Care Home: Grosvenor Lodge

What the care home does well The atmosphere in the home was comfortable, homely and relaxed and staff were seen to be kind and caring towards people living in the home. Care planning systems ensure that social, personal and health care needs are identified and met. Residents spoken with said that staff are very good as were the meals. Wholesome, nutritious and well balanced meals are provided in addition to daily activities and outings. There is an open-house policy, which welcomes visitors at all reasonable times and there are systems to ensure complaints are handled well. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has a well maintained garden to the rear of the property and limited parking at the front. Most parts of the home are well maintained and both safety checks and quality monitoring systems ensure any shortfalls are identified and addressed. There is a comprehensive staff training programme and the manager provides good overall leadership whilst remaining aware of residents individual needs. What has improved since the last inspection? Systems are in place to ensure residents privacy and dignity are respected and nutritional intake is monitored as necessary. A quality monitoring system has been devised and implemented and the Registered Manager has the required qualification. What the care home could do better: Some minor shortfalls in respect of the environment and care planning systems were noted but as the Registered Manager and Registered Provider agreed to address the matters without delay no requirements were made. Key inspection report Care homes for older people Name: Address: Grosvenor Lodge 40 Old Shoreham Road Hove East Sussex BN3 6GA     The quality rating for this care home is:   two star good 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: Gwyneth Bryant     Date: 1 1 0 8 2 0 0 9 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 24 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Grosvenor Lodge 40 Old Shoreham Road Hove East Sussex BN3 6GA 01273739739 01273739450 grosvenor.lodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs M Holliday-Welch care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 31 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: Dementia - DE Date of last inspection Brief description of the care home Grosvenor Lodge is a privately owned residential home for up to thirty-one older people who have dementia. The homes provider also owns a further three registered homes for older people within the Sussex area with each home being a standalone business. The home is a large detached property situated in Hove on the main A270. It is located near to local amenities such as shops, cafes and bus routes into Brighton and Hove. The home is presented across four levels, basement, ground, first and second floor with access to the first floor and second floors via stairs or shaft lifts. Resident?s accommodation consists of twenty-seven single and two shared bedrooms, with all rooms providing en-suite facilities. Shared facilities include two lounges, dining room, Care Homes for Older People Page 4 of 24 31 Over 65 0 Brief description of the care home hairdressing room, conservatory and rear garden. The front garden is mainly paved to provide off road parking. The homes literature states that the home is committed to offer a highly professional care service for the elderly with a personal touch. The fees range from £464 to £520 a week depending on the room occupied. These fees include all services and facilities apart from hairdressing, chiropody and newspapers/magazines and toiletries, which are itemised separately on the monthly invoices or paid from residents monies held by the home. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Grosvenor Lodge will be referred to as residents. This was an unannounced inspection which began at 08:45 and ended at 14:35. The purpose of the inspection was to check compliance with key standards and other standards. There were thirty-one people in residence on the day of which one was in hospital. Five residents were spoken with in addition to discussions with the Registered Manager and the Registered Provider. The last key inspection was conducted on 28 September 2007 and an Annual Service Review carried out on 13 August 2008. A number of documents and records were viewed; including personnel files, medication charts and care plans. Twenty-one bedrooms were visited as were two communal bathrooms and communal lounge and dining areas. Five surveys from residents were Care Homes for Older People Page 6 of 24 received in addition to two from staff. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. Care Homes for Older People Page 7 of 24 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. 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 8 of 24 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 9 of 24 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 moving into the home benefit from an admission process that ensures their individual needs and wishes are assessed and identified as being able to be met prior to moving into the home. Evidence: Four pre admission records were viewed in conjunction with care plans. The assessments clearly identified all care needs and included the action the home will take to meet those needs. Information in the AQAA demonstrated that residents and their families are provided with information on the services provided prior to moving into Grosvenor Lodge. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning systems ensure that the health, medical and personal needs of those living in the home are identified and planned for in a consistent and comprehensive manner. Evidence: Four care plans were viewed and were found to clearly identify individual needs including action to demonstrate how those needs were to be met. Care planning documents also included information on meeting healthcare needs such as dental, hearing and eyesight checks and preferred leisure interests. Risk assessments had been carried out and they clearly identified the hazards and included sufficient detail for the management of risks. One survey completed by a relative was I can confirm the excellent care and attention by the Grosvenor Lodge team. Other comments in surveys included: * offers a lovely garden. * I cant find anything to complain about. * Its clean. * the garden is kept nice. * I have a place to smoke cigarettes. * I feel its like a social club. Throughout the site visit it was evident that staff are aware of the care needs of those Care Homes for Older People Page 11 of 24 Evidence: living in the home and of how to ensure their privacy and dignity is protected. Care plans include information on how the individual prefers their care to be delivered and any other personal information that promotes their confidence such as assisting with small tasks in the home. Daily notes were variable with some being informative and giving a good insight to each residents daily routines, some were more limited with comments such as washed and dressed and no problems. It is important that staff record their input to residents care both to recognise the work they do and to assist the review process. Staff handover notes were good and highlighted where residents needed additional care on a particular day. These notes also showed that residents were enabled to get up at night and sit in the communal areas and were given drinks and snacks as requested. Residents are weighed regularly and records included information on what action staff need to take when weight loss is noted. Medication records and storage arrangements were viewed and systems are effective. Medication administration charts were up to date, accurate and clear. Only staff who have been trained administer medication. All medication is stored in a locked cupboard to ensure unauthorised persons cannot access it. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals. Evidence: The home has developed a daily activity programme and it was good to note that it is flexible with some activities being provided during the afternoon and others in the early evening. One resident said they visit a relative each week and staff accompany her on the journey. This resident also said they enjoy watching films in their room and that they have invited other residents to join her. Activities provided within the home include musical entertainers, board/ball games and sing-a-long. Discussion with the Manager found that staff often spend time with residents, either chatting or reading the newspaper to them. This is not recorded but should be as its important to reflect staff input and demonstrate the one-to-one activities. The home also has four house parties each year, to which friends and relatives of residents are invited. One staff survey included the comment that the home could have more outings for clients. Menus were viewed and found to be well balanced and nutritious and choices are offered at each meal time. It was good to note that at the start of the visit one resident was given a fortified drink and was left to sip at it at their leisure, whilst sitting in an armchair. The lunchtime meal was attractively presented and it was Care Homes for Older People Page 13 of 24 Evidence: clearly enjoyed by residents. Residents spoken with all said that the meals were very good and that they could have a choice. Fresh vegetables are used and there was a good selection of them in the food stores. Responses in surveys all said that the food was good. Throughout the site visit staff were seen to treat residents with care and respect, giving gentle encouragement when necessary. There is an open house visiting policy allowing visitors to visit at all reasonable times. Residents are offered a key to their rooms to ensure they can maintain their privacy. One resident spoken with confirmed that they have a key to their room. Care Homes for Older People Page 14 of 24 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. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: Information in the AQAA indicated that there are detailed policies and procedures on both complaints and Safeguarding Adults. The complaints log was viewed and the home has not received any complaints since the last inspection in 2007. All staff have received appropriate training in Safeguarding Adults so are aware of the procedure in the event of an allegation. There is an on-going staff training programme to ensure all staff remain up to date on the latest guidance. The Registered Manager is aware of the Mental Capacity Act and the accompanying Deprivation of Liberty Safeguards. She has ensured that the one person who needs an advocate under the Mental Health Act has access to one. Care Homes for Older People Page 15 of 24 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. The standard of decor and maintenance within the home is satisfactory, providing people living in the home a safe, homely and comfortable environment. Evidence: Twenty-one bedrooms were visited as were two communal bathrooms and the communal lounge and dining areas. The ground floor has two lounges, dining area, large hallway, with seating, a hairdressing room and large conservatory. The conservatory overlooks an attractive and secure garden to the rear of the property. The various communal areas facilitate the provision of activities whilst leaving areas for residents to sit quietly or watch television. The communal bathrooms all had an assisted bath installed ensuring that all residents can be bathed regardless of mobility problems. Residents rooms were attractively decorated and it was evident that many had taken the opportunity to personalise their rooms with pictures and ornaments. All bedrooms have washable flooring and discussion with the Manager and Registered Provider found that this was usual practice in the home but agreed to review the policy and provide carpeting for those residents who would prefer it. The Registered Provider said there is a plan to lay laminated flooring in all bedrooms as part of the maintenance programme. Not all bedroom had lidded bins for the disposal of gloves and aprons. Discussion with the Manager found that some residents use bins inappropriately but agreed to review the matter to ensure used gloves and aprons can be disposed of in Care Homes for Older People Page 16 of 24 Evidence: line with good infection control practices. Not all bedrooms had bedside lamps and this was discussed with the Manager and Registered Provider as most falls in the home occur at night. They agreed to explore the options of fitting over bed lamps or battery operated lights. The Registered Provider also agreed to explore the use of pressure mats so staff are quickly alerted when residents get out of bed. Laundry facilities are clean and hygienic. Staff were seen to be wearing gloves and aprons in communal areas but the Manager found that it was prior to delivering personal care so there was no risk to residents. Currently staff are made aware of infection control from the homes policies and procedures and good practice is that all staff receive formal infection control training. The Manager agreed to ensure this is booked as soon as possible. Care Homes for Older People Page 17 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are ample staff with appropriate skills to meet the needs of those people living in the home and the recruitment practice is sufficiently robust to safeguard those living in the home Evidence: The home provides excellent staffing levels with five care staff on duty from 7am to 9 pm and three night waking staff. Staff were seen to be working unhurriedly and able to spend time with residents. In addition to care staff domestics, a laundry assistant and two cooks are also employed, therefore staff do not have spend care time on domestic tasks. Comments in staff surveys included: * staff are very well trained. * there is always plenty of staff on each shift so we have time for clients and dont have to rush. * the home is very good at putting the needs of the resident first and welcome the input of relatives. Of the nineteen care staff fourteen have achieved at least National Vocational Qualification at level 2, therefore the home exceeds the required 50 of care staff with the qualification. The home also employs two bank staff which reduces the need for agency staff and ensures that residents are cared for from staff they know. Recruitment records for the last three people to be employed were viewed and all had Care Homes for Older People Page 18 of 24 Evidence: provided the required documentation of a POVA first check, Criminal Records Bureau check and two written references. All had a full induction period and provided evidence of their qualifications. Residents spoken with all said that the staff were very good, kind and caring. There is a robust and comprehensive staff training programme and while it is good to provide regular training for staff, updates may not be necessary when staff are already following good practice. This was discussed with the Manager who agreed to review staff training to ensure unnecessary training was reduced and more training in other areas such as infection control. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and staff benefit from clear leadership and direction and all aspects of their health, safety and welfare are protected and promoted. Evidence: The Registered Manager has the required experience, skills and qualifications to effectively manage the home. Although she takes responsibility for the running of the home she also has detailed knowledge of each resident. Throughout the site visit it was evident that both residents and staff are comfortable in approaching her with any concerns which indicates and open and approachable management style. Small amounts of money are held for people living in the home and all transactions are recorded and receipts provided as necessary. Each resident is provided with a lockable cash box which then locked in the safe and only designated staff have access to the keys. One comment from a staff survey was - we can always speak to the manager if we have any problems or concerns. Although staff meetings are irregular due to the difficulty of arranging for all staff to Care Homes for Older People Page 20 of 24 Evidence: attend, the staff handover give staff a good opportunity to raise any issues. In addition all staff have regular one-to-one formal supervision and an annual appraisal. Information in the AQAA showed that regular safety checks are carried out on all equipment, electrical and gas appliances and systems. Accident records were viewed and it was found that they are appropriately maintained in accordance with health and safety guidance. The Manager said she regularly reviews these records in order identify potential hazards and as part of the quality monitoring system. As part of the quality monitoring process all policies and procedures are regularly updated and the Manager undertakes training to update her skills and knowledge. All staff have been trained in fire safety and a fire safety risk assessment has been carried out for all parts of the premises. These systems ensure the safety of people living in the home in the event of fire. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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 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 Care Homes for Older People Page 23 of 24 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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