Care Home: Graceland Care Home

What the care home does well Graceland provides a warm, friendly and caring environment for people to live. People who live there spoke of being happy and were very positive about the staff who provided their care. One person spoken to said that they was happy with the care they received, they could go to bed and get up when they wanted, they could have a cooked breakfast if they wanted and had no complaints whatsoever about the food. They said they could exercise their right to have a vote, they felt they were treated with respect and as far as they were physically able, they exercised their independence. Another person said, "I can have a bath or shower any day I want", she said she was "happy enough, but it isn`t the same as being at home, but it is the next best thing". A member of staff said, "This is a well run home, we are well able to express our opinions and able to suggest changes". Staff believe they are well trained. One member of staff said, "I have had quite a lot of training this year, they encourage training". They were able to detail client specific training such as, Ageing, Dementia Awareness and Continence Awareness. 62% of staff are trained to NVQ Level2. The expert by experience said of the people who lived at Graceland, "Residents felt they were treated with respect, Staff tended to knock on doors before entering" "Felt that their dignity was upheld when they were bathing or dressing" "They could follow their respective religions if they so wished" "They had a right to exercise and use their voting powers" "They could go out and visit shops or relatives if relatives wished to make suitable arrangements" "They could make choices i.e. go to be and get up when they wished" "Felt that their visitors were always welcomed and the offer of tea or coffee was appreciated by both residents and visitors" "Clothing was always was nicely washed and ironed" What has improved since the last inspection? Following discussion with the care manager, progress has been made in developing the care records and social records further. This work is still ongoing. The bathrooms were much cleaner and no risks were identified within the environment such as bubble bath and denture cleaner. What the care home could do better: A small number of areas have been identified as in need of improvement or building upon the progress already made. The main area for improvement is in relation to the environment, which must be improved. There is the need for full refurbishment including new furniture, redecoration, new carpets and the refurbishment of bathrooms and showers. The individual areas have not been fully detailed as it has been confirmed by the provider that there is a detailed plan in place for this and it is anticipated that work will commence within the next two months and it includes refurbishment throughout the home. The work that has commenced on improving the level of detail within the care needs assessments and plans needs to continue, as does the level of detail within the social assessments. It is also recommended that the main medication system is audited. Staff who do not have a National Vocational Qualification need to complete the Skills for Care Common Induction Standards. CARE HOMES FOR OLDER PEOPLE Graceland Care Home Belmangate Guisborough TS14 7BB Lead Inspector Jackie Herring Key Unannounced Inspection 09:30 18th March 2008 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 Graceland Care Home DS0000000169.V350953.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. Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Graceland Care Home Address Belmangate Guisborough TS14 7BB 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) 01287 639351 01287 635647 info@gracelandcarehome.co.uk Paramount Agency Services Limited Mrs Joan Parvin Care Home 53 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0) of places Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Age category for individuals with dementia is age 60 One named individual who is under the age category is allowed to reside in the home. 27th July 2006 Date of last inspection Brief Description of the Service: Graceland is a care home providing nursing and personal care for older people with mental health needs. It is a two-storey purpose built home providing single and double accommodation for 53 Residents; the 31 single bedrooms are a minimum of 10 sq.m. The 11 double bedrooms are a minimum of 16 sq.m. There is a passenger lift giving access to the upper floor. There are a selection of lounges and three dining rooms, one on the first floor and one on the ground floor. There is a car park at the front of the home and there are two garden areas. The weekly fees for living at Graceland range from £458.08 for personal care and £559.08 for nursing care. Graceland Care Home DS0000000169.V350953.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. This was an unannounced Key Inspection of Graceland; as such all of the key standards related to older people were looked at. This was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. The visit to the home was conducted in one inspection day by one inspector. The inspector was accompanied by an ‘expert by experience’. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. During the visit to the home, a number of records were looked at, including records of people who use the service, along with medication records, staff records, training records and maintenance information. Time was spent talking to people who use the service, relatives and staff. Time was also spent walking around the home, observing interactions and generally finding out what Graceland was like for the people who live there and staff. Discussion also took place with the care manager and there was also some discussion with the manager and proprietor. The manager has completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards. This was received prior to the inspection, was extremely well completed with excellent level of detail and it was then used as part of the inspection process. Some of information has been reflected within the report to support the judgements made. Discussion took place with the Proprietor and Manager who both acknowledged there was the need for improvement and further development at Graceland. It was however clear that the organisation were totally committed to making these improvements. Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Following discussion with the care manager, progress has been made in developing the care records and social records further. This work is still ongoing. The bathrooms were much cleaner and no risks were identified within the environment such as bubble bath and denture cleaner. Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 7 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. Graceland Care Home DS0000000169.V350953.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 Graceland Care Home DS0000000169.V350953.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): Standards: 3 & 6 were looked at during this inspection. People who use the service experience good quality outcomes in this area. People have their needs assessed before being admitted to the home and they were assured those needs would be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA detailed the pre admission assessment process. It was stated, “We carry out comprehensive pre-admission assessment, the care manager visits them at home, in hospital, where the individual is living at that time. We also contact relevant professionals e.g. Social workers for a copy of their assessment”. “We make sure the transition from where the individual is living and moving on to their new home is as smooth as possible with the aid of an allocated named nurse and key worker”. Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 10 Three sets of care records of people who use the service were looked at, one for a recent admission, one for a person who had lived at the home for six months and one for a person who had lived at the home for some time. There was a pre admission assessment in place in all three records along with a care management assessment. The pre admission sheet detailed that welcome pack was given along with conditions. Graceland do not provide intermediate care. Graceland Care Home DS0000000169.V350953.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): Standards: 7, 8, 9 & 10 were looked at during this inspection. People who use the service experience good quality outcomes in this area. People receiving the service are happy with the way in which care is delivered by staff. Some of the records detailing how health and personal care is to be delivered and associated risks need more detail and information. The systems for managing medication is good and only staff who have received the appropriate training have any involvement with medication. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The same three sets of records were looked at in more detail. The actual format in terms of information flow was good, leading from assessment to care plans, related risk assessment and daily records. It was clear from the random inspection that progress had been made and care records were continuing to be developed. The records generally contained the information needed to show how people’s needs were being met. The assessment tools continue to Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 12 be are of a numeric nature however it was identified that some additional comments are now being made, this needs to continue. By increasing the level of detail this would enhance the records further and create a more person centred plan of care. An example of this was, when the term aggression is used, there is the need to be more specific and give more details about the type of aggression, how it presents and any potential triggers. Interventions were also discussed and it was agreed that these could also be more thoughtful and more explanatory; examples of this were shared with staff during the inspection. Regular evaluations of care are being carried out. There could be more details to demonstrate if the care is being effective or not. There was discussion with the deputy manager and two of the qualified nurses, with some examples given as to what information would be helpful. All agreed with the comments made and thought it was very constructive. A range of supporting risk assessments are in place, including amongst others, one for nutrition, moving and handling and pressure risk. There are clear records that detail the involvement of other people such as GP’s, District Nurses, Optician and Continence Advisors. A GP was observed to be visiting on the day of inspection. During discussion with staff they believed they received appropriate training to meet the needs of the people living at the home. One member of staff said, “I have had quite a lot of training this year, they encourage training”. They were able to detail client specific training such as, Ageing, Dementia Awareness and Continence Awareness. Staff were well able to discuss the core values of care such as respect, dignity, privacy and rights. One member of staff said, “You have to think about it being you and how you would want to be treated”, whilst another said, “We do see that people are treated with dignity and privacy”. There was evidence contained within the files to show that relatives of people who use the service have been involved in the assessment and care planning process. A person living at the home said, “I can have a bath or shower any day I want”, she said she was “happy enough, but it isn’t the same as being at home, but it is the next best thing”. The medication systems were discussed with one of the qualified nurses. The system was good in terms of ordering, storage and administration, with appropriate checks and supporting records in place. The records looked at contained appropriate information. It was confirmed that only qualified nursing staff were involvement in the administration of medication and that there is some ongoing competency assessments. Audits are in place for Controlled Drugs however it is advisable for the main medication system is also Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 13 audited. It was recommended that the temperature of the upstairs office, where medication is stored should be monitored. Graceland Care Home DS0000000169.V350953.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): Standards: 12, 13, 14, 15 were looked at during this inspection. People who use the service experience good quality outcomes in this area. People are encouraged to live their lives as they wish and a programme of activities is organised that people can choose to join in with. People enjoy visits from families and friends. The food provided is of a good quality and meets the dietary and cultural needs of the people who use the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA detailed a lot of information about the range of activities offered to people who live at Graceland. It states, “Overall activities are planned appropriately to met the needs of our residents and we endeavour to ensure that residents are able to complete tasks and achieve success”. It states clearly that, “We establish firstly through the pre-admission assessment what the individual and their family might feel is a special occasion, e.g. anniversary or birthday and offer food for a celebration at the relevant time”. The AQAA also detailed how individual’s people’s spiritual and cultural beliefs are met. An activities organiser is employed and they spend time on a one to one basis with bed bound people, where people may have a hand massage or be read Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 15 to. Group activities were also described such as; skittles, arts and crafts and some life skills including gardening and cooking. Photographs were on display in the home showing people being involved in different activities. At the random inspection, it was identified that when the activity organiser was not available there was limited access to equipment. Boxes containing a good range of equipment are now available within each of the units. A member of staff said, “We have a good activities co-ordinator, I generally think that everyone has an opportunity to be involved, even people who are nursed in bed”. A relative spoken to thought that perhaps there could be more stimulation and perhaps more opportunities to go out of the home. Relatives are free to visit the home and said that they were always welcomed. The menu was looked at and showed a three-week rolling menu, providing traditional British food. The AQAA states that, “We provide a choice of nutritionally balanced meals, which we sent to the dietician for her approval and advise prior to implementation”. “We utilise the services and skills of a Food Safety auditor, who carries out an audit each month. The expert by experience spoke to a person who lives at Graceland, “When I asked about meals she/he told me that it was her/his choice to have her/his meals in her/his own room. They felt that the food was well cooked and there was enough to eat”. The expert by experience visited the kitchen and spoke with the cook. Cook said that she always buys fresh vegetables, and they were in evidence. When asked about fresh fruit, the cook said she had grapes and bananas in stock, and if residents had difficulty in eating fruit, then she turned them into “smoothies.” Another person who lives at the home was spoken to. This resident said that they was happy with the care they received – they could go to bed and get up when they wanted, they could have a cooked breakfast if they wanted and had no complaints whatsoever about the food. They said they could exercise their right to have a vote, they felt they were treated with respect and as far as they was physically able, they exercised their independence. Dining rooms were observed to be pleasant and table cloths; condiments and flower decorations were in place. Observations took place over lunchtime and the following comment was made by the expert by experience, “Two members of staff were feeding lunch to residents who were unable to feed themselves, these two staff members were not “rushing” the resident to eat but waited patiently for the resident to be ready”. Graceland Care Home DS0000000169.V350953.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): Standards: 16 & 18 were looked at during this inspection. People who use the service experience good quality outcomes in this area. Relatives of people who live at the home are generally confident their complaints would be listened to, taken seriously and acted upon. People who live at the home are protected from abuse by the home’s policies and procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA detailed “Information is in place for those who wish to make a complaint”. A copy of the complaints procedure is on display on a number of notice boards throughout the home. There is also a suggestion box in the main reception. The AQAA also contained the following statement, “We are approachable and welcome comments or complaints, we take them seriously and respond quickly when dealing with them. We view complaints as an opportunity to improve the service we provide”. Some of the relatives spoken to said they were well aware of the complaints procedures while others were not. They were advised that there was a clear complaints procedure and that if they had any concerns they should speak to the home manager. A comment made in a survey was, “If there is anything I am concerned about I usually speak directly to the nurse-in-charge but if there Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 17 was anything of a serious matter I would put my concerns in writing with a copy to the home and one to Social Services”. The complaints records were looked at and it was identified that the actual procedure would benefit from more contact information; such as if the manager cannot resolve the concerns then these should be referred to the proprietor. This had been updated during the inspection site visit. The AQAA detailed that there had been two complaints in the past twelve months. Investigation records and outcome letters were available. The AQAA also detailed that Adult Protection training takes place. A training matrix was also available which showed this, as were individual staff training records. There have been some adult protection issues. The correct procedures were followed and appropriate action has been taken in response to them. Staff who were spoken to confirmed they had received this training. Graceland Care Home DS0000000169.V350953.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): Standards: 19, 21 and 26 were looked at during this inspection. People who use the service experience adequate quality outcomes in this area. Although the environment is generally appropriate to the specific needs of the people who live, improvements are needed to ensure that it is more homely and comfortable. People are able to personalise their bedrooms and the home is warm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Graceland provides care for older people with dementia across three units. It is a spacious home with a good amount of communal rooms, suitably located throughout the home. Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 19 In a number of bedrooms looked at, there was evidence of much personalisation, with photographs and other personal belongings. A relative said, “Mum’s room is lovely, well-lit with natural light, and she has her photographs and a few possessions with her.” There were a number of very nicely appointed rooms. Throughout the home, there is the need for refurbishment, as a number of areas are looking tired. This includes replacement of bedroom furniture as drawers are broken, a number of chairs are in need of replacements as does carpets and there is the need for redecoration. There was discussion with the proprietors who confirmed that within the next two months substantial refurbishment work would be undertaken. Planning permission has been granted to increase the size of the home and the plan of works includes all of the bedrooms becoming single rooms with some increase ground floor space. The plans include full refurbishment of the home including bathrooms, bedrooms and lounges, with the replacement of furniture. Some work has already commenced with the installation of new lighting. On the day of the inspection a number of rooms needed the carpets hovering and rooms dusting, it may be that the housekeeping staff had not yet attended to those rooms. The AQAA detailed that the housekeeping hours are being reviewed. When asked about any improvements that were needed to the home, staff said that it was definitely the environment and furniture. They did however say that there was sufficient equipment in place. Graceland Care Home DS0000000169.V350953.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): Standards: 27, 28, 29 & 30 were looked at during this inspection. People who use the service experience good quality outcomes in this area. People who live at the home have their needs were met by the numbers and skill mix of staff who were trained and competent to care for the residents at the home. Residents are protected by the home’s recruitment procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA set out very detailed information about the staffing of the home, the need for a good level of skill mix and the recruitment procedures. Staff spoken to said that there were generally sufficient staff to meet the needs of the people living at Graceland. One member of staff, “I feel comfortable to met people’s needs, I would say something if I found difficulties”. Another member of staff said, “There are generally sufficient staff, sometimes it can be a bit of a struggle on a morning and mealtimes can be hard”. Another member of staff thought they would benefit from an additional staff member. A person who lives at the home said that he/she was unable to walk, said “they tell me all about what is happening and involve me, if I want to be Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 21 involved” the staff, he/she felt were “ very good and helpful, but they did not have a lot of time on their hands”. The expert by experience said, “I observed Nursing Staff and care Staff being very kind and supportive of residents. Bells requesting attention were quite quickly answered”. A relative said of the staff, “Everyone appears friendly and caring”. One of the people who live at the home said, “ The girls were worth their weight in gold”. She said she was very happy in the home and well looked after. Three staff files were looked at, two new care workers and a longer serving qualified nurse. In the main, the information showed that good recruitment practise was in place such as application form, references and Criminal Records Bureau checks. In one of the records looked at, one of the references was not from the previous employer. The staff member responsible for the recruitment records was aware of this and said that there was an acceptable reason for it and agreed that some comment should be made on the file. It was also confirmed that identify information had been seen to enable the CRB check to be carried out, however in two of the files looked at copies of this information had not been taken. It was agreed that this would be done. In house induction and orientation is in place, it was however unclear if staff who did not have an NVQ Level 2 completed the Skills for Care common foundation standards. It has since been clarified that this is the case, not only for new staff who do not hold and National Vocational Qualification but also for existing staff who have this qualification. There is a system in place for checking that qualified nurses are registered with the Nursing and Midwifery Council and ongoing checks are undertaken. It was confirmed that 62 of staff are qualified to NVQ Level 2, a further seven are underway with this, which when completed will take the percentage up to 75 . Individual training records are in place and in the files looked at there were certificates showing a range of mandatory training such as fire and moving and handling as well as training in Respect and Dignity. In the file of the qualified nurse there was also training in Record Keeping, Care Planning, Mental Health Update and Stoma Care. A staff training matrix, which details all of the training staff are involved in, is on display within the training room in the home. Graceland Care Home DS0000000169.V350953.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): Standards: 31, 33, 35 & 38 were looked at during this inspection. People who use the service experience good quality outcomes in this area. The home was well managed and run in the best interests of the people who use the service. The health, safety and welfare of residents and staff was promoted and protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is registered with CSCI and had substantial experience and has the required qualifications and skill to manager Graceland. A new manager who also has the relevant experience and skill is about to be appointed, as the current manager is to manager a new service that has recently been registered. The manager had completed the AQAA, which contained a very Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 23 good level of detail and also showed that continuous improvement is important with a number of plans for development in place for the next twelve months. This clearly included the refurbishment of the home along with further staff training. A member of staff said, “This is a well run home, we are well able to express our opinions and able to suggest changes”. The quality assurance systems were discussed with the care manager. A range of audits were in place including; medication, care plans and health and safety. In addition, a quality assurance report detailing survey results from relatives and people who use the service was also made available. Graceland does not manage personal monies of people who use the service. A range of maintenance and service information was detailed within the AQAA and a sample of these records was looked at. This included records of water temperatures and weekly fire checks. When asked, the care manager confirmed that these were carried being carried out weekly. A maintenance matrix is in place showing when equipment was last serviced and when it was next due. This is good. Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 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 N/A X X 3 Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 14 Requirement Timescale for action 31/07/08 2. OP19 23 The work that has commenced improving the information contained within the individual records must continue. The assessments of need must contain more person centred information enabling detailed individual plans of care to be developed. 31/10/08 The refurbishment of the home must take place; this is to be a full refurbishment programme. Once completed this will enhance the environment for the people who live at the home. This work includes the replacement of bedroom furniture, carpets, a number of areas in need of redecoration and renewal of bedding and soft furnishings throughout the home. The planned refurbishment of the bathroom and shower rooms must take place, making these more pleasing rooms to use by the people who live at the home. 3. OP21 23 31/10/08 Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations The monthly evaluations of care should contain more information about the effectiveness of the care interventions and adjustment to the care plan as needed. The main medication system should be audited. The upstairs office where medication is stored should have the temperature monitored to ensure it is not too hot. The work that has commenced on increasing the level of detail within the social assessment should continue. There should be arrangements in place to keep the home clean throughout. 3. 4. OP12 OP26 Graceland Care Home DS0000000169.V350953.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Graceland Care Home DS0000000169.V350953.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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