Care Home: Grampian House

What the care home does well When asked what the service does well comments in the surveys received include: "Staff are friendly approachable and accommodating." "The service offers a spotlessly clean and safe environment, for example it has a robust risk management approach.""The environment is relaxed offering fairly open visiting hours, choice of lounges or privacy of own room." "The service treats service users as individuals, respecting their privacy and dignity and encourages independence whilst giving support." "Carers work well as part of the integrated team working with health and social services. They are very good at communicating the needs of the service users and work extremely well alongside the other services." One relative of a permanent resident commented:"Everything is still excellent now as it was when xx first came in." Service users are provided with a clean, nicely decorated and comfortable place to live, this means that they live in surroundings that are safe and pleasant. Service users in both the residential and intermediate care units spoke positively about the home and the service delivered within it. Some comments include:"The home is nearly as good as my own home and it is meeting my needs" "We are well looked after." "The nurses and physiotherapists see to my health needs well." "The staff have helped me to get about again." Service users are pleased that they can make choices about their lives. Some comments include:"We can choose what we do during the day". "We decide what we have for dinner, there is always a choice." One permanent resident commented:"It is nice to have different people coming in to talk to." The health and safety of residents is well managed and staff receive special training so that they know how to look after the residents well and safely. Staff are attentive and work with enthusiasm, showing competence and interest in their different roles. Good relationships have developed between the different staff groups and respect and understanding for each other`s roles is evident.Grampian HouseDS0000031225.V364662.R01.S.docVersion 5.2Page 7This is because everyone understands the aims and objectives of the service and carry out their work practices in the best interests of the service users. There is a good senior staff team that supports the manager in her role and in her absence can maintain a well run home. This means that service users receive a consistent service and they are always in safe and effective hands. What has improved since the last inspection? The manager now receives confirmation that all staff that come into contact with service users, have the appropriate employment and Criminal Records Bureau checks carried out. This confirms that they are suitable to work with the people who use the service. CARE HOMES FOR OLDER PEOPLE Grampian House Grampian Drive Peterlee Co Durham SR8 2LR Lead Inspector Elsie Allnutt Key Unannounced Inspection 4th June 2008 09:30 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 Grampian House DS0000031225.V364662.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. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grampian House Address Grampian Drive Peterlee Co Durham SR8 2LR 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) 0191 5864833 0191 5864776 maria.luke@durham.gov.uk www.durham.gov.uk Durham County Council Mrs Maria Luke Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (10) of places Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2006 Brief Description of the Service: Grampian House is registered as a care home for older people and is operated by Durham County Council. It now mainly provides intermediate care services in partnership with the Health Authority and the Primary Care Trust. There are now only four permanent residents living at the home, all who have lived there for several years. There are to be no further admissions for permanent care. The building is situated in a housing estate and is close to local amenities. All accommodation for service users is on the first floor and there is level access into and around the building. The ground floor provides a range of offices for social and health care staff who provide the professional health services support for the intermediate care unit and the local community. A lift provides access to the first floor as well as two separate sets of stairs. The home provides single rooms to all service users and the layout of the passageways allows for separate self-contained units, each providing bedrooms, lounge, and bathroom. Consequently the permanent residents are able to maintain their own private space. The intermediate care unit provides short-term care and treatment for people who need to improve their mobility and ability to care for themselves, before they can return home after, for example, a stay in hospital. On the ground floor there is a day centre room that can be used by residents. The service has developed a Service User Guide to inform service users and other interested people of the services offered. There are no fees charged for those people assessed for the rehabilitation service, which can last up to 6 weeks. The fees charged for residential care is £432.32 per week. Grampian House DS0000031225.V364662.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. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 04/06/08 During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: When asked what the service does well comments in the surveys received include: “Staff are friendly approachable and accommodating.” “The service offers a spotlessly clean and safe environment, for example it has a robust risk management approach.” Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 6 “The environment is relaxed offering fairly open visiting hours, choice of lounges or privacy of own room.” “The service treats service users as individuals, respecting their privacy and dignity and encourages independence whilst giving support.” “Carers work well as part of the integrated team working with health and social services. They are very good at communicating the needs of the service users and work extremely well alongside the other services.” One relative of a permanent resident commented:“Everything is still excellent now as it was when xx first came in.” Service users are provided with a clean, nicely decorated and comfortable place to live, this means that they live in surroundings that are safe and pleasant. Service users in both the residential and intermediate care units spoke positively about the home and the service delivered within it. Some comments include:“The home is nearly as good as my own home and it is meeting my needs” “We are well looked after.” “The nurses and physiotherapists see to my health needs well.” “The staff have helped me to get about again.” Service users are pleased that they can make choices about their lives. Some comments include:“We can choose what we do during the day”. “We decide what we have for dinner, there is always a choice.” One permanent resident commented:“It is nice to have different people coming in to talk to.” The health and safety of residents is well managed and staff receive special training so that they know how to look after the residents well and safely. Staff are attentive and work with enthusiasm, showing competence and interest in their different roles. Good relationships have developed between the different staff groups and respect and understanding for each other’s roles is evident. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 7 This is because everyone understands the aims and objectives of the service and carry out their work practices in the best interests of the service users. There is a good senior staff team that supports the manager in her role and in her absence can maintain a well run home. This means that service users receive a consistent service and they are always in safe and effective hands. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grampian House DS0000031225.V364662.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 Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with detailed information about the service and comprehensive assessments are carried out that reflect service users’ needs. This means that informed choices and decisions can be made to establish that this service is appropriate and is effective in meeting the needs of individual service users. EVIDENCE: This service has developed and recently updated a Statement of Purpose and a Service User Guide that informs people about the aims and objectives of the service. All of the information required is included in the documents, including advice about the fees to be charged. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 10 One service user stated that they had expressed their preference to the hospital that they wanted to use the service at Grampian House. They said:“The hospital I was in was unaware of Grampian, but I had heard good reports of it so I said that I wanted to come here.” All of the residents living here as permanent residents had their needs assessed prior to moving into the home several years ago. The care plans in place, as well as the identified changes of need that have occurred over the period of their stay, are reflected in these. People who use the service for rehabilitation purposes go through an assessment process carried out by the agency/agencies that refer them to the home. Prior to a decision being made to offer a service, the multi disciplinary team at Grampian House meets, to discuss the individual’s needs, while also taking into consideration the needs of the people currently using the service and the resources available. When this process has concluded and a decision is made to offer a period of intensive rehabilitation within a residential setting, members of the multi disciplinary team visit the person. This visit gives the prospective service user the opportunity to find out more about the service and to raise any questions or concerns. This process enables the person to make an informed choice about using the service. Following a decision to use the service, a comprehensive assessment of need is carried out and this includes recording individual preferences, any special dietary or cultural needs and risks related to moving and handling. One healthcare professional stated that:“The service uses a very comprehensive screening tool to ensure at assessment level (before a client comes into Grampian) that all health care needs are identified.” Care plans that reflect the assessed needs and any evident risks are developed and the documentation completed is kept in the individual’s care file. Service users confirmed that they were aware of the assessment process and that a care plan was in place. Care plans include signed agreements describing the goals to be achieved within the rehabilitation programme. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 11 There are to be no further admissions to this home for permanent care and everyone using this service has been informed and is aware of this. People admitted for intermediate care stay for a maximum of 6 weeks with the aim of returning home. On occasions alternative services are sought. Separate accommodation with specialised facilities has been provided for the equipment and the professional staff needed to carry out the short-term rehabilitation programmes. Qualified staff, including occupational therapists and physiotherapists, have been employed to carry out the therapy programmes. Furthermore, care staff have received the necessary training to equip them with the appropriate knowledge and skills to support service users with these programmes during their daily routines. Care staff demonstrated enthusiasm with regard to the development of the service the changing approach to their role. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent staff are guided to deliver personal care and therapy treatments in a consistent way and as an outcome this assists service users to reach their individually set goals, which in turn promotes their independence in a safe and dignified way. EVIDENCE: Care plans are in place for all service users living at this home. They are clearly set out with information that is concise and to the point. This provides clear guidelines for staff to follow in a consistent way and in a way that addresses the assessed needs of the service user. Goals are identified and the support needed is evident, with clear guidance about how the individual’s independence is to be promoted, while at the same time stating any individual preferences, for example, the level of support needed when going to the bathroom and whether the person prefers to have a bath or use the shower; and the support needed when getting in and out of Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 13 bed, while also considering the individual’s physical comfort. This demonstrates that service users are consulted about their care and support and their preferences are listened to. Specialist advice from the healthcare staff is at hand and guidelines set by them are in place for carers to follow. For example, the level of support needed when assisting a service user to move from one place to another and the sort of therapy exercises individual service users should be encouraged to do as part of their daily routine. Risks are identified in the assessment process and are reflected in the care plan, where risk strategy plans are put in place, to promote the individual’s independence in a safe way. The level of support needed when mobilising is evident, following a detailed moving and handling risk assessment. One service user requires much patience and perseverance from staff, so that the maximum potential of their independence can be achieved. Service users spoke about how their cultural needs had been addressed and although one person could not visit their regular place of worship, they were content that during the time spent at this service, they could attend a religious service of their choice within the home. The level of support needed to achieve this was recorded in the care plan. Another person described how they loved to read and how good it was that the home had a library facility where they could choose and change books during their stay. Care plans are monitored daily and reviewed monthly and annually when any changing needs are recorded. Service users spoke confidently and were complimentary about the way staff supported them, some comments include:“Because of their help I am able to go home fitter and more capable from when I arrived.” “This service here is second to none.” “The care and attention is superb.” “They respond to every whim.” “Although I find it difficult at times, staff listen to me and take note of my suggestions if I want something done differently.” Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to exercise choice and control over their lives in an environment that is stimulating and active and where opportunities for therapeutic programmes take place in a dignified and safe way. While at the same time the good wholesome food that is provided adds to the development of a healthy lifestyle. EVIDENCE: An activity person, who is well organised and has developed a good rapport with the service users, is employed to work at the home 30 hours a week. This enables the home to offer a wide range of activities on a weekly programme, that can be found advertised on notice boards around the home. So that everyone who lives or stays at the home gets a chance to take part in the activities, the organiser divides her time between the different units. However anyone is able to join in the different activities wherever they are going on. This includes those organised in the daycentre, based on the ground floor of the home. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 15 Service users discussed the range of activities available and willingly took part in these. A reminiscence game, lead by the activities organiser, was made interesting and fun and service users and a member of staff clearly enjoyed the experience. Others discussed the bingo that takes place on a Saturday evening and the quiz on a Wednesday afternoon while others discussed the visiting entertainers that had performed at the home. One service user said:“Each morning we have either games or physical exercises with the physiotherapists and the OT’s, then we have mind stimulation exercises which really wakes up the brain.” One service user explained that they preferred their own space and company and stayed in their room to listen to music that they enjoy. Service users’ preferences were clearly recorded in the their care plans and these guide staff to support individuals in the way that they prefer. Two scarecrows made by service users and staff waited in a lounge to be entered into a community based competition and visitors were seen to move freely in and out the building throughout the day, although for safety reasons anyone entering the home is asked to sign the visitors book at the entrance. Therapy staff have developed a 6 week rolling programme of therapeutic activities to supplement individual exercise programmes. Each theme, for example, Stay Active, Falls Prevention, Mood and Anxiety, Welfare Rights, Healthy Eating and Pain Management, takes place over a full week, supported by guest speakers, quiz, specific activities and groupwork, promoting general awareness and increase the knowledge and understanding underpinning rehabilitation. It is also hoped that family/carers will be involved in this process to raise their own understanding and ability to further support and promote service users independence. A midday meal was taken with service users in one of the two dining rooms. This was found to be a comfortable and pleasant experience. A menu is available on the notice board in both dining rooms and this informs everyone of the choice of food available. Staff support service users to make their choice the day before, but in the event of someone changing their minds on the day, other options are available. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 16 Staff offered one person an alternative meal when it was noted that they were not eating what they had been served. Service users spoke favourably about the food and one said:“The food is extremely nice, having their own chef we have a variety of choice and it is hot. If it is not liked staff try to manage a suitable change.” The cook, who is qualified, visited the dining room to see how the meal had been enjoyed. She confirmed that information is shared with her regarding any special dietary and nutritional needs. The cook also confirmed how different training events have broadened her understanding and knowledge about nutrition and the part it plays in individual’s healthy living. For example, how the diet can be fortified when people loose weight or have a loss in appetite, or when an illness has an effect on what or how people can eat. One care plan recorded how a service user needed their food prepared and the special appliances they needed to use when eating in order to promote their independence. Small well equipped kitchens attached to the dining rooms enable service users to redevelop and practice their cooking/domestic skills as part of their rehabilitation programme prior to them returning home. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive arrangements are in place, which help protect service users from abuse and seriously address complaints and concerns about the service. EVIDENCE: The home has a comprehensive complaints procedure which service users and their representatives are aware of. Service users were confident that their concerns or complaints would be addressed appropriately. Service users and their representatives are encouraged to discuss their concerns on a daily basis and these are addressed directly. Although no formal complaints have been made to the home over the past 12 months many compliments have been made and recorded. If particular staff are named or referred to, how this is brought to their attention, is recorded. Some comments from service users include:“If I have a concern I know that I will be listened to.” “Although I have nothing to complain about, I know who I would go to if I had.” Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 18 Staff receive training regarding the local authority’s Safeguarding Adults procedures and they are aware of the action they would take if an abusive incident was observed or reported to them. This training is repeated with the mandatory training programme. Service users who attend the home for rehabilitation purposes are encouraged to look after their own finances and locked facilities are available in their individual rooms. For those who need support with this, comprehensive procedures are in place for staff to follow and appropriate records are kept, clearly demonstrating the balance and any transactions made. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, warm and well maintained, offering service users a homely and safe environment in which to live or temporarily stay. Furthermore the environment is equipped with specialist equipment to meet individual needs. EVIDENCE: The home is decorated and furnished to a good standard and the cleanliness throughout reflects effective cleaning routines that are discreetly and safely carried out by the domestic staff team. All staff have completed a comprehensive infection control course and practices carried out reflect this. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 20 The home is divided into different units, one of which caters for the four remaining permanent service users. The unit is small and easily negotiated, making it easy for service users to find their way around. However it is becoming increasingly difficult to maintain this area as a private place, solely for the use of people who permanently live here. Two of the bedrooms in this unit are currently used for two service users attending shortterm rehabilitation programmes and who also use the dining room in this area. Although every effort is made to protect an identified area of the home for the permanent residents as there own space and that they can refer to as “their home,” this at times fails to be achieved and could, as the number of permanent residents decrease and the rehabilitation service develops, become more difficult to achieve. The manager agreed that every effort would continue to be made to maintain the privacy of these residents. It was also agreed that the use of the staircase leading up to the unit would be limited for the use of the permanent residents, their visitors and staff. Service users have access to a public phone box that is situated in a place where private calls can be made. However this is at the top of a stairwell and due to an accident that took place in a different care establishment, the local council directed that a gate be fitted at the top of the stairwell. The gate has a lock, however even when left unlocked many service users would be unable to open this gate. A discussion about the safe use of this gate took place with the manager. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust recruitment and selection procedures and regular training opportunities ensure that service users are appropriately supported and protected by a competent and qualified staff team, who work with enthusiasm and are focussed in their role. EVIDENCE: The number of care staff on duty meet the service users’ needs effectively. There were four carers, a supervisor and the equivalent of three full time domestics on duty and in addition, an occupational therapist, a physiotherapist and two therapy assistants. There were four permanent service users living at the home and ten service users receiving intermediate care. However one healthcare professional felt that at times there was not enough care staff on duty. They said:“The care of the clients is first class, but staffing levels can be very poor.” Another stated:Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 22 “The manager is always mindful of recruiting suitably experienced staff from their bank of staff if/when extra staff are needed to assist for example when clients need to transfer etc.” When asked if staff listen and act on what they say, service users responded as follows:“Absolutely there are no problems whatsoever and I mean this sincerely.” “This is a very good service and the staff are very good.” “Staff are extremely caring all day long and night if necessary, it is a case of tender loving care.” “I feel staff listen to me and take into consideration what I ask of them.” Staff work sensitively with service users, supporting them with personal care needs, as well as supporting their individual therapy routines. There are clear boundaries to individual staff roles and all staff work well together, to form an effective multi disciplinary team. Many of the staff have worked at the home for many years and have worked well through the transition period from the home being a residential service to a developing Intermediate Treatment centre, where it is now more focussed on promoting independence in preparation for people to return home. Two peripatetic carers who mainly work within the community also work within the home’s setting when hours permit. They commented that the opportunity of working within the home keeps them in touch with service users from the community, who maybe using the intermediate care service for a short period and with those who they will come into contact with in the community once they have left this service. This they feel gives service users some consistency of care. There is an extensive training programme that effectively addresses individual staff training needs. Staff spoke very positively about this and one said“The training is excellent it has helped us to understand our changing roles and to have more insight into the needs of the service users who now come here with the aim of returning home.” Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 23 Staff work through a comprehensive induction programme that follows the Skills for Care standards and then move onto achieving the NVQ standards. All staff but one have achieved NVQ level 2 and some level 3. A record of training courses attended is kept for all staff, the most recent being Equality and Diversity. Comprehensive recruitment procedures are followed and records kept include copies of individual application forms, two references and the numbers of the CRB and POVA First checks. This also includes staff employed by the PCT and the Hospital Trust, who may work within this service. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager, who is well supported by her staff team, provides good leadership and runs a service that has effective monitoring systems that are focussed on the best interests of the service users. EVIDENCE: There is a clear management structure within this integrated service, of which the registered manager plays a very important part. A copy of the management structure is in the Service User Guide, so everyone using the service is aware of the person responsible for the management of the different teams. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 25 An Intermediate Care Integrated Team Manager is overall manager and a principal social worker, a lead nurse, a therapy lead and the registered manager support this role. All are based in the same office and work as one management team, sharing information and ideas. The registered manager is responsible for the day to day running of the home and ensuring that this is carried out in compliance with the regulations of the Care Homes Act 2001. The registered manager is well qualified and has worked in care for the local authority for many years. She has achieved NVQ4 in Care and Management, has the NVQ Assessor Award and regularly attends training related to her role, as well as being up to date with mandatory training. Staff spoke positively about the manager’s leadership skills and her interest in their work and lives; one described her in a complimentary way, as “a sponge she takes everything in,” and another said, “she is very clear when giving direction.” Four care supervisors support the manager in her role and are responsible for directly supervising the staff team. In the absence of the manager, the supervisors demonstrated their competence, accommodating the inspection process, answering questions and referring to different documentation, related to the regulations and the general running of the service. The service ran well in the manager’s absence, which is a good reflection of the overall management style of the home. Regular supervision sessions take place for all staff, the most recent being recorded 28/04/08 and these follow a set agenda that includes Personal Development Planning. Service users are supported to manage their own financial affairs and were this is not the case, comprehensive procedures are followed to document all transactions, which safeguard service users financial interests. Service users have secure facilities in their individual rooms so that they can maintain their valuables and money independently and safely. Financial audits are regularly carried out by Durham County Council audit department, the last audit being in September 2007. Effective quality assurance systems are in place and service users and their relatives are regularly asked to comment on the service. This is used as a base line for improvements to be made to the service. The manager suggested that the AQAA (Annual Quality Assurance Assessment) document will be used as a way of recording and planning quality assurance issues. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 26 Monthly fire drills and weekly fire tests take place and Health and Safety training is regularly updated with appropriate health and safety risk assessments in place. Records are also maintained of equipment repair and servicing. A fire risk assessment is in place which was reviewed in March 2008 and the workplace control document is currently undergoing review. The handyperson conducts monthly water temperature testing and thermostatically controlled valves are in place in service user bathrooms, toilets and bedrooms. An asbestos management plan is held on site and a legionella risk assessment of Sept 07. Window restrictors have recently been fitted. The manager was advised to take advice from the Fire Service regarding the safety rail/gate to the stairs in the residential unit. So that this exit can be maintained as a fire exit, it is advised that this gate is kept unlocked so that free access is maintained. Since this inspection was carried out a meeting with the Fire Officer has been arranged. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 28 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 OP38 Regulation 13(4) & 23(4)(b)& (c)(iii) Requirement The registered manager must take advice from the Fire Service regarding the rail/stair gate recently installed across the top of the stair well in the residential unit and this advice must be shared with CSCI. This gate must not be left locked at any time as this could prevent people quickly escaping from a dangerous situation. Timescale for action 04/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP20 Good Practice Recommendations Care should continue to be taken to maintain the dignity and privacy of the service users who live at the home as permanent residents, so that they have areas of accommodation that they can call “their home.” So that the service is confident that they can continue to meet service users’ needs effectively as the service DS0000031225.V364662.R01.S.doc Version 5.2 Page 29 2 OP27 Grampian House develops the staffing resources should be reviewed as the number of service users increase. Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Grampian House DS0000031225.V364662.R01.S.doc Version 5.2 Page 31 - 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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