Care Home: The Granary Care Centre

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What the care home does well The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Information about the home and the pre-admission process ensures that those people who choose to live in The Granary will have their individual care needs met. Because of improved care planning and service delivery arrangements, people will be looked after in the way that meets their individual needs. Medicines are handled safely in the home to safeguard people’s health. People will be treated with respect and dignity. People are able to spend their time as they wish but they will be provided with the opportunity to participate in a wide range of activities. They are able to maintain contact with family and friends. They will be provided with a well balanced and nutritious diet and food is well cooked and nicely presented. People who live in The Granary, and their relatives, can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to harm. The Granary is a well designed, comfortable, safe and well-maintained home. Each person will have a comfortable bedroom and specialist equipment is available to meet people’s needs. The design of the home ensures that people are catered for in small units rather than a large establishment. People will be cared for by staff who are competent and have the necessary skills to meet their individual needs. Robust recruitment procedures will ensure that the right nurses and support workers are employed. Management of the home has stabilised meaning the staff team is provided with leadership and direction and the people who live there, receive the support that they need, in the way that they want or is in their best interests. What has improved since the last inspection? There has been a marked improvement in compliance with the national minimum standards and regulations of the Care Standards Act 2000 meaning that the standard of service provided to people who live in The Granary has now been judged as Good. 14 requirements were issued after the last inspection in May 2009 and each one of them has been met. Improvements have been met in the pre-admission assessment procedure, care planning and risk assessment processes, meaning that people will receive the individual care that they need and the management of any identified risks will be incorporated in to the person’s plan of care. The improvements that were needed in the management of medication procedures have been made. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Staff are being well supported and are supervised on a regular basis to ensure that people receive a good service. They have received training in health and safety, manual handling procedures, fire awareness, safeguarding of vulnerable adults and dementia care. This means that staff have greater skills and are more competent and confident in their role. We have been notified of any notifiable events as the home are required to do and we have seen that they keep records of any incidents or events that have happened. An appropriately qualified and competent home manager has been appointed who has already made application to the Care Quality Commission for registration. She provides clear leadership and direction for the staff team a quality that had previously been missing. Recruitment of more qualified nurses and care staff is still ongoing, although there is already greater stability in the staff team and agency staff are familiar with the home and the people who live there. What the care home could do better: The following good practice recommendations have been made : ⇒ It would be good practice to complete a body chart for all new admissions as part of care planning processes. ⇒ Information about meals being served could be in a more appropriate format so information is accessible to all. ⇒ Continue to work towards having a 50% ratio of NVQ qualified staff. ⇒ Continue with robust “Regulation 26” monitoring to ensure that good standards are maintained. ⇒ Service User Handling Plans should detail exact equipment to be used and method. Key inspection report CARE HOMES FOR OLDER PEOPLE The Granary Care Centre Lodge Lane Wraxall Nailsea North Somerset BS48 1BJ Lead Inspector Key Unannounced Inspection 17th and 18th November 2009 09:30 DS0000072886.V378345.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 2 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 The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Granary Care Centre Address Lodge Lane Wraxall Nailsea North Somerset BS48 1BJ TBC TBC 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) Shaw Healthcare (Wraxall) Ltd Manager post vacant Care Home 60 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 60. The maximum number of service users who can be accommodated to receive nursing care is 40. 19th May 2009 2. 3. Date of last inspection Brief Description of the Service: Shaw Healthcare own The Granary, a new purpose build care home in Nailsea, first registered with the Commission in November 2008. The Granary Care Centre provides a total of 60 beds, 20 providing personal care only for people with dementia and 40 providing nursing care for people with dementia. In addition to the above the home has a ten place day centre on the ground floor, and a 20 bedded private hospital secure mental health unit on the ground floor. The accommodation is on the first and second floors, accessed by passenger lift or stairs. There are six lounge/dining rooms (3 per floor) providing a variety of aspects to the surrounding countryside. There is an assisted bathroom on each wing (total of 6 bathrooms) and all the bedrooms have an en-suite showering facility. There are a total of 60 single rooms with en-suite facilities, 40 dedicated nursing beds and 20 dedicated personal care beds. The philosophy of the home is to provide the best possible care and related support services for those who are unable to care for themselves without help. The telephone number for this service is 01275 858000 The email address is thegranarymanager@shaw.co.uk The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection of this service was undertaken in May 2009 and our overall judgment about the quality of the service provided for the people who lived in The Granary at that time, was that people received a poor service. We did a further random inspection on 26th August to check on the progress the home was making in complying with regulations and meeting National Minimum Standards. On this visit the inspectors felt that the home had made significant improvements, the atmosphere was calm, people looked well cared for, and staff reported improvements in respect of training, leadership and direction. After the key inspection in May we planned to visit again within six months. This inspection took place over two days and was unannounced. It was undertaken by Vanessa Carter Lead Inspector and Sue Fuller Pharmacy Inspector. A total of 19 hours were spent in the home. Prior to this inspection we asked the home manager to submit their annual quality assurance assessment (AQAA) –the timescale that we set for it to be submitted was after the inspection visit had been completed. The AQAA is a self assessment document that focuses on how well outcomes are being met. During this inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to those staff on duty, some of the people who live in the home and we observed the interactions between support workers and people who live in the home. We also spoke to the home manager, the area manager and regional manager from Shaw Healthcare. We had sent out surveys to people who live in the home, relatives and health and social care professionals who visit the home. We had 12 completed forms returned to us. At the time of writing this report the current fee’s are from £413 (residential basis), and from £540 (funded) to a minimum of £727 for nursing care. Actual placement costs will be dependent upon assessed needs and fee’s can be discussed with the home manager in more detail. Additional charges may be made for other services and these are detailed in the home’s brochure. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. What the service does well: The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 6 Information about the home and the pre-admission process ensures that those people who choose to live in The Granary will have their individual care needs met. Because of improved care planning and service delivery arrangements, people will be looked after in the way that meets their individual needs. Medicines are handled safely in the home to safeguard people’s health. People will be treated with respect and dignity. People are able to spend their time as they wish but they will be provided with the opportunity to participate in a wide range of activities. They are able to maintain contact with family and friends. They will be provided with a well balanced and nutritious diet and food is well cooked and nicely presented. People who live in The Granary, and their relatives, can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to harm. The Granary is a well designed, comfortable, safe and well-maintained home. Each person will have a comfortable bedroom and specialist equipment is available to meet people’s needs. The design of the home ensures that people are catered for in small units rather than a large establishment. People will be cared for by staff who are competent and have the necessary skills to meet their individual needs. Robust recruitment procedures will ensure that the right nurses and support workers are employed. Management of the home has stabilised meaning the staff team is provided with leadership and direction and the people who live there, receive the support that they need, in the way that they want or is in their best interests. What has improved since the last inspection? There has been a marked improvement in compliance with the national minimum standards and regulations of the Care Standards Act 2000 meaning that the standard of service provided to people who live in The Granary has now been judged as Good. 14 requirements were issued after the last inspection in May 2009 and each one of them has been met. Improvements have been met in the pre-admission assessment procedure, care planning and risk assessment processes, meaning that people will receive the individual care that they need and the management of any identified risks will be incorporated in to the person’s plan of care. The improvements that were needed in the management of medication procedures have been made. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 7 Staff are being well supported and are supervised on a regular basis to ensure that people receive a good service. They have received training in health and safety, manual handling procedures, fire awareness, safeguarding of vulnerable adults and dementia care. This means that staff have greater skills and are more competent and confident in their role. We have been notified of any notifiable events as the home are required to do and we have seen that they keep records of any incidents or events that have happened. An appropriately qualified and competent home manager has been appointed who has already made application to the Care Quality Commission for registration. She provides clear leadership and direction for the staff team a quality that had previously been missing. Recruitment of more qualified nurses and care staff is still ongoing, although there is already greater stability in the staff team and agency staff are familiar with the home and the people who live there. 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. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home and the pre-admission process ensures that those people who choose to live in The Granary will have their individual care needs met. EVIDENCE: The Statement of Purpose and Service User Guide were last reviewed and updated in October 2009. They remain a true reflection of the services and facilities available in The Granary. Copies of both documents are kept in the main reception area and all 12 people who completed our survey forms said that they received information about the home that enabled them to make an informed choice. An information pack is provided for all new admissions and their families. One person who had recently moved in to the home said “the home is meeting my needs and the staff have been very helpful in settling me in”. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 10 Each person will be provided with a Service Agreement of Contract that sets out the terms and conditions of staying in the home. This means that people will know what to expect. We looked at the pre-admission process followed for two people who had not been living in the home for long. We saw that a comprehensive assessment had taken place before the person was admitted and that the assessment included a full picture about the person’s medical history, their mental health, current medications and social care information. There was an assessment of daily living activities that covered communication needs, behavioural problems, continence, nutrition, sensory perception, skin integrity, pain management, personal hygiene needs, and personal safety issues. This assessment information is used to form the basis of the care planning documents. At the previous inspection in May 2009 we found that people had been admitted having not been assessed properly beforehand and we have seen evidence that this has now been addressed. All new placements in the home will have an initial trial period. A review of how things have gone will be completed at the end of this period, with the person where appropriate, family or other representative, social workers and a member of the staff team. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Because of improved care planning and service delivery arrangements, people will be looked after in the way that meets their individual needs. Medicines are handled safely in the home to safeguard people’s health. People will be treated with respect and dignity. EVIDENCE: We looked at the care planning documentation for six randomly selected people, three from each floor. Comprehensive care plans had been prepared for each person, based upon the individual’s assessment of care needs. On the whole we determined that the plans were well prepared, contained specific information about how particular needs were to be met, had been prepared in conjunction with the person and/or their family and provided a very clear picture of how to look after the person. We made a number of suggestions where amendments or additional information was required and these were addressed by day two of the inspection. As part of the process of getting to The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 12 know the person, family are asked to provide a ‘pen picture, all about me’. This includes information about the person’s likes and dislikes, personal care and self image, maintaining and making relationships, and any safety issues to name a few. People we spoke with during the inspection said that they were well cared for – “everyone is so kind to me”, “I couldn’t be better looked after” and “I was not happy about leaving where I used to live but I am settling in well here and being looked after”. The 11 people who returned our survey forms were “always” or “usually” satisfied with the care and support they receive. We observed the care staff being attentive towards those they were looking after and attending to their needs in a polite and courteous manner. Management plans are prepared following risk assessments in respect of nutrition, the likelihood of developing pressure sores, falls, continence, and moving and handling tasks. Following the moving and handling risk assessment a ‘service user handling plan’ is devised. These must always contain information about the specific equipment, including sling size, so that the staff know how the task must be completed. We looked at how the home manages the care of people’s wounds. We saw that care plans are prepared detailing how often dressings are to be attended to and what products are to be used. An evaluation of the wound is made each time the dressing is attended to. A Body Map chart will be completed to record where any wounds are. We suggest that this chart always be used as part of the admission process, so that the home can record an assessment of the person’s skin condition, when they are admitted in to the home. We saw that appropriate pressure relieving equipment is being used where this is appropriate and were advised that the home had a plentiful supply of equipment. A daily record is kept for each person and those kept for the six people were looked at. It was possible to evidence the care and support given and that people were being well looked after. The records were detailed, informative and written in a respectful style. Good accounts were made of any significant events and the actions taken. Other records that looked at included fluid and food charts, measurements of body weight, and positional change charts. Records are kept when the GP or any other healthcare professionals visit – this includes dentists, opticians, chiropodists and social workers. We asked why community district nursing services had been used to administer the recent flu vaccinations and were advised that qualified nurses will have the relevant training in readiness for next year. We looked in great depth at medication procedures because of the serious concerns we had at the last key inspection. None of the people living in The Granary are able to look after their own medicines, so are administered by staff. Two senior carers have been trained to give medicines to people who are The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 13 not receiving nursing care. The manager told us that the intention was to increase this in time so that nursing staff would give medicines to people receiving nursing care and senior carers would give medicines to other people. This will help to ensure that all medicines can be given at an appropriate time. On the day of the inspection the nurse on each floor gave all the medicines and a senior nurse was available to cover the doctor’s visit. All the people living at The Granary are registered with a local doctor’s practice. A doctor visits each floor once a week to see people. The pharmacy provides medicines using a monthly blister pack system. We saw some lunchtime medicines being given on one floor of the home, using safe practice. Medicines were given from the labelled containers supplied by the pharmacy and the medicines administration charts (referred to as MAR sheets) were signed when they had been given. We saw records of medicine checks that the manager completes on a regular basis. The results of these checks are communicated to staff via a book, including any action that is needed. Staff are asked to sign that they have read the record. This helps ensure that medicines are being given safely and that the appropriate records are kept. Systems have been put in place to enable staff to check that medicines not supplied in the blister packs have been given correctly. A check of several blister packs and standard packs showed that medicines had been given as recorded. Monthly MAR sheets are supplied by the pharmacy for staff to complete. Clear records were seen of the use of creams and ointments and food supplements, indicating that these have been given as prescribed. Additional information sheets have been completed for medicines prescribed “when required” so that staff have clear information about how they should be given. Each person also has a sheet with their medicines records which has a photograph of the person and information about how they like to be given their medicines. This is good practice but staff must ensure that these are kept up to date so that they are always accurate. Suitable secure storage is available for medicines. Medicine trolleys are used to safely transport medicines around the home. A medicines fridge is available on each floor and records show that fridge and room temperatures are in the safe ranges for storing medicines. Suitable storage is available for controlled drugs, which need additional security. Records show that these medicines have been looked after safely. Records are kept of the receipt and disposal of medicines so there is an audit trail of medicines used in the home. However action should be taken to ensure that the date medicines are actually removed from the The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 14 home is also recorded, so it is clear which medicines in the disposal book are still in the home. We looked at two people’s care notes and saw that they both had medicine reviews by the doctor on a regular basis. However both had been assessed as needing to have medicines disguised so that they could take them. However no care plans were in place about giving medicines to help staff give them in the most appropriate way and this should be addressed. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 able to spend their time as they wish but they will be provided with the opportunity to participate in a wide range of activities. They are able to maintain contact with family and friends. They will be provided with a well balanced and nutritious diet and food is well cooked and nicely presented. EVIDENCE: There are two Activity Organisers who each arrange a variety of different activities throughout the week. A plan of the week’s activities is displayed on a notice-board on both floors. We saw that the weeks plan included pamper sessions, discussion groups, bingo, board games, church services, shopping and arts and crafts sessions. People were observed during the inspection busily making decorations in readiness for Christmas. At other times a group of people were involved in an ‘exercise’ game and a sing-a-long session. Care staff are also involved in meeting people’s social care needs and are encouraged to take part in activities and spend 1 to 1 time with people they are looking after. We saw one carer varnishing a lady’s finger nails – “she has been unwell recently and wanted her nails done to make her feel better”. In The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 16 addition to weekly activities, events are arranged. Recent examples include a bonfire party, a trip out to Portishead Marina, a visit by a musical entertainer, a craft fair and a poppy day service. One person told us “I take part in those things that I want to but am always told what is going on”. The ground floor of the atrium is used for group activities – the sensory stimulation that events produce can be enjoyed on the first and second floors and we observed many people looking over the balconies to see what was going on. The activities organisers are in the process of preparing Life Books for each person. This will contain information about the person’s family and social life and record details about likes and dislikes. Staff are able to add information as and when they find out new information about people that will help them care for the person. This is very good practice for people who have dementia as this may be information about things that worked to help the person settle when very agitated. There are open visiting arrangements and people can be visited at any reasonable time. Those relatives who completed survey forms on behalf of their family member stated “we are always made to feel welcome” and “I am elderly myself and the staff seem to care about me too, which is very welcomed”. It was evident throughout the inspection that people are able to choose how they spend their time, where they spend their day and what they have to eat. Those people who have dementia are given choices and care staff will make best interest decisions where these are needed. We discussed with the home manager and area manager how the care staff are managing the care of one specific person who is resistant to personal care intervention. Specialist training has been arranged to enable staff to be confident and competent in the management of aggression and agitation and to effectively de-escalate conflicts. Mental Capacity Act and Deprivation of Liberty Safeguard training is also being rolled out with the team. We discussed mealtime arrangements with the home manager and the chef. There is a four week rolling menu and a copy is displayed in each of the dining rooms. Consideration should be given to making this more accessible though. It is currently in A4 format detailing the week’s meals – this is not appropriate for people with visual impairment or dementia. We observed the main midday meal and saw that people are offered a visual choice – plated meals are shown to each person and they can choose what they want to eat. Those people who needed help to eat were provided with assistance in a caring and unhurried manner. We saw people being encouraged to eat or to continue eating, and being tried with several different meals. Supplementary diet drinks are prescribed for people whose dietary intake is poor, and monitoring records are kept for those people whose diet gives cause for concern. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in The Granary, and their relatives, can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to harm. EVIDENCE: The home’s complaints procedure is included in the Statement of Purpose, information supplied to people who live in the home, and is displayed in the main reception area. We received 12 completed survey forms back from people who live in the home, relatives and health and social care colleagues – eight people said that they were aware of the home’s complaint procedure but four did not know who to complain to if they were unsatisfied with the service. Those people we spoke with during the inspection who were able to respond appropriately, said that they felt able to raise any concerns – “I would ask to speak to the boss”, “there is absolutely nothing to complain about” and “everyone is so helpful here I am sure they would sort things out”. We saw evidence that ‘complaints, concerns, comments and compliments’ are discussed in each resident’s meeting but would suggest that may be additional information is made available for people who live in the home. In the main reception desk, there is a communication book where visitors can make comments – we saw that there was a record of action taken following some of The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 18 the comments made. We are assured that concerns and complaints are handled correctly. The manager has a Complaints log and we saw that five formal complaints have been recorded since the beginning of July 2009. A record is made of any investigations as a result of complaints and action taken. We also saw that a number of compliments from thankful relatives had been received in this time period as well. Safeguarding of vulnerable adults (SOVA) training is included as part of the induction training programme for all new recruits. Refresher training will be arranged on an annual basis. The training matrix evidenced that the majority of staff have received SOVA training in the last year, those that haven’t already have booked training within the next two months. We spoke to qualified nurses and care staff during the inspection and all demonstrated their awareness of adult safeguarding issues and when to report concerns. Information about the North Somerset Safeguarding reporting procedures are displayed on the staff notice board, this includes telephone numbers. Since the last inspection when serious safeguarding concerns were raised, the management team of Shaw Healthcare have worked closely with the North Somerset Safeguarding team and commissioning team, the doctors and the Care Quality Commission to address each of the issues, and to raise the standards and quality of service provided. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Granary is a well designed, comfortable, safe and well-maintained home. Each person will have a comfortable bedroom and specialist equipment is available to meet people’s needs. The design of the home ensures that people are catered for in small units rather than a large establishment. EVIDENCE: The Granary is a purpose built care home which has been operating since November 2008. It is situated in amongst residential housing and is surrounded by landscaped gardens. These gardens have been designed to provide sensory stimulation – there are water features, covered areas for seating, meandering pathways for people who want to explore the outside environment, and the flower beds have been planted up with a variety of The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 20 different plants. There is plenty of car parking space and level access to the front of the building. The Granary is three storey building but the ground floor consists of a day care centre, a 20 bedded secure mental health unit, offices and service areas. The two units do not form part of the care home registration. The main entrance to the home is secure and leads into a reception area which is staffed during office hours. A communal “Atrium” area provides seating for visitors and a view up to the first and second floors. This area is also well used for activities and social gatherings. The nursing home and care home facilities are on the first and second floors, and can be accessed by a passenger lift or stairs. The home is arranged as six 10 bedded units, three on each floor. Each unit has its own communal toilets, assisted bathrooms, lounge/dining rooms and kitchenettes. This arrangement makes it feel like people are being cared for in a small care environment. Each of the units radiates out from the central “atrium” and are each decorated and furnished differently. The design of the building means that people are able to wander freely around, but be supervised by the support workers. The home is fully equipped with specialist nursing beds, pressure relieving equipment and moving and handling equipment. Each person who needs equipment, for example special cushions, hoist slings or slide sheets will be provided with their own equipment – this is to prevent cross infection but also ensures that each person has full access to the equipment that they need. A nurse call bell system is installed in each of the bedrooms and all communal areas of the home. All the corridors have handrails fitted on both sides and are extra wide, creating a feeling of space and freedom. The doorways into ‘service’ rooms are less prominent than bedroom doorways and the doors are painted the same colour as the walls – this measure is with the aim of preventing unnecessary access by people who are wandering about and exploring their environment. The toilets and bathrooms are fitted out with visual prompts to aid people with dementia or other impairments. Doors to WC’s, and the toilet seats are red, and grab rails are in dark colours to make them easier to see. Memory boxes are sited outside each bedroom – these can be filled with mementoes or any other such items that may orientate people who have dementia, in locating their bedroom. The home is centrally heated, is well ventilated and has plenty of natural light through the large central atrium and large windows. The whole home was clean, tidy and free from any offensive odours. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 will be cared for by staff who are competent and have the necessary skills to meet their individual needs. Robust recruitment procedures will ensure that the right nurses and support workers are employed. EVIDENCE: Significant improvements have been made in the establishment of a stable staff team although there is still some movement in staff. Agency nurses and care workers are still being used to cover shifts. The same four qualified agency nurses are always used and when care workers are required, on the whole the agency will send someone along who has worked in the home before. This means that although the agency staff are not employed by the home, they are familiar with the ways of working, and the care and support needs of the people they are looking after. A number of new staff are just about to start working in the home having completed all the pre-employment recruitment checks. There is still one floor manager vacancy, one team leader post for night duty and a number of care worker posts. Recruitment for these positions is already underway and some interviews were taking place during the inspection. We looked at the staffing rota’s for the next two week period – this showed that The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 22 most vacant shifts will be covered by staff doing extra duties, or the qualified agency nurses. There was only one care workers shift that may need to be covered by an agency worker. The home manager is however monitoring how much extra work staff members do, to ensure that they are not too tired and are able to care for people appropriately. Consideration is currently being given to the introduction of a ‘twilight shift’, to cover the evening period when people with dementia are likely to need extra support and supervision. Staffing levels are currently based upon the collective care needs of the 44 people in residence. During the day there are six support workers for each floor, two allocated to work upon each unit, plus one registered nurse per floor. At night there are three support workers and one nurse per floor. We saw evidence that verified these arrangements. On those days when planned doctors ward rounds take place, an extra nurse is on duty. The dependency needs for each person is constantly kept under review, to ensure that the right numbers of staff are available to meet people’s needs. As the home fills the remaining empty beds, staffing levels will be adjusted. Nursing staff and care workers are supported in meeting people’s daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. At the present time, only one in four support workers have achieved a National Vocational Qualification (NVQ) in care. The home manager told us that in January 2010, all other support workers will be registered to undertake the training and we saw that this was included in the home’s training plan. There will also be an expectation that senior support workers will undertake NVQ training at Level 3. There are plans for Shaw Healthcare to set up their own NVQ Centre and have Assessors who will visit the home and work with staff. Progress in this area will be followed up in future inspections and service reviews. The home is now following safe recruitment procedures and we looked at the recruitment files for six members of staff. New staff will have had to complete an application form and attend for interview. Two satisfactory written references, POVA1st clearance and CRB checks will be obtained for all new recruits. We spoke to one member of staff who had just started working in the home and they confirmed these arrangements. These measures will ensure that the right people are employed to work in the home. Recruitment is currently undertaken by senior Shaw Healthcare managers – it is envisaged that this task will revert back to the home manager. New staff will complete an induction training programme when their employment begins. They will be made familiar with the home’s policies and procedures, and be trained to ensure that have the necessary skills and competencies to meet the needs of the people who live in the home. This training will include fire awareness, moving and handling, safeguarding of The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 23 vulnerable adults and health & safety. The new staff member confirmed that they were working through the programme. A training matrix has been prepared that evidences that the majority of the staff team have attended mandatory training – COSHH, fire and fire drills, health & safety, infection control, moving and handling (practical and theory), safeguarding, risk assessment and food hygiene. Where there were blanks on the matrix, we were given the dates that the staff member was attending the training session. There are procedures in place to ensure that the manager is aware when staff are due for refresher training. For the last year, the training plan has been very much based upon induction training, including mandatory training, and setting up of the staff teams. The Learning and Development Plan for 2010 has already been prepared. This will include NVQ Level 2 in care, medication training, dementia care and mental health in the elderly, clinical tasks (wound care, pressure area care and venepuncture for example), and meals and menu planning. We were told about “Studio 3” training – enabling staff to be confident and competent in the management of aggression and agitation, and to be able to effectively deescalate situations. Training around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) is also included in the plan. The manager and senior staff will attend first and cascade information to the rest of the team until they are then able to attend a training session. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home has stabilised meaning the staff team is provided with leadership and direction and the people who live there, receive the support that they need, in the way that they want or is in their best interests. EVIDENCE: At the last inspection in May 2009, the management arrangements were in disarray and there had been four different home managers in a six month period. An interim home manager had been brought in from another Shaw Healthcare home and has been managing the home since May. This manager has now been appointed as the home manager and has already made application to the Care Quality Commission for registration. The manager is a The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 25 registered nurse, has a diploma teaching qualification, and has an NVQ Level 4 in management. She has the necessary skills and qualities to be able to manage a care service and demonstrated her abilities during the inspection process. It was evident from discussions with staff that significant improvements have been made in the management of the home. They reported that the manager was approachable and listened to them. They felt able to make suggestions and could discuss any issues about people’s care or home activities. Those people who live in the home who were able to provide an opinion felt that the manager was interested in how they were feeling. “The manager always asks how we are” and “she is always popping in and out and checking on things”. Meetings are held on a regular basis with residents/relatives, the staff team and specific staff groups and clinical team meetings. Some are held monthly whilst relative meetings are held three monthly. We saw the notes of these meetings as evidence that they had taken place. Regular monitoring visits (called Regulation 26 visits) are made on a monthly basis and a report is made of the findings. This visit may be undertaken by the Head of Quality for Shaw Healthcare, or other nominated officers. We looked at the reports that have been completed since May 2009 and found them to be very detailed and in-depth, evidencing the organisations commitment to improving standards at The Granary. We were told that the ongoing responsibility for these monitoring visits will now be with the area manager – we recommend that these visits remain as robust as they currently are, to ensure that quality outcomes remain good. Quarterly audits are completed in respect of a number of other matters namely, medications, infection control, accident and incidents, health & safety, fire safety and care planning. These measures will help ensure that the quality of the service is maintained. Each audit will result in a remedial action plan, this has to be signed off as completed, by the home manager. The home looks after small amounts of money for those people who want this service. We were told that computer records are kept of all transactions in and out of each person’s account. We did not look at these records and have no reason to be concerned about how people’s money is safeguarded. Supervision of the staff team is undertaken on a daily basis with qualified staff ensuring that support workers meet people’s needs as planned. Formal supervision is arranged with each staff member on a very regular basis (more then the minimum of six times per year). Supervision may also be arranged with a group of staff if there are specific issues that need to be addressed. We saw the records that confirmed these arrangements and those staff spoken with also verified that they are regularly supervised. A number of qualified nurses and senior support workers were attending “Effective Supervision” training on day one of the inspection. Those staff spoken with during the The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 26 course of the inspection said they received regular supervision and were well supported by the management team. The home record’s that were examined during the inspection were all well maintained, kept secure, and easily produced upon request. It is evident that there are good administrative systems in place to maintain all the records necessary for the running of the home. The home is well maintained throughout and no health & safety issues were identified as a result of this inspection. We were told that “snagging visits” are still being completed by the builders and any issues are being dealt with as and when they arise. The fire log evidenced that all weekly monthly and quarterly checks have been completed. The Fire Risk Assessment was completed June 2009 and will be reviewed on a yearly basis. Practice fire drills are held on a regular basis and there will be formal fire safety training annually for all staff. Staff will receive both theoretical and practical training in moving and handling tasks and also regular updates to ensure they follow good practice. The measures in place to ensure staff always follow safe working practices would be better if greater information was recorded in the ‘service user handling plans’ – these should record exact details about the equipment and/or method to be used, sling sizes, and the number of staff required to complete the task. We observed staff going about their duties and using manual handling equipment properly. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 1. 2. 3. 4. 5. Refer to Standard OP7 OP15 OP28 OP33 OP38 Good Practice Recommendations It would be good practice to complete a body chart for all new admissions as part of care planning processes. Information about meals being served could be in a more appropriate format so information is accessible to all. Continue to work towards having a 50 ratio of NVQ qualified staff. Continue with robust “Regulation 26” monitoring to ensure that good standards are maintained. Service User Handling Plans should detail exact equipment to be used and method. The Granary Care Centre DS0000072886.V378345.R01.S.doc Version 5.3 Page 29 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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