Care Home: Grays Court

What the care home does well The management team undertake a pre-admission assessment before people come to live at the home so they can be sure they know and can meet the person`s needs. This information is carried through into the person`s plan of care along with their wishes and preferences so that staff have the necessary information to provide people with the care they need in the way that they want. A health professional said on what the service does well "very dynamic team who work closely together to provide a holistic care approach to clients needs". The staff team are safely recruited and many of them have worked at the home for several years, providing consistency of care for residents. All the comments from residents and relatives about all the staff at Grays Court were positive and complimentary and included "provide continual, careful, cheerful help and companionship to residents all day, never forget medicines and provide entertainment every afternoon. Another relative commented "all the staff really do `care`, something nurses and doctors in the hospital do not have time for, they are always friendly and helpful and are very professional and take pride in what they do". Residents spoken with were satisfied with the food and one commented "the food is lovely". Residents spoken with were also satisfied with the premises and in particular their own bedrooms which one person described as "lovely". The manager provides clear and effective leadership to the staff team to ensure best quality care outcomes for people using the service. Residents and relatives spoken with and comments received through surveys indicated that people felt comfortable and confident to raise any concerns or comments and expect to be listened to, and confirmed that they found the manager approachable. What has improved since the last inspection? A safe system is now in place to ensure that robust recruitment procedures protect people living at Grays Court and that all appropriate references and checks have been undertaken on prospective staff before they start working at the home. Outstanding requirements from the last inspection have been addressed to varying degrees including ensuring the safe recording of medication administration to demonstrate that residents have had their prescribed medication at the right time, identified assessment of risks for individual residents and staff training for example in relation to moving and handling to promote the health and safety of both residents and staff, and the provision of regular supervision for all staff to support them in caring for people using the service. What the care home could do better: Information for people using the service could be kept up-to-date and the service user guide should be amended. Information on people`s rights and responsibilities while living at Grays Court should be made available prior to/on admission for all people using the service, irrelevant of the source of their funding.The positive aspects of the pre-admission process needs to be developed to ensure that a basic care plan and baseline risk assessments are in place for all residents on admission. This will help ensure that their needs are identified clearly to support staff to meet them in everyday practice from the outset and smooth the admission experience for the resident. The meal-time experience for residents should be reviewed to ensure that residents have opportunity to make real choices about the food they receive, that their nutritional intake is monitored effectively and that meals are presented in a way that supports more people to enjoy them. The system to obtain residents` views and feedback from other interested people such as relatives and health and social care professionals needs to be developed so that the manager and her team can continue to monitor and improve the quality of the care provided to people using the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grays Court Church Street Grays Essex RM17 6EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 1 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Grays Court Church Street Grays Essex RM17 6EG 01375376667 01375397497 grayscourtcarehome@msn.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Minster Care Management Limited care home 87 Number of places (if applicable): Under 65 Over 65 0 87 dementia old age, not falling within any other category Additional conditions: 87 0 The maximum number of service users who can be accomodated is 87. The registered person may provide the following categories of service: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling into any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Grays Court Care Home provides personal care and accommodation for eighty-seven older people who may have a diagnosis of dementia. The home was registered to provide nursing care in 2008 at their request, but currently do not provide this service as they do not have the appropriately qualified nursing manager and staff employed. The home is purpose built and is designed round a secure central courtyard, which provides an attractive garden area with seating. Accommodation is provided on two floors and is divided into units. Each unit is self contained with small kitchen for snacks, dining room and lounges. There is ample space with small lounges, which can be used for a variety of activities. All bedrooms have spacious en-suite facilities. There Care Homes for Older People Page 4 of 32 Brief description of the care home is a small shop on the premises for residents and staff use. The home has a designated activity room with attractive displays. The Grays Court is within easy reach of trains, buses and local facilities. The e-mail address is grayscourtcarehome@msn.com The most recent inspection report was readily available in the entrance hall of the home. The manager advised that the weekly fees for residents range from £407 per week to £550 per week. Additional costs incurred relate to hairdressing, chiropody, newspapers, toiletries, cigarettes, confectionary, taxis and reflexology. Care Homes for Older People Page 5 of 32 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: The last key inspection of this service was undertaken on 8th May 2007. An Annual Review of the service was undertaken on 16th April 2008 and identified that the service continued to offer good quality care outcomes to people living there and that we did not need to review our inspection plan. This unannounced key inspection site visit was undertaken by two inspectors, Bernadette Little and Anna Rodgers, over a nine hour period on one day. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has Care Homes for Older People Page 6 of 32 improved and what they plan to do better. The AQAA contained a good level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, relatives, staff, social and health professionals. Subsequent to the site visit, surveys were received from three residents/relatives, one staff member and twosocial/health professionals. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and the registered provider attended at the end of the site visit for feedback. The outcomes of the site visit were fed back and discussed with the manager and registered provider and opportunity given for clarification were necessary. Both responded positively to the feedback provided. The assistance provided by all those involved in this inspection process is appreciated. What the care home does well: What has improved since the last inspection? What they could do better: Information for people using the service could be kept up-to-date and the service user guide should be amended. Information on peoples rights and responsibilities while living at Grays Court should be made available prior to/on admission for all people using the service, irrelevant of the source of their funding. Care Homes for Older People Page 8 of 32 The positive aspects of the pre-admission process needs to be developed to ensure that a basic care plan and baseline risk assessments are in place for all residents on admission. This will help ensure that their needs are identified clearly to support staff to meet them in everyday practice from the outset and smooth the admission experience for the resident. The meal-time experience for residents should be reviewed to ensure that residents have opportunity to make real choices about the food they receive, that their nutritional intake is monitored effectively and that meals are presented in a way that supports more people to enjoy them. The system to obtain residents views and feedback from other interested people such as relatives and health and social care professionals needs to be developed so that the manager and her team can continue to monitor and improve the quality of the care provided to people using the service. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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 can expect to have sufficient information about the home on which to base a decision about living there and that they will be appropriately assessed to ensure that the team at the home can meet their needs. Evidence: A statement of purpose and service user guide was readily available in the reception area. The statement of purpose reflects information in response to the homes recent registration for nursing care. The manager stated that they do not offer, or plan to offer, nursing care and do not have the required nurse manager and nursing staff to provide this as shown in statement of purpose. The service user guide was noted for example to contain inaccurate contact details and information in the complaints procedure or on the new way the home operates in terms of units. The manager agreed that both documents needed to be amended to provide accurate and up-todate information. Care Homes for Older People Page 11 of 32 Evidence: A copy of the most recent inspection report was displayed in the entrance and so was readily available to people interested in the service. A relative told us they had looked at the reports on the Internet. The managers AQAA advises that a copy of the service user guide is provided to all residents in their bedrooms on admission. They also advised that the majority of residents or their relatives visit prior to admission and are given this information about the home at that time. This was confirmed by relatives spoken with. Surveys received from two people using the service confirmed they felt they had had enough information before they moved in to help them decide if this home was the right place for them. Two surveys received from health and social care professionals advised that the managers assessment arrangements always ensured that accurate information is gathered and at the right services planned for people. Assessment documentation was reviewed for two more recently admitted residents to ensure the home had obtained all information necessary before admission to make sure they could meet the persons needs. The manager advised that they or senior team members undertake all the preadmission assessments of prospective residents. Assessments were available on all files sampled and contained appropriate detail. The manager was advised that all documents need to be dated to show that they had been completed prior to admission. The manager confirmed that prospective residents do not receive written confirmation as required that based on the pre-admission assessment, the home could meet their needs, but that this will be implemented. The managers AQAA tells us that prospective residents or their relatives are encouraged to visit the home. Relatives and a resident spoken with confirmed that they had visited the home prior to admission. This would give prospective residents opportunity to see if the home and its routines was the right place for them. One relative advised that they felt reassured by the invitation to visit and view the home at any time without appointment. The managers AQAA states that a contract is provided to all privately funded residents. The manager confirmed in discussion that in future, all residents, irrelevant of their funding status, will receive a statement of the terms and conditions of their residency at Grays Court, so they have information about their rights and responsibilities while living there. Intermediate care is not offered at Grays Court. Care Homes for Older People Page 12 of 32 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. Although there are some shortfalls in care planning, overall there are positive care outcomes for residents and their privacy and dignity is respected. Evidence: Residents and relatives spoken with confirmed they were satisfied with the care provided at Grays Court. Surveys received from people living at the home/their relatives confirmed that they receive the care and support that they need and one person said was very frail,.. what they have done is almost unbelievable.. I would say (resident) is healthier now than they were two years ago thanks to the staff at Grays Court. The managers AQAA tells us that each service user has an individual care plan in place within 24 hours of admission. Care plans were reviewed for four residents to assess the quality of the information provided to staff on the care needs and wishes of individual people and how these are to be met in everyday practice. No plan of care was available for one recently admitted resident. Assessments are not routinely Care Homes for Older People Page 13 of 32 Evidence: completed on admission such as in relation to continence, tissue viability, dependency, nutrition or falls to provide a baseline to inform care planning, risk management and monitoring of effective care. The AQAA confirms that the home do not carry out nutritional screening, even for those people at risk of malnutrition. Additionally on one care plan, where the person was recorded as being at risk of pressure sores due to poor intake of fluids, nutrition and delicate skin, no preventative plan of care was available to manage this specific individual need. In other aspects the care planning system was generally comprehensive and included moving and handling assessments. Additional risks for residents had been identified and documented in their individual file as required by the last inspection report. There was evidence that the resident and/or their relatives had been involved in the development of the plan of care. Many of the care plans were noted to be particularly positive in encouraging independence and skills maintenance and respecting peoples right for privacy and choice. Daily care recordings varied in the quality of their content. Minutes of a staff meeting showed that this had been raised with them showing that care documents are monitored by the manager and senior team. Residents were weighed regularly and staff spoken with were aware of particular nutritional needs of different residents. Care records had been reviewed and updated and showed that staff had accessed health professionals to support residents individual needs such as dietician, psycho-geriatritian, GP, optician, podiatrist and optician. Surveys from residents/relatives confirmed that the home always makes sure that they get the medical care they need. One recently admitted resident told us that the community nursing team had already been in to see them. Surveys from two health professionals confirmed the view that Grays Court always seeks advice and act upon it to meet residents social and health care needs and improve their well-being and ensure their care needs are properly monitored, reviewed and met. One survey included the comment they have a very good relationship with the community nursing team and are pro-active in developing their skills to benefit the residents of the home. Medication systems were sampled on two units and found to be in good order, including in relation to controlled drugs. The requirement of the last inspection had been met and no omissions were noted on peoples medication administration recording charts (MAR), indicating that people had been given their medication as prescribed. Good practice recommendations had also been acted upon and handwritten changes to the MAR charts were signed by two people or by the GP who had prescribed the change. A survey from a health professional confirmed that Grays Court supports people to administer their own medication or manage it correctly where this is not possible. One Care Homes for Older People Page 14 of 32 Evidence: of the care files sampled confirmed that a resident managed some of their own medication, were provided with safe storage and were involved in signing for their own medication where appropriate. A list of the staff deemed competent by the manager to administer medication was available on one unit, but not on the other. Senior staff spoken with confirmed that they are provided with medication training and updates. They were also aware of residents who needed medications at individual times, understood why this was necessary to their health and well-being and demonstrated an effective system that supported this. The service users charter in the statement of purpose outlines the homes approach to privacy and dignity and the standards that residents can expect as a right. Observation of daily life in the home indicated that these are met for example in the way that that staff spoke and interacted with residents. Surveys from residents confirmed that staff listen to them and act on what they say. This was also confirmed by residents and relatives in discussion and in the surveys received from health professionals. Care Homes for Older People Page 15 of 32 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. Residents of Grays Court can expect to experience of fulfilling lifestyle led by their abilities, preferences and choices and to enjoy a varied diet. Evidence: In the service user guide, the manager states that Grays Court endeavours to ensure that any routine only exists to optimise the service users lives and to facilitate a safe, warm and caring environment for everyone within the home. Evidence was seen to support this with needs and preferences identified at assessment, for example times for going to bed and getting up, continued into the preferences and choices list present on each care file and carried through into their individual plans of care. Staff were also aware of this in practice, for example providing a person with food of a particular colour. Life histories were seen on each file that would also provide information for staff as to the persons interests. The home employ two activity coordinators for a total of almost 60 hours per week. The activity coordinator spoken with advised that they tend not to plan rigidly for activities and work with the abilities and preferences of residents at a particular time. This is considered good practice but it was also suggested that some Care Homes for Older People Page 16 of 32 Evidence: more able residents may enjoy having information in a user-friendly format of some planned activities that they may wish to look forward to and join in with. The activity coordinator confirmed that they have not had any training in provision of activities or in relation to dementia care but would be interested in developing their skills to benefit the residents. Various activities are provided to stimulate people living at the home, for example some people enjoy one-to-one chats, a manicure, limited massage, painting or music. Group activities were also available that included bingo, quizzes and Friday afternoon films on the fifty inch screen in the ballroom. Care plans identified for example that a resident likes to exercise by walking in the well maintained enclosed garden and another resident was seen to be tending to the plants. A timetable of events was available in relation to outside entertainment and some outside trips that are planned for the summer months. Church services are held regularly in the home. A member of a local church was providing communion and taking prayers with some of the residents at the time of the site visit. It was noted during the tour of the premises that a member of staff was dancing with a resident to some country music in one of the lounges, which both were clearly enjoying and was entertaining for the other people in the room. Another resident was tending to flower pots on the balcony and from discussion it was clear they were pleased with the results. They advise they had never been interested in gardening previously but jokingly added I want the pots this side of the courtyard to be better than those on the other side, and they are. Surveys received from residents/relatives identify that the home arranges activities that they can take part in if they want. One included the comment Holds normal conversations about everyday things and spends a lot of time during the day with the staff involved in the day-to-day running of the home.. provide (resident) with a purpose in life. Two surveys suggested that residents would benefit from more entertainment with comments such as although afternoon activities are good, there are long periods of boredom. Something to relieve the boredom would be good... and if they had more funds they could provide more entertainment, better gardens and Im sure come up with ideas to improve the residents well-being. Surveys from health professionals indicated that people are supported to live the life they choose wherever possible at Grays Court and that diverse needs of individual people are responded to. Friends of Grays Court meetings are held regularly and minutes of this months meeting showed attendance by a number of relatives. Relatives spoken with said they feel welcome to visit. Visitors were observed to chat to staff and other residents in the home, knew them by name and were clearly relaxed Care Homes for Older People Page 17 of 32 Evidence: and comfortable. The menu demonstrates a good choice of meals. It was not available in a format that was easy for residents to see or understand and residents and staff spoken with did not know what was for lunch that day until it arrived. Ample food stocks of quality brands were seen to be available along with a range of fresh fruit. Surveys from residents said they always or usually like the meals at Grays Court. Dining rooms were pleasant, spacious and homely. Residents were offered a choice of drinks and encouraged to have more throughout the meal. Staff sat with residents who needed assistance and provided this quietly and in a way that respected the persons dignity. They were also seen to discreetly monitor residents and encourage them to eat their meal. Residents make a choice from the menu the day before. It was discussed with the manager that two plated meals could be offered to the person at the time of serving, and that this would be a more effective choice opportunity for people living with dementia. Meals are served in individual dining rooms from hot trolleys. It was observed that portions were large, some combinations were unusual, the meal appeared dry and it was suggested that this could be offputting. Much of the food was wasted and there was no clear record available of the food, including the amount, eaten by each resident to support good nutritional monitoring. A review of the choices available to residents who have diabetes was recommended to ensure they had the same opportunities as other residents, while meeting their specific need. The manager and responsible individual responded positively to the suggestion that smaller meals could be served initially and a second portion offered, which would have remained hot in the trolley. They also responded positively to ensuring that individual elements of the meal will in future be blended and served separately to retain colour, flavour and appeal. Care Homes for Older People Page 18 of 32 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. Residents can be assured that their concerns would be listened to and dealt with appropriately and that as far as possible they would be safeguarded at the home. Evidence: Information on Minster Care Management Ltds complaints procedure was clearly displayed in the reception area. The procedure contained clear information on steps to take and the timescales people can expect responses by. Information on complaints in the service user guide contained out of date contact information for the Commission. Neither contained information on contacting Social Care (social services) who would investigate complaints. One resident/relative survey received said they would not know how to make a formal complaint while the other said they would. People spoken with during the site visit were clear they would be able to raise any concerns with the manager or staff. Surveys received from health professionals indicated that the service always or usually respond appropriately if they have raised any concerns. A number of cards and letter of compliment were available noting for example thanks for the friendship, love and care offered. Since the last inspection, the manager has introduced an improved system for logging and filing complaints/investigations. The managers AQAA states that two complaints Care Homes for Older People Page 19 of 32 Evidence: were received in the past 12 months. These were reviewed and found to have been responded to promptly and openly and appropriate action taken. One related to the possible safeguarding issue referred to in the managers AQAA. The investigation shows that advice had been taken from the safeguarding team at Thurrock and records demonstrate confirmation that no safeguarding referral would be made as they were happy with the managers investigation and response. The manager confirmed that no other safeguarding referrals have been raised since the last inspection. The manager will access a copy of the new Southend, Essex and Thurrock guidance on safeguarding. The manager advised she had had no training on safeguarding for some years, preferring to ensure that her staff had access to the training available. The manager was able to describe awareness of types of abuse and appropriate actions to take in response to any allegations. The manager has also undertaken the first session of the Mental Capacity Act Deprivation of Liberty Safeguards training to keep their knowledge up-to-date. A clear whistleblowing procedure was available for staff. Four staff spoken with confirmed that they had had training on safeguarding vulnerable people, were able to identify types of abuse and confirmed that they would report it without hesitation, to their manager or more senior person within the organisation, or to the Commission if that was appropriate. The survey received from a staff member confirmed that they would know what to do if someone had concerns about the home. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle, meets their needs and which is well maintained and clean. Evidence: Grays Court is purpose-built and registered to care for older people, some of whom have mental frailty/dementia. The accommodation is located on two floors and divided into four units. Grays Court is built around a secure central courtyard garden. The gardens are well cared for. A water feature has been put into the courtyard as a result of comments made by residents. In another area of the secure gardens, residents have access to a paved area which has tables and chairs and a pagoda providing shade. There is new garden furniture that had been purchased in part from the residents fund. This money is either from relatives or from fundraising and its usage is agreed at the Friends of Grays Court meetings. Staff spoken with said they were hopeful that they will be able to have barbeques when the weather is warm enough. The home has a number of lounges and dining rooms as well as several other places to sit around the home. Residents were seen to use these facilities freely throughout the day. One resident was observed lying on a sofa with a cold drink on the nearby coffee table and staff confirmed that this was their usual daily routine. Other residents were observed to be walking round the corridor areas and periodically sitting down for a Care Homes for Older People Page 21 of 32 Evidence: while before continuing their walk. Staff were observed to acknowledge the residents as they went past and to stop and speak with them. Furniture in some of the areas is looking a bit tired, as was the decoration in the communal areas. It is noted positively that the management ensure that residents individual bedrooms are given priority in terms of redecoration rather than just those areas seen by the general public. It is however recommended that a detailed cyclical plan for redecoration and renewals be available to ensure the home is maintained to the best possible standard in a timely way. The building itself is well maintained. The home employs two maintenance people and there are systems in place for staff to report issues requiring attention. The lounges available for communal use were equipped with a variety of single armchairs, tables and televisions. A number of residents were making use of these facilities. There is also a large lounge on the ground floor, known as the ballroom, that is equipped with a large television flat screen and used for weekly film shows. The dining rooms each had a small kitchenette attached. This enables staff to make residents a hot drink or to help a resident make their own drink as and when required. It is a facility that can also be used by relatives when they visit. The dining tables were laid for lunch and included table cloths, napkins and flowers on each table. The space between the tables allowed the residents to get up and move around as they wished. Bedrooms had been individually personalised. Residents can (with relatives if they wish) have their photograph on their bedroom door with their preferred name and also the name of their key worker. Residents are also encouraged to bring their own furniture if they wish. The manager is aware that some rooms are quite dark because of their location, although they try to ensure that the natural light is not obscured. Residents are involved in choosing colours for their room when either they first move in or if the room is scheduled to be redecorated. Bedroom furniture is in the process of being replaced and make rooms look like to the new furniture chosen is of a light wood. A resident spoken with confirmed that they were very pleased with their bedroom and that they had been provided with appropriate equipment to meet their individual needs. As with resident bedrooms, bathroom and toilet doors are painted in primary colours to assist residents in orientation. Call bell facilities are available in both areas and within access should a resident need assistance. It was noted in one ensuite facility that the bell cord had been broken. However the manager reported it to the maintenance man and it was replaced by the end of the inspection. Surveys received from residents and relatives indicate that the home is generally clean Care Homes for Older People Page 22 of 32 Evidence: and fresh. A visitor spoken with confirmed this and that staff act to deal with any accidents and resulting odour immediately. Discussion with the housekeeper confirmed the information in the AQAA and it was clear that domestic hours have been reviewed so that domestic staff work later in the afternoon ensuring that odours are managed. The team were aware that this was the time of day where they could improve the domestic service offered to residents. The managers AQAA indicates a high percentage of staff have attended training on prevention and control of infection. Good infection-control practices were observed throughout the day with staff wearing appropriate protective equipment when providing personal care or serving food. The kitchen and laundry were seen to be clean. The laundry room was well equipped and organised. There was safe storage of items such as latex gloves, which could pose a choking hazard to people living with dementia. The domestic staff are responsible for all the laundry and it was evident from observation and discussion with the housekeeper that the team take a pride in their work and recognise the importance of ensuring residents clothing is cared for. The housekeeper said that they use traditional ways to keep clothing looking nice when necessary, for example soaking of personal clothing to ensure stains are removed. Residents looked well dressed with co-ordinated clothing. Residents were also wearing clothing that was appropriate for the time of year and temperature in the home. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident they are cared for by a competent staff team who have had appropriate recruitment checks carried out and who have the skills to meet their needs. Evidence: The manager and registered provider confirmed that staffing levels have been reviewed to ensure they meet the needs of the current resident group. Rotas viewed confirmed that in addition to the manager and deputy manager, there are eight staff throughout the waking day on the first floor and seven staff throughout the waking day on the ground floor. There are eight waking staff to cover both floors at night. Staffing levels at the time of the site visit were noted to be appropriate to meet the needs of people using the service. Call bells were answered quickly and residents needs were attended to promptly. A resident told us that a member of staff had told them to use the call bell at any time as that is what we are there for. Discussion with staff confirm they have sufficient time to undertake their duties and spend time with residents. Staff were observed to take time to interact with people in a relaxed and respectful manner. A member of staff was asked what they enjoyed about the job and said I like helping the activities coordinator, and enjoy meeting and spending time with the residents. They went on to say it is important to listen to Care Homes for Older People Page 24 of 32 Evidence: them. A resident spoken with said they were very happy at the home and thought the staff were great. A comment from a survey included I could not fault their dedication, enthusiasm and friendly approach to their work. From discussion with staff it is clear that staff agree their designated areas of work at the beginning of each shift. This makes sure that there are the right numbers of staff with the necessary skills available to ensure residents receive the level of support they require. Surveys received from people living at the home confirm that they feel that staff are always available when they need them. The care staff team are supported by a housekeeping team, a kitchen team that rotas and discussion confirm are available between 7am and 7pm and an administrator who has worked at the home for a number of years at the desk in the front hall and provides a good welcome to visitors to the home. The home is committed to training and the majority of the team hold or are in the process of completing National Vocational Qualification (NVQ) level 2 in care. The senior team i.e. the unit managers are completing their NVQ level 3 training. New staff have an induction work booklet which complies with Skills for Care which they work through with a senior member of staff. This ensures that staff are given sufficient initial training and information about residents to enable them to provide care and meet their needs. A member of staff who recently completed their induction said they had enjoyed it and they found it helpful. They have now started their NVQ level 2 training. Another induction booklet seen had been completed but was not dated although it was clear it related to a member of staff spoken with during the course of this inspection who explained they had completed their induction. Four staff files were looked at and were found to have been appropriately maintained and showed the homes recruitment practices offered protection to those living at the home. Each file had an index which formed a checklist of all the elements of their recruitment process. All the necessary pre-employment checks had been undertaken. The files showed that each member of staff had a completed an application form as well as evidence of their interview with a recorded outcome. With the exception of one file, two references were available on file for each member of staff. Also one reference, (which was in addition to the two required references) was addressed to to whom it may concern and was not dated. Advice was given not to accept these generic references that do not relate specifically to the skills required for the job applied for. There was also evidence that each member of staff had a satisfactory enhanced criminal record bureau check on file and that none had commenced their employment prior to a satisfactory check. Each file included a Care Homes for Older People Page 25 of 32 Evidence: contract of employment. There was evidence from discussion and inspection of records that staff have attended a range of training to ensure they can meet the needs of the residents. Staff have received training relating to health and safety, fire safety, emergency first aid, administration of medication, manual handling and infection control and also training specific to caring for older people for example valuing older people, person centred care planning, dementia training and safeguarding. The manager acknowledged in the AQAA that a mandatory training programme needs to be devised. The training records would benefit from having a training matrix that collates overall staff training, and an individual record that shows the training undertaken by each member of staff. The manager also highlighted in the AQAA and the need to have a budget to accommodate the training programme. Care Homes for Older People Page 26 of 32 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. Residents can expect to live in a home that is well managed by a manager who provides positive leadership to the staff team who will ensure residents live in safe environment. Evidence: The manager is suitably qualified and experienced and there is a clear organisational structure in place to support effective care outcomes for people using the service. The manager has worked at Grays Court since 1999 and became manager in 2001. They completed NVQ Level 4 in Management, Registered Managers Award. The manager has attended additional training to keep their knowledge and skills up-to-date and they and the deputy manager recently attended a conference on dementia care. The manager was clearly enthused by their attendance at the conference and advised of new ideas on how to improve the environment and staff practice to support people living with dementia. Care Homes for Older People Page 27 of 32 Evidence: The manager is supported by a senior team that includes a deputy manager and four unit managers. As noted in the previous section of this report, these staff are all in the process of completing their NVQ level 3 award. The manager recognises the need as stated in the AQAA of more training on the prevention of abuse and dealing with incidents, physical and/or verbal aggression by service users. Staff and visitors spoken with during this inspection confirms the approachability of the manager. The manager has clearly stated in the AQAA all service users and relatives are encouraged on admission to raise any concerns with the manager immediately so they can be resolved before they become a problem. A visitor said that they had had an occasion when they were not happy about something and spoke with the manager who ensured the issue regarding the visitors relative did not reoccur. Staff spoken with confirmed that the manager provided sound leadership and took an interest in what was happening in the home. Unit team meetings are held and from a sample of minutes seen indicated that a range of topics are discussed. This included for example cleaning rotas and care plans. There was evidence in the records that the manager monitors these and makes comments. A quality assurance system is in place although it requires development to ensure the views of residents are actively sought and taken into account. This has been acknowledged in the section of the managers AQAA that looks at what they could do better, circulate questionnaires with regards the running of the care home and what we could improve on. They also demonstrate understanding that questionnaires need to be user-friendly. There are regular Friends of Grays Court meetings that are attended by relatives and friends of the residents and usually chaired by an independent person. However, the last meeting was chaired by a member of staff as sadly, the elected chairperson had died, and a new person has to be identified. The last meeting took place in May 2009 and the agenda showed that there were discussions about clothing, food and the intake of salt/sugar, day trips and the planning a summer fete. There is also a relatives fund and it was agreed that some of the money was to be used to develop a patio area with some furniture, which had been achieved. The home does not manage residents finances but will hold money provided by relatives. Three resident personal allowances were checked and found to be correct. The administrator maintains a record of how the money is spent, which provides a clear audit trail should a relative request to see the record. It was noted that the record is titled pocket money and advice was given to review this to ensure it is age appropriate and promotes peoples dignity. Care Homes for Older People Page 28 of 32 Evidence: The arrangements for staff supervision were inspected as this was an identified requirement of the last inspection. Supervision is cascaded from the manager to seniors and from seniors to care staff. Two files were looked at and show that supervision has been arranged every two months for between half an hour and an hour, which meets the minimum standards of six times a year. The records showed that the person being supervised was able to discuss practice and also to receive feedback on their performance and to discuss training identified or received. However, records seen were not dated so it was not possible to ascertain when the sessions took place. While the requirement to provide supervision six times a year is considered as met, dated records would support better evidence of this. A number of records were looked at during this inspection and are commented on throughout the report. Generally records are informative but there is a need to ensure that all records and entries are dated and include the year and month referred to. It is noted in the managers AQAA that the homes policies and procedures are to be reviewed. Advice was given to ensure these are dated and reflect the planned review date. Training records relating to health and safety confirmed that staff are trained in moving in handling (people handling), infection-control, fire safety and health and safety. A sample of records of routine safety checks were seen to ensure a safe environment was maintained for residents and staff. Service inspection details were available relating to the fire alarm, fire equipment including emergency lighting and extinguishers and the vertical passenger lift and hoists located in the bathrooms. There was also evidence of laundry equipment being maintained and callouts to replace faulty equipment. The record of water temperatures were up-to-date and showed that the temperature is well within the safe range. Care Homes for Older People Page 29 of 32 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 30 of 32 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 Each person must have a care plan in place that identifies effectively all their assessed needs and preferences. To ensure that staff have the information needed to ensure residents needs and preferences are respected and met. 22/06/2009 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 2 So that people have all the information possible, all residents should be given a statement of terms and conditions on their admission telling them what care and services they can expect during their stay and what their rights and responsibilities are. The views of stakeholders to be sought on how the home is achieving its goals and those of people using the service to be sought in a user friendly format that supports their needs. 2 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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