Care Home: Grosvenor Court

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What the care home does well What has improved since the last inspection? Some furniture has been replaced and some decoration has taken place. The process of changing people`s care plans to the CareTech format has begun. What the care home could do better: CARE HOME ADULTS 18-65 Grosvenor Court 15 Julian Road Folkestone Kent CT19 5HP Lead Inspector Christine Lawrence Unannounced Inspection 18 August 2008 10:00 Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 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 Grosvenor Court DS0000023425.V369161.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 Adults 18-65. 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. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor Court Address 15 Julian Road Folkestone Kent CT19 5HP 01303 221480 01303 221481 grosvenorcourt@counticare.co.uk 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) Counticare Ltd Mrs Christine Weathered Care Home 17 Category(ies) of Learning disability (0) registration, with number of places Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users who can be accommodated is 17. 26 October 2006 Date of last inspection Brief Description of the Service: Grosvenor Court is a care home providing residential care for up to 17 people with a learning disability. The home is a detached property made up of an original house which has been extended and linked to form the current accommodation. The grounds include a private walled garden and a parking area. The property is located in a quiet residential area in Folkestone and is within easy reach of facilities such as health centres, shops, recreational facilities, and the companys day centre. Counticare is part of a larger organisation called CareTech. Information about the home will be provided on request to them, including more detailed information about the fees and what they include. The fees are currently £850 to £1600 per week and this is dependant on assessed needs. Grosvenor Court DS0000023425.V369161.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 star. This means the people who use this service experience good quality outcomes. The inspection visit was notified to the home a few days before to ensure that there would be someone available; it started at 10.30 and finished at 15.00. We (the Commission for Social Care Inspection, CSCI) looked at various records in the home and also used information sent to us by the manager before the visit. This was the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection was also referred to as well as the Annual Service Review. We observed the residents who live at the home, noting how they reacted to staff and how relaxed and comfortable they were within the home. A tour of the building was undertaken and this included some residents’ rooms. We made observations of staff interacting with, and supporting residents. We spoke to staff on duty. We also used information contained in staff surveys completed prior to this inspection. The deputy manager assisted the inspection process. What the service does well: What has improved since the last inspection? What they could do better: There are no formal requirements from this inspection but the manager has identified that some improvements need to take place with regard to the décor and the garden which we agree with. She also plans to complete the Caretech service user plan system for all residents; to complete the communication system for each person and to obtain further training for the staff team in all forms of communication. The policies and procedures in place at the home need to be reviewed to ensure they are all up to date and relevant. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 6 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. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents’ individual aspirations and needs will be assessed. EVIDENCE: We looked at records for three people who live in the home. The company’s placement team visits any prospective resident first and an assessment is carried out. This initial assessment is given to the manager of the home who will judge whether she feels that the home can meet the identified needs. If so then the manager will visit to carry out a more in depth assessment, which might also include other staff visiting and the prospective resident visiting the home. Information would be gathered from the placing authority and from any current placement or family members. The manager stated that wishes as well as needs are identified. The information from the initial assessments plus assessments of time spent visiting the home is used to compile a care plan. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their changing needs will be noted in their individual plans and that they will be supported to make decisions and take risks to enable as independent a lifestyle as possible. EVIDENCE: We looked at three individual records. As noted previously the care plans are based on assessments. The plans were individual and reflected a ‘person centred’ approach and include sections called ‘How I want staff to assist me’ and ‘How I don’t want staff to treat me’. The home is in the process of changing all care plans over to the format provided by CareTech. Care plans are reviewed monthly to ensure that support needs are monitored and a member of staff spoken to during this inspection said that things would be changed sooner if necessary. Communication varies from individual to individual and this is something that the staff team are working on to ensure that communication needs are identified and responded to. We saw examples noted in care plans of Makaton, reference pictures and clear guidelines about Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 10 how individuals make their wishes known, especially if they have no speech. Our observation of staff on duty showed that these guidelines are used in everyday activities. Each person will eventually have a ‘communication profile’ and one of those seen for this inspection was clear and detailed and related to feelings as well as needs. The care plans contain lots of information to help staff enable residents to make choices about things like food, clothes and activities. Risk assessments were in place for various aspects of people’s lives such as managing finances and using the home’s vehicle. These assessments noted actions to take to reduce risk rather than saying that people can’t do a particular thing. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Activities and involvement in the local community, as well as support for personal relationships will be provided for residents. They will benefit from having a healthy diet. EVIDENCE: We looked at care plans and daily records, as well as the records of ‘talk time’ (individual time with a keyworker). These showed that the people who live at Grosvenor Court have opportunities to enjoy different activities both in the house and outside in the community. Some people use the company’s own day centre in Folkestone and there were also examples of going out for walks, bus rides and rides in the company vehicle, bowling and using a computer. One person keeps fish. Staff try to do make-up and hair/nail sessions for those who enjoy that kind of activity and there are games appropriate for different abilities in the home. Residents go to local shops as well as larger supermarkets and town centre shopping. The care planning process includes Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 12 setting short term goals that people want to achieve and examples included arranging a holiday and buying new clothes. These goals are written down with details of who will support the individual to achieve them and allowing for how things have progressed to be recorded. Staff spoken to, as well as completing surveys felt that they could make more use of the garden if it was improved. We noted examples of residents being supported to maintain their relationships with family and friends. There are no restrictions on visiting the home and some residents go to stay with family members on a regular basis. Staff endeavour to create an atmosphere where people can be as independent as possible but still have a sense of responsibility for things in the house. The care plans seen did identify ‘household chores’ but this can be quite limiting due to individuals’ abilities. Staff comments at the time of the inspection or through the completed surveys showed that they felt that when all the care plans were completed in the new format, there would be more focus on building on the knowledge about what people wanted and needed and how their daily lives could be improved in terms of personal development. One person also said that it was essential that what is written down is acted on by all staff. Information about likes and dislikes regarding food is noted. We observed that special equipment was available to assist residents to be as independent as possible with eating such as plate guards and special utensils. Care plans contained guidance for staff about the level of support people needed eg can feed self but needs food cut into small pieces. There were examples of specialist needs relating to nutrition ie diabetes, using a percutaneous endoscopic gastrostomy (PEG) feeding tube and individuals’ records contained clear guidelines. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s policies and procedures regarding medication and their physical and emotional needs will be responded to. Their preferences and requirements for support are respected. EVIDENCE: Care plans contain information about how to support people appropriately. These support requirements are written from the point of view of the resident. Staff said that wherever possible this is based on preference but sometimes it is about observing how an individual responds. Staff also confirmed that dignity and privacy are an important part of providing care at Grosvenor Court. Through the AQAA the manager stated that privacy and dignity are discussed within the induction process. There are male and female staff working at the home so same gender care can be provided. Residents were individual in their appearance, reflecting their different personalities. The records seen for this inspection showed that residents’ health care needs are identified and responded to. There was evidence of various health care professionals being involved such as dentist, chiropodist, GP, learning disability community nurses, speech and language therapists etc. The manager informed us that she has Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 14 received training regarding replacing PEG feeding tubes to allow this to happen at home rather than hospital. The records seen also showed that residents’ weight is monitored. We saw examples of pressure relieving equipment being used where required. There are guidelines in place regarding unplanned hospital admissions. Medication storage and record keeping was satisfactory and staff who administer medication have received training. There were particular special guidelines in place for some individuals about their medication all of which indicated the support of the GP. Some staff have received training through the speech and language team regarding how to support people when seeing their GP and the manager has identified that this would be useful for other staff to attend. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ views are listened to or ascertained, and acted on. There are systems in place to protect residents from abuse. EVIDENCE: A copy of the complaints procedure is on display in the entrance to the home. Complaints are noted and dealt with according to the procedures of the provider although the policy needs to be reviewed to ensure it is up to date. A new format has been introduced for residents. Residents have regular one to one times with their keyworkers when any concerns can be talked about. The manager informed us that all staff have received training with regard to adult protection. Some of the policies relating to this need to be reviewed and updated if necessary. Staff have also received training regarding the Mental Capacity Act and more is planned. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some communal areas of the home are in need of improvement to ensure a more pleasant atmosphere for the people living there. The home was clean and fresh. EVIDENCE: Although the individual rooms seen for this visit were personalised, bright and well maintained, some of the communal areas and hallways were unattractive and in need of brightening up and making more inviting and home like. The manager indicated that there are plans to do this and at the time of the inspection staff said there was money now available for purchasing soft furnishings etc. The home is in a good position in terms of local facilities and it is in keeping with the local community. Access for those who use wheelchairs is satisfactory with lifts to all but three of the home’s bedrooms. There is a problem with accessing the garden but we were informed that this is being Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 17 dealt with. The laundry was satisfactory and the house was clean and fresh at the time of the inspection. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sound recruitment procedures and training already provided and training planned, will have a beneficial impact on residents. EVIDENCE: We observed staff to be responsive and interested in residents during this visit. Seven of the staff have national vocational qualifications in care at level 2 or above and two people are currently undertaking this qualification. Staffing levels appeared to be satisfactory although two staff members who completed surveys expressed the opinion that sometimes levels were not sufficient. The manager also identified that there had been some shortages in the past twelve months. The service is currently seeking funding for one to one staffing for some of the people living there. We looked at the records of three members of staff and they showed that there is a satisfactory recruitment procedure in place. This includes application forms (which identify any gaps in employment), references, criminal record bureau checks and terms and conditions of employment. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 19 There are training opportunities for staff and a programme of training is in place. The Skills for Care induction format – Common Induction Standards is incorporated into the provider’s own format. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home and their health and safety is promoted and protected. EVIDENCE: The manager is registered and qualified. She is a registered nurse and has completed her NVQ level 4 as well as a City and Guilds Advanced Management in Care qualification. She informed us that she also attends training courses regularly to ensure she is up to date with current knowledge. The provider carries out monthly visits as required by the regulations. There are also regular audits carried out by the provider’s own quality assurance team. There are residents’ meetings for those who wish to attend and these are minuted and the minutes displayed. There are policies and procedures in place for a Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 21 variety of things including health and safety (see below) but some of these need to be reviewed to ensure that they are all up to date and relevant. A spot check was made on maintenance and service contracts and they reflected the details given in the AQAA. There is a staff training programme relating to health and safety and various policies and procedures in place although some of these have not been reviewed since 2006. Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Grosvenor Court DS0000023425.V369161.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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