Care Home: Greville

What the care home does well People living in the home are kept safe and protected from risk of harm. Care staff interactions with people are largely good and caring. People are treated with dignity and respect whatever their situation or behaviour. A relative commented: `I have been very impressed with the staff`s response when we have had concerns with regard to my relative`s health and wellbeing. We have had no cause to complain about the care she has received`. Staff commented: `In my opinion the service provides excellent care for its service users and good supportive training for staff` and: `Staff communicate well with people and try to meet their needs` Managers and staff have reacted positively to requirements made at the last key inspection and they are all keen to improve standards further. If they continue with this people will get a more person-centred service that caters for their individual needs and preferences. (Person-centred care means care that looks at a person`s whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks).Managers and staff are therefore to be commended for their positive attitude towards the major changes that are taking place. What has improved since the last inspection? We`d done a random inspection in September `08 to follow up progress with meeting requirements from the June `08 inspection. Information gained from that and this visit shows that managers and staff have worked hard to improve the standard of care and environment that people with dementia should have. Ten remaining requirements following the random visit had all been met. These included: - Improved care plans and regular progress records give better information about meeting of peoples` needs, - Proper use of staff protective clothing keeps peoples` dignity and prevents spread of infection, - People are not restrained at any time during the care giving process and are treated with respect, - Specialist advice about improving the environment of the home helps people find their way around better and gives them a more comfortable and homely place in which to live, - An ongoing programme of refurbishment and redecoration has improved the standard and accessibility of the environment for people and: - Improvement in staffing levels and the way in which staff work. Further, a range of training in person-centred care practices and more frequent supervision means people with dementia get a better standard of care and quality of life. What the care home could do better: Although changes and greater staff efforts have helped give people a much better quality of life in the home, this must be kept up. Managers and staff told us how much better they found working in the changed environment and how good it now is for people living there. This is commended but needs to be built on so that people get a truly person-centred care service. One requirement was made about improving the quality of meals in the home. Although it was clear that menus are taken from peoples` likes and preferences, more needs to be done to make sure they get nutritious meals using fresh ingredients. This will give people more enjoyment of their meals. A further requirement about making sure staff get regular training in essential food hygiene was made to make sure people are kept safe. Four good practice recommendations were made. These were about: - Making sure people are made aware of the choice of meals available so that they know what`s on offer,- Making sure that information about the home given through the newsletter is made accessible for people with dementia and makes sure they are the main focus of it, - Finding better ways of managing staff routines in the morning so that household tasks are given equal focus with activities and person centred care and: - Making sure kitchen staff adhere to proper health and safety standards by use of protective clothing. CARE HOMES FOR OLDER PEOPLE Greville Lacey Road Stockwood Bristol BS14 8LN Lead Inspector Sandra Garrett Unannounced Inspection 09:30 8 & 9 December 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greville Address Lacey Road Stockwood Bristol BS14 8LN 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) 01275 837034 01275 892007 Bristol City Council Mr Michael Sullivan Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2008 Brief Description of the Service: Bristol City Council runs Greville and it’s registered with the Commission for Social Care Inspection (the Commission). The home gives personal care and support for up to 35 people with dementia that are over 65 years of age. The philosophy of the home is to meet peoples care needs as set out in its Statement of Purpose. Greville is situated in Stockwood, a large residential area in South Bristol. It’s a purpose built home on one level. It’s accessible to disabled people and visitors. It’s also next door to a dementia care day centre that gives older people with dementia living in the community support. Fees are £619.71 per week. This doesn’t include chiropody, hairdressing, newspapers etc. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk A copy of the key inspection report for 2007 was on display in the entrance lobby of the home. However this wasn’t the most recent report and managers were asked to replace it with the most up to date one. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Before the visit, all information the Commission has received about the service since the last inspection was looked at. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. Two inspectors visited and spoke to six people living at the home, six staff, the manager, deputy and assistant managers on duty. We both looked at a wide range of records including care records, complaints, menus, minutes of meetings, health and safety and staffing records. Because people with dementia aren’t always able to tell us about their lives, we use a formal way of watching them to help us understand better. We call it the: ‘Short Observational Framework for Inspection’ (SOFI). This means using a methodical and structured way of watching peoples experiences of living at the home. We did this for 2 hours in the lounge and dining room and recorded peoples experiences in five-minute time slots. It included looking at their wellbeing, how they interacted with other people living at the home, staff members and the environment. We also saw how other people live their lives at the home. Information from SOFI is included throughout this report. What the service does well: People living in the home are kept safe and protected from risk of harm. Care staff interactions with people are largely good and caring. People are treated with dignity and respect whatever their situation or behaviour. A relative commented: ‘I have been very impressed with the staff’s response when we have had concerns with regard to my relative’s health and wellbeing. We have had no cause to complain about the care she has received’. Staff commented: ‘In my opinion the service provides excellent care for its service users and good supportive training for staff’ and: ‘Staff communicate well with people and try to meet their needs’ Managers and staff have reacted positively to requirements made at the last key inspection and they are all keen to improve standards further. If they continue with this people will get a more person-centred service that caters for their individual needs and preferences. (Person-centred care means care that looks at a person’s whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks). Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 6 Managers and staff are therefore to be commended for their positive attitude towards the major changes that are taking place. What has improved since the last inspection? What they could do better: Although changes and greater staff efforts have helped give people a much better quality of life in the home, this must be kept up. Managers and staff told us how much better they found working in the changed environment and how good it now is for people living there. This is commended but needs to be built on so that people get a truly person-centred care service. One requirement was made about improving the quality of meals in the home. Although it was clear that menus are taken from peoples likes and preferences, more needs to be done to make sure they get nutritious meals using fresh ingredients. This will give people more enjoyment of their meals. A further requirement about making sure staff get regular training in essential food hygiene was made to make sure people are kept safe. Four good practice recommendations were made. These were about: - Making sure people are made aware of the choice of meals available so that they know what’s on offer, Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 7 - Making sure that information about the home given through the newsletter is made accessible for people with dementia and makes sure they are the main focus of it, - Finding better ways of managing staff routines in the morning so that household tasks are given equal focus with activities and person centred care and: - Making sure kitchen staff adhere to proper health and safety standards by use of protective clothing. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greville DS0000035878.V373478.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 Greville DS0000035878.V373478.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Use of clear and detailed pre-admission assessments makes sure that the home is the right place for people using the service and that staff are able to meet their needs. However, not all information is accessible to people or puts them first. People are now looked after well in respect of their specialist needs by staff that are suitably trained and gaining in person-centred care experience. EVIDENCE: We looked at use of pre-admission assessments to check that peoples needs were being transferred into care plans. We looked at four peoples assessments. Three were done some years ago and their needs had changed somewhat since then. Letters from mental health professionals were also seen that gave information about background and the need for residential care. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 10 These letters give clues about the person and help staff understand them better. One person was staying at the home for a short while to give relatives a break from caring. The care assessment wasn’t with her/his daily records and it was found filed away in the office. The manager said staff at the home don’t do care plans for people that come in for respite care and the social work one is used. We recommend that this care plan be kept with the person’s daily records, otherwise staff may not be fully aware of peoples needs. Peoples specialist needs were being better met following the requirements made at the last visit. Staff had done a range of training in dementia awareness and care, person-centred care and activities for people with dementia. Staff showed that they were more in touch with what people need and were less focussed on doing basic tasks than before. Good and discreet interactions were seen between people and staff. An example of this was taking people to use the toilet before lunch. Staff spoke quietly to people one to one and invited them to go with them. People readily went along with staff and visitors wouldn’t have known where they were going or what for. Where staff needed to use equipment such as hoists or stand-aids this was also done quietly and in the person’s own time. We regularly get copies of the home’s newsletter (called ‘Greville Gossip’) sent to us. Copies were also seen in the lobby of the home together with the 2007 inspection report. The newsletter is in large print so that people can see it more easily and it also has pictures. However, it’s not all printed in an accessible font that would be easier for people to read (people with dementia may not be able to see objects in the same way as other older people). Further, the emphasis is on putting staff first, that denies the importance of people living at the home. We recommend that the newsletter be put in an accessible font and size throughout and the emphasis changed to put people with dementia at the centre of it. Greville DS0000035878.V373478.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in looking at care plans, keeping of food and fluid charts and recording peoples weight regularly, makes sure peoples changing needs are picked up and met. People living at the home are looked after well in respect of healthcare needs. Secure management ensures people living at the home are looked after well in respect of medication needs and are kept safe from potential errors. Being treated with greater dignity and respect benefits people living at the home. EVIDENCE: We asked staff: ‘Are you given up to date information about the needs of people you support or care for’? One staff member commented: ‘Yes, by my manager. Also care plan is always updated to support care needs’. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 12 We case-tracked three people’s care. This means looking at all records associated with a small number of people living at the home and tracking their care by talking with both them and staff caring for them. Case tracking is a way of thoroughly checking all the information the home keeps. That way we can assess whether the care given overall is adequate and meets peoples needs. Care plans were more detailed in needs picked up and actions taken. However they weren’t written in a clearly person-centred way that puts people at the heart of the plans and includes their wishes, rights and choices. More work needs to be done to make them truly person-centred, particularly about the outcomes for people. We therefore gave advice to the manager about how this might be achieved. However, plans did now include better information about food and drink for people that eat very little and are at risk of malnutrition. We followed up a requirement about this made at the last visit. The requirement was met as the person now had a clear food and fluid chart that gave good information about what s/he was eating and drinking. The person was also being weighed regularly and was keeping her/his weight stable, although low. Staff had properly picked up one person’s emotional needs. This resulted in a GP visit and prescription of medication. Records showed that the person was now ‘much brighter and happier after change of medication’. All care plans had been checked monthly and any changes noted. Care plans had also been more formally reviewed with management staff and relatives of people concerned. Relatives had said they were happy with care being given and again changes were recorded. A requirement made at the last visit about writing more respectful records that maintain peoples dignity was met. Daily records were much better. There were lots of records about people doing activities or joining in entertainment and staff had recorded their actual comments. There were little or no entries about bodily functions. Key time records also showed improvement: from not being very frequent in September they had increased by November. Key time is one to one in depth time spent with people by key staff that care for them. Records showed cakemaking, knitting, manicures and chats had happened and people had enjoyed the sessions. Records were all regular with few gaps. They gave a picture of peoples enjoyment of living in the home and their relationships with staff. This is good practice. We saw that managers check the records: one entry on a key time record should have been written in the daily records and this had been picked up. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 13 Moving and handling risk assessments were in place for each person. However we saw from one person’s care records that s/he is at risk of falls. There was no risk assessment for this and we strongly recommend that this be done. One relative commented: From our experience they have always met my relative’s health needs. We saw records of healthcare professionals’ visits including GP, district nurses, mental health professionals, opticians and chiropodist. Healthcare conditions such as diabetes were highlighted on care plans and a list of people needing a diabetic diet was seen in the dining room. Flu vaccinations had been offered and one person had declined to have it. A requirement made at the last visit about improper use of protective gloves and aprons was met. During our time watching people in the dining room we saw that staff didn’t wear gloves or aprons all the time as they had done before. We did see staff wearing gloves at other times but this was when it was right to do so. We did a check of medication and found all to be in order. We checked medication administration sheets (MAR) and no gaps were seen. One person’s sheet couldn’t be found to check controlled medication against it. However the person was in hospital and the assistant manager said she thought the sheet had gone with her/him. If this happens a note should be put in the file to show a clear audit trail. The medication returns book didn’t have a reason for return of any unused medication. The assistant manager immediately took the sheet away to redo it. We looked at the office message book. This had some messages for staff including when food or fluid charts hadn’t been filled in and weighing people. This together with the above showed that management staff are checking the quality of care and recording. This is good practice. As seen from the SOFI (see standards 1-6 above) and from comments by relatives, we found that staff treated people with respect and their dignity was kept up as far as possible. Peoples choices were respected e.g. one person chose to remain sitting on a dining chair all morning instead of moving to an armchair. Staff respected her/his wishes and spent time with her/him so s/he wouldn’t be left alone for long periods. One relative commented: ‘We understand how difficult it can be to protect the privacy of people with dementia. However staff always strive to do so and for the most part they achieve this’. Greville DS0000035878.V373478.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements made give people living at the home opportunities to have a stimulating and varied life where various formal and informal activities happen regularly. Encouragement and improvement of contact with the community helps people stay in touch with what is happening outside the home and helps meet their spiritual needs. Few restrictions placed on people living at the home now give them greater choice in a relaxed atmosphere. Menus don’t fully reflect all the various choices that people could have for a diet that meets their needs. Further, overuse of packaged ingredients doesn’t give people a wholesome or nourishing diet. EVIDENCE: It was apparent from our discussions with them, that staff are much more focussed on peoples individual needs. A number of them were enjoying finding out more about peoples personal histories. One staff commented that they Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 15 were now doing more individual activities with people that’s better for them as group activities often didn’t work. The trainer in dementia awareness has helped in this by visiting the home and giving staff advice. Staff said that the trainer had advised them on suitable activities based on peoples past lives. Therefore a wider range of different types of activity is being done both with individuals and in small groups. These include colouring in books, looking at pictures and talking about them, cooking or gardening and games. One person had joined in a game of indoor football and staff had written that she was a ‘very good kicker’! Activities and entertainment were also listed in a diary kept for the purpose. This showed regular sessions including singalongs, outside entertainers visiting, trips (to a garden centre and local shops), music and movement and watching DVD’s to name a few. A number of people had enjoyed watching DVD’s of recent films such as ‘Mamma Mia’. The diary simply listed the activity and the number of people attending. Individual records gave information about other activity but not always the ones listed. We recommend that where group activities are held a summary of peoples enjoyment be recorded in the diary. From the SOFI observation we found that people showed good levels of wellbeing. Only one person showed any sign of ill-being. Staff were quick to pick this up and the person was encouraged to rest in her/his bedroom as s/he complained of being tired. Management staff are still trying to involve the local community in coming to the home. They told us that they have now found an ecumenical minister who is willing to come and hold services at the home. However, this may not meet everyone’s religious needs. From care records we saw only one person out of four had their religion recorded. Staff should therefore try and find out the religious wishes of everyone living at the home and meet those needs where possible. Due to improvements in person-centred care approaches, better use of the environment and changes in staff awareness and attitudes, people living at the home now have greater freedom of choice. This was seen from doing the SOFI exercise. People were clear about what they wanted to do, where and when. One person spent time moving purposefully around the home and picking up objects. Others spent time sitting in lounges or resting on their beds. The assistant manager showed us some photos she had copied from bygone newspapers and these were taken around by staff to talk with people about if they wished. We did the SOFI exercise partly in the dining room over the lunchtime period. The room had been recently decorated and was brighter. Tablecloths contrasted well with the colour scheme and each table had a small vase of fresh flowers, condiments and cutlery. People were able to sit where they liked and tables were arranged in groups of four or six. Some tables were for one person only. We saw people choosing to either sit with a group or on their Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 16 own. One person accidentally spilled her/his drink. A staff member changed the cloth quietly and with little disruption to people sitting there. Drinks were given to everyone if they wanted and there was a choice of fruit squashes. Staff brought two plates each showing the dishes available and people chose what they wanted to eat. The day’s menu had been written on the whiteboard in the dining room. However the dessert choice just stated ‘a choice of hot and cold desserts’. In fact there was a wide range of either hot or cold desserts that some people may have been able to read about and understand. The assistant manager gave us copies of new menus that had just been done. We had made a good practice recommendation at the last inspection about redoing them with greater use of fresh ingredients and vegetarian options. We were disappointed that the menus still showed that tinned, frozen or packaged food is being used. Further, the menus often showed only one choice at lunchtime instead of two. Desserts were recorded as ‘a choice of hot and cold dessert from the sweet trolley’. The menu for the first day of our visit stated it would be sausage casserole. The other choice was fish cakes and boiled potatoes with tinned processed peas. However the meal that was served wasn’t sausage casserole but frankfurter or chipolatas in a packaged sweet and sour sauce with tinned processed peas. As two of us were at the inspection we each sampled different choices. The only freshly cooked ingredient in each was the boiled potatoes and the meals weren’t tasty or nutritious. We checked the previous menus and found that sausages in a sweet and sour sauce had been on the menu (but this wasn’t what should have been cooked that day). We also saw in one person’s records that this was a dish s/he liked. However, people with dementia should be entitled to expect tasty and nutritious meals using freshly cooked ingredients. We discussed all the above with the manager who said that fresh ingredients are used wherever possible. However from our experience at this visit we weren’t able to check if fresh ingredients are used regularly enough. This will be followed up at the next visit. At present staff change over their shifts at 1pm. This happens in the middle of peoples mealtime. It particularly affects people being helped with eating as one staff member helps with their first course yet another takes over to help with dessert. Further, it could affect other people who see one group of staff completely change into another group. From our observations there was very little handover in the dining room, which could further affect the meeting of peoples needs. We discussed this with the manager and deputy manager. The deputy manager said she had been thinking about ways of dealing with the situation and the manager said he and the deputy would work together to improve matters at lunchtime for the benefit of people living at the home. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 17 Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory management of complaints makes sure peoples concerns will be dealt with properly and in good time. Improved arrangements for protecting people from harm makes sure that they are protected as far as possible. EVIDENCE: Two complaints had been received since the last inspection. These were about the changes made to the home and an admission to hospital. The team manager for the home had dealt with both and records were available to show actions taken. A copy of the complaints procedure was seen in the entrance hall. However this may not be fully accessible to people with dementia. Further, people with dementia may not be able to express their concerns verbally and staff need to be aware of behaviours that could show someone is not happy with their care. We asked staff ‘Do you know what to do if a person or their relative had concerns about the home?’ Staff said that they did although one commented: ‘But we are not told of the outcome which we think we should do’. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 19 We now receive more notifications from the home about incidents affecting people. Recent notifications were about challenging behaviour between people and these had been handled properly. Risk assessments are in place for people at risk of using behaviour that challenges others. Staff have had recent training in safeguarding adults from abuse and are aware of their responsibilities. A requirement made at the last inspection about not restraining people whilst they have healthcare treatments, was met. The manager said he had talked to the chiropodist and staff and made clear that peoples wishes about having treatment or not must be respected. No instances of restraining people were seen at this visit and people’s behaviour was relaxed. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People now benefit from living in a well maintained home that is accessible to them and meets their needs. Décor and furniture in individual bedrooms makes sure people are comfortable and have all they need. Good, proper cleaning and hygiene makes sure people are protected from risk of infection as far as possible. However, where odours are noticed action should be taken to remove them. EVIDENCE: We did a thorough inspection of the premises and made the following observations: Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 21 The corridors have been re-decorated in line with consultation from Dementia Voice – an organisation that specialises in giving advice about improving the environment for people with dementia. This advice has helped with improving the way people find their way around and use the home. This was also a requirement made at the last visit that is now met. A further requirement made at the last visit about making individual bedrooms accessible to people was also met. Each bedroom now has different photographs e.g. of people when they were younger or family photos (including pets) and/or pictures of their hobbies or interests on the doors. This helps people to find their own rooms more easily. They also give a snapshot of the person as a unique individual with a life history. The pictures have the added benefit of stopping people from going into others’ rooms (that was the reason staff kept them locked before). We followed up an additional requirement made at the random inspection in September ’08. This was to make sure each bedroom has a lockable space in which valuables or medication can be kept. At this visit we saw medicines such as eyedrops or prescribed creams and lotions left out in peoples rooms. The assistant manager said they were kept on top of a light over the vanity unit in each room but people could still get them and be at risk from them. We later spoke to another assistant manager who said the new cabinets had just been delivered and were being put into rooms. A delivery order was sent to us to confirm purchase of the cabinets. Fifteen bedrooms were looked at. They were all found to be generally clean and personalised. A number of rooms have been redecorated in plain colours with no patterns (that could be difficult for people to see clearly or creates barriers for them). Some rooms are still in need of re-decoration and we understand that these have been identified by the management team and are part of an ongoing programme. People were observed having freedom to move around the home. They had access to their bedrooms at all times that now remain unlocked. One person likes to lock her bedroom and a member of staff said this is written in her care plan. Rummage boxes and a hat stand with different hats on have been put in corridors together with armchairs and new pictures. One person was seen wearing a hat and staff said she loves to wear a different one each day. This person was more chatty and engaged with objects and tasks than we had seen at the last two visits. Some of the new pictures are of film stars and singers from the fifties. They were being hung in corridors and all were at the right level for people to see them clearly. In other corridors colourful travel poster type pictures and modern art prints were seen. In the garden corridor armchairs and a sofa have replaced wooden chairs that make it a more comfortable place for people to sit and look at the garden. It was pleasing to see that doors to the garden that had previously been frosted over were now clear again so that people can see out. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 22 The majority of the community areas were accessible to people. One was in the process of being re-decorated. However the visitors’ room was again locked. Staff said that this was for safety reasons. We strongly recommend that alternative means be sought to keep people safe that doesn’t restrict their access to this room. During the two days of our visit decorators were repainting corridors. A carpet was also being replaced in the large lounge. This made the home smell strongly of paint and glue. However, people living at the home didn’t seem to be affected by the smell or the wet paint. We picked up a few maintenance issues such as: the flush in the visitors’ toilet needed fixing. Also, a radiator guard in one of the toilets needed replacing, as it was broken and could be a potential hazard. One room didn’t smell fresh and had an unpleasant odour. For the comfort of the person using it this needs to be improved. We spoke with the manager who said he would take action to find the cause of the odour. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-trained care staff are employed in adequate numbers to meet peoples’ needs. Failure to provide regular, essential training in food hygiene doesn’t make sure people are kept safe. EVIDENCE: We took the opportunity to speak with 6 staff that were on duty. They all spoke positively about the recent changes that have taken place. We looked at rotas and got comments from surveys we sent to staff before the visit. Staff were more positive since an extra staff member had been put on the rota to help in the mornings. They were also happier that they now have time to spend with people both doing activities and key time. Staff did however comment in surveys that: ‘Need more staff at lunch and tea times. At these times we are struggling with individual needs. Also need more for personal care in the morning as people need more support’. Relatives also commented: ‘I think the staffing ratio is not adequate especially on the morning shift to care for people 100 . Their needs such as quality time are not always met because of the lack of care assistants’ and: ‘more staff Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 24 would enable them to give more one to one time with residents. Also the opportunity to take residents out on short trips, or to spend time in the grounds in nice weather. This would really improve their quality of life’. However relatives also commented on the quality of staff contact with people: ‘The staff are very approachable. They are always ready to listen and help whenever asked’, ‘They are very kind and caring and obviously enjoy what they do. They often have fun with residents despite dealing with very demanding situations’ and: ‘In my visits to the home the care workers are always very good at their work, very helpful and jolly’. We found however, that whilst staff now spend much more time with people doing activities and more person-centred ways of working, essential tasks shouldn’t be forgotten or left. We had noticed a high level of interaction with people from staff that is commended. However, we also noticed that some rooms were left untidy with beds stripped and not made until late in the day, towels left on the floor and commodes not emptied. This is disrespectful to people and stops them from being able to use their rooms to relax in at any time. A balance has to be found between person-centred care and staff tasks. Both the manager and deputy manager said they would be looking at this further to make sure all areas of work are covered properly. A requirement made at the last visit about making sure staff have the right training to meet peoples needs, was met. Staff all confirmed they had recently received training about how to do activities with people with dementia and about person-centred care planning. This is a positive development and has helped staff to work with peoples individual needs and preferences. Staff training records we looked at showed evidence that: 22 staff received safeguarding adult training in October and November of this year, 30 staff have received person-centred care training since August of this year, and: 28 staff have had manual handling since 2007. Further, the trainer in personcentred care activities has visited the home and done in house sessions to help staff give more individual time for these activities. Staff said they found this helpful as the advice given i.e. to do activities in short bursts of ten minutes and to do more with individual people helps them plan their time and key work sessions better. From looking at staff training records only nine staff have had basic food hygiene training. Some staff have had effective recording training and we saw records of more dates booked for this in the New Year. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 25 Individual staff training profiles were not being kept up to date. It is recommended that the system for recording training be improved so that the management team can more clearly identify who needs training and when. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improved management particularly in the environment, staff training, supervision and health and safety, makes sure the home meets the needs of people living there and keeps them safe. Proper mechanisms for checking quality of care for people keep them safe and protected. People get consistent care from a staff team that have opportunities to regularly reflect on their working practices. Satisfactory management of health and safety in the home including telling us about any incidents, makes sure people are kept safe. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager Mick Sullivan and the deputy manager were both on duty over the two days of our visit. All staff we spoke with said they felt they worked well as a team and that they could approach the management team if they had any concerns. The team manager for the home also visited and was present for our feedback. Both the manager and team manager have taken on board all our concerns from the June ’08 visit and quickly put in place a programme of change. We saw evidence of this throughout the visit that is commented on above. From all of the evidence gained and our observations from this visit it’s clear that the home is now being run in the best interests of people living there. This is commended. Management staff were welcoming and open to the inspection process. The deputy manager told us she was ‘devastated’ at the previous inspection report but now said the changes ‘are so much better – it’s wonderful’ and she can see why they were necessary. She told us that she is very happy at the progress being made with both the environment, peoples responses to the changes and staff attitudes to them. She said she has lots of ideas to make it even better for both people living there and staff. We did however advise the manager about not making ‘knee-jerk’ reactions to requirements. From this we mean not responding immediately to requirements made without thinking them through clearly. Please see standards 27- 30 above). We had previously been sent a copy of the home’s own independent survey (done in June ’08) that we commented on in the previous inspection report. As well as the yearly survey the team manager makes monthly visits to the home and sent us copies of her reports. The reports give information about people, their care needs, staffing, training needs, health and safety and budget monitoring. Therefore quality is being regularly checked. Staff confirmed that they get regular supervision and that they found this useful to talk about any worries they might have and about the welfare of people they care for. A requirement made at the last visit about supervision was met. We looked at five staff records in detail. These gave evidence that staff are getting supervision more regularly and that more detailed notes are being kept of these meetings. The deputy manager also supervises agency staff and records were seen of these also. The management team must therefore keep up this good practice to make sure that the good work and higher standards are being kept up. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 28 The kitchen was found to be well maintained and clean. There were up to date records of fridge and freezer temperatures and of core temperatures of food as required by health and safety legislation. It was recommended that a note be made of the safe range of temperatures on the recording sheets. This would be of particular use to agency staff that may not be aware of the required standard. Kitchen staff weren’t wearing hats, nor was long hair tied back. In the interests of food hygiene they should make sure they do so. We saw a number of systems in place for re-cycling in the kitchen. This is good practice. Hoists and fire extinguishers have been serviced at regular intervals. A hand test of hot water indicated that temperatures are kept to within safe levels. Fire safety records showed that staff get regular fire drills. We were able to witness this at the random inspection visit in September. The fire alarm had gone off just as we arrived and all staff congregated in the entrance hall quickly and calmly. The assistant manager took proper action to find the source of the alarm, contacted the fire service and gave clear instructions for staff to follow. People were reassured and the event was over in 20 minutes. A fire service officer confirmed there was no fire and told us the situation had been handled well. Records showed that night staff get regular fire safety training and do ‘walk-through’ drills (that simulate an actual fire drill). All health and safety records were kept regularly. Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 29 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 X X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X 3 X 2 Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 30 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 OP15 Regulation 16(2)(i) Requirement Main meals must be cooked using fresh ingredients wherever possible. This will make sure people with dementia get nutritious and tasty meals that they enjoy All care staff and kitchen staff must have regular training in essential food hygiene. This will make sure people are kept safe from infection. Timescale for action 31/01/09 2 OP30 18(1)(c)(i) 31/03/09 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 OP4 Good Practice Recommendations All information including the regular newsletter should be made available to people in an accessible format that meets their need. Further, such information should make sure people are the main focus of the newsletter not staff. This will help people keep in touch with daily life at the home and treats them as important individuals in their own right. DS0000035878.V373478.R01.S.doc Version 5.2 Page 31 Greville 2. OP13 3. OP15 4. OP27 Religious needs or wishes of everyone living at the home should be researched and recorded. This will make sure they have the right of worship from a minister of their choice and any religious needs will be met. Information about the lunchtime choice of meal including all desserts should be made available to people each day before they eat. This will make sure people know what is on offer so that they can make the right choice for them. Ways should be found of maximising staff time so that household tasks are completed equally with more personcentred care and activities. This will make sure that people will get a good balance of care that meets all their needs. Kitchen staff should keep their hair tied back and wear appropriate clothing including protective headgear. This will make sure people will be kept free from infection. 5. OP38 Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greville DS0000035878.V373478.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!