff are all kind from the top to the bottom.’ ‘I never want for anything.’ ‘The staff at Viera Gray are unfailingly helpful and always supportive.’ ‘We are very happy with the care at the home.’ ‘My carer recently left and there is a vacuum and if my daughter did not visit regularly and point things out to the other staff I would be in trouble.’ ‘I feel they could do more than they currently do to help my relative with daily routines.’ Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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 Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have enough information to help them make a decision about whether they want to live at the home. There are opportunities for the staff to assess people’s needs to make sure they can meet these. EVIDENCE: There is a welcome pack, including a guide to the service and statement of purpose. Copies of these are available in the home’s foyer. People told us that they had enough information to help them when they moved to the home. One person said, ‘we were invited to visit and discuss our needs and requirements. We were given photographs of the home to help familiarise us with it’. Another person said, ‘we visited the home and had a guided tour, I was then invited back to spend a day at the home’. One person said that they had been on the waiting list for several months and then when a place became Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 10 available they had to move to the home suddenly when their next of kin was away and that this had been distressing and too rushed. We spoke to someone who had recently moved to the home. They told us that they were quite happy there and ‘getting used to things’. People are invited to the home for senior staff to assess their needs. If this is not possible assessments are carried out in hospital or the person’s home. Assessments include information from the person, their family and professionals. These assessments identify whether the person’s needs can be met at the home and we saw records of some of these. We saw copies of licence agreements for people living at the home. These had been signed. One person told us, ‘we received the contract after 6 weeks’. Another person said, ‘the contract was agreed and recently reviewed after 1 year of residency’. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are clear records of support people need, however some staff do not always give this support. There have been improvements to medication training and management however, there is still some issues about medication practices which put people at risk. EVIDENCE: There is a care plan for each person. These clearly record needs and personal objectives. Care plans include information on personal care, health, cultural needs and night care. The care plans emphasised the need to involve people in tasks around the house and encourage independence. Information on social needs was basic and this area could be expanded. Care plans are signed by the person or their relative and are updated monthly. People told us that they were happy with their care plans, although one person commented that staff did not always follow this. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 12 We saw risk assessments had been made for each person. These were clear and recorded action to help protect people and keep them safe. These had been signed and reviewed monthly. People are registered with local GPs and other health care professionals. One person told us, ‘The home arranges for a chiropodist, optician and dentist to visit regularly’. Another person told us, ‘The doctor visits regularly and my relative is kept in very good health’. However one person said, ‘at times ongoing medical support is not offered until a family member contacts the medical professionals’. One of the health professionals who contacted us said, ‘the staff team are all very welcoming and are respectful to residents.’ A hairdresser visits the home weekly. The Manager is looking at increasing the number of visits because there is a high demand for the service. There is a medication procedure and all staff have been trained in medication. The pharmacist who supplies medication to the home has recently changed and the Manager said that this has been positive. The Manager said that they regularly meet with the pharmacist to discuss problems. We saw staff administering medication. Some people’s medication was left in pots by them while they ate and the staff did not observe them taking their medication. We saw one person who was unaware their medication was there knock it on the floor. Some people told us that staff leave medication with people at nighttime and do not observe them taking this. This practice has potential risks. There must be a recorded risk assessment for any people who are left with medication which staff do not observe them taking. Staff must not sign medication records unless they have seen people take the medicines and must use appropriate coding on records to indicate that the person was left with medication. We were told by one member of staff that a particular person had their medication crushed and hidden in food. There was no record of this. However, there was a document about this for another person. The Manager said that the staff member must have made a mistake. This is a concern because the member of staff is responsible for administering medication. The person who had a statement from the GP stating that they could have medication crushed had no care plan or risk assessment regarding this. We found an unlabelled pill crusher and this contained residue of a powder. We looked at medication storage and records in two units. Some medication administration records did not have photographs and should do so that staff can easily identify them. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 13 We found that records of some tablets did not tally with the actual amount held. The Manager investigated this following the inspection and accounted for all tablets. There was a list of staff signatures so that these could be easily identified. Some people needed to add their signatures to this list. We saw that codes and symbols were used to help record administration details. On some administration records there was no key for these codes. One person told us that their relative wanted to have a shower at least twice a week but did not have this. They said that some staff were too forceful with their relative and they refused care from them and did not always get weekly showers because of this. This person told us that some staff showed respect and understanding. We found that records of baths were periodic and some people had only a small amount of recorded baths or offers of baths. Records said that some people had consistently refused baths. We saw that some people had accepted baths from some members of staff but not others. The Manager should investigate this and see if some staff need more training and supervision so that they can understand how to support people positively. One person told us, ‘there was a four week gap when my relative did not have a shower because her key worker was on holiday’. One person told us, ‘there has been several weeks gap when my relative’s teeth were not brushed and her dental health deteriorated’. We saw some people being supported with their meals. One member of staff was supporting someone without any conversation or interactions with them. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in organising and planning activities and most people enjoy participating in some of these. There has been more consultation with people who live at the home and their visitors. Some staff offer good support. People are generally happy with a varied menu. However, people are not always able to make choices and their freedom is sometimes restricted. Some of the staff do not have the skills and abilities to support people who have dementia. EVIDENCE: The staff have worked hard to create a full and varied activity programme throughout the week and at weekends. Regular activities include art and crafts, bingo, quizzes, films, church services and baking. From our surveys and conversations with people we found that the views on activities were very mixed. Some people said that they really liked the organised activities while others told us that there was not usually anything they wanted to join in with. Some of the things people said about activities were, ‘Viera Gray runs a wide Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 15 variety of activities from outings to poetry reading’, weekends’ and ‘my relative loves the activities’. ‘it is very quiet at On the day of our visit an exercise class was held in the main lounge. People were supported to attend this. We saw that lots of people arrived before the class started. A member of staff held an impromptu quiz to keep people entertained and this was enjoyed. This is a good example of supporting people. We saw that people enjoyed the activity class. Special events such as a summer fete and barbeque are organised. There are new flat screen televisions in the lounges on all units. We saw people watching these and using the subtitles. A loop system has been installed in the main lounge for people who are hard of hearing. The Manager told us that activity resources were available on the units for people to use whenever they liked. We did not see these and we did not see staff supporting people or encouraging them to take part in anything except the organised group activities. We did not see the staff sitting and talking with people who remained in the units or supporting them to do anything. There is a notice board in the entrance hall that gives details of the menu, special events and minutes of meetings. There is a monthly newsletter for people living at the home. This gives information on special events, activities and celebrations. The newsletter is displayed on the central notice board. The Manager has set up regular meetings with people who live at the home. There are two cats, who are popular members of the household. We saw that staff knocked on people’s doors before entering. There are photographs of the Manager and senior staff on duty in the entrance hall. There are supposed to be photographs of staff on display in the units, however only a few of these were displayed on the day of our visit. The staff do not where name badges and it may be difficult for some people to identify them. We saw some good examples of staff supporting people. For example we saw one member of staff walking with someone around the home wherever they wanted to go. We saw some staff chatting with people. The Assistant Manager has a very good rapport with people and lots of people told us how much they liked him. We saw him asking people about the enjoyment of their meals and their general well being. However, most of the staff did not do this. Throughout the visit we saw staff performing tasks without communicating with people or with only very basic communication. For example staff handing out meals did not speak to people while doing this. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 16 We felt that some staff lacked awareness of how to support people with dementia. The Manager told us that the staff had been trained, however, we saw little evidence that the majority of them had understood this and used their knowledge in their work. For example, we saw staff making people sit down for lunch about 20 minutes before the lunch was served. When people stood up and walked away, the staff repeatedly told them to sit down at dining tables again. People were restricting from going where they wanted or sitting where they wanted. Staff serving meals did not tell people what they were having and there was no allowance for them if they said they did not want what they were given. One person used a spoon to eat their main meal. A staff member took this away from them and told them that they were not supposed to use a spoon for the main course and told them they had to use a fork. One person told us, ‘My relative has dementia and although the staff listen to her they are not always to make judgements or act on what she says’. Another person told us, ‘since my relative has got older and frailer the home do not appear to help her, I feel they could do more for her’. And another person said, ‘most of the time when I visit the home, residents in the dementia unit seem to be adrift without clear activity or orientation’. One visitor told us that they had heard staff shout at people who have dementia and engage in conflict with them. We saw other examples of poor practice. These included when one person told a member of staff that they were hungry, the staff member just ignored this and did not offer them a drink or something to eat. We saw a staff member sitting reading a newspaper rather than spending time with people. We overheard a member of staff telling someone in a raised voice, ‘come back here and drink this tea’. One visitor told us that they had seen a person washing up dishes and watering the plants. They told us that this was important for this person. However, they said that on more than one occasion they had seen some staff aggressively telling this person off for doing these things and did not support or encourage them. People who contacted us said that they felt some staff did not know how to work with people who have dementia. One person told us that the staff were sometimes very sharp with people who live at the home and insisted that they did things which they did not want to. One person told us that some of the staff were argumentative with people living at the home and challenged the things they said and did. They told us that they gave instructions to people rather than listening to what the person wanted and this caused confusion and arguments. One visitor told us that the people living in the home sometimes thought that they had done something wrong because of the way staff talked to them and treated them. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 17 Some visitors told us that they were not always made welcome by staff. One person told us that evening visits were not generally welcomed by staff. Other visitors said that they were made welcome. The Manager has recently established quarterly relative meetings to support relatives to feel more involved and informed. There is a 4 week menu with a choice of main meals and puddings. People give their choice the day before. Alternatives are available if someone does not like either main meal. Special diets are catered for. The Chef has worked closely with people who live at the home to develop a varied menu. People have been able to make suggestions for change. The Chef attends residents’ meetings for feedback. The menu was not on display for people in the dining areas and people we spoke to did not know what they were having for dinner. In one unit, we found that staff serving the meals followed choices which people had made the day before however did not give them choices when serving and for some people who are confused a further choice and conversation about the meal would be helpful for them. We saw that staff serving meals did not consider individual portion sizes and plated up everyone’s food in the same way. We also saw that when one person said that they did not want part of their meal, the staff just scraped this off and returned the plate to them. We felt that the staff could show more respect towards people when serving their meals, offering them more choice, speaking about the food they are giving, consider different people’s appetites and portion sizes and generally making the whole mealtime more relaxed and pleasurable. We shared a meal with people in another unit. People were encouraged to help themselves to vegetables and condiments. However when someone asked for gravy they were told by the staff that this was not available. We felt that this would have been a simple request to meet and with some planning and provision in the kitchenettes the staff could make instant gravy for those who wanted. We saw some people struggling to cut up food. In one instance no one offered assistance. In another instance a staff member stood over someone to cut up their food. We felt that the staff could show a bit more awareness and understanding to make sure everyone’s needs are met at meal times. Bowls of fruit were seen on the units but these were difficult for people to access and did not contain a wide selection of fruit. One person told us, ‘some fresh fruit, like apples, is available, but we would like things like strawberries and raspberries for pudding’. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 18 In one unit, we saw that people were not offered a choice of drinks at lunch time and were all given orange squash which had been made up in a jug and left in the kitchen several hours earlier. One person commented that different cutlery should be provided for some people as the normal cutlery difficult to use. Some of the things people told us about food were, ‘there is a wide selection of good food’, ‘my relative arrived at the home with a poor appetite, this has improved at the home and she enjoys a wide variety of foods’, ‘sometimes cheaper poor quality items are used, such as the yoghurts they buy’, ‘there needs to be more variety’ and ‘my mother likes the meals’. Viera Gray House DS0000017396.V372720.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures and these are available for people to see. Most people feel confident that these procedures are followed although some people would like to feel more supported when they raise concerns. EVIDENCE: There is an appropriate complaints procedure and this is displayed in the home and issued to new people when the move there. We saw that complaints, action taken to investigate these and outcomes had been appropriately recorded. Most people told us that they knew how to make a complaint. One person told us, ‘they have always dealt promptly with any concerns we have’. Another person said, ‘I had to conduct my own research to make a complaint and I feel the management should provide standard guidance’. Someone else commented, ‘issues have not been dealt with fairly or professionally’. Another person told us, ‘I have been happy that our concerns were listened to’. Information on advocacy services is available on the central notice board. A local advocacy service visit the home to ask people about their experiences once a year and they write a report of their findings. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 20 Richmond Churches Housing Trust has procedures on whistle blowing and protection of vulnerable people. The home has copies of the Local Authority procedure on safeguarding people. One person told us that they were concerned about petty pilfering. Another person said that the home do not appear to have a policy for lost property, they said that they had not been impressed when their relative had some property going missing. Viera Gray House DS0000017396.V372720.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe and well maintained environment. The building is generally clean although some areas need to have more thorough cleaning. EVIDENCE: The building is divided into four units, each with between 7 – 12 bedrooms. Everyone has their own bedroom with an en suite WC. Each unit has a lounge/dining area, a small kitchenette and bathrooms. There is a separate lounge on each floor. There is an enclosed garden which we saw people using. One person told us, ‘I was impressed with the garden when I first saw it and continue to enjoy it’. In general the building was well maintained. Areas have recently been decorated and new furniture and equipment has been purchased. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 22 The signs on bedroom doors are small and it may be difficult for people to identify their bedroom. The signage for units and bathrooms is also discrete and people who live at the home may find the layout confusing. People should be given the opportunity to label and identify their bedroom. The staff should consult people and their relatives to find out what would be best for each person. Staff should think of different ways of identification, such as a picture or photograph of something important in that person’s life, their house number or something they feel would help them recognise that room as theirs. We saw that bedrooms had been personalised and people told us that they were generally happy with their rooms. However one person told us, ‘every time I come back to my room someone has opened the windows and it gets quite cold in here’. We noticed that it was very cold in the room. Although it is important that bedrooms are aired, the staff should make sure they respect people’s choices and should always make sure the room is at a comfortable temperature for the occupant. We found that many people spend time in their rooms. One person told us ‘I would come out into the lounge if the television was not on all the time’ however another person said, ‘I’m quite happy here; they leave me in my room to read my books which I love’. Quite a number of people commented to us that they were very cold and that the heating had not been working properly. Staff explained that the boiler had been set on the summer setting and had not been changed. The problem was rectified during the day. However, some people told us that they had alerted staff to the problem several days earlier. The staff must make sure the home is appropriately heated and heating adjusted to meet the needs of different people in different areas. We saw that most areas of the building were clean and fresh. throughout the day there was an unpleasant odour in one corridor. However, One person told us, ‘The home is pleasant and a considerable effort has gone into improving cleanliness’. Another person said, ‘my relative’s room is not always as fresh and clean as I would like it’. Another person told us, ‘Bedrooms need to be cleaner and I have never seen a window cleaner’. Someone else said, ‘over the years my relative has lived at the home there has been numerous incidents when the room has been dirty and I have had to constantly report this’. And another person said, ‘when my relative moved in the bedroom had a stale smell that comes back whenever the windows are shut, I was told that this was because the previous resident was incontinent, we asked for the carpet to be properly cleaned but this has not happened’. People told us that the laundry service was generally good. One person said, ‘the laundry service is really good and if my clothes go the laundry in the Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 23 morning I can sometimes get them back that very afternoon and they are all nicely washed and folded for me’. There is a room allocated for smoking. Staff who smoke use this room. The Manager has evidence to show that this is permitted within the laws about smoking in public places. However, this should be reconsidered as it is a home and staff should not be smoking in someone else’s home without their permission. Staff who smoke on breaks should consider the impact of this when supporting people with personal care after this. Legislation states that any smoking room should be ‘primarily for the use of residents’. Staff working at the home told us that the smoking room at Viera Gray is used primarily by staff who smoke. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared for by well trained, supported and skilled staff some of the time. However, some staff lack the skills people need and want. The staff are offered a good range of training and there are appropriate procedures to protect people when recruiting new staff. EVIDENCE: People told us that the majority of staff were kind and helpful. However, a lot of people told us that some of the staff were not. Some of the things people told us about the staff were, ‘I never want for anything the staff always get whatever I need’, ‘there are some excellent workers’, ‘the staff are always available but not always able to answer queries, there is not always continuity’, ‘senior staff are not always available but are extremely helpful when we do see them’, ‘senior staff are excellent but there is an occasional lapse with junior staff’, ‘sometimes there are communication problems with staff whose first language is not English’, ‘some staff are excellent and help when asked, but not all staff’, ‘some staff are excellent but others are inept and unsuitable to work with people who have dementia’ and ‘workers in my relative’s unit do not follow her care plan and do not meet her needs’. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 25 Most of the staff who contacted us said that they felt well supported and had good training. Some staff felt that the team should work better together and some staff said that they did not feel supported and felt that that other people’s bad practice was ignored by managers. There are some staff vacancies and these are filled with temporary staff. Some of the staff told us that it was hard when they had to work with agency or temporary staff because they did not always do their share of work. The home employs a part time cleaner who does some general cleaning. However the care staff are expected to carry out a number of domestic duties. Some staff told us that the carpet cleaning machine was too heavy to use. Other staff told us that they did not have time to attend to cleaning duties and care tasks. There should be a reassessment of this to make sure people’s needs can be met within the time allocated to caring. There must be a risk assessment on the use of the carpet cleaning machine to make sure people are not put at risk. Two of the senior staff are qualified to NVQ level 4 and the others are qualified to NVQ Level 3. All other care staff are qualified to NVQ Level 2. Some of the staff are taking an English course. We saw records of staff training. The staff who spoke to us said that they had a good range of training to help them in their roles. We saw that staff had recently attended dementia and person centred training. Fire safety, protection of vulnerable adults and manual handling training is updated regularly for all staff. There are regular team meetings for the staff and these are recorded. The staff have regular planned individual meetings with their manager. There are communication books and meetings to handover information when the staff change shifts. There are appropriate procedures for the recruitment of staff. These include formal interviews and reference and criminal record checks. We saw evidence of these checks and checks on ID of recently recruited members of staff. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home which is well managed. Regular checks on quality and health and safety help protect people . EVIDENCE: The Manager has worked at the home for several years and is experienced and appropriately qualified. She has a good knowledge of the service. When we told her about things that concerned she investigated these. The Manager is undertaking a training course to tutor others. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 27 The Manager told us that she has developed a survey for people to tell them what they think about meals at the home. There are regular quality checks on the service, including monthly checks by senior management within the organisation and an annual review by an independent advocacy service. Requirements made at previous inspections have been met and the Manager has listened to and acted upon things we have said in the past. Recent improvements have meant that people have been consulted more and had more information, organised activities and staff training have improved. People are able to leave small amounts of cash for safekeeping with the Manager. We saw that this money is kept safe and that there are accurate records and receipts for all expenditure. Areas of the home have access restricted by key pad locks. One member of staff told us that they did not know the combination to access these locks. The Manager should make sure all the staff are aware of the combination in case emergency access is needed. Kitchenettes in the units have fridges and a small supply of food. In one kitchenette the ice compartment door was missing and there was unwrapped frozen food stored in the compartment. This could be hazardous. Food must be properly wrapped and stored to prevent risks to health. There are regular recorded checks on health and safety. Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 28 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 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 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement The Registered make sure: Person Timescale for action must 07/11/08 1. Staff do not leave medication with anyone without observing them taking this unless there is a recorded risk assessment in respect of this. 2. Staff do not sign to say that they have observed someone taking their medication unless they have actually seen this. 2. OP9 13(2) The Registered make sure: Person must 30/11/08 1. Medicines must only be administered covertly or crushed if it has been agreed by a multidisciplinary team and there is an appropriate risk assessment in place. The homes policies and procedures must be followed so that Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 30 residents medication prescribed. receive their safely and as 3. All staff responsible for administering medication know exactly who they are administering to and whether that person has any special instructions. 4. Pill crushers are labelled with the name of the person who they are used for and are not used for anybody else. 5. All powder residue from pill crushing is used and the device is thoroughly cleaned after each use. 3. OP9 13(2) The Registered Person must: 1. There is a photograph of each person attached to their medication record. 2. Recording of receipts, administration and disposal of medicines must be accurate with the correct endorsements and initials of the care worker administering medication. This is to allow audits of medication to be carried out to provide evidence that residents are receiving their medication as prescribed. 30/11/08 4. OP10 12 The Registered Person must 30/11/08 make sure people are offered regular baths or showers. The Registered Person must 14/11/08 Version 5.2 Page 31 5. OP10 12 Viera Gray House DS0000017396.V372720.R01.S.doc make sure all staff show patience, understanding and support people appropriately with personal care. 6. OP10 12 The Registered Person must 14/11/08 make sure people are offered support with dental hygiene care every day. The Registered Person must 30/11/08 make sure all staff know how to support people to make choices and express themselves. The Registered Person must 31/12/08 make sure the staff have the skills and knowledge to support people who have dementia. The Registered Person must 14/11/08 make sure the staff do not argue with, shout, behave aggressively or challenge people who live at the home. The Registered Person must 30/11/08 make sure all areas of the home are free from offensive odours and are clean. 7. OP14 12 18 8. OP14 12 18 9. OP14 12 13 10. OP26 23(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000017396.V372720.R01.S.doc Version 5.2 Page 32 Viera Gray House Standard 1 OP5 Care should be taken to make sure people have the support they need, including the presence of their next of kin if they want this, when they move to the home. There should be more information on people’s hobbies and interests available to staff working with them. The Manager needs to make sure everyone has access to the medical services they require and that people are supported to contact medical professionals if needed. The Manager should make sure people are supported by staff they feel comfortable with. The staff should make sure activity resources are available for people to use outside of organised activities. The staff should make sure visitors feel welcome at all times. The menu should be on display for the people who live at the home so that they know what they will be having for meals. People who are confused should be given a further choice when they are served their meals as they may have forgotten choices that they made the day before. The staff should show more respect towards people when serving their meals, offering them more choice, speaking about the food they are giving, meeting requests, thinking about individual portion sizes and meeting their needs. Consideration should be given to providing different cutlery and crockery to meet individual needs. The Manager needs to make sure people feel supported when they raise a concern and feel that their views are listened to. People should be given the opportunity to label and identify their bedroom. The staff should consult people and their relatives to find out what would be best for each person. The staff must make sure the home is appropriately heated and heating adjusted to meet the needs of DS0000017396.V372720.R01.S.doc Version 5.2 Page 33 2 3 OP7 OP8 4 5 6 7 OP10 OP12 OP13 OP14 OP14 8 9 OP14 10 11 OP14 OP18 12 OP19 13 OP25 Viera Gray House different people in different areas. 14 15 16 OP19 OP36 OP27 The Manager should reconsider the use of the smoking room by staff. The Manager should make sure there are systems so that all staff can feel supported. There should be a reassessment of the fact care staff attend to cleaning duties to make sure people’s needs can be met within the time allocated to caring. The Registered Person should make sure the people living at the home can identify staff on duty at all times. 17 OP27 18 OP38 The Manager should make sure all staff know the combination for key pad locks. 19 OP38 The Manager should make appropriately within the units. sure all food is stored Viera Gray House DS0000017396.V372720.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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