Care Home: Granville House

What the care home does well The manager and staff are dedicated and caring and understand the importance of being flexible to respect the choices of people in the home. One person spoken to said "staff are very kind" and "they look after us". The manager has a good relationship with residents and visitors to the Home. People at the home were positive about the care they receive. One person stated that what the home does well is "Taking interest in ourselves and our families, our happiness, wellbeing, concerns when we feel unwell or have problems". The admission process takes into consideration cultural needs to ensure these can be met by the home. One person said "they try to keep up the culture in the home that`s why we like it". The manager and staff are knowledgeable of the needs of people in the home to ensure these can be met effectively. Granville House was clean and homely and the atmosphere was relaxed and friendly. Staff working at the home were positive about their role. One person states in a comment card received by us "good care is provided to all residents" another states "the home`s top priority is the care of our residents, every need is catered for". "The staff are kind and caring". What has improved since the last inspection? The care plans have been further reviewed to ensure they identify the needs of people in the home and the staff actions required to meet them. People in the home now have their weight regularly monitored and any risks to their health are being identified and reviewed to ensure they are cared for safely. Action has been taken to address the outstanding health and safety checks for gas and electric since the last inspection. A statement of Terms and Conditions has been developed by the home for new residents. A new small screen has been purchased for the double room to provide some privacy. Some audits of the service have been introduced including an environmental audit to ensure a quality service is delivered. What the care home could do better: A review of medication management is required to ensure this is managed effectively consistently for all people in the home. The service must ensure that staff do not start their employment until they have a Protection of Vulnerable Adult (POVA) check or a Criminal Records Bureau (CRB) check to ensure they are deemed safe to work with vulnerable people living in the home. Comments provided by people at the home and staff suggest the provision of social activities needs to be reviewed to ensure the social care needs of residents are being met. Staff training records need to demonstrate that all staff have completed statutory training as required. Suitable actions need to be taken where it is identified training is not up-to-date to ensure staff can work with people in the home safely. The Service User Guide and Statement of Purpose need to be reviewed to ensure they are sufficiently detailed. These need to contain all of the required information to help people make a decision on whether to stay at the home. Staff should use the care plan files when caring for residents to ensure they are fully aware of all of their needs and to prevent any oversight in care. Records of meals provided should be kept to show that all residents are receiving sufficient choices and that cultural needs are being met consistently. Suitable systems need to be in place for recording any complaints. The procedure should also be reviewed to ensure this contains each stage of the investigation process and then made available to each person in the home. Duty rotas should clearly demonstrate care staff hours allocated to ancillary duties. This is so that it is clear there are sufficient care hours as well as ancillary hours to provide effective care and services to people in the home. Induction training should be provided immediately following the commencement of a new member and should be based on the Skills for Care Common Induction Standards. This is to ensure staff receive suitable training to work with people safely. People at the home should have access to a lockable facility in their room so that they can store any personal items safely if they wish. They should also have access to a comfortable chair to sit on. A up-to-date Fire Risk Assessment for the home must be developed to ensure the health and safety of the residents. Consideration needs to be given as to who is left in charge of the home in the absence of the manager. This is to ensure the home continues to be effectively managed when the manager is not available. Key inspection report Care homes for older people Name: Address: Granville House Granville House 4 Moultrie Road Rugby Warwickshire CV21 3BD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Granville House Granville House 4 Moultrie Road Rugby Warwickshire CV21 3BD 01788568873 01788550574 trustedcareltd@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trusted Care Ltd care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 17 Date of last inspection Brief description of the care home Granville House provides personal care for 17 older people aged 65 years and over. It does not provide any specialist services or nursing care. The providers are hands on in the running of the home. Granville House is a converted domestic dwelling, extended to the rear. It is situated approx half a mile from the town centre of Rugby. The home is sited on the corner of Moultrie and Elsee Road opposite Lawrence Sheriff School. Shops, buses and the main town are within a short walk of the home. Accommodation is over two floors. There are 13 single rooms and 2 shared. No ensuite rooms are available. A passenger lift enables access to both floors and is large Care Homes for Older People Page 4 of 36 Over 65 17 0 Brief description of the care home enough to take a wheelchair. The gardens to the front and rear of the house are well tended. A large conservatory is available to the rear of the building as is the car park which has parking for a limited number of cars. At the time of this inspection the fees for the home were £389 to £400 per week. Extra charges are made for private chiropody, hairdresser and personal toiletries. The manager usually attends hospital appointments with any residents where this cannot be accommodated by family at no extra charge. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This inspection took place between 8.45am and 9.45pm. The last key inspection to the home took place on 8 April 2008. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment was received from the service prior Care Homes for Older People Page 6 of 36 to the inspection detailing some information about the care and services provided. Questionnaires were also sent out to residents within the home to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. Residents were observed in the lounge/dining areas to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: A review of medication management is required to ensure this is managed effectively consistently for all people in the home. The service must ensure that staff do not start their employment until they have a Care Homes for Older People Page 8 of 36 Protection of Vulnerable Adult (POVA) check or a Criminal Records Bureau (CRB) check to ensure they are deemed safe to work with vulnerable people living in the home. Comments provided by people at the home and staff suggest the provision of social activities needs to be reviewed to ensure the social care needs of residents are being met. Staff training records need to demonstrate that all staff have completed statutory training as required. Suitable actions need to be taken where it is identified training is not up-to-date to ensure staff can work with people in the home safely. The Service User Guide and Statement of Purpose need to be reviewed to ensure they are sufficiently detailed. These need to contain all of the required information to help people make a decision on whether to stay at the home. Staff should use the care plan files when caring for residents to ensure they are fully aware of all of their needs and to prevent any oversight in care. Records of meals provided should be kept to show that all residents are receiving sufficient choices and that cultural needs are being met consistently. Suitable systems need to be in place for recording any complaints. The procedure should also be reviewed to ensure this contains each stage of the investigation process and then made available to each person in the home. Duty rotas should clearly demonstrate care staff hours allocated to ancillary duties. This is so that it is clear there are sufficient care hours as well as ancillary hours to provide effective care and services to people in the home. Induction training should be provided immediately following the commencement of a new member and should be based on the Skills for Care Common Induction Standards. This is to ensure staff receive suitable training to work with people safely. People at the home should have access to a lockable facility in their room so that they can store any personal items safely if they wish. They should also have access to a comfortable chair to sit on. A up-to-date Fire Risk Assessment for the home must be developed to ensure the health and safety of the residents. Consideration needs to be given as to who is left in charge of the home in the absence of the manager. This is to ensure the home continues to be effectively managed when the manager is not available. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 9 of 36 order line 0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to some information about the home but this is not sufficiently detailed to enable a fully informed decision to be made. Pre-admission assessments are carried out to ensure the needs of prospective residents are identified and to ensure these can be met by the home. Evidence: The Service User Guide and Statement of Purpose for the home were viewed. These documents contained some information about the home but were not compliant with our standards and regulations in regards to all of the details required. The Service User Guide should have a copy of our summary inspection report as well as a Statement of Terms and Conditions for the home. This document should also contain summary details of the more comprehensive Statement of Purpose document. This is so that people who may wish to stay at the home have all the information they need to make a decision on whether to stay at the home. Care Homes for Older People Page 12 of 36 Evidence: The manager agreed to review both the Statement of Purpose and Service User Guide to ensure these contained all of the required information. The manager said that potential residents and their relatives are encouraged to visit Granville House and have a look around before agreeing to move in. She also said that she discusses with any potential resident or relative the care and systems the home has in place. The care files of two people who had recently admitted to the Home were reviewed to evidence the admission process at Granville House. It was evident that pre-admission assessments had been undertaken. People who may wish to stay at the home also have the opportunity to stay for a four week trial period before agreeing to a permanent placement. This trial period ensures that the person feels happy about their stay and also enables staff to fully identify their needs to ensure they can be met. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place for each person using the service but these are not always used in an effective way to ensure their needs are met consistently. Systems are in place to ensure the effective management of medication to maintain the health of people at the home. Evidence: Those people living at Granville House looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. Since the last inspection the manager has completed further work to improve the care plans to ensure all people in the home have care plans which reflect their needs and risks to their health. Whist the care plan files contained this detailed information, staff were actually using a summary sheet referred to as a daily reporting sheet to work with and not the fully detailed care plans. The sheet lists what staff need to do to support each person and Care Homes for Older People Page 14 of 36 Evidence: staff are then required to sign to say which tasks have been completed. As these sheets do not contain the detailed information contained in the full care plans, there is risk that all care needs may not be met. There is also no specific place for staff to record any additional information. The care plan for one person stated they had some paralysis and needed support of one or two staff on occasions to get up and transfer from one place to another such as bed to chair. The daily reporting sheet makes reference to the person not being able to walk but does not give any specific instruction on how their mobility is to be managed by staff. In the main care plan however there is a moving and handling transfer sheet stipulating how many staff are to support the resident. The sheet also did not state any specific support the person may need due to the paralysis such as their food being cut up which was in the main care plan. For each section on the sheet such as Washing and Dressing, Care Early Evening there are a number of instructions for staff to follow but only one box to sign. This means if staff have only done two of the four tasks there is no way to indicate this on the sheet. For example one task states give hot drink, toilet, wash, if wants to watch tv sit up in bed staff have signed to say this is done but they may not necessarily have done all tasks. This makes it difficult to get an accurate picture of what has been done. It was also found that staff are not consistently signing the sheets to confirm they have completed the tasks stated. For example one daily reporting sheet stated that a strip wash should be given daily but this was not signed on two days to confirm this had been done. The manager explained that because Granville is a small home and they have detailed handovers all staff know the people living in the home very well and know how the residents need to be supported. She also explained that each persons care is reviewed on a monthly basis and any changes are documented on the sheet as appropriate. Sheets viewed contained details of reviews carried out and were signed and dated. It was established during discussions with the manager that any extra information relating to a persons care is documented in a staff diary which they read each day. This means that the diary contains information relating to care for several people. This is not ideal in terms of complying with data protection as information would be openly Care Homes for Older People Page 15 of 36 Evidence: shown for several people even if someone only wanted to view information for one person. Following discussions with the manager, she agreed to review how tasks are written on the daily reporting sheets so that it is clear what staff are signing to say they have done to support each person. These will need to fully reflect the care needs of each person in the home. The manager also stated that she would implement a separate sheet to be used in conjunction with the daily reporting sheets where staff could record any additional information they feel necessary relating to the care given. It was evident throughout the inspection that people receive good care and staff were supportive and friendly towards them. All people at the home spoken to were positive about the care they receive. One person commented that the carers were all very good another said staff are ever so nice. It was evident that specialist support is accessed when required. Records showed that contact had been made with doctors, district nurses, chiropodists and opticians as required. A review of medication was undertaken. On the whole this was noted to be managed well. The pharmacist had recently carried out an audit of medication to make sure these were being managed as appropriate. Medication was checked for the two people case tracked as well as for a person taking Warfarin and controlled drugs. All medication available corresponded with the amount recorded on the medication records. Medication checked in regards to what had been received, given and remaining was found to be correct. There were some issues identified for attention and these are detailed below. Paracetamol had been prescribed for one person four times a day. Records showed this was not been given four times a day. A new entry had been written on the medication record to say this should be given as required. There was no evidence that the doctor had prescribed it this way and had agreed this. Eye drops had been prescribed for one person and instructions on the medication record stated these should be stored in the fridge after opening and discarded after seven days. These had been opened on 1.6.09 but were still in use on the eighth day. They were also not being stored in the fridge and were located in the medication trolley. Care Homes for Older People Page 16 of 36 Evidence: Some of the records completed in red pen contained a code not defined on the medication record. The manager confirmed this meant not required. Any codes used on the medication record should be defined. Warfarin and controlled drugs were being managed appropriately and a controlled drugs register was in place to show medication received, given and remaining as required. The privacy and dignity of people at the home was seen to be respected throughout the inspection. People using the service were well presented and staff knocked on their doors before entering and all personal care was undertaken in private. Since the last inspection a small screen has been purchased for use in the double room to allow for some privacy when more personal care is being given. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some social activities provided to enhance the daily life of people who use the service. Visitors are made welcome and their needs considered. People enjoy their meals and both cultural and specialist needs are considered to make sure meals are appropriate. Evidence: There is no activity co-ordinator employed at this home and at the time of inspection there was no formal activity programme in place. The manager said that staff ask people what they would like to do and activities are then provided in accordance with their choice. It was evident from care files that conversations has taken place with people in the home and their families about choices but there was little information in these about what social activities were being offered and whether people were interested in these. There are some activities that take place such as dominoes, library books, hand and nail care, jigsaws, skittles but on the day of inspection there were no social activities observed. The Service User Guide for the home says we have regular activity and entertainment schedules purely for fun and enjoyment of our residents but this was not evidenced. Two people spoken to said they saw the hairdresser each week, they Care Homes for Older People Page 18 of 36 Evidence: said they had played dominoes at one time and they had a ball to throw amongst each other. They stated they had not done any activities lately. They said that staff would do activities with them if they wanted. Another person said they would like more access to social activities and in particular to go on outside visits on a mini bus. Questionnaires completed by staff and returned to us showed that they felt the provision of more social activities is something the home could do better. One stated more outside activities and another states the residents need stimulation and trips out into town etc, we do what we can but its not always possible to spend much time with them. The manager agreed to review this area. A visitor to the home said that they liked the flexibility to be able to visit when they wished they explained that there are no restrictions and that open access to their relative was important to them. They stated they try to keep up the culture in the home thats why we like it, we mutually arrange for X to go to the day care centre. At lunch time there is one main meal provided but if people do not like what is on the menu for the day, the manager explained the cook will provide an alternative meal. Records had not been completed consistently to show the alternative meals being provided to demonstrate this is happening consistently. At lunchtime people in the home were seen to enjoy their meal which was served from a hot trolley in the dining room. Good sized portions were given and the meals looked hot and appetising. The manager explained that the cook also provides for cultural needs as well as specialist dietary needs. These included alternative meals such as curry and food items with reduced sugar. A visitor to the home explained how this is well managed by the cook. They explained that at times when religious festivals are held it is inappropriate for certain food to be eaten. They explained how the home respected this for their relative and ensured appropriate meals and food was provided during these times. People in the home spoken to were all complimentary of the food, one stated the food was second to none and really good they also said on Friday I had scampi and chips but today it was chicken casserole and that was nice. Another person said suits me what I have. They explained they were diabetic and the cook therefore provides yoghurts and sometimes semolina or rice pudding as an alternative for them. Care Homes for Older People Page 19 of 36 Evidence: It was not evident that records are being maintained of the meals being provided to demonstrate the home meet both cultural needs as well as specialist needs consistently. Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to and acted upon but reporting processes are not always clear to ensure this can be done effectively. Evidence: No complaints have been received by the Home or us since the last key inspection. A copy of the complaints policy was on display on the wall in the managers office but this was noted to need updating to reflect current guidelines and our current details. The complaints procedure was not documented in the Service User Guide to ensure all people using the service are familiar with the process of reporting these. There was also no logbook in place to record any comments, concerns or complaints but the manager agreed to address this. The manager also said that she shares a good working relationship with all people at the home and they know they can always approach her if they have any concerns. This was confirmed during the inspection visit. People who were spoken to about concerns or complaints all said they would speak to the manager if they were not happy about something. One person said I would speak to Rita (Manager) first, I did speak to her about X troubling us which went on for a long while but they are not here any more. Another said Oh yes Rita sorts things. A visitor said if there is any serious problem I sit down with Rita to discuss and most Care Homes for Older People Page 21 of 36 Evidence: of the time actions are taken straight away and they follow up any comments. Protecting people from abuse was discussed with the manager and it was confirmed that there is a policy and procedure in place for managing this and this was located in one of the files in the managers office. The manager also had written in the home diary what staff needed to do should any abuse be observed or reported to them although staff would have needed to remember which page this had been written on. Staff spoken to were aware they needed to report any concerns of this nature to the manager. They also knew that these needed to be reported to Social Services. There have been no allegations of abuse at the Home since the last inspection. It was found when completing the review of staff files that Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adult (POVA) checks had not been obtained prior to staff starting at the home. This issue was raised at the last key inspection and remains an outstanding requirement. This can place residents at risk as staff have not been deemed as safe to work with people living in the home. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Granville offers the people living there homely surroundings, which are clean, free of offensive odour and generally safe and well maintained but with shortfalls related to infection control. Evidence: A tour of the premises was undertaken, this included the bedrooms of those residents being case tracked, the laundry, kitchen, bathrooms and communal areas. No unpleasant odours were identified. Communal areas were clean and hygienic and had a homely feel. Some residents were seated in the main lounge watching the television whilst others preferred to sit in the lounge adjoining the sunny conservatory listening to the radio, reading a book or sitting quietly next to the fish tank. One resident assisted another resident to get a book from the book case who said she had read many of the books already. The owner said the books are changed regularly. The kitchen refurbishment has been completed and the kitchen was clean. Fridge and freezer temperatures had been recorded and all were within the appropriate levels for storing food safely. There were some eggs in use that were past their date. The manager said these had only recently been delivered to the home. She removed them Care Homes for Older People Page 23 of 36 Evidence: from the kitchen to be returned. All bedrooms seen were clean and had been personalised with pictures and ornaments. It was noted that in some of the bedrooms there was no comfortable chair for residents or their visitors to use. In some there were chairs but these were not comfortable lounge chairs. The manager said that the owner was providing new ones. The chairs in the dining room were noted to have limited support in that they had no arms and were not very sturdy for the less mobile residents. It was established from talking with residents that they only use the dining room at lunch time as they have breakfast and tea in the lounge with small over tables or in their room. They said that those people with limited mobility tended to sit in their wheelchairs at the dining table. Residents spoken to said that they did not have any problem with the dining room chairs but they would like more chairs for their rooms. There were no lockable cabinets in bedrooms or areas where residents could lock away their personal belongings as stipulated in the standards. The manager agreed to discuss this with residents and provide this facility to those that required this. There is a shower room and also a bathroom with a bath chair for those people who are less mobile and there is a shaft lift that goes to the upper floors for any resident who is unable to use the stairs. The area used as a laundry is very limited in space and has one washing machine and two tumble dryers. The washing machine does not have a sluice cycle although it does have the facility to wash on a hot wash. The manager said any items that need sluicing are dealt with in the sluice room before they are put into the washing machine. Putting soiled laundry in a washing machine with a sluice cycle reduces the amount that these items need to be handled and therefore reduces the risk of cross infection. Clean washing is stored in a separate area in the home and each resident has their own basket for washing to be returned to their room. It was noted that open weave baskets were being used to sort dirty laundry. This baskets are difficult to clean to maintain good hygiene and were also not clearly labelled to ensure it was clear they should only be used for dirty items. The manager said that there are clearly identifiable white baskets which are only used for clean items. The laundry floor and walls are not impermeable to ensure these can be effectively Care Homes for Older People Page 24 of 36 Evidence: cleaned. There were areas where the floor area was wood and the walls wood panelled. This can impact on good infection control practices being maintained. Since the last inspection action has been taken to fit a sink into the laundry area so staff can wash their hands. It was noted that there was no liquid soap or paper towels to allow staff to practice good hygiene. A sink in the shower was being used to wash urine bottles. The sluice area should be used for this purpose. This again is to promote good hygiene and infection control practices. Staff have access to supplies of gloves and aprons and were seen to use these during the inspection. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably trained staff are employed to meet the needs of the residents although it is not clear all recruitment checks are carried out prior to staff being employed to ensure they have been deemed safe to work with the residents. Evidence: A copy of the Homes duty rotas were taken for review. The manager confirmed that staff shifts are broken down into 8am to 2pm - 3 care staff, 2pm to 6pm, - 2 care staff, 6pm to 10pm - 2 care staff and 10pm to 8am - 1 waking and one sleeping staff member. Duty rotas confirmed these numbers of staff on duty. During the inspection staff were noted to be busy undertaking their duties throughout the day. Staff numbers appeared to be sufficient to meet the care needs of people living at the home although staff commented through discussions and comment cards received by us that they would on occasions like to spend more time with residents. The manager and owners provide on call arrangements so that staff have access to advice and guidance twenty four hours a day. There is a cleaner who is indicated to work two days pers week from 1pm to 3pm but on other days there is no indication of who is completing cleaning. The manager said that carers within this home also undertake some ancillary duties such as laundry and cleaning. Duty rotas do not indicate the care staff hours allocated to these duties to Care Homes for Older People Page 26 of 36 Evidence: demonstrate that there are both sufficient care hours as well as ancillary hours being provided to the home. Duty rotas also do not show the full names of staff to ensure there is an effective audit trail. People spoken to were very complimentary of the staff and the care that they receive. One person said staff are very kind and they look after us another said of staff great they are and all very good. When asked if the call bell was answered promptly one person said yes straight away and no problem at all. Comment cards received by us from staff show that they feel good care is provided. One stated good care is provided to all residents another states the homes top priority is the care of our residents, every need is catered for. The staff are kind and caring. A relative who has commented on a resident comment card states they are all very caring and always look after mums needs. The manager is always available to talk to. A resident states always there when wanted, all health issues dealt with immediately. There are nine care staff who work at the home and the manager stated that six of these are nurses who qualified overseas, one has completed a national vocational qualification (NVQ) II in Care and one is currently completing training to achieve an NVQ. This means that staff who work at this home are suitably trained and qualified to meet the needs of the residents. The manager confirmed that staff have also completed statutory training which includes fire, moving and handling and food hygiene training. There was no at-a-glance training schedule in place to confirm dates when staff had completed training and the manager agreed to address this. The manager confirmed that some staff are due to complete their food hygiene training but she was able to produce certificates to confirm all staff had recently completed moving and handling training. The manager said that she completes fire training with staff. Staff spoken to confirmed that they had completed moving and handling and fire drills and said they had done infection control training. A new member of staff had received induction training and had worked alongside other staff but it was not evident this was in line with the Skills for Care common induction standards. This issue was raised during the last inspection to the home. The manager said this member of staff had instead been put forward to complete a National Vocational Qualification but there had been some delay in getting a vacancy and this training did not commence until after six months following the person commencing with the home. The manager gave assurances that any new member of Care Homes for Older People Page 27 of 36 Evidence: staff would be put forward for the Skills for Care induction programme. Staff files were viewed to confirm recruitment practices carried out. All had completed application forms and two written references. It was not clear that Protection of Vulnerable Adults (POVA) checks had been received before new staff had started. Criminal Record Bureau (CRB) checks had been received following their recruitment. The POVA checks were not on file and the provider agreed to forward these following the inspection. These checks have subsequently been received and show that staff had been employed before these checks had been received. The manager has stated that the staff were completing induction training only and were not working as part of the duty rota until after the date when the checks were received. However staff should not be employed by the home until all appropriate checks are in place. This is to ensure staff are deemed safe prior to working with people in the home. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is of good character and is qualified to run the service but there are some actions required in regards working practices and record keeping to ensure the home can demonstrate the health and safety of people living in the home. Evidence: The manager has worked at the home for around 6 years and has attained the Registered Managers Award so it suitably trained to care for the people in the home. She advised that she has recently done moving and handling training and training in the safe handling of medications. Both staff and relatives were complimentary of the manager. One stated in a comment card received by us the manager is always available to talk to a member of staff has stated in their comment card Rita is always there for help and advice and a resident has responded to a question about what could the home do better by stating nothing as I feel this is like being home from home. Care Homes for Older People Page 29 of 36 Evidence: The manager has continued to make improvements with all care records being reviewed to be more person-centred to help in the more effective delivery of care and services to the people at the home. Although care staff have access to these records, they do not routinely use the care plans when caring for people at the home, this could lead to an oversight in care and is an area requiring further review. The Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the inspection states when assessing a new resident we do ask their religion and how they would like to include this in their daily lives living at the home, we also involve their families who in return explain their culture and their needs be it prayers, dress code, food, cultural celebration. This was confirmed during discussions with a visitor to the home. It was not clear that all areas of the AQAA had been completed in full detail so that it was clear what improvements had been made since the last inspection and what improvements needed to be made. The sections on health and safety checks and policies and procedures also had not been completed to show that these had been done and were in place. This was discussed with the manager who agreed to ensure this was addressed for furture assessment documents. Staff who work within the home are trained up to NVQ II level but not above this as there are no senior carers working at the home. The provider explained that it is made clear to new starters that they will not be able to progress above this level of training. It was not clear in circumstances when the manager was not available who would be responsible for management tasks in the home. The manager agreed to consider this matter with the provider. Since the last inspection the manager has devised a quality questionnaire which had recently been sent out to people at the home and their relatives. At the time of this inspection two responses had been received back and both of these contained positive comments. One stated we are very happy with the care given to our mum and the prompt attention to any health problems and accidents. Another stated I am very happy with all the present employees currently working at the home, gives a good sense of continuity and stability. The home had also received a letter from the family of a past resident stating I find it very difficult to adequately express how happy X was at Granville House and how pleased we were with X treatment. There are no resident or relative meetings, the manager advised this is because she Care Homes for Older People Page 30 of 36 Evidence: chats to residents and visitors on a regular basis to find out if the quality of the service provided meets their needs and expectations. This was evident from speaking with two visitors to the home. The manager had undertaken environmental audits whereby all rooms are viewed on a monthly basis to check if any maintenance is required. It was evident that one room had been fitted with new windows, a blockage had been cleared in a wash room and the fish tank had been cleaned following this audit showing that actions are being identified and acted upon. Staff meetings are periodically held and the last one was recorded for November 2008. It was evident that the manager had discussed with staff the making of beds, the management of medication and laundry to ensure the quality of care and services provided could be maintained. A review of money was undertaken for those people case tracked and for one extra person. All records and monies were in order and receipts were available for any transactions undertaken. Accident records were seen on the files of people who use the service. It was evident that one person had falls which required medical intervention. These should be reported to us so that we can be sure appropriate action has been taken by the home to address these. The manager agreed to ensure this happens from now on. A random sample of records were reviewed to evidence whether the health and safety of staff and residents is maintained. The portable electrical appliance testing was undertaken in May 2009 and the gas checks in March 2009. Hot water records were viewed and all were within acceptable levels to prevent any scald risks to people at the home. Some of the hot taps were also tested during the tour of the home and none were found to be too hot. Fridge and freezer temperatures had been taken ito ensure food is being stored safely and all were noted to be within acceptable guidelines. Staff had attended a fire drill in April 2009 but an up-to-date Fire Risk Assessment for the home remains outstanding. The manager said that the fire officer had advised this was something she could do. This must be addressed to demonstrate the health and safety of the home is being maintained. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 18 Systems must be in place to 25/06/2008 ensure that staff do not start working in the home until satisfactory pre employment checks, including CRB and PoVA, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medications must be stored 30/06/2009 as stipulated to ensure their effectiveness is not affected. This is to ensure the medication remains effective in treating the health problems of the resident. 2 9 13 Medications must be given as prescribed consistently. This is to ensure the health of the resident is maintained. 30/06/2009 3 38 23 A up-to-date Fire Risk Assessment for the home must be developed. This is to ensure the health and safety of the home is maintained to safeguard residents. 31/07/2009 Care Homes for Older People Page 33 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide for the home need to be reviewed to ensure they contain all of the required information. This is to ensure prospective residents have access to all the information they need to make an informed decision on whether to stay. Records must demonstrate that the needs of residents have been met consistently. A review of how care records are used should be undertaken to ensure staff have all the information they need to care for residents safety and effectively. A social activity programme should be developed to allow people who use the service to receive varied activities, entertainment and outings in accordance with their choice. Records of meals provided to people living in the home need to be kept each day. These need to demonstrate choices, cultural variations and any specialist meals provided to show the needs of people in the home are being met consistently. The complaints procedure should be reviewed to ensure it contains all of the appropriate information and stages in the investigation process. A copy of this must also be made available to each resident in suitable formats as required. It is advised that the process for reporting any allegations of abuse is formalised into a procedure for staff in the home. This is so staff are clear on the processes that must be followed, who they need to contact and have contact numbers to hand should they need them in the absence of the manager. A review of seating within the dining area and residents rooms should be undertaken to ensure all residents have access to safe, comfortable and suitable chairs to support their needs. People at the home should have access to a lockable facility in their room so that they can store any personal items safely if they wish. It is advised that more solid laundry baskets are used for for dirty washing to ensure these can be effectively cleaned to reduce the risk of spread of infection. The whole floor surface area within the laundry should be Page 34 of 36 2 3 7 7 4 12 5 15 6 16 7 18 8 19 9 19 10 26 11 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations non-permeable and easily cleanable to enable good hygiene practices and prevent the spread of infection to residents. 12 26 Items such as commode pots and urine bottles should be cleaned in an appropriate sluice area and not within bathrooms used by residents. This is to prevent the spread of infection and ensure good hygiene practices in the home are maintained. Staff must have access to soap and hand drying facilities in the laundry. This is to ensure they can practice good hygiene and maintain good infection control practices in the home. Duty rotas should clearly demonstrate any care staff hours/times allocated to ancillary duties. This is so that it is clear there are sufficient care hours as well as ancillary hours to provide effective care and services to the people in the home. Duty rotas should include staff full names to ensure there is an effective audit trail. It is advised that an at-a-glance training schedule is devised for all staff so that it is clear they have completed this training within the required timescales to care for people safely. Induction training should be provided following the commencement of a new member of staff which complies with the Skills for Care Common Induction Standards. This is to ensure staff receive suitable training to work with residents safely. Consideration needs to be given as to who is left in charge of the home in the absence of the manager. This is to ensure the home continues to be effectively managed when the manager is not available. 13 26 14 27 15 16 27 30 17 30 18 31 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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