Care Home: Grasmere

What the care home does well Admissions are not made to the home until a full needs assessment has been undertaken. Residents were observed to be treated with respect by staff and to have their privacy and dignity respected. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them. The home ensures that residents and their representatives are consulted regularly to gather information about their satisfaction with the home. The ethos of the home is that it welcomes complaints and suggestions about the service and uses these positively and learns from them. What has improved since the last inspection? Progress has been made with regards to the general management of the home. Improvement has also been made in the management of medication. Medication records are generally up to date for each resident, and medicines received, administered and disposed of are recorded appropriately. What the care home could do better: The staff are reminded that care plans must include all aspects of the residents` health, personal and social care needs to ensure that all their needs are being met. The hot water temperature must be within the recommended level so that residents are not put at risk of being scalded. It is recommended that a visual inspection be carried out on a regular basis as this will help to identify any potential risks and hazards within the environment that may pose a risk to residents. Key inspection report Care homes for older people Name: Address: Grasmere 49 Grange Road Sutton Surrey SM2 6SY     The quality rating for this care home is:   two star good 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: Mohammad Peerbux     Date: 0 5 0 5 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 23 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 23 Information about the care home Name of care home: Address: Grasmere 49 Grange Road Sutton Surrey SM2 6SY 02086428612 02086429953 grasmereresthome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Zeenat Nanji,Salim Nanji care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Grasmere is registered with the Commission to provide personal care for twenty-five older people. The home is situated in south Sutton and is within reasonable walking distance of shops and public transport. The original building has been extended over recent years and a number of the single rooms lead directly onto the garden. Many of the rooms have ensuite facilities and there are also sufficient numbers of bathroom and toilet facilities conveniently located throughout the home. There is also a well-equipped kitchen and a separate laundry room The garden is used by residents in suitable weather and can easily be accessed by those whose mobility is restricted. There are three communal rooms including the dining room and a shaft lift. Residents have regular access to services of healthcare professionals such as district nurses, dentist and opticians as well as chiropodists. 2 9 1 0 2 0 0 8 0 Over 65 25 Care Homes for Older People Page 4 of 23 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: two star good 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: This unannounced visit to the home was undertaken as a part of the inspection process for the year 2009/2010. In writing the report, consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints.A tour of the building was also carried out. The deputy manager facilitated this inspection. Some of the residents were spoken to and they commented positively on the care they are receiving. One resident stated staff are good to me .They are all thanked for their time and for providing feedback during the inspection process. All registered adult services are now required to fill in an annual quality assurance assessment (AQAA) .It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from this AQAA is Care Homes for Older People Page 5 of 23 included in the report. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 23 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 8 of 23 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. No one is admitted into the home now without a comprehensive assessment being undertaken, so that the home is aware of how they will need to be supported and confident that their healthcare needs can be met. Evidence: Admissions are not made to the home until a full needs assessment has been undertaken. The assessment involves the individual and their family or representative, where appropriate. Prospective residents and their family, have the opportunity to visit and spend time in the home prior to agreeing admission. Intermediate care for rehabilitation and return to the community is not provided by the home. Care Homes for Older People Page 9 of 23 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. Generally residents care plans include detailed information about their needs and personal goals. This helps staff to know the residents needs and how to meet them. Evidence: A number of care plans were sampled at random and it was noted they generally included information necessary to deliver the residents care needs. However the staff are reminded that care plans must include all aspects of the residents health, personal and social care needs to ensure that all their needs are being met. The home is in the process of introducing a new care planning system which will be user friendly and person centred. It was positively noted that the care plans included a risk assessment in line with clinical guidelines produced by the relevant professional bodies concerned with the care of older people. The daily records were sampled and it was noted that they did not contain all the care that have been provided to the residents as detailed in the care plan. Detailed daily records will help the manager to audit the care being provided to the residents, and ensure that staff are following the guidelines in the care plans. It is in the homes Care Homes for Older People Page 10 of 23 Evidence: interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. There is a key worker system that allows staff to work on a one to one basis and contribute to the care plan for the individual. Care plans that were sampled, were being reviewed and updated accordingly. The service listens and responds to individuals choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. More information is being gathered by staff in the home from different sources regarding the residents to enable the staff to have a greater understanding of the residents and to ensure the care they provide is in accordance with their wishes and life style. Staff listen and take account of what is important to them. Residents have access to healthcare and remedial services. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. There was evidence in the care plans of health care treatment and intervention, and a record of visiting professionals. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Generally medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. The home is reminded that there need to be a record of all items being received in the home to avoid mishandling. Residents who are able to manage their medication are given the support they need. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly following a random inspection at the end of last year. All of the residents looked clean, well dressed and cared for. Any personal care is given in their rooms and they told us staff are good to me and I am happy here and the staff look after me well. The staff that we met during the inspection seemed to be very pleasant and had a good relationship with the people that they were caring for. Observation of the staff team interacting with the residents showed that the carers were mindful how they addressed residents, and they were seen to be polite and friendly. Care Homes for Older People Page 11 of 23 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. The home tries to be flexible and attempts to provide a service, which is as individual as possible. Dietary needs are well catered for and a well balanced diet is provided, to ensure health and enjoyment of food. Evidence: Staff are aware of the need to plan the routines and activities of the home in a way, which meets the choice, and wishes of residents. The home tries to be flexible and attempts to provide a service, which is as individual as possible by using its staff and resources effectively. The home has a strong links with the local community so that they can access their services, i.e church services to come to the home, also carol services around christmas and other relevant festivities throughout the year. The home also belongs to a group called Care Aware an independent advocacy service for their residents. Leaflets for this service is placed at the entrance of the home. The care manager has regular residents forums where ideas of improvements, menus and activities are discussed. Relatives and visitors are invited to come along to these forums by notices placed at the entrance and around the home. Minutes are also made available. Care Homes for Older People Page 12 of 23 Evidence: Choice of when to rise and go to bed is carefully recorded in the care plan together with residents likes and dislikes. The home tries as much as possible to make the routines of daily living as flexible as possible. The home encourages open visiting so that the residents are able to keep in contact as much as possible with their social relationships. There is internet access for residents who wish to communicate with their friends and relatives by email and by web camera. Residents are able to choose how they spend their days, the clothes that they wear and the meals that they prefer. Their visitors would always be made welcome, times are not restricted, and they are able to go out with them if they wish to. Residents know they can entertain their family and friends in their own room. If they prefer they can use communal areas of the home to talk to visitors. While we were in the home the lunchtime meal was served. It was hot and looked appetising and well presented. There is always a choice available, and menus are reviewed regularly. Picture menus are also in place to help people decide what they would like to eat. Residents are offered a choice of suitable menus, which meet their dietary and cultural needs, and which respect their individual preferences. Care Homes for Older People Page 13 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are generally managed well, which should ensure that residents and relatives concerns are listened to. Evidence: The home has a complaints procedure that generally meets the national minimum standards and regulations. The complaints procedure is widely distributed and is available within the home. Unless there are exceptional circumstances the home always responds within the agreed timescale. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. The home is clear when an incident needs to be referred to the Local Authority as part of the local Safeguarding procedures in place. Most of the staff working within the home are fully trained in Safeguarding Adults and know how to respond in the event of an alert. Training of staff in safeguarding is regularly arranged by the home. Care Homes for Older People Page 14 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, wellmaintained and comfortable environment, which encourages independence. Evidence: The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable and has a programme to improve the decoration, fixtures and fittings. Overall the home is decorated to a good standard throughout and appears to be comfortable, bright and warm. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The home is kept clean and hygienic and free from offensive odours throughout. The management has a proactive infection control policy and they work closely with their own staff and external specialists to ensure that infections are minimised. Care Homes for Older People Page 15 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally has the numbers and skill mix of staff sufficient to meet residents needs and ensure their safety. There is a staff training and development programme in place. This ensures that staff fulfill the aims of the home and meet the changing needs of residents. Evidence: People who we spoke to stated they were happy with the staff who care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. The deputy manager informed more than 50 of staff have an NVQ level qualification at level 2. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements. The deputy manager is aware that there are Care Homes for Older People Page 16 of 23 Evidence: some gaps in the training programme. These are being addressed and further training sessions have been arranged. All staff usually receive relevant training that is focussed on delivering improved outcomes for residents. Care Homes for Older People Page 17 of 23 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 home management generally provides guidance and direction to staff to ensure residents receive consistent quality care. There is a quality monitoring system and this ensures the home is run in a way that is in the best interests of the residents. Evidence: The registered manager was off duty during this inspection which was facilitated by the deputy manager. The registered manager, deputy manager and registered provider are all working hard to continuously improve services and provide an increased quality of life for residents. There have been improvements made with regards to the general management of the home since the last inspection. With regards to effective quality assurance and quality monitoring systems, the registered provider stated that there is a system based on seeking the views of residents to measure success in meeting the aims, objectives and statement of purpose of the home. The AQAA was received on time and contains clear and relevant information. The AQAA lets us know about changes the home has made and where Care Homes for Older People Page 18 of 23 Evidence: they still need to make improvements. It shows clearly how they are going to do this. The deputy manager informed us that small amounts of money are kept in separate envelopes for each resident with a running balance sheet appropriately maintained for sundries, such as hairdressing costs. A sample of these was seen and was accurate and well maintained. Records with regards to health and safety are of a good standard and are routinely completed. Certificates relating to health and safety were up to date servicing certificates. However it was noted that the hot water temperature in the shower room was above the recommended level of 43 degrees Celsius. It is recommended that a visual inspection be carried out on a regular basis as this will help to identify any potential risks and hazards within the environment that may pose a risk to residents. Care Homes for Older People Page 19 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 23 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 7 15 Care plans must include all aspects of the residents health, personal and social care needs. To ensure that all their needs are being met. 04/07/2009 2 9 13 The record for receipts of medication must be kept accurate. To ensure that there is no mishandling of medication. 19/05/2009 3 38 13 The hot water temperature must be within the recommended level. To prevent residents and staff from scalding. 19/05/2009 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 38 It is recommended that a visual inspection be carried out Page 21 of 23 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 on a regular basis as this will help to identify any potential risks and hazards within the environment that may pose a risk to residents. Care Homes for Older People Page 22 of 23 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). 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