Care Home: Gracefield Nursing Home and Residential Care Home

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What the care home does well The home provides a good level of information in the service user guide and statement of purpose. The care plans and risk assessments are detailed and provide an excellent level of information for staff, enabling them to provide high quality care. All staff are receiving supervision and appraisals.There were no odours in the home and there were new carpets being laid in the hallway and bedrooms on the day of inspection. What has improved since the last inspection? This was the first inspection under new ownership. What the care home could do better: The home does not have a registered manager in place at the present time, which could affect the interests of the people living in the home. CARE HOMES FOR OLDER PEOPLE Gracefield Nursing Home and Residential Care Home St Neots Road Dry Drayton Cambridge Cambridgeshire CB3 8AY Lead Inspector Mrs Alison Hilton Unannounced Inspection 22nd January 2008 08:35 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 Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.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. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracefield Nursing Home and Residential Care Home St Neots Road Dry Drayton Cambridge Cambridgeshire CB3 8AY 01529 469162 Address 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) Greenacres Care Home Ltd vacant post Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Learning registration, with number disability (1), Learning disability over 65 years of places of age (17), Mental Disorder, excluding learning disability or dementia - over 65 years of age (17) Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user with Learning Disabilities under 65 years but over 60 years (LD) New service Date of last inspection Brief Description of the Service: Gracefield has been running as a privately owned residential home for many years and has recently been taken over by Greenacres Care Home Limited. There is currently no registered manager but the former deputy is acting manager. Gracefield provides nursing and personal care to 17 elderly people, most of whom have a mental health diagnosis of dementia. The registration allows for the placement of older people with a learning disability, and there is a condition of registration that permits one named person under the age of 65 years. On the day of inspection the home had 15 residents. There are qualified nurses on all shifts. The home is a single storey building set in its own grounds. It is set back from the road, which used to be the A 428, which is now a side road since the building of the new dual carriageway. There is parking and a small area of garden at the front of the building, and large gardens to the rear. There is a patio area with access from a small conservatory. There are 9 single bedrooms and 4 double occupancy bedrooms. There is a lounge, which leads into a conservatory/dining area. This leads onto the patio and into the extensive gardens. There is another small area in the home where residents and their families can eat and sit privately if they wish. The inspection reports are available from the office whilst decoration takes place in the entrance hall. The current nursing care charges are between £779 per week (low dependency in a double room) and £999 per week (high dependency in a single room). Residential care fees start at £544 per week. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.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 2 star. This means the people who use this service experience good quality outcomes. We, the Commission for Social Care Inspection (CSCI) carried out an unannounced inspection of Gracefield Nursing and Residential Care Home using the Commission’s methodology described below. This report makes judgements about the service based on the evidence we have gathered. This inspection was undertaken because Gracefield had registered a new owner requiring the Commission to inspect within the first six months of trading. (The home had been running for some years prior to this and had its last inspection on 26 June 2007.) An Annual Quality Assurance Assessment (AQAA) was requested and this was returned prior to this inspection. Surveys were sent to staff and the relatives of those who live in the home. Information from the last report was taken into consideration, together with an unannounced visit to the home and speaking to staff, the acting manager and Responsible Individual. The Responsible Individual and the Acting Manager were present for the whole of the inspection. Information received in the relatives questionnaires included: “Staff always make sure mother is happy and relaxed. They have a sensible and calm approach, never shout or get angry.” “New owners have more ideas on how to meet relative’s needs socially.” “Kept up to date with important issues. Always made welcome.” “Always clean and odour free.” “All staff have a caring attitude.” “Residents are always clean and their clothes beautifully ironed.” “Good ratio of staff to residents, one on each shift is nurse trained.” “The furniture and carpets could be improved.” “The home has tried to make life as normal as possible for its residents.” What the service does well: The home provides a good level of information in the service user guide and statement of purpose. The care plans and risk assessments are detailed and provide an excellent level of information for staff, enabling them to provide high quality care. All staff are receiving supervision and appraisals. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 6 There were no odours in the home and there were new carpets being laid in the hallway and bedrooms on the day of inspection. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 7 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 Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 8 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): 1,2,3,5,6 Quality in this outcome area is excellent. The home provides excellent information to ensure people can make an informed choice about the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gracefield does not provide intermediate care. The Statement of Purpose and Service User Guide have been updated since the new owner took over the home. The information in them meets the requirements. Information provided in the Annual Quality Assurance Assessment (AQAA) showed that relatives are encouraged to visit the home where staff can show Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 9 them the facilities. On the day of inspection the family of a person considering the home were shown round and given information verbally and written (Statement of Purpose, Service User Guide and brochure). The brochure gives information about the fees charged for all levels of care. The acting manager said a contract is provided when the person moves into the home. The acting manager said that before admission a trained member of staff completes a full assessment of the prospective resident’s needs to ensure the home will be able to meet their care requirements. This was confirmed by information on the three files seen as part of this inspection. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 10 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): 7,8,10,11 Quality in this outcome area is excellent. Care plans and risk assessments are excellent and ensure staff know how to meet the needs of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details provided in the AQAA showed the home has comprehensive care plans for each service user, which are updated on a monthly basis or whenever changes occur. This was confirmed during the inspection. The quality of care plans is excellent and this standard receives a score of 4. The home arranges regular G.P. visits. Pressure relief measures and continence assessments are in place with a continence advisor available if needed. These areas were detailed in the care plans and risk assessments on files seen during this inspection. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 11 Policies and procedures are in place for the administration of medications. Trained staff carry out detailed Drug Audits, which includes resident’s individual medication records, household remedies, receipt, storage and disposals of medications. Some trained staff have completed a Distance Learning Course on Safe Handling of Medication. The homes Medication Administration Record (MAR) sheets and controlled drugs register were seen for four people living in the home. The MAR sheet for one person showed medication signed as being given and then ‘R’ for refused written over the top. The acting manager was spoken to and it was explained that the person looked as though he/she had taken the medication and then when the nurse went back a moment later he/she had spat it out. It was discussed that a record, of this type of overwritten entry, should be made as it could be interpreted that the nurse had signed prior to giving the medication. Chiropody and music therapy are available and sight tests are carried out annually. All staff are trained to adhere to privacy and dignity policies and this was seen on the day of inspection when residents were assisted to the bathroom. There were details in the files seen of a ‘living will’ (not an official form under the Mental Capacity Act), which showed whether the person wanted to be resuscitated, and what they wanted to happen after their death. The acting manager said that most of the people living in the home had dementia and were unable to make a choice therefore these had been completed with the relatives. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 12 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 good. Social activities provide variation and interest for people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA showed that a qualified instructor in music therapy visits the home weekly. Outings are arranged and a priest from the local church attends fortnightly. Indoor activities take place daily, which include ball games, memory games and skittles as well as entertainers visiting the home regularly. Some staff provide hand massages and the manager said that they have a person come in for aromatherapy. The home hopes to incorporate more visits from the Salvation Army as their visit was thoroughly enjoyed during the Christmas period. One person likes to go shopping and visiting garden centres and the staff take her when possible. The acting manager said they were also looking at the possibility of day centre attendance. The home has use of a vehicle and this means people have more opportunity to go out. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 13 There are no restrictions on visiting times for relatives. Comments in the relatives surveys returned showed that staff were welcoming and provided drinks and meals. Relatives are encouraged to bring small items of furniture, photographs and pictures to personalise people’s rooms and these were seen during the inspection. The menus were seen and found to be varied and there was always a choice. The cook said the home has one person who is a vegetarian but there were no other people with special requirements. The cook said that she had now been given the task of ordering the food, which she felt was better as it ensures that appropriate orders are made. The new owner has provided a fridge to store vegetables so that there is less waste. The acting manager said that the new owner is going to purchase cordless ‘phones so that staff can answer calls and still be near to those living in the home. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. Complaints are handled effectively and people are ensured a proper response to any suspicion of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details provided in the AQAA stated the home has a comprehensive complaints procedure, which is easily accessible to people who live in the home, families and staff. This was seen as part of the inspection. There has been one Protection of Vulnerable Adult meeting as the result of a complaint around a hospital admission. The outcome was that the home had handled the situation in the best interest of the person living at the home, although there was a need for a new policy on resuscitation to be written. This was done the day after the meeting and a copy was forwarded to the Commission. There was evidence that staff had received PoVA refresher training. The AQAA stated that all staff are Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults (PoVA) list checked before commencing Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 15 employment at Gracefield Nursing Home. The file of one new member of staff was seen and this contained the necessary checks. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 16 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): 19,20,23,24,25,26 Quality in this outcome area is good. Improvements are being made to the décor, providing people with safe and comfortable surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details provided in the AQAA stated the home maintains a safe environment inside and outside the building. A maintenance program is in place. Evidence of this was seen during the inspection. The home has an infection control policy, which is implemented throughout the home. A new cleaning schedule has been introduced and a member of domestic staff made accountable for the upkeep of cleanliness. More cleaning Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 17 materials have been introduced and the acting manager said that COSHH had been updated to include them. On the day of inspection new carpets were being laid in the hallway and some bedrooms. The acting manager said that there was a new carpet being laid in the lounge area the following day. This was going to be done early in the morning so as to create as little disruption for the people who live in the home as possible. The new owners had decorated some of the corridors and rooms. The owner said that bedrooms are being decorated as they become vacant. There were no unpleasant odours in the home during the inspection. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 18 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. The procedures for the recruitment of staff provide the safeguards to offer protection to people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA showed that the weekly staff rota is displayed in advance. There is a staff nurse on duty every shift. The homes recruitment procedure is based on equal opportunities. An audit of one staff file showed that it contained the required references, CRB clearance, proof of identity. There was evidence of induction and other training. The acting manager said the contract of employment had been given to the member of staff and was awaiting its return with signatures. There are currently 13 staff working at Gracefields. Four staff are on duty in the morning, four in the afternoon until 6pm and three until 9pm when the night staff come on duty. There are two waking staff during the night with an on call person available. There is a domestic on duty 9am to 2:15pm Monday to Friday and alternate Saturdays. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 19 The home has a new induction programme incorporating the common induction standards to meet the General Social Care Council code of practice. The programme is completed over 12 weeks and the acting manager said that she, the senior nurse and a carer sign the areas as competently completed. Details on files showed that staff training has included Protection of Vulnerable Adults (PoVA), dementia, infection control, food hygiene and health and safety using videos and questionnaires (understanding and competency are checked by the acting manager); challenging behaviour is completed internally and first aid using outside consultants. The acting manager said that medication training had recently been undertaken through distance learning. Staff surveys returned prior to this inspection showed that they received training. The acting manager said that all staff had had an appraisal in December 2007. There are general staff meetings (the last was 4th January 2008) and other meetings for clinically trained staff (11th January 2008). The minutes of both meetings were seen. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 20 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): 31,33,34,35,36,37,38 Quality in this outcome area is good. There is leadership and guidance to ensure people living in the home receive consistent care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a registered manager at the moment due to a change of ownership. The current acting manager has been deputy in the home for a number of years and is a qualified nurse. Staff supervision is provided regularly. This was confirmed in the staff surveys Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 21 received by the Commission. The home has a risk assessment to cover all risks inside and outside the home. Maintenance inside and outside the home is being improved. Records indicated that all relevant checks on emergency lights, fire alarms and equipment had been completed. The acting manager said that people who live in the home are unable to manage their own finances and relatives manage this on their behalf. The home does hold small amounts of money for hairdressing and other small items. The money for four people was checked and was accurately recorded, with details of expenditure and receipts on file. There was positive feedback from relatives of people who live in the home in relation to the staff team and the new owner. Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 22 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 4 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 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 2 X 3 3 3 3 3 3 Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP31 Regulation 8 Requirement A manager must be appointed and seek registration with the Commission to ensure the home is managed appropriately. 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 Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Gracefield Nursing Home and Residential Care Home DS0000070496.V358398.R01.S.doc Version 5.2 Page 25 - 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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