Care Home: Granville

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What the care home does well Granville provide a welcome break to guests to support their carers and give them an opportunity to attend the home. Some families felt that the breaks could be more regular to give them additional time to have holidays or to have a break from caring. The home is well maintained, clean and homely. Guests were complementary about the care and support they receive and the skills and personalities of staff. During this visit there was a relaxed and informal atmosphere, and guests appeared comfortable in their environment. Guests spoke highly of the staff team and the way in which they supported them. Staff were observed as they engaged in meaningful conversations with guests and, where appropriate, they offered support in a sensitive and caring manner. Encouragement is given to guests to develop and maintain relationships with family and friends, and to be involved in the local community. This provides guests with a feeling of self-worth and belonging. There are procedures in place that enable guests to make their views known and there are policies and procedures to protect these people from abuse. Guests said they felt confident in expressing their views and in talking to the manager and staff about any concerns or complaints. What has improved since the last inspection? The registered manager and two assistant managers have completed the registered managers award level 4. Another of the assistant managers has completed her N.V.Q. 4 in care management. A requirement was made on the last inspection in relation to medication practice. This was to make sure that the medication administration records include for each medication the strength of each drug/liquid is recorded. This was indicated on the medication records examined on the visit and is therefore complied with.The introduction of the referral panel means the managers have all relevant information before introductions are made, this enables Granville to plan ahead It also allows for more flexibility on the services which can be offer to the person being referred, and for packages of care to be planned to ensure the best possible outcome for the prospective guest. We were told that two managers have undertaken basic training in Total Communication and are attending a communication course that will enable them to assess the communication needs of the people they support. Granville have purchased four hospital beds. The home also has four epilepsy seizure monitors, which alert staff if a guest is having a seizure. What the care home could do better: There was on the last inspection a requirement issued in relation to medication. One section of this requirement was achieved as detailed in the section above. The requirement also included that the medication administration records must record the name, dose and dispensing procedures for each drug. This was identified on this visit as not being complied with and needs to be addressed by the managers. There are four requirements and thirteen recommendations arising from this inspection. So guests have up to date and accurate information about Granville, the statement of purpose and service user guide need reviewing and updating ensuring they reflect the service provided and are in a format, which is easily understood by guests. All guests need to be provided with a copy of the service user guide when it is amended. Care plans and risk assessments need to be put in place for all guests. These need to be up to date and reflect the current needs and support of the individual. A representative from the local authority should, in line with Regulations, visit the home once a month and undertake specific tasks to check that Granville is being managed appropriately. This is in accordance with the Regulations. A report should be made of the visit, which is sent to the home and made available to the Commission. To ensure staff are able to recognise potential abuse and are aware of what to do in this situation, all staff need to be provided with training on the protection of vulnerable adults. All staff need to be provided with training in moving and handling, infection control and health and safety to ensure staff are able to do their job well and not put themselves or guests at risk. CARE HOME ADULTS 18-65 Granville 10 Victoria Road Ellesmere Park Eccles Manchester M30 9HB Lead Inspector Kath Oldham Unannounced Inspection 23rd April and 2nd May 2008 08:45 Granville DS0000038835.V362931.R01.S.doc Version 5.2 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 Granville DS0000038835.V362931.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 Adults 18-65. 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. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granville Address 10 Victoria Road Ellesmere Park Eccles Manchester M30 9HB 0161 789 1041 0161 789 7096 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) City of Salford Community & Social Services Ms Francine Laurukenas-Sproston Care Home 12 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0) of places Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of service users accommodated for personal care only at any one time shall not exceed 12 service users whose primary reason for needing care is learning disability, but who may also have associated physical disability. Service users are accommodated for a maximum stay of three weeks. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. That dependency levels of service users are assessed on a continuous basis and staffing levels adjusted where appropriate to ensure continued compliance with the Residential Forum’s guidance on `Care staffing in Care Homes for Younger Adults`. 7th February 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Granville is a residential care home operated by Salford Social Services. The home provides respite care for up to twelve (12) adults with learning disabilities. The home is situated in a residential area of Eccles in a large Victorian house. The house has been adapted for the purpose of providing respite care. The grounds offer secure landscaped gardens to the side and rear of the property. The garden to the rear is fully enclosed. Internally, there are large communal lounges and dining areas offering spacious and suitable furnished facilities. Accommodation is offered in single rooms. Three bedrooms are adapted for wheelchair users. There are adaptations in the bathrooms that allow assisted bathing. Placements are booked three months in advance and the maximum stay for a service user is three weeks at a time. Fees for the service range between £7.52 and £14.70 per night. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This visit was unannounced, which means the managers and staff were not told we would be visiting, and took place on 23rd April 2008, commencing at 8:45am until 4.30pm. A second day was arranged to view the staff files for staff appointed since the last inspection. This was at Crompton House on 2nd May 2008. The inspection of Granville included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection. We also sent the manager a form before the visit for her to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Granville was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. The requirements and recommendations from the last inspection were assessed. There was one requirement and one recommendations arising from that inspection. The requirement had been complied with on this inspection. The recommendation had been actioned however was not addressed in full. Comment cards were sent prior to the inspection for distribution to people staying at Granville their relatives and staff, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We found our information at the visit by observing care practices, talking with people staying at Granville; talking with the manager, assistant manager and staff. A tour of Granville was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Granville was meeting the needs of guests and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of guests. The care service provided to two guests was looked at in detail to help form an opinion of the quality of the care provided. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 6 A brief explanation of the inspection process was provided to the manager and assistant at the beginning of the visit and time was spent at the end of the day to provide verbal feedback to the manager. What the service does well: What has improved since the last inspection? The registered manager and two assistant managers have completed the registered managers award level 4. Another of the assistant managers has completed her N.V.Q. 4 in care management. A requirement was made on the last inspection in relation to medication practice. This was to make sure that the medication administration records include for each medication the strength of each drug/liquid is recorded. This was indicated on the medication records examined on the visit and is therefore complied with. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 7 The introduction of the referral panel means the managers have all relevant information before introductions are made, this enables Granville to plan ahead It also allows for more flexibility on the services which can be offer to the person being referred, and for packages of care to be planned to ensure the best possible outcome for the prospective guest. We were told that two managers have undertaken basic training in Total Communication and are attending a communication course that will enable them to assess the communication needs of the people they support. Granville have purchased four hospital beds. The home also has four epilepsy seizure monitors, which alert staff if a guest is having a seizure. What they could do better: There was on the last inspection a requirement issued in relation to medication. One section of this requirement was achieved as detailed in the section above. The requirement also included that the medication administration records must record the name, dose and dispensing procedures for each drug. This was identified on this visit as not being complied with and needs to be addressed by the managers. There are four requirements and thirteen recommendations arising from this inspection. So guests have up to date and accurate information about Granville, the statement of purpose and service user guide need reviewing and updating ensuring they reflect the service provided and are in a format, which is easily understood by guests. All guests need to be provided with a copy of the service user guide when it is amended. Care plans and risk assessments need to be put in place for all guests. These need to be up to date and reflect the current needs and support of the individual. A representative from the local authority should, in line with Regulations, visit the home once a month and undertake specific tasks to check that Granville is being managed appropriately. This is in accordance with the Regulations. A report should be made of the visit, which is sent to the home and made available to the Commission. To ensure staff are able to recognise potential abuse and are aware of what to do in this situation, all staff need to be provided with training on the protection of vulnerable adults. All staff need to be provided with training in moving and handling, infection control and health and safety to ensure staff are able to do their job well and not put themselves or guests at risk. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 8 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. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lack of up to date and easy read documentation does not give guests the information they need. EVIDENCE: The statement of purpose and service user guide, which are documents that let guests know about the home and the services provided, have not been reviewed or updated since July 2006. The documents are not in an easy read format for the people who use the service and are in a small print. The statement of purpose needs to be updated to reflect the qualifications of the management team and also the changes in contact telephone numbers. The regulations indicate that these documents are kept under review. The service user guide indicates that all staff have undertaken moving and handling courses this is not accurate, as not all new staff have undertaken this training. The majority if not all the guests have been having short stays at Granville for many years. An assessment was completed by the placing social worker on first admission. The managers have not undertaken the review of these Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 11 assessments so it is not always clear if needs have changed or if they are known to staff when the guest returns for future stays. The following section of this report describes the omission of the support plan for the two guests whose care files were examined on this visit. It cannot be assumed that because guests have been supported on past short stays that their assessed needs are the same. The managers need to ensure that up to date assessments are arranged before guests come to stay at Granville. We were told that the guests do not always have a social worker/care coordinator allocated to them. We were told that initial referrals are made by care coordinators and a referral panel meeting is held every four to six weeks where each referral is evaluated to decide which service will meet the individual needs of the service user. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 &9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure the safety and wellbeing of guests care plans and up to date risk assessments are needed to provide details of guests’ care needs and the interventions required to meet these needs. EVIDENCE: Examination of two guests care files staying at Granville identified that they didn’t have support plans in place. The care needs of these guests were not written down for staff to follow. It was of some surprise to the manager that these support plans were not in place. To ensure guests receive the care and support they need when they need it support plans need to be completed. Staff need to be aware of the support and interventions. There are new staff employed at Granville and could meet guests for the first time without any recorded detail and would be reliant on someone telling them what support Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 13 was needed. This practice does not safeguard guests or staff and doesn’t demonstrate that guests receive the care and support they need. Guests require differing degrees of support in aspects of daily living. This was clearly evident from observations of direct intervention and support provided by staff. Guests said that they are encouraged to make decisions and exercise choice and to maintain and enhance their daily routines. They are able to discuss their choices with the manager and staff. Guests’ privacy is maintained by staff knocking on doors before entering the room, by speaking quietly to guests and providing care and attention in bedrooms and bathrooms. Guests are not routinely given the opportunity to have a key to their bedroom door. Granville could amend practice to provide a key as a matter of routine and record if guests decline this offer or if they would be at risk from this. This would further enhance Granville’s empowerment of guests to maintain their privacy. On the visit guests’ bedroom doors were open when vacated and anybody could walk into their room. This practice doesn’t support the individuals’ privacy and respect for their belongings and individual space. Independence and increased life skills should be promoted within a risk management framework. The two care files looked at on this visit did not include up to date risk assessments. There should be documentary evidence that risk assessments had been updated to ensure that the staff team manage newly identified risks appropriately. The service needs to record how it demonstrates it is responsive to each guest’s changing mental and physical needs and ability to self-care, which would help guests to maximise their choices and independence. The detail within the risk assessments needs to ensure all risks are identified and action taken to minimise the risk. Granville provides short stay care service, this influences the type of care, which is provided, and care staff respond well to the arrival and departure of guests. All guests have been to Granville before and are familiar with how it is run. One relative said “(cared for resident) is well cared for and is very happy whilst she is in respite”. Another relative said, “We are very satisfied with (cared for residents) care”. A further relative said, “I am quite happy about the care he gets there”. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Guests are supported to engage in activities and maintain social contacts. EVIDENCE: Guests are promoted to continue with activity, as they would do at home. Activities are arranged routinely throughout the day and the week dependent on who is staying and what they would like to do whilst there. When guests attend day centres, employment or college, this continues and they are supported to attend whilst at Granville. Guests are able to use communal areas of the home freely and are able to use their bedrooms at any time they want. Guests who were spoken to confirmed they are supported and encouraged to try out different activities, such as college courses and going to local community centres. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 15 There is a clear emphasis on developing and maintaining social links with resources and public facilities, which meet guests’ needs. During this visit, guests were seen coming and going. Staff were observed engaging in conversations with guests, asking about their day and what their plans were for the following day. The cook in consultation with guests plans the meal and menu arrangements. The cook demonstrated how she is kept informed of the needs of guests at any time and had information cards she had developed in respect of guests who attend Granville on a rotational respite basis. There were ample provisions to offer guests a varied and balanced diet. Meal times are arranged to support guests who attend day centres. Breakfast will be served up to 09:00am during the week; the breakfast time at weekends extends to 10:30am. Guests spoke highly of the meals served in the home. There were examples during this visit of a flexible approach to meals. Guests were observed being asked what they would like to eat for particular meals to assist in the development of the menu. Guests who commented about the meals said they, “liked the meals” and “you get plenty of food”. Some staff have obtained food hygiene training; others need to undertake this to ensure the practice they adopt is in keeping with safe and acceptable practice. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health care arrangements ensure guests’ needs were being met. EVIDENCE: All guests at the Granville live within their own home and their independence is promoted whilst at Granville for however long the period. Health appointments, which may have been made whilst they were at home, are supported and arrangements made for them to continue with their lifestyle as they would if they were at home. Guests’ health care needs need to be detailed within the support plan. This information must be appropriate to the needs of guests and the support they need whilst staying at Granville. The administration of medication is assessed on guests’ arrival at Granville. If guests ordinarily self-medicate, then this would be supported. In practice, staff predominantly administer most guests’ medication. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 17 All the medication administration records are handwritten; this is due to the short-term service provided at Granville. Best practice indicates that handwritten medication should be signed as being verified by a second member of staff to ensure the accuracy of the detail. The medication records were not signed or verified by two people, as is best practice. This would make sure that the entries have been written correctly. The medication administration records for several people were examined and had in the main been completed properly in accordance with procedures. There was on the last inspection a requirement in relation to medication. One section of this requirement was achieved. The requirement also included that the medication administration records must record the name, dose and dispensing procedures for each drug. One guest have brought a dossette with them with all their tablets in. Staff were signing all the mornings medication together and there wasn’t a list of each individual medication on the administration records. This is not good practice as staff are not checking and recording the individual medications administered. The medication records must detail and name the individual medication prescribed to the guest and record individually the medication administered by the signature of staff. The medication policy needs to be reviewed and refined to ensure that the policy is reflective of practice and staff are able to make reference to the policy if they need clarification. Best practice is to include specimen signatures and initials of staff competent and trained in giving out medication. Signatures were in place however the usual initials staff sign were not. This needs to be rectified so that it is clear who is signing the medication records. Photographs to assist in the identification of guests were on most of the medication administration records, as is best practice. This needs to be extended so all guests have photographs on file. Staff were observed to be reassuring and respectful towards guests, and to take the time to explain their actions, resulting in reduced anxiety for guests. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written complaints procedures ensure guests or their representatives have a means to raise views about the service they receive. Adult protection training needs to be arranged for all staff. EVIDENCE: Guests were clearly comfortable approaching staff to ask questions or seek reassurance. All of the guests spoken with said that they would speak to someone at Granville or with their family or friends if they had any concerns, and felt confident that action would be taken in response to their worries. There have been no complaints since the last inspection. We were told that guests or their families are able to identify any comments or complaints as they happen. A record could be made of these comments raised. This would be beneficial to the managers to further demonstrate that they take on board all comments and compliments and it will also help them to see at a glance if there are any patterns to the comments that might need further investigation or changes to practice or routines. Discussions and training records did not confirm that all staff had attended training in adult protection. Some staff have taken part in training seminars in the definitions of abuse and how to identify abuse. The remainder of the staff team need the training to ensure they are able to recognise potential abuse and know what to do if abuse is alleged. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 19 Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, homely and offers a safe environment for guests. EVIDENCE: Granville is a detached house built in the 1800’s, which has 12 bedrooms on the ground floor. There is an alarm call system in operation throughout the building, which can be used by guests to alert staff. There are two lounges; both have televisions and video and DVD players are also in place. There is a dining room, which doubles up as an activities room for social occasions. The kitchen is situated of the dining room. There are toilets situated near to the lounges and bedrooms. There is a lift to the upstairs of the house where there is a games room. Central heating is situated throughout the house. Granville’s premises are suitable for its stated purpose, it has wheelchair access to the side of the building, and the grounds are enclosed to ensure Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 21 safety of the guests. It appeared well maintained and the furnishings comfortable and homely. The premises are kept clean, hygienic and free from offensive odours; there are systems in place, in accordance with departmental policies to control the spread of infection. We were told that four hospital beds have been purchased and Granville now have four epilepsy seizure monitors, which can be used to alert staff if a guest is having a seizure. We were told that staff feel that Granville needs a doorbell fitted to the front and side door, which would allow people to gain entry independently. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 &36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have clear roles and responsibilities that meet the needs of guests. Additional staff training would further enhance the service provided. EVIDENCE: The AQAA indicated, “Granville recruit staff via Salford’s councils recruitment and selection and equal opportunities policies. Human resources staff ensures all new staff have their C.R.B checks, references and medicals in place prior to their commencement date. We can request training at any time to meet the needs of the guests. Staff undertake mandatory training as and when they need their updates. Regular staff meetings take place, but because the building needs covering at all times, not all staff can attend”. Examination of three staff files identified that they had been part of a thorough recruitment and selection procedure. Three managers interview prospective employees and notes are made at interview. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 23 The staff files did not detail in the job application form the dates they had worked for previous employers so it was not possible to check if they had any gaps in employment. We were told by personnel department that the application form is to be amended so that when people apply for jobs, actual dates of when someone started and finished work with past employers will be indicated in the revised job application form. Identification required to be kept on staff files is not. A record is maintained of what documents were seen by office staff to support the request for a criminal disclosure check. On one staff file this didn’t include obtaining or seeing a photograph of the applicant. The regulations in relation to recruitment are in place to safeguard guests and changes need to be made so photographic identification is kept on file, preferably at the home. This would enable the managers to check themselves that the person coming for interview and appointed to a position is one of the same person. References were available on all files and criminal record bureau checks were obtained prior to staff starting work as is required. Staff were reported to meet with their line manager regularly to discuss their practice, identify any training needs and to develop the service provided at Granville. Induction training is undertaken with all new staff. The content of the training is not to skills for care specification. Some staff have not had updates to their moving and handling training or other mandatory training. The training provided to staff needs to be arranged in a timely manner to ensure staff have the skills they need to support guests. We were told that the hours allocated to Granville are arranged to meet the needs of the guests accommodated and what the guests are doing during the day. A number of guests go to day centres, for example, during the day and return to Granville before tea so not as many staff would be on duty at this time or if all guests were out for the day, the staffing would be arranged to accommodate this. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and guests are promoted and protected by Granville’s policies and procedures. Additional attention to detail in relation to fire procedures would further enhance guests and staff health and safety. EVIDENCE: The registered manager and two assistant managers have completed the registered managers award level 4. Another of the assistant managers has completed her N.V.Q. 4 in care management. A representative from the company should, in line with Regulations, visit the home once a month and undertake specific tasks to check that Granville is Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 25 being managed appropriately. The visits and the reports of these visits had not been completed. The home was informed that these need to be done and a copy kept at Granville available for examination by the Commission. A quality assurance system is in place that seeks and acts upon the opinions of guests in terms of their day-to-day experiences and improvements that could be made. The most recent comment cards for 2007 could not be located. We were told that the quality assurance questionnaires had not been sent out this year to obtain guests views. The management team supports staff and there was evidence of an ongoing supervision programme for staff. This ensures that senior staff monitor the performance of staff and any training needs are identified. The sample of staff files looked at provided evidence that staff received supervision and appraisals, which examined staff performance in delivering care and identified any training needs. The homes certificates of registration and public liability insurance were available for examination. These were up to date. We were told the fire risk assessment had been reviewed and updated to reflect the development of the home and the changes made to fire safety. Fire equipment had been regularly maintained and we were told all staff had received fire drills. The checks to the fire alarm system had not been recorded as having been undertaken since 24th March 2008. These checks should be done weekly to make sure if an emergency occurs staff are alerted by the fire alarm. These checks need to be recorded as having taken place at the regularity prescribed by the fire authority. Some staff had not attended fire training and some staff had not had updates to this training. This is necessary to ensure staff are aware of what to do in an emergency situation. Staff need to be confident in what they do in an emergency and this training needs to be provided to staff in a timely manner. Staff spoken to said they had been shown where the fire panels were and it had been explained to them what they need to do if an emergency occurred. Two of the final exit fire doors had bolts fitted to the doors. To safeguard guests and staff, the managers need to consult with the fire authority to check that this is appropriate as, in an emergency situation, to enable people to leave from these exits they will have to know to unbolt the lock at the top of the door. Staff meetings are arranged which provides staff with an opportunity to influence how Granville is run and contribute to its effectiveness. Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 26 We were told that staff did not help manage guests’ personal finances. There were small amounts of money held on behalf of some guests for purchases whilst a guest at the home. Guests do not routinely sign to say they have received their monies or that they have been returned to them. The managers undertake this. Best practice would be that guests or their representative sign for their monies. This would provide an additional safeguard to guests and staff. Granville DS0000038835.V362931.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 Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 28 Yes 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 YA1 Regulation 4 &6 Requirement So guests have up to date and accurate information about Granville, review and amend the statement of purpose and service user guide ensuring they accurately reflect the service provided and are in a format, which is easily understood by guests. Provide all guests with a copy of the service user guide when amended. Ensure that care plans and risk assessments are in place for all guests that are up to date and reflect the needs and support of the individual. The medication administration record must record the name, dose and dispensing procedures for each drug. (Previous timescale of 04/04/07 not met) Timescale for action 01/06/08 2 YA6 15 01/06/08 3 YA20 13 01/06/08 4 YA37 26 A formal unannounced visit by a representative of the local authority should be undertaken in accordance with the Regulations and a report made of the visit, which is sent to the home and made available to the Commission. 01/06/08 Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations So that the home is clear they have the skills and abilities to look after guests and any changing needs are identified ensure an up to date assessment is carried out before guests are accommodated. Carry out a risk assessment to enable guests to, where practicable and possible, have a key to their bedroom door to promote their privacy and dignity within their bedrooms and to keep their possessions safe and secure. To ensure practice is in keeping with safe and acceptable standards arrange for all staff that have the responsibility of preparing or serving food to attend food hygiene training. Medication procedure must be checked to ensure all hand written records are signed, by the person completing the record, and countersigned by a further member of staff to verify that the written record is accurate. To promote best practice and to aid in identification, a photograph of all guests needs to be with their medication administration record. To promote best practice, staff that are trained and are competent to administer medication should detail their initials, which should accompany the medication records. To ensure staff are able to recognise potential abuse and are aware of what to do in this situation, provide all staff with training on the protection of vulnerable adults. To safeguard guests ensure that job application form is amended to detail when staff started and finished work with previous employers then any gaps in employment can be discussed and this will also make sure that a full employment history is recorded. Maintain evidence that identification has been confirmed with all documents kept on staff files. Provide all staff with induction training to skills for care specifications within the first six weeks of employment. To make sure that staff carry out moving and handling techniques safely ensure all staff receive updates to their Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 30 2 YA9 3 YA17 4 YA20 5 6 7 8 YA20 YA20 YA23 YA34 9 YA35 moving and handling training in line with health and safety guidelines which are currently annually. Provide all staff with mandatory training in a timely manner ensuring they are supported to do their job in line with regulations and standards. Provide all staff with fire training annually, ensuring that all staff know what to do in the event of such an emergency. To ensure all fire detection equipments is working properly make arrangements for the fire alarm to be tested and recorded as having been done at the regularity prescribed by the fire authority. To ensure that the safety of guests, staff and visitors is not compromised in an emergency situation by the placement of bolts on the fire doors, the managers needs to consult with the fire authority to check that this practice satisfies fire regulations. Best practice would be that guests or their representatives sign for their monies on receipt. This would provide an additional safeguard to guests and staff. 10 11 YA42 YA42 12 YA42 13 YA42 Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Granville DS0000038835.V362931.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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