Care Home: David Gresham House

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What the care home does well The home has been assessed as consistently providing excellent outcomes for the people that live at the home and this is to be commended. The way in which prospective residents are assessed ensures that the home admits only those residents who`s needs can be met safely by living at the home. Without exception all persons consulted about the home spoke positively about their experiences. A sample of comments included: "it`s a wonderful place I could not have wished for a nicer place"; "friendly atmosphere"; "I came for a weeks assessment I hadn`t been here more than a couple of days when I knew that I could live her for ever" and "I Can not speak highly enough about the home its like a private hotel 100 out of 100". Personal support is offered in ways, which promotes and protect resident`s privacy and dignity. Residents are helped to exercise choice and control over their lives with flexible routines are an integral part of daily practice, a resident said: "I choose when I want to go to bed and get up". An excellent range of opportunities for occupation and leisure enriches resident`s lives. Residents commented: "there is always quite a few things going on scrabble, bridge and card games, crafts they don`t push you to join in if you don`t want to" and "very good at organising outings, they always seem to be doing something". The meals are excellent offering both choice and variety, comments about food included: "food excellent always a choice, chef asks what you want and he does ask us if everything is ok". Residents continue to live in a clean, spacious well-maintained and homely environment. A relative commented:" it always smells nice and is spotlessly clean". Residents benefit from a dedicated, stable, well trained and competent team of staff that know them and who are suitable recruited and employed in sufficient numbers as is necessary to meet their needs. Comments about staff included: "very good, excellent, marvellous "; "extremely helpful" and "Lovely kind thoughtful and caring"; "very polite and courteous"; "always someone around to help you very professional staff". Resident`s lives are further enhanced by the involvement of a team of enthusiastic volunteers that visit and support the daily running of the home. Resident`s continue to benefit from an experienced and established manager who ensures a clear ethos and values of the home that enables staff to provide excellent quality care to residents. The home regularly reviews aspects of its own performance by seeking feedback on the quality of its services and facilities and uses this to identify any areas for further service development. A resident said " they are always asking us if there is anything else we want or how to make things even better". What has improved since the last inspection? There were no shortfalls in practices resulting in requirements made at the previous inspection. The manager reported that there has been some decoration of the home including a few bedrooms and replacement of the dining room floor, this has helped to further enhanced the environment. Comprehensive new care planning documentation has been introduced this provides staff with an excellent level of guidance on residents needs and how to meet them. What the care home could do better: Not all of the homes medication practices protected resident`s safety and the home have been required to review aspects of its practice to improve residents and staff safety. CARE HOMES FOR OLDER PEOPLE David Gresham House David Gresham House 226 Pollards Oak Road Hurst Green Oxted Surrey RH8 0JP Lead Inspector Jane Jewell Unannounced Inspection 30th April 2008 11:00 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 David Gresham House DS0000013622.V361042.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. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service David Gresham House Address David Gresham House 226 Pollards Oak Road Hurst Green Oxted Surrey RH8 0JP 01883 715948 01883 715446 pampac@lineone.net 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) Abbeyfield North Downs Society Limited (The) Mrs Pamela Ann Packham Care Home 28 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (3), Sensory Impairment over 65 years of age (3) David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The combined total of service users within categories PD(E), DE(E) and SI(E) shall not exceed six (6) 3rd October 2006 Date of last inspection Brief Description of the Service: David Gresham House is a residential care home for up to twenty-eight older people. It is owned by the Abbeyfields North Downs Care Society Limited, which is a charity and is compiled from a federation of Voluntary Housing Associations. The registered provider and manager are supported by a large committee who help support aspects of the running of the home. In addition to longer-term placements the home also provides, short term/respite care placements along with some day care provision. The home was purpose build in the 1980’s. It is located in the village of Hurst Green, near Oxted. There is a small parade of shops adjacent to the home. There are outdoor areas for residents to use and there are raised flowerbeds in some areas. The home is presented across two floors, a third floor accommodates four sheltered housing flats, which are not inspected under the commission. The home offers single bedroom accommodation with the vast majority of the rooms providing en-suite facilities. Communal space consists of large ground floor lounge and dinning room, conservatory, art/therapy room, a hairdressing salon and treatment room, as well a further lounge on the first floor. There is a raised veranda leading from the ground floor lounge into the garden, this has many seats and raised flowerbeds. The homes literature states that the societies aims “that it’s residents should have as full and active a life as their health will allow, enjoying the respect of those who support them with their dignity preserved and their privacy ensured” The fees for residential care are currently £2125 per calendar month. Extra such as: newspapers, hairdressing, chiropody, toiletries are additional costs. David Gresham House DS0000013622.V361042.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 Three star. This means the people who use the service experience Excellent quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home. This includes discussions with relatives and stakeholders involved in resident’s care. The inspection was facilitated in the main by Pam Packham (Registered Manager) and in part by the head of care. The inspection involved a tour of the premises, observation, examination of records and discussion with resident’s staff and a visitor. There were twenty-eight residents living at the home at the home at the time of the inspection. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: The home has been assessed as consistently providing excellent outcomes for the people that live at the home and this is to be commended. The way in which prospective residents are assessed ensures that the home admits only those residents who’s needs can be met safely by living at the home. Without exception all persons consulted about the home spoke positively about their experiences. A sample of comments included: “it’s a wonderful place I could not have wished for a nicer place”; “friendly atmosphere”; “I came for a weeks assessment I hadn’t been here more than a couple of days when I knew that I could live her for ever” and “I Can not speak highly enough about the home its like a private hotel 100 out of 100”. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. Residents are helped to exercise choice and control over their lives with flexible routines are an integral part of daily practice, a resident said: “I choose when I want to go to bed and get up”. An excellent range of opportunities for occupation and leisure enriches resident’s lives. Residents commented: “there is always quite a few things going on scrabble, bridge and card games, crafts they don’t push you to join in if you don’t want to” and “very good at organising outings, they always seem to be doing something”. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 6 The meals are excellent offering both choice and variety, comments about food included: “food excellent always a choice, chef asks what you want and he does ask us if everything is ok”. Residents continue to live in a clean, spacious well-maintained and homely environment. A relative commented:” it always smells nice and is spotlessly clean”. Residents benefit from a dedicated, stable, well trained and competent team of staff that know them and who are suitable recruited and employed in sufficient numbers as is necessary to meet their needs. Comments about staff included: “very good, excellent, marvellous ”; “extremely helpful” and “Lovely kind thoughtful and caring”; “very polite and courteous“; “always someone around to help you very professional staff”. Resident’s lives are further enhanced by the involvement of a team of enthusiastic volunteers that visit and support the daily running of the home. Resident’s continue to benefit from an experienced and established manager who ensures a clear ethos and values of the home that enables staff to provide excellent quality care to residents. The home regularly reviews aspects of its own performance by seeking feedback on the quality of its services and facilities and uses this to identify any areas for further service development. A resident said “ they are always asking us if there is anything else we want or how to make things even better”. What has improved since the last inspection? What they could do better: Not all of the homes medication practices protected resident’s safety and the home have been required to review aspects of its practice to improve residents and staff safety. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. David Gresham House DS0000013622.V361042.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 David Gresham House DS0000013622.V361042.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 and 5 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing residents, with a good level of information about what services are provided and what to expect when living at the home. The home continues to be able to identify and meet the wide range of residents needs accommodated at the home. The way in which prospective residents are assessed ensures that the home admits only those residents who’s needs can be met by living at the home. EVIDENCE: There is a range of well-documented information about the home and the services it provides, this includes a statement of purpose and service user guide. These documents are compiled into a “welcome pack” that is displayed in each bedroom. The manager said that the information about the home is in the process of being reviewed with a view to its further improvement. A David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 10 residents said; “I lived locally so knew about the homes good reputation I didn’t need to look around as I used to come here visiting myself I did get an information booklet in my room which told all about the home”. Residents are provided with a written contract of terms and conditions of residency with the home, once they are admitted to the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. A signed copy of the contract is retained in resident’s files. There is a significant waiting list to apply to become a resident at the home, with all referrals first assessed by a member of the management team and the committee. All prospective residents needs are comprehensively assessed with advice sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. The needs assessment then forms the basis of their care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. There is a wide range of needs accommodated at the home, this include three high dependency placements, the vast majority of residents are assessed as low needs and who live very independent lives. In addition to long-term care the home offers two short-term care placements, which are also used as assessment placements. Through discussion and examination of documentation the home is able to clearly demonstrate that it is able to identify and meet the needs of the residents. Without exception all persons consulted about the home spoke positively about their experiences. A sample of resident’s comments included: “it’s a wonderful place I could not have wished for a nicer place”; “Couldn’t find a better home”; “friendly atmosphere” and “I came for a weeks assessment I hadn’t been here more than a couple of days when I knew that I could live her for ever”. A sample of comments made by relatives included: “Could not be improved”, “Happy environment” “I Can not speak highly enough about the home its like a private hotel 100 out of 100” and “ She used to come to day care she said that if she didn’t get in the home that she did not want to go anywhere else. Residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted with said that they were aware of the home before they moved in and therefore did not always feel the need to have a formal visit to look around. The first six weeks of occupancy is looked upon as trail occupancy. Where social services are the placement authority it is usual practice that within this period a review be undertaken to determine whether the residents wishes to stay permanently or not. Intermediate care is not available at this home. David Gresham House DS0000013622.V361042.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 and 11 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from an excellent care planning process, which provides clear, up to date and accurate information about their needs. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. The health needs of residents are well met with evidence of regular input from a range of health care professionals. Not all of the homes medication practices protected resident’s safety. EVIDENCE: New care planning documentation has recently been introduced. Five individual plans of care were inspected and were found to contain comprehensive, detailed and up to date information on resident’s needs and the appropriate guidance for staff on how to support residents to meet these needs. There were several examples noted of commendable practices in the care planning process, this included the regular review and update of care plans to ensure that any changes in needs are promptly identified and that resident’s were David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 12 actively involvement in the development and review of their care plans. Staff demonstrated a good knowledge of the contents of care plans and were observed following the guidelines set out in them. Individual risk assessments are in place, which covered core and specialist areas of risks and records the actions to manage any identified risks. The home maintains a daily record for each resident on events and occurrences. The standard of daily recording was noted to be good with a clear account of actions and events that had occurred which was written in a respectful and sensitive language. Records of medical intervention showed that the home works closely with health care professionals including GP’s, District and specialist nurses, chiropodists, opticians and dentists to ensure residents receive a range of health care intervention. Residents consulted said that when they have asked to see a Doctor then this has been sought promptly. Medicines are generally managed well however some night medicines are secondary dispensed, namely they are put into named lidded pots for distribution by the night staff some hours later. This practice is not considered to be a safe administration method, as it increases the risk of mistakes occurring when medicines are not administered directly from the dispensing mechanism issued by the pharmacy and immediately given to the resident. The advice from the Commissions pharmacy inspectorate on secondary dispensing is that the homes procedure needs to be sufficiently robust to ensure that the care worker giving the medicines has the container with the original prescription label so they are certain that each person receives the right dose of the right medicine at the right time, as prescribed. There needs to be clear records (signatures) of the different tasks each staff member has undertaken at the different times. The home has been required to review this practice to ensure that it provides a sufficiently robust system necessary to safeguard residents and staff. Staff consulted with showed an understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give many examples of how they promote these rights in their every day care practices. The inspector observed much good practice by staff in the respectful and dignified manner in which they spoke and supported residents. Residents confirmed that staff always treated them with dignity, a resident also commented, “ Staff help me to get dressed and they are always very considerate closing the door to make sure no one can see in”. The head of care spoke of the support they had received in the past from Health Care professionals during the care of residents who were dying. Staff spoke sensitively about the care and support they had provided to residents and their families when residents have become terminally ill. The manager David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 13 spoke of their plans to further improve end of life services through staff training. David Gresham House DS0000013622.V361042.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 and 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are helped to exercise choice and control over their lives with flexible routines being an integral part of daily practice at the home, there is much evidence that residents are treated as individuals. Resident’s lives are enriched by the home providing an excellent range of opportunities for occupation and leisure. The meals are excellent offering both choice and variety. EVIDENCE: Observation of the daily routines and discussion with residents confirmed that staff accommodate resident’s personal wishes with regard to meal times, going to bed, rising and bathing. A resident said: “I choose when I want to go to bed and get up”. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy. Staff gave many examples of how they promoted choice and David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 15 supported resident’s individual lifestyle and preferences. A staff member when asked what the home does best responded, “Residents are treated like individual people”. Much evidence was seen of the extensive range of activities and meaningful opportunities for occupation provided by the home. Residents spoke of playing bingo, making poppies and craft sessions. Many opportunities are also provided for outings, this included on the day of the inspection residents going out to see a local bluebell wood, followed by a cream tea at the home. A sample of residents comments about the range of activities included: “there is always quite a few things going on scrabble, bridge and card games, crafts they don’t push you to join in if you don’t want to” ; “plenty of books which they change regularly”; “I like doing the crafts its fun” and” trips are well organised I like to join in the quizzes bingo”. A relative commented “very good at organising outings, they always seem to be doing something”. The committee that support the running of the home organise and run most activities, which much evidence that these are well attended and organised. Much use is made of the local community resources including local shops, churches, cafes and pubs. Without exception all visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. During the course of the inspection many visitors were observed around the home, with the home described by a staff member as always really busy with people popping in. Residents confirmed that their guests were able to visit them at any reasonable time. Many residents had their own telephone and spoke of the importance of this as they were able to keep in contact with their friends and family. The inspector had lunch with residents, the meal was presented to a high standards with residents individual preferences observed. Meal times are an important social part of the day with most residents choosing to eat their meals in the dinning room. Residents spoke of being regularly encouraged to change tables in order to meet up with different people. Residents served their own vegetables, with many choices of deserts offered. Discrete sensitive support was provided to those residents who needed support to eat. Without exception all persons consulted spoke positively about the food, a sample of comments included: “good variety and portions just the right size”; “good choice on the menu”; “food excellent always a choice, chef asks what you want and he does ask us if everything is ok”. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 16 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 and 17 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An effective complaints procedure and appropriate adult protection policies protects the rights and interests of residents. EVIDENCE: There is an accessible complaints procedure for residents, their representative and staff to follow should they be unhappy with any aspect of the service. All residents and relatives consulted with felt confident to approach any member of staff with their concerns and where they have raised minor concerns in the past these have been addressed promptly. The manager stated that there have been no complaints received by the home since the previous inspection, the manager does keep a record of minor concerns raised to demonstrate the actions taken to address them. There are written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have received formal training in safeguarding adults and prevention of abuse and the care staff consulted with showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. In order to ensure that all “persons in charge” have a clearer David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 17 understanding of their roles and responsibilities if potential safeguarding issues are raised to them it was discussed that they should undergo an update in safeguarding adults practices, which the manager agreed to undertake. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 18 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 20 21 22 24 25 and 26 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents continue to live in a clean, spacious well-maintained and homely environment with their individual accommodation personalised to reflecting their individual tastes and lifestyles. EVIDENCE: The home was purpose built and is presented across three floors with the ground and first floor providing residential accommodation, the third floor provides sheltered accommodation and does not form part of this inspection. Standard of maintenance and décor are high with evidence of every reasonable effort being undertaken to maintain a safe environment. Much effort is also undertaken in the décor and furnishings to maintain a homely feel to the David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 19 premises. The home is well located in relation to local shops, pubs and bus links to the nearby town of Oxted. There is a good provision of communal space enabling residents to engage in different activities and to be with people that they want to be with. Resident’s bedrooms were observed to have been individualised with resident’s personal effects, with residents commenting: “My bedroom has everything I need” and “bedroom really nice”. Bedrooms doors were fitted with locks, with many residents having their own key. Three bedrooms were described as designed to accommodate higher dependency needs, the doors of which had small observational windows in them. These were fitted with curtains to preserve the dignity of the occupant. A resident using one of these bedrooms said that they were able to draw the curtain if they wanted but liked it to remain open at night so the staff could keep checking on them. There was a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, walking aids, hoists, ramps, grab rails and level access throughout the home. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Many residents had been provided with neck pendants to enabling them to easily call for assistance when moving around the home. A resident said that they felt re-assured having a neck pendant and when ever they have had to use it “staff always come very quickly”. There were sufficient number of toilets and bathrooms located around the home, including the vast majority of bedrooms providing en-suite facilities. There is a range of assisted bathing facilities with a resident commenting: “you can have a choice of a shower or a bath”. The external building and entrance lobby is covered by CCTV, this is to help promote the security of the premises. A key pad lock on the front door enables staff to be aware of who is entering and leaving the building. All areas inspected were observed to be cleaned to a high standards, a relative commented “it always smells nice and is spotlessly clean”. The home employs sufficient domestic staff to ensure that standards of hygiene and cleanliness can be maintained. Systems were in place for the control of infection and all staff have been trained in this area and were observed to be working in ways that minimised the risk of infection. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 20 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 and 30 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a dedicated, stable, well trained and competent team of staff that know them and who are suitable recruited and employed in sufficient numbers as is necessary to meet their needs. Resident’s lives are further enhanced by the involvement of a team of enthusiastic volunteers that visit and support the daily running of the home. EVIDENCE: Staff, relatives and residents felt that there was sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. In addition to care staff there are management, senior care officers and ancillary staff on duty throughout the day. All staff were noted to have a good rapport with residents and visitors and were often observed using humour in their interactions, which promoted a relaxed atmosphere in the home. Staff were observed to operate with a clear sense of direction and demonstrated a good understanding of residents individual needs and preferences. A staff member said :“what makes the difference here is that the staff are long standing so we know the residents very well and they know us”. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 21 Without exception all persons consulted about the home spoke positively about the staff team, a sample of comments made by residents included: “very good, excellent, marvellous ”; “extremely helpful” and “Lovely kind thoughtful and caring”. Comments made by relatives included: “very polite and courteous“; “always someone around to help you very professional staff”. Many letters of compliment were displayed around the home, the main theme of these was the particular praise of staff for their helpfulness and sensitivity and the care provided. The staff team are supported by a seventy strong committee made up of volunteers from the local community, who along with their management responsibilities for the voluntary organisation which own the home are also involved in some day to day events at the home. This includes arranging and running activities. A member of the committee consulted with said that all volunteers go through a selection process and have a criminal records bureau check to ensure that they are safe to work with vulnerable people. Committee members observed during the course of the inspection conducted themselves in an appropriate manner towards residents and clearly contributed positively to the wellbeing of all people living at the home, through their commitment and enthusiasm, this is to be commended. The personal files of the last appointed staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. The home has been proactive in ensuring that half the staff team receive a National Vocational Qualification (NVQ ) in Care. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with older people. Staff commented: “Lots of training they are really keen on training” and “we do loads of training here all you have to do is ask for any training you want”. Staff on duty had undergone all of the mandatory training in Fire, Food safety, safeguarding adults and manual handling needed to help them work safely with residents. Staff spoke of also undertaking specialist training in areas such as dementia, mental capacity, deaf and blind awareness. A training and development plan has been developed which identifies the training undertaken and planned for in order for the home to meets its aims and objectives and residents needs. The manager confirmed that new staff undertake the industry recommended minimum inductions standards. This is designed to help ensure that all new staff entering into the care industry have a minimum level of initial training. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 22 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 and 38 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s continue to benefit from an experienced and established manager who ensures a clear ethos and values of the home that enables staff to provide excellent quality care to residents. The home regularly reviews aspects of its performance through a good program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. EVIDENCE: David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 23 The manager has fourteen years relevant management experience and holds the recommended management qualifications. There was clear evidence available, that the home continues to be managed effectively with a strong sense of leadership and direction being provided and is run in the best interest of residents. The consensus of comments received regarding the manager highlighted their approachability and professional competency. A sample of comments included: “always freely available if I need to see here”; “very nice can speak to anytime as she is always there nothing is too much trouble”; “Cant fault management very on the ball well informed runs a pretty tight ship” and “very appreciable and hands on”. The manager is supported by a head of care who demonstrated good role modelling in best care practices in the care of older people. It was clear that the management team work effectively in creating an open and transparent management. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The manager stated that they do not manage the personal finances for any current residents. There is a programme of staff appraisals. Staff consulted with said that they received regular supervision with the manager and felt supported to be able to undertake their roles. The home had recently identified a problem with staff not using the bath hoist consistently so developed a programme of supervision to ensure staff know who to use it properly. There are many mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include: residents and staff meetings, internal quality audits, written feedback from relatives and residents. Examples were noted whereby improvements to working practices and the environment have been made based on this feedback. A resident commented: “ they are always asking us if there is anything else we want or how to make things even better”. Staff spoke of a suggestion box they are able to use if they wish to raise ways of improving aspects of the home, which can be anonymous. Written guidance is available on issues related to health and safety. The manager confirmed that all of the necessary servicing and testing of health and safety equipment has been undertaken. Weekly health and safety checks are undertaken on the building. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 24 reported that they have completed a fire risk assessment. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 4 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 3 3 x 3 3 4 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 4 x 3 David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 26 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 That there are arrangements in place for the adequate recording, handling, safekeeping and safe administration medicines at the home to ensure that service users receive medication in accordance with their prescribed instructions, this is particular reference to the practices of secondary dispensing. Timescale for action 30/06/08 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 Standard Good Practice Recommendations David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI David Gresham House DS0000013622.V361042.R01.S.doc Version 5.2 Page 28 - 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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