Care Home: Grandville Lodge Residential Home

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What the care home does well The home is well managed in the interests of the people who live there. The manager is competent and experienced and takes a hands on role in both running the home and providing care. People using the service are complimentary about the way she manages the home. People are supported by a competent, stable staff team. Relatives of people living in the home were complimentary about the way staff provide care. There is a range of activities in place that are designed to meet people`s wishes and needs. The home encourages and promotes the involvement of family and friends. Relatives told us they are made welcome and are consulted about their relative`s care. A relative who completed a survey told us, "Grandville Lodge takes great care looking after my 94 year old [relative] who has Alzheimer`s disease. The love and care [they get] is great". People living in Grandville Lodge enjoy living in an environment that is pleasant and homely. The decor and the furnishings are of good quality and the home is clean and well maintained. A relative who completed a survey told us, "Grandville Lodge has a welcoming and homely feel creating a good atmosphere to be in". What has improved since the last inspection? Since the last inspection a greater number of staff have achieved a National Vocational Qualification (NVQ). There is an established, competent, well-trained staff team in the home which ensures that people living there receive a high standard of care. There has been redecoration and refurbishment in various areas throughout the home. As part of the ongoing programme of maintenance and redecoration many improvements have been made in the past year in both communal ares and individual bedrooms. People living in Grandville Lodge benefit from a homely, well-maintained environment that continues to improve. The manager has continued to develop the home`s Quality Assurance programme and ensures that they seek the opinions of people using the service and use the information to develop and improve. What the care home could do better: The manager should consider how to improve signage throughout the home for people who have dementia or who are becoming forgetful as a result of the aging process. Better signage, including pictures on doors can help people make more sense of their surroundings and assist with orientation. A small area of the laundry room flooring that is damaged could be improved so that good infection control can be maintained. Key inspection report Care homes for older people Name: Address: Grandville Lodge Residential Home 17-19 Grand Drive Leigh-On-Sea Essex SS9 1BG     The quality rating for this care home is:   three star excellent 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: Ray Finney     Date: 3 0 1 2 2 0 0 9 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 Older People Page 2 of 29 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. 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 Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Grandville Lodge Residential Home 17-19 Grand Drive Leigh-On-Sea Essex SS9 1BG 01702470976 01702472575 sg_barnes@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grandville Lodge Limited Name of registered manager (if applicable) Mrs Christine Greenwood Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 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 categories: Old age not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Grandville Lodge is a home providing care for up to 19 older people or people who have dementia. Accommodation is in single rooms, some with en suite facilities. There are homely and comfortable communal areas including lounges and dining rooms and there is a pleasant garden to the rear of the property. Access to the first floor rooms is Care Homes for Older People Page 4 of 29 Over 65 0 19 19 0 Brief description of the care home by means of stairs or a passenger lift. There is off road parking available to the front of the property. The home charges between £362.46 and £600.00 for the service they provide and there are additional charges for personal items such as hairdressing, chiropody, taxis, newspapers and toiletries. This information was given to us in January 2010. Information about the home, including the Statement of Purpose and Service User Guide can be obtained by contacting the home. Care Homes for Older People Page 5 of 29 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of the service took place on 2nd August 2007. Since that time there has been a change in the company owning the home and this is the first inspection since that change of provider. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment, which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 30th December 2009 and included a tour of the premises, discussions with relatives of people living in the home and members of staff. Completed surveys were received from members of staff, relatives and a healthcare Care Homes for Older People Page 6 of 29 professional. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. On the day of the inspection we were given every assistance from the manager and staff team. Care Homes for Older People Page 7 of 29 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 Care Homes for Older People Page 8 of 29 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 Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Through the comprehensive admission process people choosing to live at Grandville Lodge can be confident their needs will be met. Evidence: The manager told us in the AQAA, A brochure and Service Users Guide will be provided to all new service users. Since the last inspection the home has gone through the registration process with the Commission to register a change of provider. As part of the registration process they submitted an updated Service User Guide and Statement of Purpose. The information in these documents informs people clearly of the service they can expect from Grandville Lodge. On the day of the inspection the updated Service User Guide and Statement of Purpose were readily available in the home. All relatives who returned completed surveys to us indicated that they received Care Homes for Older People Page 11 of 29 Evidence: enough information about the home to help them decide if it was the right place for their relative. The manager told us in the AQAA, A full pre-assessment will be undertaken to ensure his or her needs can be fully met by the home. A full individual care plan is then devised taking into account all the service users needs to enable management, care staff and all concerned to provide the best possible care. We discussed the homes admission process with the manager and examined a sample of individual pre-admission assessment documents. At the time of the last inspection we reported that assessments included a detailed history for each person living in the home and provided clear information on their social, personal and health requirements. This robust process continues to be in place. There is a comprehensive pre-admission assessment carried out for each person wishing to be admitted to Grandville Lodge. The documents include a dependency profile that covers a wide range of assessed needs including mobility, continence, hearing, eyesight, speech and communication, memory, mood, sociability, dressing and bathing. The information from the assessment is used to form the basis for individual care plans. A member of staff who completed a survey told us that what the home does well is, makes every effort to accommodate the service user and finds out as much information from the service user, their family and professionals to ensure they are happy and looked after. Care Homes for Older People Page 12 of 29 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident their personal and healthcare needs will be identified and they will be provided with the support to ensure these needs are met as they would wish. Evidence: The manager told us in the AQAA, The service users care plans at Grandville Lodge contain all the information to help us meet the service users needs using a Person Centred approach. As previously reported, Grandville Lodge continues to use Standex system for peoples care files. This system provides documentation to enable peoples health and social care needs to be fully recorded, including professionals meetings, doctors notes and risk assessments. On the day of the inspection we examined a sample of three individual plans of care. Each person has a physical assessment that is reviewed every four weeks to take account of any change of needs. There is a range of care plans in place specifically Care Homes for Older People Page 13 of 29 Evidence: relating to the persons individual assessed needs. We examined care plans relating to personal hygiene, pressure area care, nutrition, continence and medication. Each care plan documents the assessment of the persons need, the goal or objective they are trying to achieve and what interactions need to be put in place with an evaluation of the planned care. Care plans are reviewed regularly and the manger has a matrix in place to keep a check on when reviews are due. A relative who completed a survey told us that what the home does well is, looks after my [relatives] needs well. The manager told us in the AQAA, We liaise on a regular basis with the local doctors and district nurses and have good relationships with health care professionals such as chiropodists, psychiatric teams etc. We are able to draw on a wealth of advice and expertise as needed and we record results from all medical appointments, including multidisciplinary team results in each file. Daily reports are also contained within the care plans, these are clear and detailed. Individual care plans contain evidence of input from a range of health care professionals including doctor and district nursing services. In the Standex system there is a range of charts used including weight charts and, for one person who is cared for in bed because of advanced elderly needs and whose care plan identifies the need to be repositioned in bed on a regular basis, there is a turning chart in place which records how frequently the person is moved. Another relative who completed a survey told us, I have been very satisfied with the level of care provided for my [relative]. We examined the homes systems for supporting people with prescribed medication. Grandville Lodge uses a monitored dose system (MDS), sometimes referred to as a bubble pack system. The MDS packs are stored in an appropriate drugs trolley that is locked and securely attached to the wall. A sample of medicines administration record (MAR) sheets examined were completed clearly and appropriately and all drugs administered had been signed by the member of staff. Medication examined in the drugs trolley was clearly marked with the date of opening. When medication is prescribed on an as required basis (usually referred to as PRN medication), there are PRN protocols in place such as when people have been prescribed analgesics for pain relief. At the time of the inspection there were no controlled drugs in use in the home. However, there is a controlled drugs cupboard available should anyone be prescribed medication that requires this increased level of secure storage. A senior care staff spoken with was able to demonstrate an awareness of good practices around the Care Homes for Older People Page 14 of 29 Evidence: storage, administration and recording of medication. Medication is administered by senior care staff who have received appropriate training. Each individual care plan contains a record of the persons required medication, dose and frequency it is to be taken. The manager told us in the AQAA, our service users are treated with respect and their privacy and dignity are upheld and All staff are trained to a high standard to provide the best possible health and personal care, which is carried out in a professional manner ensuring privacy, dignity and respect at all times and ensuring all service users cultural, spiritual, religious or other needs and wants are met and respected. Throughout the course of the inspection we observed good interactions between staff and people living in the home. Staff were courteous , friendly and behaved professionally. Relatives spoken with were confident their relatives are treated with respect. A relative who completed a survey told us, The manager and all the staff at Grandville Lodge always show my [relative] and the other residents a genuine warmth, privacy, respect and dignity. Care Homes for Older People Page 15 of 29 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Grandville Lodge are provided with variety and choice in their daily lives and their expectations and preferences with regard to lifestyle are well met. Evidence: The manager told us in the AQAA, Social activities take place daily and there is an activities chart on display on the notice boards for all service user to see. Staff members also inform service users of the activities about to take place. All service users have the option to take part and are encouraged to do so, however, the privacy of the service user and their right to choose whether to take part is of paramount importance and we respect their wishes should they require a quiet room. The manager also told us, We hold many events to include BBQs fetes and theme days for which the service users and their families, advocates and friends get involved. Many of our service users enjoy baking, craft work, flower arranging, card and board games etc. Our activities co-ordinator is regularly adding new activities. We also have three other members of staff trained in activities suitable for our service users. Care plans examined contain an activities care plan and a social activity plan, which document what the person does on a daily basis. Some of the activities include listening to music, making phone calls, watching television and listening to the radio Care Homes for Older People Page 16 of 29 Evidence: and social visits. One activities plan recorded that the person does not take part in many activities especially as a group, but does seem to enjoy doing reminiscence and occasionally playing bingo. Very much enjoys looking at/reading the newspaper and magazines. A relative who completed a survey told us that what the home does well is, a variety of activities throughout the year. The manager told us in the AQAA, Our service users are encouraged to have as much social contact as possible with friends and family and Visitors are always made welcome at Grandville Lodge and are also invited to the events held throughout the year. We offer visitors tea and coffee and meals can be arranged with prior notice. The home produces a regular news sheet to inform relatives and people living in the home of what events are planned and to tell people about events and occasions that have taken place and how they went. News sheets show a number of successful events that people enjoyed, including a summer fete, a Halloween party, a bonfire night bar-b-que, St Georges Day celebration and a Cockney Day with pie and mash lunch and an afternoon quiz. There is ample photographic evidence of what activities people take part in such as making balloon faces, flower arranging, cake decorating, craft work and sing-alongs. A relative who completed a survey told us, Relatives and visitors are always welcome. The manager told us in the AQAA, Service users are encouraged to make as many personal choices as they are able to. These choices may range from where they wish to sit at the dining table through to the management of their own finances. The right to choose is upheld by all members of staff. As reported at the last inspection, the home continues to hold residents meetings to seek the views of people living in the home and their relatives around activities, events and menus. Care plans document peoples food preferences and where they like to eat. One persons care plan states, has breakfast in own room and lunch/tea in the main dining room, loves chocolate, enjoys cups of tea and some fruit juices. The manager told us in the AQAA, We provide fresh, nutritionally balanced home cooked meals that are appropriately spaced during the day. We provide snacks (biscuits, sandwiches, cakes, jacket potatoes etc) and hot and cold drinks throughout the day or when requested by the service user. She further told us We have found Care Homes for Older People Page 17 of 29 Evidence: food preferences or likes and dislikes hard to record with certain service users due to their confusion (possibly saying they like something or changing their mind when they receive their meal saying they did not choose it) and to reduce the impact of this they continue to offer choices but record what the service users like or dislike to try to establish a routine/pattern. Menus examined record a good variety of food is available; staff spoken with and our observations confirmed that food is home made, fresh and of good quality. Many of the choices are traditional meals such as casseroles, roast dinners, shepherds pie, sausage and mash or fish and chips. Each day a second option is available for people who may not wish to have the planned meal. People also enjoy a range of puddings such as apple crumble, rice pudding or jam sponge and custard. A lighter evening meal is provided which may be sandwiches, jacket potatoes and cheese or beans on toast. Pictures of the meal are set out on the tables before lunch so that people know what the planned meal is. Lunch on the day of the inspection was cottage pie with vegetables and Black Forest Gateau for dessert. We observed that the food appeared well cooked, appetising and was well presented and it was evident that mealtimes are a social occasion and people enjoyed the food. Staff brought round sauces and asked people what they wanted. Tables were attractively laid with napkins, which contributed to a pleasant dining experience. There were large fruit bowls on the dining tables with a good variety of fruit. A member of staff who completed a survey told us, food/meals are home cooked and quality products. Care Homes for Older People Page 18 of 29 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 using the service can be confident that their concerns about how they are treated are listened to and acted upon. Evidence: The manager told us in the AQAA, We have not received any complaints, although any complaints will be taken seriously by the home. Comments and concerns are brought to our attention and are dealt with immediately and successfully. As at previous inspections, Grandville Lodge has an appropriate complaints policy and procedure in place, which was updated in 2009. The complaints procedure is clearly available in the entrance hall for visitors. There have been no complaints recorded in the past year. Through discussions with the manager and our observations, any minor concerns are dealt with as an when they arise. A relative spoken with told us they had no complaints. They said when their relative first moved in to the home there was an unsettled period at first, but any concerns were dealt with appropriately by the home. The manager told us in the AQAA, Training is highly important, all training regarding the protection of service users is undertaken fully and all staff take their responsibilities in this area very seriously. All staff complete the Safeguarding of Vulnerable Adults training on induction. There is also a range of information leaflets and brochures displayed in the entrance Care Homes for Older People Page 19 of 29 Evidence: hall that visitors may find useful. These include information about vulnerable adults and abuse with details of who to contact if anyone has concerns, including the police and the local authority who deal with issues relating to safeguarding. Other information readily available relating to keeping people safe includes contact details for organisations such as Action on Elder Abuse, MIND, Womens Aid and the Male Advice and Enquiry Line. There are information booklets relating to the Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DOLS) and Independent Mental Capacity Advocacy (IMCA) Services. A sample of personnel records examined confirms that staff have received training around safeguarding. Staff spoken with during the inspection were able to demonstrate an understanding of their responsibilities around keeping people safe and recognising abuse or poor practice. When asked if they knew what they should do if someone had concerns about the home a member of staff who completed a survey confirmed they did. Care Homes for Older People Page 20 of 29 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, 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. 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 can enjoy living in an environment that suits their lifestyle and which is homely, well maintained and clean. Evidence: The manager told us in the AQAA, The environment we provide is clean, safe, with a high standard of furnishing. Where possible the rooms provided encourage independent living. It is homely and designed to meet the needs of the service users within the constraints of an older style property and We have purchased various items for the garden as a result of suggestions from those who use our services such as new garden furniture, large table and good sturdy garden chairs, large parasols and gazebo for sun protection. A tour of the premises confirmed that Grandville Lodge is pleasant, homely and well maintained. Communal areas, including the lounge and two dining rooms, contain good quality furnishings. Tables in the dining rooms were laid with table covers, napkins and place mats. At the time of the inspection, the lounge and dining rooms were decorated to reflect the festive season with Christmas trees, fairy lights and crackers. A relative who completed a survey told us, Physical environment is very good. Care Homes for Older People Page 21 of 29 Evidence: As part of the ongoing programme of maintenance, redecoration and refurbishment there have been a number of improvements in the past year. A new passenger lift has been installed and the plumbing and heating system has been upgraded. Carpets in all the communal areas have been replaced. The corridors have been redecorated, carpets replaced and new lighting installed. There are new chairs in the lounges, the lower lounge/diner has been redecorated and there is new oak furniture. The upper lounge has been decorated and has a new dining table. Nine of the bedrooms have been refurbished including redecoration, furniture replaced, new curtains and bedding and new carpets. Some of the toilet suites have been refurbished, replacing some of the baths with either a shower or wet rooms and re-tiling floors and walls. As previously reported, the home has 19 individual bedrooms, 12 of which have ensuite facilities, one has its own bath and all have hand-washing basins. Peoples individual rooms also contain good quality furnishings and there is ample evidence of personal possessions, photos, memorabilia and ornaments. It was noted, however, that there is very little signage to assist people with dementia or confusion as a result of the aging process and enable them to make more sense of their environment. Many of the bedroom doors look similar and do not have anything familiar to the individual to distinguish one from another. We discussed with the manager how this could be improved by using appropriate photographs or other memorabilia to help orientate people and enable them to distinguish between different rooms. In particular toilets and bathrooms could have appropriate signage so that people who are confused are better able to understand when they are being supported to go into the bathroom or toilet. The manager told us in the AQAA, The schedule of maintenance is planned and prioritised at the start of each financial year but reviewed throughout the year. We noted that the home was clean and odour free throughout, including good quality carpets that were stain free. The laundry was small, but appropriate for the size of the home. Walls and flooring had cleanable surfaces and were clean. However, there is one area of the room where equipment had been moved and the flooring needs to be made good. A member of staff who completed a survey told us the, home is always clean and does not smell and I like the way each room has been furnished and decorated and the resident can have their say in what they would like. Care Homes for Older People Page 22 of 29 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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 living in the home can be confident they are cared for by a competent staff team who can meet their needs. Evidence: The manager told us in the AQAA, On the morning shift we have three care staff and the manager during the week and three care staff at the weekends, which includes the senior carer in charge. There are two waking night staff. Rotas and working arrangements are altered if the needs of the service users require this and Grandville Lodge also employs two administration staff, activities co-ordinator and a maintenance man in addition to care staff. Throughout the inspection we noted that there were ample staff on duty so that people did not have to wait unduly for their care needs to be met. Since the last inspection levels of staff with a National Vocational Qualification (NVQ) have increased. The manager told us that all but 3 members of staff now have achieved the award at either level 2 or 3. A relative who completed a survey told us, Staff are always friendly and approachable. Very hard working. Care Homes for Older People Page 23 of 29 Evidence: The manager told us in the AQAA, Before any employment commences at Grandville Lodge, two written references are obtained as well as a POVA check. CRB checks are also applied for. All gaps in employment are checked and the manager will ensure that she is satisfied with the information given on the application form and also at the interview. As previously reported, Grandville Lodge continues to operate a robust procedure for recruiting staff. A sample of personnel records examined contained all the documentation required by regulation including appropriate application forms with no unexplained gaps in employment history, two written references, appropriate proofs of identity and Criminal Record Bureau (CRB) checks. The manager told us in the AQAA, We have an excellent training programme and work alongside reputable companies that offer all mandatory and other relevant training for Grandville Lodge and improvements in the last year include, Home manager gained NVQ level 4 in Health and Social Care. Four staff have gained NVQ level 3 and one NVQ 2 in Health and Social Care. Four staff (including home manager) have gained Palliative Care Level 3. Two staff have gained Dementia Level 2. The sample of personnel records examined contained evidence that new staff have an appropriate induction when they commence work. Staff also receive a range of training appropriate for the work they do, including courses in Principles of Care, Protection of Vulnerable Adults or POVA (now referred to as safeguarding), Infection Control, Health and Safety, Dementia Awareness and Understanding Dementia, Basic Food Hygiene, Fire Safety and Medication Handling. Staff spoken with where knowledgeable about their responsibilities and we observed staff carrying out their duties competently and professionally. A health care professional who completed a survey told us, The carers are kind. We are treated well and politely when we visit. Care Homes for Older People Page 24 of 29 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed to ensure their best interests are met. Evidence: As previously reported, the manager of Grandville Lodge is long established in post and has now been employed at the home for approximately 16 years. She has attained the Registered Managers Award (RMA) and has now completed a National Vocational Qualification (NVQ) level 4 in Health and Social Care. Through discussions the manager was able to demonstrate a thorough understanding of her responsibilities. We observed that she takes a hands on role in running the home and was able to provide us with ample evidence of her commitment to providing a high quality service. The manager provided us with information in the AQAA that was clear and detailed, giving us a good picture of Grandville Lodge. Evidence examined at the site visit and from surveys received by us at the Commission, support the information provided by the manager and confirm it as an accurate account of the service provided at the Care Homes for Older People Page 25 of 29 Evidence: home. Evidence examined during the inspection further confirmed that the manager has robust systems in place for the management of the home, including ensuring records are well maintained. The manager is supported by an established staff team who have a good understanding of the homes processes. When asked if they manager provides enough support, a member of staff who completed a survey responded, always. The manager told us in the AQAA, Grandville Lodge has a Quality Assurance system in place together with monitoring systems, based on seeking the views of service users, to measure success in meeting the aims, objectives and Statement of Purpose of the home and We hold regular service users/relatives/advocates and staff meetings to seek their opinions, suggestions, comments etc, which makes us aware of any problems or matters that can be acted upon as quickly as possible. We also provide questionnaires to help highlight any other issues that can be discussed and dealt with accordingly. There is also a comments section on our Visitors Book in the entrance hall which helps us to monitor others views and of course welcome and thank them for their compliments. In the past year the manager has continued to develop the homes quality assurance process. As part of this process, they provide visitors, staff and residents with questionnaires and collate the information they receive. The manager carries out internal quality audits to identify areas for improvement. The quality assurance process records improvements made in the current year and planned improvements for the coming year. Through discussions the manager explained that, as previously reported, Grandville Lodge does not manage the finances of anyone living in the home. Any expenditure on behalf of residents is invoiced to relatives or other legal representatives who manage the finances of people living in the home. We examined the homes Health and Safety documentation and found it to be well organised. Up to date certificates are in place for the fire alarm system, emergency lighting system, fire equipment, hoists, gas appliances, electrical installation, lift, portable appliance testing, legionnella water testing and the nurse call system. A relative who completed a survey told us Grandville Lodge is, very well managed. Care Homes for Older People Page 26 of 29 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 Older People Page 27 of 29 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 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 19 The manager should consider how to improve signage throughout the home for people who have dementia or who are becoming forgetful as a result of the ageing process. Better signage, including pictures on doors can help people make more sense of their surroundings and assist with orientation. The manager should consider how to improve the small area of the laundry room flooring that is damaged so that good infection control can be maintained. 2 26 Care Homes for Older People Page 28 of 29 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. 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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