Care Home: Grove House - City of York Council

What the care home does well People are properly assessed before they are admitted. This helps to make sure that Grove House is the right place for them and that it will meet their needs. People are involved in the assessment wherever possible. People are satisfied with the care that they get. They say staff are kind, and that they treat them with respect. People are encouraged to remain independent. Staff are available in sufficient numbers to make sure people get their care when they want it. People can exercise choice in their daily lives. They can choose rising and retiring times, can have their visitors when they want, and can choose from a range of home cooked meals which they say they enjoy. People know they can complain, and they are confident that their concerns would be listened to and acted upon. The environment is clean and warm, and provides people with a range of communal rooms where they can sit with others. There are gardens which people can enjoy. The acting manager is very enthusiastic, and has a clear action plan which she is communicating with staff about, to move the home forward in the best interests of those who live there. What has improved since the last inspection? There were no requirements made at the last key inspection. There were however a number of recommendations made, and action has been taken to meet the following: Staff now write in people`s records every day, so there is a better account of how they have spent their time, and what support they have received. The right dosage of medication given to people was recorded in the controlled medication register. This means the records were kept properly up to date, to show what staff had administered to people. The medication fridge temperature is now checked daily. This helps to make sure that medication which needs to be kept cold is stored at the right temperature. The bathroom areas were clean and tidy, and there was no accumulation of dust. This makes the areas more pleasant and hygienic. What the care home could do better: Priority could be given to completing and updating people`s risk assessments, so these assessments give a true reflection of current areas of risk to each individual. This will help to maintain safe and consistent care. To keep people safe from avoidable risk, some improvements could be made to the way medication is recorded, audited and handled. So they can be sure they are monitoring practice properly and safely, staff could have some extra training where they undertake additional medication responsibilities, such as observing people who inject their own medication. People could be asked about whether they would like regular religious services to take place at Grove House, to assist in meeting their spiritual needs. Menus could be provided on each dining table, so people can be reminded about what meal they have ordered, and look forward to their meal in advance. Prospective staff could be asked questions about their previous employment history in their interview, where there are gaps seen on their application form, to check these gaps do not make them an unsuitable person to work with vulnerable people. As part of the staff training plan, priority could be given to the provision of specialist training which will help staff to understand more about the needs of specific individuals living at Grove House. Checks could be made to make sure that action has been taken with regard to shortfalls identified in the fixed wiring certificate. This is to make sure any remedial action has been taken to keep people safe. People, their relatives and visiting professionals could be surveyed, so the home can be certain that it is running in people`s best interests, and that changes there are made in response to their views and wishes. The hot water temperatures could be adjusted so they are sufficiently hot to make sure people can bathe at a comfortable temperature. Kitchen records could always be dated so that they are easy to audit when checking that food has been stored and served at safe temperatures, to reduce the risk to people from food poisoning. It could be made clearer to staff who is the nominated first aider on any shift, so they always know who they should go to in an emergency requiring first aid attention. Key inspection report Care homes for older people Name: Address: Grove House - City of York Council Grove House 40-48 Penleys Grove Street York North Yorkshire YO31 7PN     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: Anne Prankitt     Date: 0 9 1 2 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 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) 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 32 Information about the care home Name of care home: Address: Grove House - City of York Council Grove House 40-48 Penleys Grove Street York North Yorkshire YO31 7PN 01904628250 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ephgrovehouse@york.gov.uk www.york.gov.uk City of York Council care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: All Service Users for Intermediate Care (up to a maximum of 11) will be accommodated within Intermediate Care Unit and be in the category OP. Date of last inspection Brief description of the care home Grove House is a care home run by City of York Council. It is registered to provide personal care for up to thirty three older people of either gender, some of whom may need high dependency care. Grove House was purpose-built approximately 40 years ago and is located within one mile of the centre of York. The accommodation is provided in single rooms on two floors. The upper floors are accessible via passenger lift. There is an enclosed rear garden. The acting manager told us on the day of the site visit that the current weekly fees are £464. People pay extra for private chiropody, hairdressing, newspapers, magazines Care Homes for Older People Page 4 of 32 Over 65 33 0 2 3 1 2 2 0 0 8 Brief description of the care home and toiletries. The service provides an information booklet about the home to people thinking of moving there. The statement of purpose and service user guide is available to people as well, as is the most recent inspection report, completed by our predecessor, the Commission for Social Care Inspection. 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 key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an AQAA (Annual Quality Assurance Assessment). This assessment told us how the acting manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. A site visit to the home carried out by one inspector over approximately eight hours on 9 December 2009. During the visit to the home, several people who live there, a visitor, some staff and the acting manager were spoken with. Three peoples care plans were looked at in Care Homes for Older People Page 6 of 32 detail, and others in less detail where we wanted to see specific information. We also looked at two staff recruitment files, some training records, and some health and safety files. Care practices were observed, where appropriate. We also spent some time watching the general activity to get an idea about what it is like to live at Grove House. The acting deputy manager was available throughout the day, and both he and the acting manager were available at the end when we gave feedback. 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: Priority could be given to completing and updating peoples risk assessments, so these assessments give a true reflection of current areas of risk to each individual. This will help to maintain safe and consistent care. To keep people safe from avoidable risk, some improvements could be made to the way medication is recorded, audited and handled. So they can be sure they are monitoring practice properly and safely, staff could have some extra training where they undertake additional medication responsibilities, such as observing people who Care Homes for Older People Page 8 of 32 inject their own medication. People could be asked about whether they would like regular religious services to take place at Grove House, to assist in meeting their spiritual needs. Menus could be provided on each dining table, so people can be reminded about what meal they have ordered, and look forward to their meal in advance. Prospective staff could be asked questions about their previous employment history in their interview, where there are gaps seen on their application form, to check these gaps do not make them an unsuitable person to work with vulnerable people. As part of the staff training plan, priority could be given to the provision of specialist training which will help staff to understand more about the needs of specific individuals living at Grove House. Checks could be made to make sure that action has been taken with regard to shortfalls identified in the fixed wiring certificate. This is to make sure any remedial action has been taken to keep people safe. People, their relatives and visiting professionals could be surveyed, so the home can be certain that it is running in peoples best interests, and that changes there are made in response to their views and wishes. The hot water temperatures could be adjusted so they are sufficiently hot to make sure people can bathe at a comfortable temperature. Kitchen records could always be dated so that they are easy to audit when checking that food has been stored and served at safe temperatures, to reduce the risk to people from food poisoning. It could be made clearer to staff who is the nominated first aider on any shift, so they always know who they should go to in an emergency requiring first aid attention. 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 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 are properly assessed before they are admitted to make sure their needs can be met. Evidence: There have been no recent admissions to the home. So we looked at some records belonging to people admitted since the last key inspection. These showed that the home collects good information about the person from various sources, such as their care manager and the hospital, before a decision is made about whether their needs can be met by Grove House. The acting manager explained that people themselves are involved in this process wherever possible. We were told that people get a copy of the service users guide before they move in. This gives them written information they can read at their leisure about what the home does, and how. People are also invited to look round the home to meet others living there, and staff who may care for them in the future. This is Care Homes for Older People Page 11 of 32 Evidence: good, because it keeps people involved in important decisions made about them, and gives them the opportunity to decide themselves whether Grove House is somewhere they may like to live. We spoke to a member of the care staff who said they get sufficient information about the person to understand what sort of care they will need when they arrive. This helps them to give the right care and support from the offset. The home does not provide intermediate care. But it can provide short term care, called respite care, where people are admitted for a short period. We spoke to one person who said they liked coming to Grove House, to give themselves and their family a break. 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 are satisfied with their care. Improving the care plans, and making some changes to the way peoples medication is managed, will ensure this care is always consistent and safe. Evidence: People spoken with said they were happy with the care they receive at Grove House. They said staff understand their needs, that they do not have to wait too long if they need help, and that staff treat them with respect, and uphold their right to privacy. This attitude helps to promote peoples independence, and maintain their well being. One person said Im happy here. Im pleased I decided to come. I can have my independence. This person said that staff understand their need for privacy. Another said Its nice here - the staff are nice. A further person commented on how respectful the staff are. We looked at some care plans, and met with the people to whom they belonged. The care plans currently in use do not explain in enough detail how people are to be supported, so that their personal needs, wishes and aspirations are understood and Care Homes for Older People Page 13 of 32 Evidence: met. One person, admitted for some time, did not have a plan at all completed by the staff at Grove House, who were following one completed by the home where the person previously lived. Those plans seen had not been reviewed for some time, and there was little evidence that they had been developed with the person to whom they belonged. The acting manager was already very aware that work is needed so that the plans reflect the care people are getting, and has a plan in place to make sure that these are improved. We looked at one care plan where this work had already started. This was better than others written previously. The staff spoken with were keen and enthusiastic about completing this work. This is a big task, which will take some time and effort to complete, if people themselves are to be involved. We advised staff therefore to firstly complete and update everyones risk assessments, some of which have not been reviewed for some time. This will make sure that any current risks to people are fully recognised and acted upon, and the care they receive is consistent and safe. It will also ensure that other professionals are involved and the right support obtained where the assessment identifies that further advice is needed. For instance, in the case of pressure area care, possible weight loss, falls, moving and handling, and where people are particularly vulnerable because of their psychological condition. We spoke to a staff member about how useful they found the care plans, They said they read them when they can, but told us they get a good verbal account of peoples needs when they start duty on a morning. They said though that evening handovers are shorter, and could be more detailed. This was discussed with the deputy manager following the site visit, who intends to speak to the staff. Staff currently look after everyones medication. They have completed training so they know how to do this safely, and are currently having an update to refresh their skills. The medication was kept safely locked away. Staff had signed peoples records to show when their prescribed medication had been given, and when any medication had been returned to the pharmacy for disposal. We spoke to one person who confirmed they always get their medication on time, so they do not suffer any unnecessary pain. We discussed the following areas where improvements are needed: Staff check and sign peoples medication sheets when new medication arrives, and when a new medication sheet is started. However, where this medication is received in boxes, the stock balance was not carried over onto the new sheet. This makes it Care Homes for Older People Page 14 of 32 Evidence: difficult for staff to audit this medication to check that it has been given in the right quantity. It also increases the risk of over ordering. Staff had used correction fluid when they had made a mistake on a persons medication records. This should not be used. Where people have medication prescribed which they inject themselves, staff observe to make sure this is done correctly. However, staff have not received any formal training to assist them with this task, and there was no risk assessment completed for the people concerned to check that they are willing and able to continue to self administer this. The trolley was left unlocked in the dining area, and was left unattended by the staff member completing the medication round for some time. We were told that another staff member had been asked to stay with the trolley until they returned. However, this staff member had needed to assist someone, so had been unable to remain next to the trolley. This is not safe practice. The trolley must remain locked when not attended. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can maintain important links with family and friends, and enjoy home cooked food. Plans to improve the activities should provide more social opportunities for people. Evidence: The atmosphere on the day we visited was lively, and people and staff interacted well with each other. A relative said its always the same whenever they visit. They said staff are always in and out, and very pleasant. There is no set daily activities programme at the home, and there is no full time activities organiser. However, there is an Arts and Craft session each week, and one person has produced some wonderful art work, which they take great pleasure in. Other peoples work was displayed in the dining room. More informal activities go on, as part of normal daily living. For instance, while we visited, we saw some people go out to the shops, or to get some fresh air. One person chose to sit in the office with staff. There is also a hairdressing salon, which is open weekly for people to have their hair done by the visiting hairdresser. Some planned activities have been organised for over the Christmas period. For Care Homes for Older People Page 16 of 32 Evidence: instance, on the day we visited, a group of people were going out for Christmas lunch with staff. People also told us that they had been out the week before, and had thoroughly enjoyed their meal. There was a sherry afternoon organised for everyone in the afternoon, which was very well attended. A Christmas raffle was set out, and there were pictures on the wall of a previous Christmas party. People also get the opportunity to join in with the activities in the adjoining day centre. Some staff thought there could be more activities and trips out for people. The acting manager has already identified that this is an area for improvement. We were told that the day centre hours have recently been condensed into four days, so that the staff member who runs it can spends the fifth day working in Grove House. We spoke to her, and she explained her plans for Grove House. These included talking to people, and drawing up individual plans, so she can be sure that the activities she provides are of interest to them. On the day we visited, she was doing jigsaws with people, and chatting. She explained that next week, she will be taking out someone out for lunch on their own, as she knows this person does not like eating with others. As the occupancy is currently low, staff said they had been making the most of this time. A key worker said they had spent one to one time with people in their rooms, chatting, and helping them sort out their drawers and wardrobes. This sort of interaction is good. The local vicar visits individuals regularly, and provides some with communion if this is their wish. We were told at the last inspection that there was a regular religious service held there. It would be good practice to see if people would like to have this service reinstated, so people can join together to have their spiritual needs met. People said they can make choices in their daily lives. On the afternoon, people said they were looking forward to a night of television watching, until they chose to go to bed. One said That wont be for a while yet - I like to stay up late. Another said they preferred to go to bed earlier and that staff made sure this happened for them. Visitors can come and go as they please. This helps people to maintain links with people who are important to them. We visited the kitchen and spoke to the staff member who was cooking that day. This person also works as a carer. She told us that breakfast times are flexible, so people do not have to get up early if they dont want to. However, lunch is served at 12 midday, and tea at 4.15pm. People also get supper provided. We agreed with one person who commented that the meals were a bit bunched up. The acting manager Care Homes for Older People Page 17 of 32 Evidence: told us she is already looking at changing the times of the meals. She said this would be discussed at the residents meeting once this is planned. The dining room was nicely set out. People are asked the day before what they would like to eat. They are offered a choice at each meal. It would be good practice to have a menu on each table, so that people can be easily reminded about what they have ordered. All of the meals are cooked on site. Regular deliveries of fresh meat and vegetables are made to the home. The cook also does home baking for people to enjoy. There was a bowl of fresh fruit in the dining area, which people could help themselves to if they wished. Although there was an ample supply of food, this was not served on full size plates. This makes it more difficult for people with limited dexterity to cut up their food, and move it around their plate, without it falling off. One person was seen to be struggling on the day. The acting manager said there were bigger plates available, and that she would ask the cook to use these in the future. 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. The service has learnt from previous shortfalls, to make sure people are properly protected from abuse. Evidence: People said they would complain if they needed to. One said I could complain if I wanted to. Especially to (the acting manager). I have confidence in her. Someone else said I have no concerns. The staff are all very nice. The complaints procedure is posted in the hallway of the home, and the council is currently updating their procedure, to make sure it is accessible to more people in the correct format. There are also Have Your Say forms available for anyone who wishes to fill one in with their concerns. Staff will also be undergoing training to refresh them about how to deal with complaints. There have been no complaints made direct to the Care Quality Commission since the last key inspection. There have been two complaints made to the home. One was recorded in the complaints record. This showed what had been done to address the concerns raised, and the response given to the complainant. The second complaint had been dealt with at a higher management level. But the acting manager was able to tell us how this had been resolved, and what lessons have been learnt as a result. Being open to complaints gives people reassurance that their concerns are taken seriously. Care Homes for Older People Page 19 of 32 Evidence: Most staff have had training in the last year in safeguarding adults. However, those spoken with were all very clear what action they would take to protect people if they thought they had been abused. From speaking to them we were assured that they take this responsibility seriously. There have been two safeguarding investigations completed since the last key inspection. The management realise that these had not been reported quickly enough, and have taken robust action to make sure that this shortfall does not happen again. Care Homes for Older People Page 20 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 warm comfortable environment. Evidence: The accommodation is provided on two floors, with a passenger lift providing easy access to the first floor. There are a number of small sitting areas where people can choose to sit. Some look out onto the gardens, where people can sit out. All communal rooms were being used on the day we visited. One of these is a dedicated smoking room. This was well ventilated, so there were no tobacco smells permeating into any other areas of the building, used by people who choose not to smoke. Some general decoration has been completed since the last inspection, and some new furnishings provided. All areas of the home were clean, tidy and free from offensive smells. They were nicely decorated, and people said they were comfortable and warm. There are a number of assisted bathrooms and toilets suitably placed around the building. Bedrooms provide single accommodation. Those seen were clean, and personalised with the occupants own belongings. This helps the person to feel more at home. Some had lino covering on the floor, which did not look very homely. The acting manager said she was already aware of this, and has plans in place for this to be replaced. Care Homes for Older People Page 21 of 32 Evidence: The laundry provides adequate facilities, and the staff are provided with protective clothing and equipment to help reduce the risk from cross infection. Care Homes for Older People Page 22 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 are cared for by sufficient staff who are now receiving training to help them work safely and consistently. Evidence: We looked at the staff rota which was difficult to follow, because it had not been kept up to date. This was brought to the attention of the acting manager, who will address this. She needs a clear record of who has worked and when, in case she needs to refer to this information in the future, and so she can be sure that there is sufficient staff on duty to meet peoples needs at any time. People said they never felt rushed, and that there were enough staff to care for them as they wished. They said staff always come when they press their buzzer during the night. They said staff were kind and caring. Staff said that they were enjoying having more time to spend with people whilst the occupancy at the home was low. They said they had time to meet peoples needs, but worried that when the occupancy increases again, they may be rushed when trying to achieve this. One staff member said in order to meet peoples needs when the home is full, they work on overdrive. The acting manager is mindful of this, and states that the staffing will be adjusted as the occupancy and dependency of people living at Grove House demands. Care Homes for Older People Page 23 of 32 Evidence: The acting manager was interviewing in order to fill current care staff vacancies on the day of our visit. She hopes this will reduce the need for agency staff, which in turn will help to make sure that people get care and support from a staff group who they know, and who understand their needs well. We looked that files of two recent recruits, which showed that the right checks had been carried out before they had been allowed to work at the home. This protects people from unsuitable workers. Although, there were some gaps in employment history on the application forms which we could not see had been followed up and checked during the recruitment process. We spoke to the deputy manager about this following the inspection. Gaps in employment need to be explained by applicants, to make sure that what they were doing during this period would not make them unsuitable to work with vulnerable adults. We were told that new starters get a full induction. We were not able to see these, because the staff concerned keep them until they are completed. However, we saw other evidence to show that other staff had completed their induction. Over half of the care staff have completed a National Vocational Qualification in Care at Level 2 or 3. Currently, none of the remaining staff are studying towards this award. However, the acting manager is making arrangements to get staff enrolled. This is good, because it means staff will work consistently, in line with current recognised good practice. The acting manager has been concentrating on getting staff updated with compulsory training, because this had fallen behind. So there has been only limited time for staff to attend any other training. However, relevant staff have received an update in medication training, and the manager is looking to see what other opportunities can be offered to staff. She intends to give priority to training in dementia care, and also some training to give staff a better understanding about the needs of people with a learning disability. This training will assist staff in providing good, person centred care to people with a variety of different needs. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A keen and enthusiastic acting manager is ensuring that peoples views and well being are central when changes to the way the service is run are made. Evidence: An acting manager currently runs Grove House. She has been in post there since September 2009. She is very enthusiastic, and she and her deputy manager are planning a number of improvements there. She is working hard to communicate with staff. She has organised a staff meeting, and all staff have now completed supervision. These developments will help to keep staff involved in the running of the home, and will give them the opportunity to see where they would like more training to improve their skills. Staff spoken with have confidence in the current management team, and spoke positively about the changes being made there. One said the management were very good. Another said Its nice working here. Everythings going fine. Another commented that the acting manager was providing more management structure, Care Homes for Older People Page 25 of 32 Evidence: clear guidelines, training and good support. Another said I think the homes doing well. I think theyre going to improve outcomes for people in the upkeep and running. I think the home is moving forward for residents. Senior staff will be attending training in Leadership and Management, to assist them in updating their skills. The acting manager is supported by the locality manager, who visits the home regularly to maintain communication, and to check standards do not slip, and continue to improve. Meetings are held monthly, to which all managers of homes owned by City of York Council attend. This is a good way of exchanging information about good practice, and the acting manager said these meetings were valuable to her. The views of people who live at Grove House are not formally requested in surveys or meetings. However, this is planned, as are residents and relatives meetings. We were told in the information provided before the visit that the views of professionals will also be sought. This sort of information is invaluable when looking at how the home is running, and where improvements need to be made. This should be introduced as soon as possible. The home will look after peoples personal allowance if they wish. The administrator has some responsibility for dealing with some peoples giro cheques and paying their fees. However, the only money handled at the home is their personal allowance. People have locked facilities in their room should they wish to manage their own. The acting manager needs to check how much the safe is insured to hold, so she can be sure that any loss will be covered. The council has systems in place to keep the home maintained, so that people are safe. We looked at some certificates where details about the service of the equipment had not been given before we visited. We asked the acting manager to check whether minor remedial work, required in the recent fixed wiring certificate, had been completed. The overall result of the test was unsatisfactory, so this needs to be checked upon. The records about the hoist maintenance seen, showed that some items had not been found at the time the check took place. The acting manager gave assurance that the engineer had just completed a further check, and that all appliances were in full working order. The fire officer has visited since the last inspection carried out by the commission. There were some matters which needed to be addressed, and he is visiting again in January 2010 to check that this work has been completed. During this site visit, the fire doors were being replaced. The deputy manager explained that the fire system remains up and running whilst this work is completed, so people are still protected Care Homes for Older People Page 26 of 32 Evidence: from the risk from the spread of fire. The fire safety risk assessment for the home has not been reviewed for some time. This was also noted within the fire officers report We advised the acting manager to update this, to reflect any current practice which is different to when this was last reviewed. For instance, we were told that it has been agreed with the fire officer that one person can have their bedroom fire door help open with a battery operated closer at night. This is the sort of information that should be included when assessing risks to people. The acting manager has informed us that this, along with all other requirements made within the fire officers report, will be completed before he returns. The acting manager said that the hot water is regulated before it enters the building, therefore weekly hot water checks are not performed. However, staff do check the water before people are bathed, and record the result. The records showed that the water was regularly below body temperature, which could make it uncomfortable for people when they bathe. This should be adjusted so that it is suitably warm for people. We were told that the Environmental Health Officer has not visited since the last key inspection. The records kept in the kitchen were seen at this inspection. The cook explained that they were kept up to date. However, some were not dated. This will make them difficult to audit, when checking that food has being stored and served at safe temperatures for people. Staff are in the process of receiving an update in compulsory training. So far, all have received fire safety and moving and handling training. One staff member said that this training so far had been spectacular. The acting manager confirmed that further training is organised for all staff to make sure they are up to date in safe practice regarding Food Hygiene and Infection Control. She also told us that there is always a trained first aider on duty. Although, the staff member we spoke to was not sure who was the nominated person that afternoon. We advised that this be made clearer, so staff know who to go to in an emergency requiring first aid attention. Care Homes for Older People Page 27 of 32 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 28 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 7 13 Priority must be given in completing and updating peoples risk assessments. This is so these assessments give a true reflection of current areas of risk to each individual, and what steps need to be atken to reduce this risk. 31/01/2010 2 9 13 Risk assessments must be completed for anyone who self administers their medication. This is so this practice can be assessed and reviewed regularly, to make sure the person remains safe and able to carry out the procedure. 12/12/2009 3 9 13 The medication trolley must not be left unattended. This is so people do not have access to medication which may harm them. 12/12/2009 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 4 38 13 Checks must be made to make sure that action has been taken with regard to shortfalls identified in the fixed wiring certificate. This is to make sure any remedial action has been taken to keep people safe. 31/12/2009 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 1 9 The amount of stock remaining should be counted and recorded on the new medication records when they are replaced each month. This is so the person responsible for auditing and ordering the medication can make sure people are receiving their medication in the right quantity, and to avoid over ordering. Correction fluid should not be used to amend peoples medication records. Further training should be sought for staff who have the responsibility to observe those people who draw up and inject their own medication. This is so they can be sure they have enough knowledge to know when this procedure is not being followed safely and correctly. 2 12 People should be consulted about whether to organise regular religious services to take place at Grove House, to assist in meeting their spiritual needs. It is recommended that menus are provided on each dining table so people can be reminded about what they have ordered, and look forward to their meal in advance. The previous employment history of prospective staff should always be explored, to make sure that nothing Page 30 of 32 3 15 4 29 Care Homes for Older People 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 which occurred during that period would make the individual an unsuitable person to work with vulnerable people. 5 30 As part of the staff training plan, priority should be given to the provision of training which will help staff to understand more about the needs of individuals living at Grove House. Plans to introduce surveys for people, their relatives and visiting professionals to complete should be given priority. This is so the home can be certain that it is running in peoples best interests, and that changes there are made in response to their views and wishes. Kitchen records should always be dated so that they are easy to audit when checking that food has been stored and served at safe temperatures to reduce the risk to people from food poisoning. It should be clear to staff who is the nominated first aider on any shift, so they always know who they should go to in an emergency requiring first aid attention. The hot water temperatures should be adjusted so they are sufficiently hot to make sure people can bathe at a comfortable temperature. 6 33 7 38 8 38 9 38 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. 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. 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