Care Home: Greville House Care Home

What the care home does well People are generally happy living at the home. They liked the staff who support them and the environment. They feel they are well cared for. Visitors are made welcome and are valued. The staff have access to a good range of relevant training which supports them to care for people. There is a specialised unit which supports people to recover and relearn skills and mobility following an accident, injury or stay in hospital. What has improved since the last inspection? The way in which people`s care needs are recorded and planned has improved. This means that the staff have better information about how to support people with their individual preferences and needs. The staff are more confident supporting people and spend more time in areas of the home where people are. The organisation has provided a high level of senior management support to help address and improve problems at the home. What the care home could do better: The home needs to make sure a permanent manager applies to be registered with the Care Quality Commission so that people live in a home which benefits from consistent and stable management. There needs to be improvements to the way in which people have their medication managed because they are at risk from poor recording and errors in administration. Some people are not receiving all the support they need to meet their personal and health care needs. People are not given the support they need to pursue individual activities and interests. They need to have clear, accurate information on planned activities so that they can make informed choices about what they do with their time. The manager needs to make sure all significant events are appropriately recorded and relevant parties are notified to evidence that people have been kept safe. The staff need to have regular supervision and support to make sure they are supporting people who live at the home appropriately. Key inspection report Care homes for older people Name: Address: Greville House Care Home Greville Road Richmond Surrey TW10 6HR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandy Patrick     Date: 2 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Greville House Care Home Greville Road Richmond Surrey TW10 6HR 02083342890 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.grevillehouse@careuk.com Care UK Community Partnerships Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Dementia Up to 25 of the residential care beds can be used for older people with mild dementia although this must not have a negative impact on the quality of life of other residents at the home. Intermediate Care A separate 12 bed unit on the first floor is used solely for Intermediate Care for Older People. Nursing Unit The second floor is solely used as a 22 bed nursing unit for older people. Date of last inspection Brief description of the care home Greville House was registered in October 2005 as a care home with nursing for up to fifty-nine people. The home has separated units for up to twenty-two people with nursing needs and for up to twelve people needing intermediate care. There are also Care Homes for Older People Page 4 of 32 Over 65 25 59 0 0 Brief description of the care home six bedrooms available for people to stay on a short term basis. The building is owned by the London Borough of Richmond and is leased to Care UK Partnership who manage and run the home. The home is located in Richmond, close to Richmond Park, local bus routes and a short drive away from Richmond town centre. The home is purpose built on three floors and all bedrooms have en suite facilities. Each floor has two lounges, a dining room, small kitchens, showers and bathrooms equipped with specialist baths. The intermediate care unit has its own facilities designed so that staff can support people living there to regain skills. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The majority of people are placed by the London Borough of Richmond. The weekly charges range from GBP887 - GBP997. Additional charges are made for hairdressing and any purchases from the homes shop. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included an unannounced visit to the home on 20th May 2010. The inspection team included two compliance inspectors and a specialist pharmacy inspector. We met with people who live at the home, their visitors, staff on duty, the acting manager, area manager and support manager. We spoke to people about the service and their experiences. We looked at the records used at the home, the environment and observed the care and practices of the home. We wrote to the manager and asked him to complete a quality self assessment. We wrote to people who live at the home, their representatives and staff and asked them to complete surveys about their experiences. We spoke to the local authority who have a contract with the home to provide the majority of beds for people funded by the borough. Care Homes for Older People Page 6 of 32 We looked at all the information we have received about the home since the last inspection including notifications of significant events. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 32 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information to help them decide whether they want to move to the home. They have their needs assessed to make sure the home is the right place for them. Evidence: The home has a welcome pack which includes information on the facilities, services, policies and procedures. People told us that they had a copy of this pack. People who are interested in moving to the home are able to visit and spend time there before they make the decision. People told us that they had the information they needed to help them decide if they wanted to move to Greville House. The manager or senior staff assess peoples needs before they move to the home. We saw copies of these assessments which were comprehensive and included information on their likes, dislikes and personal preferences. Care Homes for Older People Page 11 of 32 Evidence: We saw that people had their needs reviewed after living at the home for a few weeks to make sure they were happy and the home was meeting these needs. These reviews were recorded. There are some bedrooms at the home which are dedicated for people to stay on a temporary basis if they need to. There are appropriate procedures for making assessments for these places and a senior member of staff is allocated to manage their admission and discharge. Part of the home is set up as a rehabilitation unit. This is designed to support people to regain skills, mobility or confidence after an injury or stay in hospital. The unit has its own dedicated staff team who work closely with health professionals to support the people staying there. They have specialist equipment to help people with their mobility and domestic skills - such as making themselves hot drinks or meals. We met some of the people who were staying on the unit at the time of our inspection. They told us that they were happy there and that they had the support and care they needed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their personal and health care needs recorded and monitored. In general their needs are met but sometime people are not getting the support they need or this support has not been evidenced. People cannot be confident that all their medication needs are recorded in care plans and risk assessments. People cannot be confident that they will receive the medication that they have been prescribed. Evidence: People have their personal care and health needs recorded in their care plans. We saw that these were kept under review and were monitored. We saw that people had their wishes with regards to their care recorded. The way in which care plans are recorded has improved since our last inspection. Information is more clearly presented and there is a greater emphasis on recording the wishes and personal preferences of the people the plans are about. Records which showed when some people had their baths indicated that they did not Care Homes for Older People Page 13 of 32 Evidence: always get offered or receive regular baths. Some records indicated people only had baths once a month. Some records showed that people who were mobile had received bed baths. The staff should consider whether this is appropriate when people are able to get out of bed. Some people told us that they did not have regular baths and other people told us that they did not always like to have a bath. Where records indicated consistent refusal of baths, the staff should look at why this is and have a plan to help make a bath or shower more appealing to that person. Everyone is registered with a local GP and other health care professionals as needed. We saw evidence of regular consultation with these professionals and saw that their advice and guidance was included within care plans. We saw that there were records of accidents and incidents and the action taken following these to keep people safe. In most cases the persons care plan had been updated following the incident. However, there was no report of a recent incident where someone had hurt themselves. There was also no care plan to show staff how they would support this person to prevent recurrences of the injury. A member of staff told us that this person had caused the injury themselves. There were photographs showing the extent of the injury. The staff need to make sure all accidents and injuries are always appropriately recorded and that they follow a consistent plan whilst the injury is healing and to help keep the person safe in the future. We saw from staff communication records that some staff felt that they did not always have the time they needed to care for people and meet all their personal, health care and medication needs. Over the past three months there have been a large number of medication errors where some people have not received the correct medication to meet their needs. The organisation has been proactive in addressing these concerns and retraining and assessing staff ability to administer medication safely. However, problems have continued and some people are at risk from having their medication wrongly administered. The safe handling of medicines was assessed by a specialist pharmacist inspector and below is their report of their findings: We looked at medication storage, the medication records for people needing different levels of support with their medicines and at the medication supplies and care plans for a selection of these people. All medicines and medicine records, for medicines prescribed to be given regularly, had clear instructions on how and when medication was to be administered. Clear records were kept to show when people were given their medicines. If a medicine was not given this was clearly recorded together with Care Homes for Older People Page 14 of 32 Evidence: the reason why. Records of the administration of medicine are checked each day to ensure that all medicines have been given correctly. All medicines were stored correctly for the protection of people. When medicines are part of a course of treatment, they are not always being re-written onto the next medicines administration record chart, therefore there is a risk that these medicines will be omitted and people will not complete courses of treatment. One medicine had a dose that changes throughout the week, this was prescribed as directed and therefore the MAR chart did not have the complete instructions on how this medicine was to be administered. Some people were prescribed medicines to be given only when needed PRN. Of those people receiving nursing care two out of six people did not have PRN protocols available with the medication administration record describing to staff when these medicines are to be given, nor was the information available within their computerised care notes. Of those people who receive residential care four out of six people did not have PRN protocols available with the medication administration record (MAR) charts describing to staff when these medicines are to be given, one person also had PRN protocols for medicines that had been stopped by their GP. Within the rehabilitation unit none of the persons receiving medicines when needed had PRN protocols with their MAR charts. The lack of such information could result in these people not receiving their medicines when they need them. Senior members of staff were made aware of the requirement regarding PRN medication. People identified as being allergic to any medicines had this information recorded on their personal detail sheet and on their MAR charts. This should prevent people being given a medicine to which they are allergic. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to entertain visitors and live in a relaxed home with a pleasant atmosphere. They are treated with respect but sometimes feel their choices are not acted upon. People do not always have the opportunity to participate in social activities of their choice. Evidence: One person told us, I would like to have more one to one engagement with staff. Other people told us that sometimes they had nothing to do. Records about peoples individual interests and social needs varied. There was no record of this for some people and some records had not been reviewed or dated for several years. The records of activities people had participated in were limited, some people had no record of participating in activities. The staff need to make sure they find out about peoples individual interests and hobbies and create a plan of care which helps them pursue these interests. At the time of our inspection there was one part time activities coordinator employed at the home. They were not working on the day of our inspection and there were no planned activities, although there was one ad hoc activity provided by care staff. The Care Homes for Older People Page 16 of 32 Evidence: organisation was recruiting to the role of activities coordinator. We saw that the part time activities coordinator has organised some events and that staff provide some ad hoc activities which are popular with people who live there. However, some people who live at the home do not take part in regular activities. And some people told us that they would like to do more. We saw that the advertised plan of activities which was displayed in communal areas was not being followed. There are organised church services and a multi faith room at the home which people can use for private worship. We saw that in some areas of the home televisions were left on in communal areas, whether people were using the room or not. In one room we witnessed a member of staff changing the TV channel without consulting the people in that room. We saw that throughout the day staff were kind and respectful to people who live at the home. We saw them asking people about their wellbeing and offering them drinks. However, we also saw long periods of time where the staff in rooms did not really communicate with people. One person told us that the staff did not always communicate clearly with them. They said they felt they were not always listened to, stating, a nod does not always mean that what has been said has been heard and understood. In one area of the home people were taken to the dining room 50 minutes before their lunch was served. This was not following their request or an expressed choice. One person told us, the service at meal times is very slow and we have to wait a long time. We saw that some people were unable to leave the dining area. People in the room were not told how long it would be until they were served and were not provided with anything to do whilst they waited. In another area of the home one person in the lounge requested that they ate their meal there. The staff agreed to fetch their meal so they could do this. However, no member of staff returned to the room for over 10 minutes and the person attempted to stand up which they were not safe to do without support. The person was unable to get the attention of staff without support. The person may have been at risk of falling as the staff were not available to check on them. When a staff member was alerted they took the person to the dining room for their meal without asking them whether this was what they wanted. There are a number of notice boards throughout the home. These were being used to Care Homes for Older People Page 17 of 32 Evidence: display information for people who live at the home and information for staff, such as training dates. The staff have separate facilities such as a rest room and offices and information for them should be displayed in these. The notice boards in communal areas should be used to share information with people who live at the home and their visitors. Visitors are welcome at any time and we saw people visiting throughout the day. Visitors told us that they were generally well informed and were able to contribute to the care of loved ones if they wished. People who live at the home told us that they liked the food. We saw that the chef spoke to people about their enjoyment of the food and menus. We saw that menus were displayed on the dining tables and that pictures of the meals were displayed to help people have a clearer idea of their meals. There were two choices of main meal at lunch time on the day of our inspection. However, we saw that the meals served did not match the planned menu. The manager should consider how best to involve the people who live at the home in the general running of Greville House, such as planning activities, recruiting staff and monitoring the quality of the service. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to make a complaint and feel that these will be acted upon. procedures are in place to help protect people from harm. Evidence: People told us that they knew how to make a complaint if they were unhappy about anything. There is an appropriate complaints procedure and people have been given copies of this. We saw that records showed us how complaints had been investigated and what action was taken to remedy concerns. The organisation has its own procedures on abuse and whistle blowing. There are also copies of the local authority safeguarding procedures. The staff have had training in this area. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, appropriately decorated and homely environment. Evidence: People told us that they liked the building and garden. Everyone has their own bedroom with en suite WC and people have personalised their bedrooms. The building is well maintained and appropriately decorated and furnished. We saw that there are records of maintenance needs and that these were attended to promptly. The home was fresh and clean throughout on the day of our visit. We saw that bathrooms were appropriately equipped with soap, paper towels and anti bacterial gel. People told us that the home was always fresh and clean. People told us that they were happy with the laundry service. Care Homes for Older People Page 20 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are cared for by staff who are appropriately recruited and trained. Evidence: The majority of people we spoke to told us that they found the staff kind and supportive and that they met their needs. The staff told us that they had the training they needed to do their jobs and that they felt they worked well as a team. We looked at a sample of recruitment files for staff. We saw that these included appropriate checks and all the required information. One potential member of staff was being interviewed for a job on the day of the inspection. Staff recruitment does not include any input from people who live at the home and the organisation should consider how best to do this. We saw that there as information for staff to help them in their roles. This included guidance and clear plans of care about meeting peoples needs. There is an appropriate induction for new staff which includes training in key areas. Training records for staff showed continuous training opportunities in areas to help them better understand peoples needs and how to keep them safe. The staff on the nursing unit told us that they had additional information sessions with the nursing manager so that they could find out about specific health care issues. Care Homes for Older People Page 21 of 32 Evidence: There are systems for staff to communicate with each other, using books, a diary and handover. We saw that these were used regularly. However, one relative told us that information was not always communicated appropriately with staff between shifts and this had a detrimental impact on the care of people who live at the home. Care Homes for Older People Page 22 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People Evidence: The registered manager left the service in November 2006. Although the home has stable management for two years since then this person did not apply to be registered with the Care Quality Commission (previously Commission for Social Care Inspection). Since our last inspection there have been four different people managing the home. The organisation have provided additional support to help manage the service, including regular input from the area manager and support managers. However, there needs to be a stable and permanent manager and this person needs to make an application to be registered with the Commission. The organisation has recently recruited a business manager and nursing manager. We spoke to both these staff members. The business manager is responsible for recruiting staff and managing the records and administration of the service. She told us that she is undertaking an NVQ Level 4 in care management. The nursing manager is a Care Homes for Older People Page 23 of 32 Evidence: qualified nurse and is responsible for overseeing the nursing unit which accommodates up to 20 people who have nursing needs. The area manager told us that the organisation have recognised there are areas where improvements are needed. We saw that they have developed an action plan which addresses these. Since our inspection visit the area manager and acting manager have kept us informed about how they have dealt with concerns and the action they have taken to improve the service. We saw that the organisation has provided a high level of support to help manage the home at this time. The organisation needs to make sure the home receives appropriate levels of additional management support as long as this is needed. In the year preceding the inspection there have been a number of incidents and accidents which should have been reported to the Care Quality Commission but were not. The local authority have alerted the Commission to some of these. These include medication errors, some of which were serious and were referred to the local authority as safeguarding alerts. The organisation also failed to notify us when the manager left the service. The area manager told us that he recognised this had been a problem but believed that the situation was now resolved. However, in May 2010 the Commission received notification of a significant number of events which had occurred two months previous. Some of these incidents were not recorded at the time they happened and others were recorded but not reported to the Commission. It is important that the organisation makes sure they notify the Commission of all significant events as soon as possible after the event so that we can monitor how they have managed these events and decide whether further action is needed. We saw that the organisation contacted relatives of people who live at the home in February 2010 and asked them to complete quality satisfaction surveys. They have created a report of the feedback which includes areas people are happy with and areas where they would like to see changes or improvements. People who have a short stay at the home are asked to complete surveys about their experiences. The organisation told us that they use the feedback from these to make changes. The London Borough of Richmond have a contract for the majority of places at the home. As part of their contract monitoring they make quality inspection visits. They told us that they had some concerns about the home from their most recent visit. These included medication errors, poor reporting of incidents and accidents and lack of support for people with social activities. They create a report of their findings which they share with the home. Care Homes for Older People Page 24 of 32 Evidence: We saw that records of individual staff supervision meetings showed that these did not always happen regularly for all staff. The manager needs to make sure all staff have the opportunity for regular, planned, formal supervision meetings. There had not been a staff meeting at the home since March 2010. There have been a number of changes in management, procedure and a high number of medication errors since this time. The manager should consider holding more regular team meetings to make sure all staff have clear information and work in a consistent manner. They must make sure the staff have regular supervision so that they can have the information and direction they need to meet the needs of people who live at the home. We found that the majority of records at the home were up to date and accurate. However, some records were duplicated or information was confusing. The manager should make sure records are clear and information is easily accessible. Some records of incidents and accidents were not completed following these and were recorded later. People make their own private arrangements for managing their financial affairs. However, the home offers a service where they will keep small amounts of cash safe for every day purchases, such as newspapers, toiletries and hairdressing. We saw that there were appropriate systems to keep this safe and that records of money held on behalf of people were accurate and regularly checked and audited. Expenditure was recorded and receipts were available to evidence this. We saw evidence of regular checks on health and safety, including fire safety, water temperatures, gas and electrical safety. We saw that action had been taken following a recent fire risk assessment. We saw that there were regular recorded fire drills. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 The Registered Person must make sure people are support to pursue their individual interests and hobbies and that there is a record of these and events which are important to that person. 31/08/2009 2 31 8 The Registered Person must 31/07/2009 make sure the manager makes an application to register with the Care Quality Commission. Care Homes for Older People Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person must make sure all accidents, incidents and injuries are appropriately recorded and care plans are updated where necessary. Because people may be at risk if incidents and accidents are not properly recorded and action is not taken to keep them safe and prevent this reoccurring. 30/06/2010 2 9 13 The registered person must make sure all medicines are transferred from one MAR chart to the next. All medication is given at the correct dose and frequency to ensure that courses of medication are completed. Because people may be at risk if they do not receive the correct mediaction or dose. 30/06/2010 Care Homes for Older People Page 27 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 13 The registered person make 20/06/2010 sure the staff are given readily available clear instructions and guidance on when to administer medicines that are prescribed for people on an as required needed basis. So that people receive the medicines and treatments that they need when they need them. 4 10 12 The registered person must make sure people are offered regular baths or showers and that the staff consider each persons preferences to make sure they are happy with these. The registered person must make sure people are only offered bed baths if their is no alternative or this is their expressed wish. Because people should to be able to have enjoyable baths or showers at a time and in a style of their choosing as often as they want them. 09/07/2010 5 12 16 The registered person must make sure there is a plan of organised activities which are accurately advertised so that people can choose 09/07/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action whether they wish to participate in these. Because people need to have opportunities to participate in organised activities and to make an informed choice in advanced so they can plan how they spend their time. 6 12 16 The registered person must make sure peoples individual social needs and interests are recorded and that there is a plan of care which tells the staff how they can meet these needs. Because people may need to have support to pursue the individual interests. 7 14 13 The registered person must make sure people are not left unattended by staff unless it is safe for them to be left. Because people may be at risk if they do not have the support they need. 8 14 12 The registered person 30/06/2010 ensure people are supported to make choices and that the staff always listen to these and act on them unless a recorded risk assessment indicates that 30/06/2010 09/07/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action this should not happen. Information for people who live at the home needs to be clear and accurate so that they can make informed choices. Because people need to feel that their choices are valued and respected at all times. 9 31 8 The registered person must make sure a permanent manager applies to be registered with the Care Quality Commission. Because people may be at risk if they live in a home which does not have stable management from someone the Commission has registered as fit to do so. 10 32 37 The registered person must make sure all significant events are appropriately recorded and that notifications of these events are sent to the Care Quality Commission as soon as possible. Because people may be at risk and the Commission needs to know whether the organisation has taken appropriate action to make 30/06/2010 31/08/2010 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action sure people are safeguarded. 11 36 18 The registered person must make sure all staff have regular planned individual supervision meetings with their manager and that these are recorded. Because people may be at risk if the staff who are supporting them are not appropriately supervised. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 09/07/2010 1 14 The manager should consider how people who live at Greville House can be supported to participate and have greater involvement in the running of the home. The registered person should make sure staff communication is accurate, appropriate and lack of communication does not have a detrimental impact on people living at the home. The manager should consider holding more regular team meetings to gives the staff team support, direction and an opportunity to discuss a consistent approach to work. 2 27 3 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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