Care Home: Grafton House

What the care home does well People sign their care plans when they are reviewed to show that they agree with the information recorded. Staff spoken to had a good understanding of people`s health and personal care needs. Staff were observed to have a good relationship with the people living in the home and people spoke highly of the staff. What has improved since the last inspection? Staff have received training in fire safety. The home submitted their annual quality assurance assessment (AQAA) to the Commission. New garden furniture has been purchased. What the care home could do better: Care plans should detail how people are being supported to pursue their aspirations and goals. Care plans must be reviewed regularly when people`s needs or circumstances change to ensure that staff have the information that they need to support people in the right way. Prescription creams should be dated when they are opened to ensure that they are used within their `use by` date. The storage of medication must be reviewed to ensure that the home is able to store any controlled drugs safely. Two written professional references should be obtained for all new employees to give greater accountability than character references. Key inspection report Care homes for adults (18-65 years) Name: Address: Grafton House 49 The Drive Kingsley Northampton Northamptonshire NN1 4SH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 3 0 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Grafton House 49 The Drive Kingsley Northampton Northamptonshire NN1 4SH 01604791635 01604711988 Jlanghorne@partnershipsincare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Partnerships In Care Ltd Name of registered manager (if applicable) Mrs Jill Mary Langhorne Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3. The registered person may provide the following category of service only: Care home only - code PC - to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia - code MD. Date of last inspection Brief description of the care home 49 The Drive is a care home providing personal care and accommodation for 3 service users from the age of 30 to 65 years with an acquired brain injury. The home is owned by Partnerships in Care Limited. The Home is situated in a suburb of Northampton close to a local shopping centre and park, easily accessible by public transport and within a mile and a half of the town centre and its amenities. The property consists of Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 0 1 0 4 2 0 0 9 Brief description of the care home a large semi-detached house with front and rear gardens. Single bedrooms are provided for all service users on the first floor. The communal rooms include a lounge; separate dining room, conservatory, and service users have the use of the kitchen. The home does not have a lift and is not suitable for people with mobility problems. The current fees are two thousand and one hundred and twenty two pounds and thirty eight pence per week and additional charges are made for hairdressing, toiletries, newspapers, magazines and gym membership. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for people using the service. As part of the preparation for this inspection a period of three hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: Care Homes for Adults (18-65 years) Page 6 of 25 The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection was conducted over two days and lasted for five hours. During the inspection one person was case tracked. This involves looking in detail at all aspects of their care and experiences at Grafton House, including looking at their individual plans of care and other records, talking to them and talking to their care staff. We also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered manager was present on the second day of the inspection. The report refers to we this is because the report is written on behalf of the commission. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? 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. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are appropriately assessed prior to moving into the home, ensuring that their needs can be met. Evidence: The home has a statement of purpose and service user guide which give people good information about the home and the services it offers. The statement of purpose / service user guide were not available in any other formats to make them easier for people to read and understand. Records show that peoples needs are assessed before they move to Grafton House to make sure that the home is right for them. Care records for one person showed that he had visited on several occasions and stayed overnight before actually moving in to ensure that he was familiar with the home and felt comfortable with the move. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed care plans help staff to identify and meet peoples needs. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, culture and religion, and health and contained good information about how people wanted staff to support them. For example the care plan for one person stated that he needs a light hearted and positive approach. and advises staff to involve him in a task if he is unsettled. Care plans seen did contain some information about peoples goals and aspirations but did not fully detail the steps being taken for people to achieve these. Staff told us that care plans are reviewed every six months. There was no evidence of Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: care plans being reviewed or amended more frequently than six monthly, for example if peoples needs change. Records show that people sign their care plans, where they are able, to show that they agree with the information recorded. People are supported to be safe without restricting their lifestyles by written assessments of the risks they face from the environment and the various activities that they do. These cover areas such as swimming, shopping and walking. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to choose how they spend their time in the home and enjoy a range of activities both in the home and the local community. Evidence: One person told us that he goes for country walks and ten pin bowling Records state that one person enjoys playing cards, we observed him playing a game of cards with staff at the table in the back garden. The manager explained that a computer with internet access was being installed in the house next door,which is owned by the same provider, and that people from Grafton House will be able to use this if they wish. People told us that they are involved in doing household chores. One person told us I like helping with the cooking. People said that the food is good. One person told us Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: staff know that I dont like vegetables. The home have a vehicle which is shared with the property next door which is owned by the same company. One person told us that he enjoys going out in the car. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met by staff who are familiar with their needs. Evidence: People living at the home are able to see a range of health and social care professionals from within the company and externally. These include general practitioners,clinical psychologists,physiotherapists, social workers, opticians and dentists. The care record for one person states that his last chiropody appointment was in March 2009. An undated note on the persons file suggests that he has discomfort from his feet. Staff explained that he does see the chiropodist more regularly but that this is arranged by the persons family. Advice was given to the manager to ensure that the persons care records show how the home is monitoring his foot care due to the problems that he has with his feet. Staff spoken to had a good understanding of peoples health and personal care needs. A signature was missing from the medication administration record for a dose of medication for one person who lives in the home. The home do not keep a record of Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: the amount of tablets that they have in stock for each person so it was not possible to check whether this tablet had been given or not. The storage of medication needs to be reviewed to ensure that the home is able to store any controlled drugs safely and to ensure compliance with the latest requirements of the Misuse of Drugs Act Amendment 2007. This specifies how care homes should store controlled drugs. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed, there are laws and regulations about how these drugs should be stored and administered. Staff told us that the dispensing pharmacy used to visit the home to carry out an audit of the medication systems and offer advice to the home but that this has not happened recently. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes policies and procedures. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. The address of the Care Quality Commission recorded in the complaints procedure was an old address that is no longer in use. There have not been any referrals made by the home to the Local Authority under the locally agreed safeguarding adults procedure. Staff spoken to had a good knowledge of how to safeguard adults and their responsibilities under the locally agreed procedures. The home have not made any applications to the Local Authority under the deprivation of liberty safeguards and observations made during the inspection suggest that people are able to move around the home freely and do not have any restrictions placed on them. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a comfortable and spacious living environment. Evidence: Grafton House is a spacious semi-detached property in a residential area of Northampton a short walk from shops and other local amenities. Each of the people who lives at the home has their own bedroom which they are able to personalise with ornaments, pictures and their possessions. Staff were observed knocking on peoples door before going into their rooms. Communal areas include a lounge, dining room, kitchen and conservatory. There is also two communal bathrooms. The property is generally well maintained and clean throughout. Communal areas had been made homely with pictures and ornaments. At the rear of the property there is an enclosed garden. People were observed sitting in the garden during the inspection. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being supported by a competent and caring staff team who have a good awareness of their needs and preferences. Evidence: The recruitment of staff is well managed with the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with vulnerable people. One of the references for one staff member was noted to be a character rather than professional one. Advice was given to the manager about the need to have professional rather than character references as these give greater accountability. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, infection control, fire safety and moving and handling. Staff were observed to have a good relationship with the people living in the home. Care Homes for Adults (18-65 years) Page 19 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements within the home ensure that people are safe and their needs are met. Evidence: Grafton House shares a registered manager with the property next door which is owned by the same company. As well as the registered manager the home also has a house senior who is responsible for carrying out some of the quality audits and staff supervision. The results of a staff satisfaction survey carried out in 2009 for both Grafton House and its sister home showed a high level of dissatisfaction for example only eight staff out of the fourteen who returned surveys stated that they agree or tend to agree that Partners in Care was a good company to work. Records show that audits are carried out on care plans and medication by the house seniors. The manager told us that the audits done under regulation 26 of the care homes regulation had been carried out for February and March 2010 but records of Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: these could not be located. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Care Homes for Adults (18-65 years) Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must be reviewed 30/06/2010 regularly when peoples needs or circumstances change. To ensure that staff have the information that they need to support people in the right way. 2 20 13 There must be a system in 30/05/2010 place to ensure the safe administration and recording of all medication and an audit trail which details the amount of medication held by the home. To ensure that people receive their medication as prescribed. 3 20 13 The storage of medication must be reviewed to ensure that the home is able to store any controlled drugs safely and to ensure compliance with the latest requirements of the Misuse 31/07/2010 Care Homes for Adults (18-65 years) Page 23 of 25 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action of Drugs Act Amendment 2007. To ensure that all medication can be stored safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 6 20 34 Care plans should detail how people are being supported to pursue their aspirations and goals. All creams should be dated when they are opened to ensure that they are used within their use by date. Two written professional references should be obtained for all new employees to give greater accountability than character references. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 25 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!