Care Home: Gracelands

What the care home does well The home provides a "family" environment with staff who have been employed by the home for some years. All of the individuals who live in the home have done so for a number of years. There is a real sense of stability and continuity and those we spoke with all commented on the "friendliness" of the home and "its like a real home for us". Individuals told us that they received the care needed "can`t fault it" "its like a hotel here" "only have to ask". It is noted that the manager has a real commitment to continuing to provide the care individuals may need and at the time of our visit was making changes to the environment improving the facilities for an individual who lives in the home. What has improved since the last inspection? We made requirements at our last inspection and looked at these on this visit and found that they had been met.GracelandsDS0000026506.V377677.R01.S.docVersion 5.2 What the care home could do better: We have made a number of requirement from this inspection. There needs to be more robust arrangements for the management of potential risks to individuals who live in the home. The completion of risk assessments to help in identifiying potential and level of risk in such areas as falls, environment, use of personal facilities will assist in managing and alleviating risk to the health and safety of individuals. The home must also look at using a dietary or nutritional assessment tool where there is identified concerns about an individual`s dietary needs being met. This will then help in establishing practice to make sure that the health of the individual in respect of their diet is maintained as far as possible. Importantly the involvement of other professionals to support the home and individuals will also clearly be identified through this assessment process. These areas of practice reflect the changing needs of individuals living in care settings. We have also made a requirement about training of staff in that some of the training undertaken by staff specifically moving and handling and food hygeine needed to be completed again in that it was some years ago this training was completed by staff. We have also made a separate requirement about staff undertaking Infection Control and Mental Capacity Act training. Whilst there was a sense that individuals were able to express their views about the service the home had no formal quality assurance questionaires which are a further way of getting views and suggestions about possible improvement to the quality of care provided in the home. They can also be used to obtain views from relatives and professionals who visit the home again this is all about continued monitoring and part of the quality assurance audit of the service. We have also recommended that the home contact the Avon Fire & Rescue Service about their practice of using objects to wedge open doors. We were told this had been agreed by the fire service recognising the efforts of the home to make the care home as homely and family friendly.This is appreciated as being invaluable however the safety of individuals is paramount. Key inspection report CARE HOMES FOR OLDER PEOPLE Gracelands 443 Fishponds Road Fishponds Bristol BS16 3AP Lead Inspector John Clarke Key Unannounced Inspection 30th July 2009 09:30 DS0000026506.V377677.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Gracelands DS0000026506.V377677.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Gracelands DS0000026506.V377677.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracelands Address 443 Fishponds Road Fishponds Bristol BS16 3AP 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) 0117 9653019 Mrs Rosemarie J Hancock Mrs Rosemarie J Hancock Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Gracelands DS0000026506.V377677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 6 23rd September 2008 Date of last inspection Brief Description of the Service: Graceland’s is operated by Ms Hancock and registered as a care home for six older adults. The property is situated on the Fishponds Rd, in close proximity of shops, amenities and bus routes. It has the appearance of a domestic dwelling, which blends well with its environment. The accommodation is arranged over two floors with communal areas on the ground floor and bedrooms on both floors. Currently there are 4 individuals living in the home and the manager has advised that she had no immediate intention to have other permanent admissions to the home. The fees charged at the home are £385.00 per week. Gracelands DS0000026506.V377677.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 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of our inspection of the service. During our visit we looked at the care plans for the four individuals living in the home, medication records and storage arrangements, staff records and those relating to health and safety. There was also an opportunity to talk with people living in the home. We received Have Your Say questionnaires from the four individuals living in the home and three members of staff. The manager also completed their Annual Quality Assurance Assessment. We have used this information to help us in making a judgement about the quality of the service provided at Gracelands. What the service does well: The home provides a family environment with staff who have been employed by the home for some years. All of the individuals who live in the home have done so for a number of years. There is a real sense of stability and continuity and those we spoke with all commented on the friendliness of the home and its like a real home for us. Individuals told us that they received the care needed cant fault it its like a hotel here only have to ask. It is noted that the manager has a real commitment to continuing to provide the care individuals may need and at the time of our visit was making changes to the environment improving the facilities for an individual who lives in the home. What has improved since the last inspection? We made requirements at our last inspection and looked at these on this visit and found that they had been met. Gracelands DS0000026506.V377677.R01.S.doc Version 5.2 Page 6 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Gracelands DS0000026506.V377677.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 Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: There have been no new admissions to the home since our last inspection. The manager advised the inspector that she had no plans to admit any further individuals on a permanent basis. However she told us that an individual was coming into the home for respite. There was a copy of the local authority assessment which provided information about the care needs of the individual. We advised the manager that it was good practice to also undertake her own assessment and visit the individual before they came into the home. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 9 Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: We looked at three care plans for individuals and they showed good information about the care needs of the individual. Included were daily routines, physical needs, moving and handling assessments. Reviews had been held the last being February 2009. For one individual there was concern about their diet but no record of weight or risk assessment around diet. There were no generic risk assessments for individuals. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 11 We looked at the medication administering records for a period of 2 weeks and found they had been completed as required with no gaps in recording. There are no individuals who require controlled drugs. One individual had medication which she self manages and this is kept in her room. There was no risk assessment regarding the self-management of medication by this individual. Records we looked at showed that individuals have access to community health services if this is required. The home will also refer individuals to the community nursing service if this is needed. One individual we spoke with told us that I only have to ask to see a doctor and they will arrange it. We spoke to individuals about how they felt they were treated by the staff and manager. They told us they all treat us well, I have no complaints staff all very good lovely staff. We asked one individual if they felt they were treated with respect definitely all the time. One individual who spends a lot of time in their room said how this is my choice it suits me. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting the social and recreational needs of residents are satisfactory and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: We spoke to individuals about the activities in the home. All of those we spoke with said they chose not to do activities rather just stay in my room. Another said she enjoyed doing quizzes and staff will always sit and have a chat. The manager told us they had tried to encourage more activities but had been unsuccessful. They recently bought a WII and had tried to encourage individuals to use it but again this has not been successful. One individual was able to go to the shops and had retained her bus pass. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 13 Individuals told us they could choose how they spent their time do what you want when you want go out when you want do what we like really. All of those we spoke with said they felt there were little routines, very flexible. We spoke to individuals about the meals provided in the home and they told us they were lovely always enjoy the food here. One individual who is a vegetarian was satisfied with the meals provided. We looked at the men and there varied choice of meals. On the day of our visit we sat with the individuals who live in the home having their meal and they all said how much they enjoyed the meals and it was well presented. They also told us that they were not always offered a choice and that would be nice. All the respondents to the questionnaire said they Always like the meals at the home. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. EVIDENCE: The home has not received any complaints since our last inspection. We spoke with individuals who live in the home about what they would do if they were unhappy about anything or the quality of the care they receive. They told us they would tell the manager and we can always speak to staff. One person said can always say if unhappy about something and Rosie (manager) will deal with it. The home has Safeguarding Adults policies and procedures in place and staff have undertaken Safeguarding training. Individuals we spoke with all said how they feel safe. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and hygienic environment for people who live in the home and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In looking around the home it was evident that rooms and communal areas of the home are generally in good state of repair and decoration. It was noted that at the time of our visit new toilet facilities were being fitted to improve access this was to take account of changing mobility and increased need for assistance for one individual living in the home. There are plans to install a walk in shower room and re-decoration of the dining room including new carpeting has taken place since our last visit to the home. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 16 There is shared communal lounge which is well decorated and homely along with dining area with additional seating. A stair life provides access to the first floor. At the time of our visit the home was clean and individuals told us its always very clean and well kept here. Respondents to the questionnaire said the home is Always fresh and clean. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: There is generally two members of staff on duty at all times, there is no waking night staff but manager and one other staff member live in the home and are available in an emergency. The home has an alarm system in place for use by individuals. We asked individuals if they ever required help at night and they told us no but would call for help if this was needed. There have been no new members of staff since our last inspection and there fore we did not look at recruitment procedures. Staff records showed that staff had completed training in moving and handling, POVA, medication, food hygiene. It was noted that moving and handling refresher training is needed by staff and we were told that manager is looking into arranging this for all staff. There was no evidence of infection control training for any members of staff or Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 18 Mental Capacity Act training. Two members of staff have completed NVQ 2 professional qualification. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe environment where individuals receive the care they need. EVIDENCE: The home has quality audits in place for the environment and systems of operation however there is no questionnaires given to individuals or others, professionals visiting the home) which look at the quality of care provided in the home. Individuals we spoke with all said they could discuss their care with the manager and there is a culture in the home where individuals are able to Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 20 express their views about the service but this is through informal discussion and meetings rather then formal questionnaire. We looked at health and safety records specifically those relating to fire safety. There are regular weekly fire alarms tests and monthly emergency lighting test. Fires drills have been held and practice evacuation in July 09. A Fire Risk Assessment has been completed. It was noted that doors were being held open by objects and when these were removed doors did not close. The manager advised this had been deemed acceptable (use of objects to wedge doors) by fire service. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 3 Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 22 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 13 (4) (C) Requirement The registered manager shall make sure that unnecessary risks to the health and safety of individuals are identified and so far as possible eliminated. This relates to the need to have risk assessments in place for all individuals for such areas as falls, environment (individual rooms), dietary needs, selfmedication. The registered manager to make sure there are at all times suitable qualified, competant persons working in the care home. This refers to the need to make sure that training is updated as necessary specifally moving and handling, food hygeine. The registered manager to make sure that the persons employed to work at the care home receive training appropriate to the work they are to perform. This refers to Infection Control and Mental Capacicty Act training. The registered manager shall DS0000026506.V377677.R01.S.doc Timescale for action 01/11/09 2. OP30 18 (1) (a) 01/01/10 3. OP30 18 (1) (c) 01/01/10 4 OP33 24 (1) (3) 01/01/10 Page 23 Gracelands Version 5.3 establish a system for reviewing the quality of care provided at the home and this shall provide for consultation with individuals who live in the home and others such as relatives. 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 Refer to Standard OP38 Good Practice Recommendations Review with the Fire Rescue service the use of objects as wedges for fire doors rather then doorguards or similar device. Gracelands DS0000026506.V377677.R01.S.doc Version 5.3 Page 24 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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