Care Home: Grays Fair Court

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What has improved since the last inspection? This was the first key inspection of the service since its registration in November 2008. What the care home could do better: Care plans should be more detailed to help staff to understand exactly how the guests wished to be supported. There must be more thorough assessments and care plans to minimise risks to guests` health and safety, caused, for example by falls or the use of bedrails. Guests who are not able, or do not wish, to join in the activities provided by the day care service, should be assisted to find alternative ways to meet their social and recreational needs. The staffing levels should be looked at very regularly. The person in charge should ensure that decisions about staffing numbers should take into account how much help each guest needs. There should be a system in place to monitor accidents as they happen. This would help to identify any guests who are at high risk of injuring themselves and to highlight any particular patterns to the accidents. Key inspection report CARE HOMES FOR OLDER PEOPLE Grays Fair Court 266 Dereham Road New Costessey Norwich Norfolk NR5 0SN Lead Inspector Jane Craig Unannounced Inspection 11th May 2009 09:15 DS0000073002.V375337.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 2 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 Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grays Fair Court Address 266 Dereham Road New Costessey Norwich Norfolk NR5 0SN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Age Concern Norfolk Post Vacant Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 - Code OP The maximum number of service users who can be accommodated is 20 New Service 2. Date of last inspection Brief Description of the Service: Grays Fair Court is a short stay residential care service provided by Age Concern Norfolk. The service can accommodate up to 20 older people for respite care. Sixteen of the beds were contracted by social services and the remaining four were available for direct bookings. The service forms part of a modern, purpose built resource for older people. It is situated close to local amenities and within easy reach of the centre of Norwich. All facilities are on the ground floor and accessible to people using wheelchairs. All bedrooms are single and have en-suite shower rooms. There are two communal lounges, a dining area and additional toilet and bathing facilities. The service user’s guide was available to anyone thinking of using the service. In May 2009 the fee for people who booked the service directly was £73 per night. Extra charges were made for toiletries, hairdressing, newspapers and chiropody. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that people who use the service experience good quality outcomes. This was the first key (main) inspection of the service. It includes information gathered since the service was registered on 24th November 2008, and an unannounced visit to the home. The visit was carried out on 12th May 2009 by one regulatory inspector. At the time of the visit there were thirteen guests in the home. We met with some of them and asked about their views of Grays Fair Court. We spent time observing daily routines and how staff interacted with the guests. Three guests were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. At the time of the visit the manager’s post was vacant. The inspection was carried out with the assistance of the respite admissions co-ordinator who was in charge of Grays Fair Court on the day. We also talked to staff, looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the service has to fill in and send to the Commission every year. What the service does well: There was a well organised admission process which helped to make sure that the large number of admissions and discharges ran smoothly. People using the service, who were known as guests, were provided with information about the service and what they could expect from their stay. Guests were satisfied with the care they received at Grays Fair Court. One told us, “It is second to none.” Staff helped people to maintain their independence and promoted their privacy and dignity. One guest told us, “The staff are very polite.” Staff helped guests to carry on their familiar patterns and routines. One member of staff told us that they had to make sure that the service was not rigid so that they could fit in with the guests. There was a varied menu with a choice at each mealtime. Everyone we spoke to said they liked the meals. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 6 There was a clear complaints procedure and guests knew who they could speak to if they were not happy with the service. Complaints were investigated and appropriate action taken. Staff had training and guidance to help them to be able to recognise and respond to poor practice or abuse. Guests were provided with an excellent standard of accommodation. There was sufficient equipment all around the building to help them to remain independently mobile. All rooms were en-suite and each guest had their own shower. Guests described the environment as, “spotlessly clean,” “very comfortable,” and “beautiful.” One said, “It is better than a luxury hotel.” New staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with people who may be vulnerable. Staff had training to help them to understand the needs of the guests and to protect their health and safety. This included fire safety training. The staff on duty on the day of the visit knew what to do when the fire alarm sounded. Their calm and unhurried manner helped to keep the guests calm. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. 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 Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 7 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. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the 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 admission process ensured there was a good exchange of information between the service and prospective guests. EVIDENCE: The reviewed service user’s guide provided clear information, in an accessible format. The guide, and information about other community services, was available in each bedroom and was on display in various areas of the home. We were told that guests were not admitted to the service unless their needs could be met. Anyone referred via social services had a recent social work assessment. On admission senior staff checked the information was still correct. People who made direct bookings were asked to provide an Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 10 application form which included information about their care needs. The example of the application form we saw did not contain enough detail for staff to be clear about the care they were to provide. However, the annual quality assurance assessment (AQAA) told us that the service was planning to introduce home assessments for anyone making a direct booking for the first time, which should help to improve the quality of information. Information was also requested from the guest’s GP to ensure staff were aware of their medical history and had the right training and experience to meet their current health care needs. Prospective guests were encouraged to visit the home prior to making a firm booking. On confirmation, the admissions co-ordinator sent out a booking letter which also included terms and conditions of the stay and a list of items the guest was expected to provide. Standard 6 is not applicable as intermediate care is not provided at Grays Fair Court. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests were assisted to meet their personal and health care needs in the way they preferred. EVIDENCE: We looked at the care records for three guests as part of the case tracking process and others were looked at to check specific issues. Each guest had a care plan based on their assessment. The plan told staff what support they needed to meet their health and personal care needs. The plans we saw had been drawn up with assistance from the guest or their family. This meant they had opportunities to tell staff about the way they wished to be supported. For example, one plan stated that the guest wanted to be asked on a daily basis whether they needed help because their needs and abilities changed each day. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 12 ‘Pabulum’ books had been introduced for guests who were confused or may not be able to communicate their needs. Family carers were invited to complete the books, which gave staff information about the guest’s usual routines and preferences in various aspects of their daily lives. The coordinator told us that staff had found them very useful. Not all of the care plans we saw contained sufficient detail to ensure that new or temporary staff would be able to provide the right level of care in exactly the way the guest preferred. The staff we spoke to were clear about the needs of the guests and said that any gaps in the care plans were filled by good verbal communication. However, it was apparent from the AQAA that care planning had already been identified by the service as an area for improvement. The example of the new care document we saw should help to increase the delivery of person centred care. Guests spoke highly of the care they received. One person said, “It is second to none,” and another told us, “The staff work very hard to make sure we get everything we need.” There were a number of cards and letters on display, from former guests and relatives, thanking staff for the care they provided. The home had been thoughtfully equipped to assist people to maintain their independence. The staff spoke about this as being one of the main aims of the service. One said that they were always mindful not to ‘take over’ because the guest may not have the same level of support at home. Any health care treatments that the guest started at home were carried on when they came into Grays Fair Court. All guests were registered with a local GP to ensure that they could receive medical attention if they needed it during their stay. Care plans included information about the guest’s mobility and assessed their risk of falls. However, the falls assessments made a judgement about the level of risk without identifying the factors that contributed to it. This meant that plans to reduce the risk of falls were not always accurate and did not focus on the specific needs of the guest. Staff told us that they only used bedrails if the guest had been using them at home, and they requested them. The bedrails were an integral part of the bed but there were no separate risk assessments to ensure that the individual resident was safe, especially if they brought in special mattresses. The service had introduced a policy to help staff to understand and promote the principles of privacy and dignity. We saw that most staff had signed to evidence their understanding of the policy and those we spoke to described how they incorporated it into everyday practice. We observed staff talking with guests in a respectful way. One guest told us, “staff are very polite,” and another commented, “we can have a laugh and a joke with staff but no-one oversteps the mark.” Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 13 Staff with responsibility for handling medication had received training and they had a set of policies for guidance. Guests were asked on admission whether they wished to administer their own medication and were assessed as to their safety to do so. Actions plans were in place where guests needed support from staff. There was lockable storage in each bedroom and guests had to agree to store their medicines safely. Other medication was stored safely. We observed a member of staff giving out medicines and found their practice to be safe and hygienic. Staff were careful to make sure that guests received their medicines at their usual time, even if this did not coincide with the planned medicine rounds. All medication was counted in and recorded to provide the start of an audit trail. The handwritten medication administration record (MAR) charts we saw were an accurate reflection of the information on the medicine bottles. However, they were not generally checked, which could increase the risk of transcribing errors. There were no gaps on MAR charts which indicated that guests were receiving their medicines as they were prescribed. We checked a small number of guest’s medication to ensure that the remaining stocks matched the records. In all but one case we found these to be correct. The admissions co-ordinator said she would keep a check on these. We were told that staff looked up any medication they were not familiar with in the British National Formulary. The copy they had was seven years old and did not contain details of medication that one guest had brought in. As a consequence staff were not aware that this should be stored and recorded in a different way. This was rectified immediately and a new book was obtained before the end of the visit. All other controlled drugs were stored and recorded appropriately. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines and meals suited the majority of guests but the social and recreational activities did not match everyone’s expectations. EVIDENCE: None of the care plans we saw included any information about the guest’s preferred routines, likes and dislikes. However, staff told us that all of the current guests were able to make their choices and wishes known. The Pabulum books would help staff to identify this information for guests who were not able to communicate their preferences. We were told that the routines were flexible and staff supported guests to maintain their usual daily schedules if they wished to. For example, guests chose when they wanted to get up, if and when they wanted assistance with bathing, and where they wanted to spend their time. One guest told us, “We can do pretty much as we please.” Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 15 Guests were welcome to join in activities with the day care group, who shared some facilities in Grays Fair Court. Staff said that guests were made aware of this on admission. We saw a list of events and activities posted on the notice board and in the information packs in bedrooms. One guest told us that they usually attended day care so felt quite comfortable continuing to do so. However, two others said they were not aware of the facility. Most of the guests we spoke to said there was not enough to occupy their time. One said, “There is not a lot going on, in a fortnight just one game of bingo.” Another told us, “Entertainment of some sort other than the TV would be good.” Information on the AQAA indicated that the management team were looking into the possibility of providing activities on the respite unit via volunteers. There was open visiting, which helped guests to maintain their usual contacts. There were facilities available for guests to meet with their visitors in privacy and visitors could purchase a meal if they wished to. The AQAA told us that the service was hoping to forge more links with relevant groups and services in the local community, such as the library service and the stroke club. It was apparent from our observations that some of the returning guests had struck up friendships. Staff told us that they received requests to arrange for guests to stay at the same time as their friend. Meals were provided by an outside contractor and we were told that there had been some initial problems. The management team had responded to guests’ comments and the situation had improved. All the guests we asked said the meals were good. One told us, “The food is lovely,” another said, “They feed you quite extravagantly.” There were two choices at each meal but if guests did not like either they could request an alternative. The restaurant was open at set times during the day and the respite service had the second sitting. We were told that there was some flexibility, for example, if a guest had an appointment they could request an early lunch. In reality, however, there would not be sufficient staff to support guests who wanted to dine earlier. We heard one guest being asked to wait for lunch until the others went in. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 were dealt with appropriately. Procedures and training were in place to help safeguard guests from abuse. EVIDENCE: There was a complaints procedure in every bedroom. The guests that we spoke to said they had never had to make a complaint but knew who they could speak to if they were not happy with the service. There were also channels for guests to make positive or negative comments about a particular aspect of the service. The records showed that the majority of negative comments were about food, which had been addressed by a senior manager. The full complaints policy also gave staff guidance on how to respond to complaints and when to report them on to someone senior. This helped to ensure that complaints were responded to positively. There had been one complaint since the service was registered. The records showed that this had been investigated and responded to within the timescales stated in the policy. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 17 Staff had training in safeguarding adults during their induction training and during their NVQ courses. There were no updates provided but there was clear written guidance available. This helped them to recognise and know what to do if they suspected a guest was the victim of abuse. The staff we spoke to said they felt confident that they would be able to recognise the signs of abuse and knew it was their responsibility to report it straight away. There had been no safeguarding referrals made by the service. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests were provided with a safe, well maintained and comfortable environment that supported their independence. EVIDENCE: The service is housed in a brand new, purpose built unit that is part of a community resource owned by Saffron Housing Trust. The AQAA told us that there is a planned schedule of maintenance carried out by Saffron. The building was thoughtfully designed with all amenities for guests on the ground floor. Corridors and doorways were wide enough for staff to manoeuvre even bulky moving and handling equipment. There were grab rails Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 19 in the corridors and all en-suite wet rooms had strategically placed handrails. Ten of the bedrooms and the communal bathroom have overhead tracking for people who need hoisting. All bedrooms are single and very spacious. There was sufficient storage space and everyone had a lockable drawer. The décor and furnishings throughout were of a high standard. All guests had a flat screen TV and a radio in their bedrooms. Although guests were only resident for a short time, some brought in pictures and ornaments to help them to personalise their rooms. There were two communal lounges, one used as a TV room and the smaller of the two was a quiet lounge. There was a drinks machine in the lounge to enable guests to help themselves throughout the day. The gardens were not fully established but there were still some pleasant areas for guests to sit out. The residents we spoke to were all very positive about the environment. One said, “The rooms are very comfortable,” and another told us, “My room is very nice and very big.” One guest said they were pleased to have their own ensuite facilities but also liked to have a spa bath. They said, “The special bath is glorious.” At the time of the visit the home was clean and tidy. Guests said the home was, “always very clean,” and another said, “It is spotlessly clean.” There was no odour. There were special disposal units for incontinence products in each en-suite. In addition to eliminating odours, these helped to reduce the risk of spread of infection. The laundry was adequately equipped for the size of the service. It was tidy and well organised. There was a simple yet effective system for tracking guests’ clothing so that they did not need to have them labelled. We were told that it was very rare for clothing to go missing. There were sufficient hand washing facilities and staff had access to protective clothing. Staff received training in infection control during their induction. There were no training updates and the written guidance available for reference was an old version. Despite the lack of up to date information, the staff had managed an outbreak of the winter virus well and had prevented it spreading throughout the service. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices provided safeguards and staff had training to help them to understand the needs of the guests. EVIDENCE: The staff we spoke to said that over the past few weeks there had always been a significant number of guests who needed help from two staff. They said that at times they had “struggled” to ensure that everyone received the attention they needed when they needed it. The admissions co-ordinator told us that this had been acknowledged and was being addressed. For example, an extra member of staff had been rostered for the day following the visit. Also, admission patterns were being looked at to ensure that, at any one time, the guests had a mix of dependencies and abilities. We discussed how staffing levels should be reviewed on a regular basis because of the rapid turnover of guests. The organisation was building up a bank of staff to allow more flexibility in staffing levels and to cut down on the use of agency staff. We were told that this had already been found to be useful in maintaining continuity of care. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 21 The guests all spoke highly of the staff team and it was apparent from our observations that many of the guests who returned to the service built up good relationships with the staff. One guest told us, “The staff are terrific,” and another said, “the staff are very good and they get very little praise.” We looked at the files of two recently appointed staff. The files included evidence that the staff had two satisfactory references and a CRB check before they started work at the home. This helped to ensure that they were suitable to work with vulnerable people. It was not possible to verify other information and documents as it is the policy of the organisation to hold the records at the head office. They produce a document confirming that the required information has been obtained and this document is held on the staff file. New and temporary staff went through an initial induction to orientate them to the building and the emergency procedures. This was followed by a three month induction training programme which met the common induction standards of the national training organisation. The programme was carried out at head office. Senior staff then assessed the new person’s competency before confirming they were able to carry out care to the correct standard. Staff told us that there were very good opportunities for further training. One said, “It is brilliant.” Another told us that they could ask the training department to locate a course if there was anything they were interested in. Other training needs were identified through the supervision and appraisal process. Although there was a central training record we were not able to decipher whether all the mandatory training was up to date. We were told that the head office tracked this and ensured that everyone who needed training was nominated for a course. The AQAA indicated that over 50 of care staff had an NVQ, which is a nationally recognised qualification in health and social care. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests benefited from a well managed service and could be confident that their suggestions for improvement would be acted upon. EVIDENCE: At the time of the visit the post of manager was vacant. A new manager was due to start later in the month. For the past few months the service had been managed on a day to day basis by the respite admissions co-ordinator who was supported by the head of development and operations. The service was part of the Age Concern organisation and, as such, had a defined upper management structure. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 23 We looked at the systems in place to monitor the quality of the service. Guests, family carers and other stakeholders were invited to complete surveys. Some improvements had already been made as a result of listening to the views of the guests and their families. Several staff had completed questionnaires, which had identified that they did not have enough time to provide activities. Positive action was being taken to find an alternative source of support. The information we received on the AQAA was very clear and gave us a good indication of how the service is planning to develop over the next year. Systems were in place for reporting and recording accidents. However, these were sent to head office to audit, which meant that action to minimise accidents was not always taken at the right time. For example, records showed that one former guest had six un-witnessed accidents in the space of ten days. There was no evidence that staff had highlighted an increased risk. Their falls risk assessment still indicated that they were low risk and no extra action had been taken. We saw that the procedure for handling guests’ money was being followed. Staff gave out receipts for money handed over for safekeeping and any further transactions were recorded. Guests signed to say money was given back to them when they went home. We checked the balances for two guests and found them to be correct. Health and safety procedures were in place. All staff had received fire safety training. They were to be commended for their response when the fire alarm sounded, unexpectedly, during the visit. Staff on duty were fully conversant with their roles and their calm, unhurried manner transferred to the guests. Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 4 X X X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 13 Requirement Risks to guests’ health and safety must be assessed and a clear plan drawn up to reduce risks. These would include risks associated with falls and the use of bedrails. Timescale for action 30/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should include more detail about the guest’s individual needs and preferences to assist staff to provide person centred care. Handwritten MAR charts should be double checked to reduce the risk of transcribing errors. Guests should be provided with sufficient support to meet their social and recreational needs. Staff should have access to up to date guidance on hygiene and infection control procedures in care homes. DS0000073002.V375337.R01.S.doc Version 5.2 Page 26 2. 3. 4. OP9 OP12 OP26 Grays Fair Court 5. OP27 Staffing levels should be reviewed regularly to ensure that there are always sufficient staff to meet the needs and dependencies of each group of guests. Accidents should be audited on a regular basis to help to identify any guests who are at risk and to highlight any significant patterns. 6. OP38 Grays Fair Court DS0000073002.V375337.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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