Care Home: Grantley Court Nursing Home

What the care home does well The number of care staff who have the NVQ2 qualification exceed the 50% of staff required to have this qualification by the minimum standards. This ensures a well qualified workforce. Recently, the service has demonstrated steady and significant improvement in meeting and raising standards. It is therefore expected that further areas of good practice will be identified at future inspections. What has improved since the last inspection? The last inspection was in January 2008. Due to short time between inspections, and the high number of requirements met at both inspections this year, improvements for both inspections will be included in this section on this occasion. What had improved at the January 2008 inspection: Initial assessments had been completed fully and contained all relevant information, including that from other professionals. This helps a new resident`s needs to be better known. A risk assessment and a manual handling assessment had been carried out and recorded for each service user, this will help protect residents while being physically moved. The medication policy, recruitment policy, and complaints policy had been reviewed and updated to meet the required standard and improve protection for the residents. The registered person had ensured that the cracked pane of glass in the laundry had been replaced. There were new carpets on the ground floor, and new dining room chairs. What had improved by this inspection of May 2008: New more holistic general assessments and additional specific social needs assessments have been carried out for all the residents. These also include end of life wishes. New, more person centred and more holistic care plans have also been written for all the residents, drawing on the information gathered from the new assessment process above. These new care plans also more clearly described how care should be provided and the residents` preferences in care provision. All the above improvements ensure that staff know all a residents needs and how they themselves prefer the care to be carried out Risk assessments are now individualised, detail appropriate interventions, and are available for all restraints and restrictions of liberty needed to protect a resident. Wound care is now recorded more accurately which should improve the effectiveness of wound care. There is now a satisfactory quality assurance system in the home. This ensures that residents and relatives are involved in the development of the home. Induction to National Training Organisation specifications is now being provided to staff. This ensures a better-inducted workforce. The service has made safe the suspected asbestos products within the home identified at the last inspection. An orientation board showing the day and meal options has been set up to help orientate residents. The in-house adult protection procedure has been updated to include reference to the Local Authority multi agency procedures. This ensures that local authority processes for protecting residents are supported by the home`s policy. CARE HOMES FOR OLDER PEOPLE Grantley Court Nursing Home 22 York Road Sutton Cheam Surrey SM2 6HH Lead Inspector BarryKhabbazi Unannounced Inspection 27th May 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 Grantley Court Nursing Home DS0000044083.V364812.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. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grantley Court Nursing Home Address 22 York Road Sutton Cheam Surrey SM2 6HH 020 8661 0273 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) cooppencare@yahoo.co.uk Mr Soondressen Cooppen Anita Dusoruth Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30) Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E) (of the following age range: 65 Years and over) Mental Disorder, excluding learning disability or dementia - Code MD(E) (of the following age range: 65 Years and over) The maximum number of service users who can be accommodated is: 30 28th January 2008 2. Date of last inspection Brief Description of the Service: Grantley Court is a home registered to provide nursing care, for up to thirty adults over the age of sixty-five, with dementia or other mental health disorders. The Registered Provider, Mr Coopen, who also owns three other homes in the area, bought the home in July 2003. The home is a large detached house situated in a quiet area in Cheam, well served by public transport links, there is off street parking to the rear of the property. Accommodation is provided in twelve single and nine double bedrooms all of which have been fitted with washbasins, some have en-suite facilities. There is an open plan lounge and separate dining room, a small smoking area has been provided for residents use. There are sufficient numbers of toilet facilities conveniently located throughout the home and kitchen and laundry facilities are clean and well equipped. There is a back garden, which includes flowerbeds, fruit trees and a patio area that is well maintained. At the time of writing this report the fees ranged from £575 to £660 per week. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating of the service is 2 star. This means the people who use this service generally experience good outcomes. As this was the second inspection in the last 4 months a new managers self assessment {AQAA} was not yet available to support this report. All the key Standards identified throughout this report were re-assessed at this inspection. This inspection also focussed on following up on previous requirements and recommendations, and any new issues arising. This inspection was unannounced. At this inspection the manager and Provider were interviewed, time was spent with the residents, and records, policies, care plans, and the building were also examined. Some comments from the residents included, ‘They treat me well here’ and ‘I like the food, what’s for dinner.’ When asked how they wanted to be referred to I was told, ‘well we’re the residents’. The last inspection report recorded that although a number of requirements remained unmet from as far back as 2006, an improvement in some standards was noted with 10 of the 21 previous requirements being met at that time. Continuing improvement in meeting standards was also noted at this inspection where all the remaining requirements were assessed as met. To achieve the above improvements, new more holistic general assessments and additional specific social needs assessments have been carried out for all the residents. New more person centred and more holistic care plans have also been written for all the residents, drawing on the information gathered from the new assessment process above. Please see the section called ‘ what has improved since the last inspection’ for full details of all the improvements made. What the service does well: The number of care staff who have the NVQ2 qualification exceed the 50 of staff required to have this qualification by the minimum standards. This ensures a well qualified workforce. Recently, the service has demonstrated steady and significant improvement in meeting and raising standards. It is therefore expected that further areas of good practice will be identified at future inspections. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The last inspection was in January 2008. Due to short time between inspections, and the high number of requirements met at both inspections this year, improvements for both inspections will be included in this section on this occasion. What had improved at the January 2008 inspection: Initial assessments had been completed fully and contained all relevant information, including that from other professionals. This helps a new resident’s needs to be better known. A risk assessment and a manual handling assessment had been carried out and recorded for each service user, this will help protect residents while being physically moved. The medication policy, recruitment policy, and complaints policy had been reviewed and updated to meet the required standard and improve protection for the residents. The registered person had ensured that the cracked pane of glass in the laundry had been replaced. There were new carpets on the ground floor, and new dining room chairs. What had improved by this inspection of May 2008: New more holistic general assessments and additional specific social needs assessments have been carried out for all the residents. These also include end of life wishes. New, more person centred and more holistic care plans have also been written for all the residents, drawing on the information gathered from the new assessment process above. These new care plans also more clearly described how care should be provided and the residents’ preferences in care provision. All the above improvements ensure that staff know all a residents needs and how they themselves prefer the care to be carried out Risk assessments are now individualised, detail appropriate interventions, and are available for all restraints and restrictions of liberty needed to protect a resident. Wound care is now recorded more accurately which should improve the effectiveness of wound care. There is now a satisfactory quality assurance system in the home. This ensures that residents and relatives are involved in the development of the home. Induction to National Training Organisation specifications is now being provided to staff. This ensures a better-inducted workforce. The service has made safe the suspected asbestos products within the home identified at the last inspection. An orientation board showing the day and meal options has been set up to help orientate residents. The in-house adult protection procedure has been updated to include reference to the Local Authority multi agency procedures. This ensures that local authority processes for protecting residents are supported by the home’s policy. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grantley Court Nursing Home DS0000044083.V364812.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 Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6: People who use this service experiance adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User guide does generally inform people about the details of the service provided although this needs more specific and include updated information about staff numbers and qualifications when the next update occurs. This will help potential new residents, their relatives and placing care managers know the levels and quality of staffing provided by the service. Prospective service users’ needs are assessed before they start at the home to ensure that all needs are known by the staff. Standard 6 does not apply to this home as it does not provide a rehabilitation service with an aim of return to the community. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 10 EVIDENCE: The second to last inspection report contained the following requirement under Standard 1: The registered person must ensure that the Statement of Purpose and Service User guide comply with the regulations and Schedules. This had been updated by the time of the last inspection and only one minor omission remained. The Statement of Purpose did not specify how many staff were employed and their specific qualifications. To be proportional the requirement was seen as met and a new recommendation set as follows: The next updating of the Statement of Purpose should specify the actual number of nurses and care staff and how many have which qualification. This recommendation had not been met by the time of this inspection and is now set as a requirement as follows: The next updating of the Statement of Purpose must specify the actual number of nurses and care staff and how many have which qualification. This will help potential new residents, their relatives and placing care managers know the levels and quality of staffing provided by the service. The second to last inspection report contained the following requirement under Standard 3: The registered person must ensure that assessments are completed fully and contain all relevant information, including that from other professionals. At the last inspection assessments for new residents were examined and these contained all the relevant initial assessment material, including the placing authorities assessment and care plan. The requirement was therefore assessed as currently met at the last inspection. Files for residents that had started since the last inspection were examined at this inspection. Again all the relevant initial assessment material was in place. Standard 6 does not apply to this home as it does not provide a rehabilitation service with an aim of return to the community. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9, 10 and,11. People who use this service experiance good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Plans of care are regularly updated and now record both health and social care needs. Care plans therefore now fully inform staff about all a resident’s needs. Residents are now better protected by the home’s health monitoring procedures. Residents are protected by the home’s medication procedures. Risk assessments are now available for all restraints but could contain more evidence of this being the only option. Including this information could reduce unnecessary restrictions of liberty for the service users. Residents are generally treated with respect and their privacy is maintained. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 12 EVIDENCE: A major improvement in the quality and extent of assessments and care planning has been identified at this inspection. The 2006, 2007, and 2008, inspection reports contained the following requirement under Standard 7: The service user plan must include an assessment of social care needs. This was not met at the last inspection. For example one care plan recorded ‘to engage the resident in her hobbies’ but there was no record of what her hobbies were. By the time of this inspection all residents’ needs had been re-assessed and this assessment contained information about social and cultural needs. In addition a further more in depth and specific hobbies and interests assessment had also been carried out. This information had also been transferred into new updated more holistic care plans for all the residents. Care plans now therefore do contain information regarding social care needs as well as religious, cultural and health needs. This requirement is therefore now met. It is suggested only at this stage, that care plans should record the word ‘need’ as opposed to the word ‘problem’. It is not a problem that a resident wants to go to church on a Sunday for example, and phrasing it as a problem can give the need a negative label that can be misinterpreted. The 2007 and 2008 inspection reports contained the following requirement under Standard 7: The registered person must ensure that specific details are present in care plans in order that care can be carried out. By the time of the last inspection the requirement remained unmet as demonstrated by one file recording ‘to provide a good level of personal care’ which was not specific enough and details of how to provide the care and at what level were not recorded at that time. By the time of this inspection all residents’ needs had been re-assessed and specific details of how to actually provide the care needed was recorded in care plans. This requirement is therefore now met. The 2007 and 2008 inspection reports also contained the following requirement under Standard 7: The registered person must ensure that care plans are person centred and demonstrate how care needs will be met. As mentioned above, by the time of this inspection all residents’ needs had been re-assessed and specific details of how to actually provide the care needed was recorded in care plans. In addition these re-assessments and new care plans are now more person centred, with details of how the individual resident prefers their care to be carried out. This requirement is therefore now met. Now that person centred plans are in place, implementing care in a person centred manner can be assessed at future inspections. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 13 The 2006, and 2007, inspection reports contained the following requirement under Standard 8: The registered person must ensure that risk assessments are individualised and detail appropriate interventions. By the time of the January 2008 inspection, risk assessments had improved but were found to still need to be more specific. In addition there were no risk assessments for some restraints like the use of cot sides. The requirement was then re-written to clarify the remaining shortfalls as follows: The registered person must ensure that risk assessments are individualised, detail appropriate interventions, and are available for all restraints and restrictions of liberty needed to protect a service user. By the time of this inspection general assessments of risk, and specific risk assessments for all restraints were available. These were also more detailed. The requirement is now therefore met. However risk assessments could be further improved by demonstrating how a restraint needed for the protection of a resident is the last resort, by including what other options had been considered to avoid the restraint. The following recommendation is made to facilitate this: To ensure that any limitations of liberty are essential and the only reasonable course of action, risk assessments should also record what other options had been considered before any limitation is implemented. The 2007 and 2008 inspection reports contained the following requirement under Standard 8: The registered person must ensure that wound care is recorded accurately in line with current guidance. For example, at the last inspection, one file sampled had records of a pressure sore but no details of the size of the pressure sore. The size is needed for monitoring to occur effectively. By the time of this inspection, files sampled demonstrated that the required details were now being recorded in sufficient detail. For example pressure sore records did now also record the grade and size of the pressure sore. This requirement is currently met. The 2006 and 2007 inspection reports contained the following requirement under Standard 8: A risk assessment and a manual handling assessment must be carried out and recorded for each service user. This had occurred by the time of the January 2008 inspection and this requirement was met at that time. Weight charts were inspected and these were being recorded monthly as required. However, one reccoed showed a 2 kilogram fluctuation and although evidence of assessing this fluctuation was presented this evidence was limited. Weight chart records could be further improved by including a section for Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 14 action in the event of a weight change. The following recommendation is now set under Standard 8 to facilitate this: Weight charts should also record action required in the event of a significant weight change. The 2007 inspection report contained the following requirement under Standard 9: The registered person must ensure that the medication policy is reviewed and up dated. This policy had been reviewed and updated by the January 2008 inspection and this requirement was met at that time. Residents are registered with a local GP practice and have access to other NHS facilities as necessary such as a dentist, optician, chiropodist, and “well woman” clinic. District nurses and other healthcare professionals attend when required. Evidence was seen of regular monitoring of service users’ health. The service users are registered with a local G.P and have regular check ups. A record of all appointments and check ups are kept. The manager demonstrated knowledge of the health status of individual residents. All staff who administer medication have had approved medication training. Medication profiles and clear medication administration record sheets were seen in records sampled. Medication and the M.A.R sheets are kept. residents were seen to be treated with respect and personal care was carried out in a manner that promoted the service users’ privacy. The 2006, 2007 and 2008, inspection reports contained the following requirement under Standard 11: The registered person must ensure that residents’ end of life wishes are documented and acted upon. By the time of this inspection, relatives and care managers had been contacted to provide the information required. In addition the residents had also been approached. Records now contain information regarding end of life wishes. This requirement is therefore now met. Residents are generally treated with respect and their privacy is maintained. See Standard 15 for improvements in this area. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 12,13,14,and,15. People who use this service experiance good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Activities in the home are occurring and these are now better linked to the residents’ choices and preferences. Residents are supported in maintaining appropriate relationships, so that their social lives are maximised within chosen boundaries. Residents are now more supported to exercise choice and control over their lives. The food provided is sufficient in quantity, and choices of food are now better recorded, and support at mealtimes is now more sensitive. EVIDENCE: Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 16 The 2007 and 2008 inspection reports contained the following requirement under Standard 12: The registered person must ensure that activities are developed in line with resident choice. As stated under Standard 7, previously care plans did not contain assessments of social care needs. Without this assessment information it was not possible to know residents preferences for activities. As recorded under Standard 7 the initial assessments have been re-done for all residents and now also contain an assessment social needs. In addition a more specific additional hobbies and interests assessment has been completed and all the new information has been included in the new care plans. Activities were examined and these do now better match the residents’ preferences as identified in these new assessments. This requirement is therefore now met. The 2007 and 2008 inspection reports contained the following requirement under Standard 14: The registered person must ensure that residents’ choice in all aspects of their daily life is evident. For example, at the last inspection choices were seen to be removed at lunchtime with all residents having the same drink and most using spoons to eat their lunch. By the time of this inspection, included in the new assessments above was information regarding the residents choices in other areas like drinks and cutlery at mealtimes and their choices regarding whether they wanted to eat alone or in a group. In addition the meal observed on this occasion did demonstrate that residents were not all using spoons to eat, alternative drinks were available, and residents were seen to have a choice of different venues to eat the meal in line with their choice and risk assessment. This requirement is therefore now met. The last inspection report recorded that staff were observed feeding service users from a standing position and also to feed two service users at one time. This does not promote dignity or provide care in a sensitive manner, which is required under the standards. The following requirement was then set under Standard 15 to address this: Staff must feed service users from a seated position and engage with them during the process unless a risk assessment shows otherwise. By the time of this inspection these practices were observed to have stopped. The requirement is currently met but this area will continue to be monitored to ensure the practices described above do not return. It is noted that the last report recorded that there were some positive interactions between staff and residents; a member of staff asked a resident if they required assistance in a gentle manner and a member of staff reassured and calmed a distressed resident in a sensitive and effective manner. These positive practices were again observed at this inspection. Residents have commented that they like the food. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 17 The last inspection report recorded that it was difficult for the inspectors to know what meals were on offer for that day. The following recommendation was then set. A pictorial menu and an orientation white board recording date day and menu choices for the day should be implemented. By the time of this inspection an orientation board had been set up which recorded dates and the days meals. This meets part of the recommendation but does not address the residents who may find it difficult to read or understand writing. The recommendation will therefore be re-written to reflect the progress that has been made and the remaining element needed as follows: A pictorial menu should be implemented. Records showed that suitable arrangements are in place to enable residents to maintain good links with their families and friends. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18: People who use this service experiance good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Residents can be confident their complaints will be listened to and acted upon where appropriate. Residents are generally protected from abuse or self-harm through the home’s protection policies and procedures, and by these being known by staff. EVIDENCE: The last report recorded that the home had received no complaints, and there had been no complaints since that time. Previous survey respondents knew how to make a complaint. There are two different complaints policies within the home. Since the last inspection both have the correct format and comply with the Regulations. The home has a Gifts Policy, a Wills policy, a Whistle Blowing policy, and a Restraints policy and guidance. The Gifts Policy does preclude staff from receiving gifts and does preclude staff from being involved in the making of, or from benefiting from service users’ wills. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 19 The 2006, and 2007 inspection reports contained the following requirement under Standard 18: The in-house adult protection procedure must include reference to the Local Authority multi-agency procedures. This policy stated that any allegations of abuse would be first be investigated in house and then only passed to social service adult protection if the service user agreed to this. These statements were contrary to the Local Authority multi-agency procedures. In fact allegations must not be initially investigated in house and must be all referred to adult protection who will make the decision about who will investigate. In addition the resident has a choice about whether they wish to bring charges but not about whether this information is passed to adult protection. At the last inspection the policy was amended with alterations being made on it by the manager. By the time of this inspection the policy had been re-written to include the amendments and made available to staff. This requirement is now met. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 19 and 26: People who use this service experiance good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The environment and furniture generally meet the residents’ needs, and the environment does generally promote the residents well being. The home is hygienic and clean. This environment therefore facilitates the residents’ health and emotional well-being. EVIDENCE: The premises were and clean, and free from offensive odours. There was suitable lighting and ventilation. The grounds were well kept. The overall condition and décor of the home was reasonable. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 21 The home has specific policies covering the disposal of clinical waste, control of infection, use of cleaning materials, storage and preparation of food, and dealing with spillages. Protective clothing was observed to be present. Laundry facilities have easily cleanable non-permeable floors and walls. The 2007 last inspection report contained the following two requirements under Standard 19: 1, The registered person must ensure that a planned programme of refurbishment and redecoration is submitted to the CSCI 2, The cracked pane of glass in the laundry must be replaced. By the time of the January 2008 inspection a planned programme of refurbishment has been implemented, there is a maintenance book showing when issues are identified and when addressed. This showed a timely response. The pain of glass in the laundry had been replaced. Both these requirements were therefore met at that time. In addition there are new carpets on the ground floor, and new dining room chairs and new reclining chairs. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, and 30. People who use this service experiance good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Duty rota indicates that there are adequate numbers of staff to meet needs. The residents are supported by a nursing staff group that are appropriately qualified. The number of care staff with the required NVQ2 exceeds the 50 required by the standards. This raises the quality of staff, their knowledge and their practices. The home’s recruitment procedures protect the residents through vigorous staff vetting. Staff now receive induction and foundation training to National Training Organisation Standards, which ensures that they are well inducted. EVIDENCE: The last two inspection report recorded that the duty rota and observation on the days of the site visits indicated that there are adequate numbers of staff to meet needs. This was also the case at this inspection. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 23 All elements of Schedule 2 {staff files} were available for inspection. Staff recruitment documents were examined for new staff and these included CRB checks, references and proof of identification. No shortfalls were identified in the staff recruitment process. The 2007 inspection report contained the following requirement under Standard 29: The registered person must ensure that there is a clear recruitment policy, which complies with the regulations. The recruitment policy had been updated by the time of the January 2008 inspection and this requirement was met at that time. The 2007 inspection report contained the following requirement under Standard 29: The registered person must ensure that training is evidenced when undertaken. By the time of the January 2008 inspection records for training were recorded and this requirement was met at that time. However it was then identified that although there was an induction process this does not meet National Training Organisation specifications and targets. The following requirement was then set under Standard 30 to address this: An induction within the first six weeks followed by foundation training within the first six months must be completed for all new staff and this must be to National Training Organisation specifications and targets. {Old requirement from 2002 that needed to be re-set.} By the time of this inspection Skills for care induction procedures had been implemented for all staff. This now meets the required standard and this requirement is now also met. Grantley Court Nursing Home DS0000044083.V364812.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): Standards 31, 33, 35, and 38. People who use this service experiance adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is managed by a person with appropriate qualifications and experience. There is a quality assurance system that involves the residents, which now has been developed to provide feedback to them, to allow them to be involved in improvements and measure improvements in the home for themselves. Residents’ financial interests are guarded. The home generally promotes the health and safety of the residents, so that practices and the environment do not place their health and safety at risk, but more diligence with keeping dangerous areas locked needs to occur. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 25 EVIDENCE: The current registered manager has the required NVQ 4 Registered Manager’s award and is suitably experienced to manage the home. The 2007 inspection report contained the following requirement under Standard 31: The registered person must ensure that the manager is supported to develop their role. At the January 2008 inspection, the manager informed the inspector that she had received appropriate support including training materials. This requirement was met at that time. The 2006, 2007, and 2008, inspection reports contained the following requirement under Standard 33: The registered person must ensure that there are satisfactory quality assurance systems in the home. There is a quality assurance system that involves the residents, but at the time of the last inspection this still needed to be developed to provide feedback to the residents, to allow them to be involved in improvements and measure improvements in the home for themselves. It was suggested that this could be done by collating all the quality assurance information {from complaints, provider visits and plans, resident questioners, etc} into one document {an annual development plan} this document could then be presented to residents and relatives to inform them of quality plans and allow them to monitor progress by presenting an updated version annually. By the time of this inspection the remaining shortfall had been addressed in the manner suggested above. In addition changes to the environment requested by residents and relatives were not only recorded in the annual development plan but had been implemented. For example, fresh flowers in the building and paintings on the communal walls. This requirement is therefore now met. Comments from quality assurance questionnaires were included the annual development plan and included the following examples: ‘Room very nice with ensuite facilities’, ‘it’s always kept very clean and tidy’, ‘every one seems very kind and caring’, ‘The recent upgrade to the living room is very good’. There were also no complaints over the last two inspections. Procedures are in place to protect service users’ money and no anomalies were identified at this or the last inspection. Infection Control, and Handling and Disposal of Clinical Waste policies are all also included in staff induction Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 26 The January 2008 inspection recorded that there was a suspected asbestos product lining the door of the cupboard on the top floor to the hot water tank. {Legally it does not matter whether this is actually asbestos, as it looks like asbestos it should be treated as a suspected asbestos product. This involves getting it sampled and tested to ascertain if indeed it is asbestos and what type. The product then needs to be labelled accordingly and a risk assessment made. If it is not asbestos it should be labelled as such. If it is asbestos the type and condition will dictate what action is required. This can range from no action, to sealing it with a special paint or professional and safe removal.} The following requirement was then set to address this: The home must provide evidence, that any suspected asbestos products within the home have been professionally identified, then labelled, sealed and left, or safely removed as risk assessment indicates, and under Health and Safety regulations. {See also, Regulation 4 of the Control of Asbestos at Work Regulations 2002.} By the time of this inspection the suspect product had been replaced with a known safer material. This requirement is now met. All of the health and safety policies and procedures relevant to this standard were seen to be present. Moving and Handling, Fire Safety, First Aid, Food Hygiene, Infection Control, and Handling and Disposal of Clinical Waste policies are all also included in staff induction. The testing of systems required in Standard 42 were also present and inspected. These included fire fighting equipment testing, fire warning testing, Portable Appliance Testing, 5-year wiring testing and bacterial analysis and testing of the water supply. One minor shortfall however was identified. The electrical cupboard on the ground floor was not locked. I closed it but it could still be opened easily without being locked as I demonstrated to the manager. It is noted that the maintenance person had been working that day but he was working on a different floor at the time of discovering this cupboard being unlocked. To protect the residents this cupboard needs to be kept locked and the following requirement is now set to address this: The manager must ensure that the electrical cupboard is kept locked. Grantley Court Nursing Home DS0000044083.V364812.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 2 x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 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 3 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 Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4{1}c {Schedual 1} 12 Requirement The next updating of the Statement of Purpose must specify the actual number of nurses and care staff and how many have which qualification. The manager must ensure that the electrical cupboard is locked. Timescale for action 30/09/08 2. OP38 15/06/08 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. 2, 3, Refer to Standard OP15 OP8 OP8 Good Practice Recommendations A pictorial menu should be implemented. Weight charts should also record action required in the event of a significant weight change. To ensure that any limitations of liberty needed to protect a resident are essential and the only reasonable course of action, risk assessments should also record what other options had been considered before any limitation is implemented. Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Grantley Court Nursing Home DS0000044083.V364812.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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