Care Home: The Grove

What the care home does well The home has a welcoming atmosphere with residents greeting people and enjoying dealing with visitors. The hallway that is accessed on entry to the home is currently being developed into a comfortable seating area. Two people who use wheelchairs explained that the wide corridors and spacious areas enable them to move around the home easily. One person said that in the summer the garden is beautiful and `the snowdrop meadow is really lovely and we can see it from the home`. Another resident said `I did not want to come into this home, but I am so happy I do not want to leave`. Residents are included and consulted about developments in the home, are part of the recruitment process for new staff and said they feel `this is my own home and staff are wonderful` One person said `staff could not be better` and another person who recently moved into the home said they felt comfortable and `staff are always available to help`. An internet cafe is almost complete and the equipment is on order and due to arrive very soon. Residents will then be able to keep in touch with relatives and friends. What has improved since the last inspection? The dining room has been upgraded and new curtains are currently on order. Another lounge area is being planned and the London marathon and additional fundraising is providing funding for this area. What the care home could do better: The one area that would benefit from improvement is the recording on care plans for each person who lives in the home. Space is quite limited on the current record plans and does not enable staff to write full information. A better format would allow staff to record full information about the person and draw all this detail together. This would then provide much needed information for the development of the programme of support and also for any reviews that are carried out. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grove Scotts Hill East Carleton Norwich Norfolk NR14 8HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Brenda Pears     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 25 Information about the care home Name of care home: Address: The Grove Scotts Hill East Carleton Norwich Norfolk NR14 8HP 01508570279 01508571057 johanna.paul@lc-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Mrs Johanna Paul Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home The Grove is a voluntary sector care home operated by the Leonard Cheshire Foundation. The premises comprise a carefully adapted period house to which purpose built extensions have been added. Accommodation is provided there for 31 people with physical disabilities. The Grove is situated within 54 acres of landscaped grounds on the edge of the village of East Carlton, to the south of Norwich. 31 Over 65 0 care home 31 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection undertaken on the 24th February 2009 and started at 10.30am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information was provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment (AQAA). During the visit to the home we spoke to the manager, with members of staff and also with five residents. These methods, observations and Care Homes for Older People Page 5 of 25 previous findings all inform the outcomes of this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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 7 of 25 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 8 of 25 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. The manager does assess the needs of any new client to make sure individuals can be fully supported before an agreement is undertaken. Evidence: A full assessment is undertaken before support is agreed and appropriate staffing levels are provided. A review of care plans and discussions with two residents confirmed that information and full discussions were carried out prior to agreements being completed. Care Homes for Older People Page 9 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contain clear information that enables staff to meet individual needs, but not all sections contained full information. Medication is handled and stored correctly for the safety and well being of those living in the home. Evidence: We looked at four care plans and these confirmed the information provided by the home that stated that the care plans and risk assessments are regularly reviewed. The care plan format has detailed sections of information that shows both doctors and district nurses provide support and other healthcare services are accessed when necessary. For instance, there are also referrals for physiotherapy support. However, daily records do not contain information on how the person is feeling and not always stated how they had spent their day. The format of paperwork that is used by the organisation does not support staff to write full details. The sections for such information are very small on the relevant paperwork and this does not allow for staff Care Homes for Older People Page 10 of 25 Evidence: to expand on the person, their mood and other information. This was discussed in depth with the manager. When the accident book was checked, we found these details on the daily record and on the medical sheet when a health check had been necessary, showing that staff had clearly recorded all areas of this information. Records of the administration of medication were clearly completed, up to date and medication was in date and stored in an orderly way. The manager said that regular audits are carried out to make sure medication is stored and handled correctly. A check is also carried out regularly to make sure medication is in date and that the date of opening is clearly written on the box. We saw that that the temperatures of the medication fridge are taken and recorded regularly. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in a range of leisure activities and to maintain contact with family and friends. A variety of healthy meals are offered and these have been chosen by the individual. Evidence: The home has a residents group meeting that is held on a regular basis. Information is shared and any developments in the home are fully discussed. All activities and changes in the home are discussed with residents and their decisions are what drives any new ventures or actions. People living in the home told us that there are lots of regular visitors who are made welcome. We saw staff giving people time and not trying to rush them. Residents have the opportunity to take religious services and the manager said that any person would be supported with a religious contact as they wished. Firework displays and outdoor eating events are also regularly enjoyed. There are regular meetings with people in the home and the representative for the Care Homes for Older People Page 12 of 25 Evidence: resident group explained that a variety of trips have been undertaken and each person finds and brings ideas for outings or events to the meetings. There is a record of activities and who has participated. A notice board in the activity area shows what has been enjoyed and what shows or events are being booked. Discussions about recording how much a person participates in each activity or sits talking to staff was discussed at this time. Records of all meetings are kept and show that ideas and matters that arise have been followed through. Residents spoken to at this inspection all said that they enjoyed the varied activities that are offered in the home and that they make decisions about the home and about what is happening. People also said that the food is very good and one person said they had been eating very well since coming into the home. Records and discussions showed that activities are varied and outings to Sea life, the coast, theatre and shows have regularly been booked. Residents have also enjoyed a sponsored walk around the snowdrop field to raise funds and the fishing lake to the back of the home provides opportunities for residents to spend time fishing. At least four people said that they enjoy the views from the large windows and watch the wild life in the surrounding fields. Care Homes for Older People Page 13 of 25 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. Full information is provided so residents know who to complain to and feel they will be taken seriously. Evidence: We looked at the complaints records and saw one complaint that was received some months ago and the home has a copy of all correspondence. When talking to people living in the home, they did say that they feel comfortable talking to the manager or staff about any problems. They said they felt action would be taken and that they would be listened to. One person said that they trust the staff and feel safe and cared for. Residents also explained that they have their own meetings where they can talk about any concerns and these can then be recorded and dealt with. There are robust practises used when dealing with money and records show there are always two signatures. All receipts are kept on file, social services and family members also provide support with money. Money is regulalry audited by finance staff, but good practice would be for a person not dealing with the money on a regular basis to audit all money and records for the home. All staff have received training with regard to safeguarding adults and recognising Care Homes for Older People Page 14 of 25 Evidence: abuse. Discussions with staff also confirm they are aware of safeguarding issues and what action to take. A selection of staff files were seen during the inspection and these show that appropriate checks are carried out during the recruitment process, further protecting residents. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide a safe, clean environment that has been purpose built to support independence and meet the needs of residents in the home. Evidence: The home has a welcoming atmosphere with residents greeting people and enjoying dealing with visitors. The hallway that is accessed on entry to the home is currently being developed into a comfortable seating area. This will enable casual discussion and provide a relaxing area for visitors and for residents to enjoy a drink. A new picture of the surrounding woodlands was being installed at this time and new furniture will also be added to this area. There is clear information around the home and this includes pictures and names of all staff to support visitors and residents in the home. Two people who use wheelchairs explained that the wide corridors and spacious areas enable them to move around the home easily. One person said that in the summer the Care Homes for Older People Page 16 of 25 Evidence: path allows wheelchairs to go around the garden and lake areas and people can independently enjoy the flowers and the woodland. The manager explained that local organisations have recognised the positive improvements that have been put in place both inside and outside the home. A physiotherapy room is being developed with sensory equipment, a television and other items that will enable residents to undertake their chosen leisure activities. Another project is the development of a room that will be used as a transitional stage for people who will undergo rehabilitation to enable them to return to their home. An internet cafe is almost complete and the equipment is on order and due to arrive very soon. This consists of tables with specific adaptations and will include the use of web cams to keep people in touch with family and friends. Care Homes for Older People Page 17 of 25 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 living in the home have their needs met by a consistent staff team who are well trained and regularly supervised, providing stability and continuity of care. Evidence: Staffing at the time of this inspection consisted of eight care staff, a chef, a cook, one kitchen assistant and three domestic staff with one laundry person also on each shift. The home also has a full time maintenance person, a part time gardener, afternoon staffing usually consists of six/seven care staff with two carers and one nurse on duty during the night. The manager explained that agency staff were used at one time but now only regular people are used from agency to ensure continuity, but currently agency staff are not often used. Two staff records were seen at this time and these contained all appropriate paperwork regarding recruitment processes. Files were orderly and well presented with a content page that showed all areas of recruitment are monitored until completion. Residents also play a part in the recruitment of new staff and assist in the decision of the suitability of the person. The records for cleaning throughout the home show which areas have had a thorough clean and which areas have not. For example the records stated that such actions as Care Homes for Older People Page 18 of 25 Evidence: bins, air freshener and tiles had been attended to and stated if completed in all areas or a basic clean only had been completed. Various areas of the home are covered by a staff team that changes on a three monthly basis. The team leaders on all sections of home remain in one area to provide continuity and support. The manager explained that this enables all residents to get to know the staff that are in their home, while training all staff regarding the needs of each person. The home provided us with a spreadsheet that shows the training that staff have undertaken and any training that has been booked. Four staff were spoken to individually at this time and these discussions and observations confirm staff have a thorough knowledge of individual needs and are trained and supervised regularly. Staff also expressed their knowledge for areas of abuse and how to support people with consideration for dignity. Discussions with residents also confirm they feel staff are caring and have a good knowledge of how to support them. Care Homes for Older People Page 19 of 25 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. Residents live in a home that is managed by a suitable person and is run in their best interests. Evidence: The manager is a suitable person to be managing the home and operates an open door policy that means residents or staff are able to discuss any matters with her. This was confirmed through discussions with staff and residents carried out at this time. Staff said that the manager does support them and that she always has time to listen to staff and residents. Staff who spoke to us said they enjoy working in the home and that they can always ask for additional training or support if they feel this is needed. There is a record of up to date servicing certificates for electrical items (PAT), hoists, fire extinguishers and all areas that require regular safety checks. The fire alarm records showed regular fire practices and also contained full details of all outcomes. Care Homes for Older People Page 20 of 25 Evidence: Regular checks are undertaken and recorded for hot water temperatures, emergency lighting and on the emergency call system. All servicing records are up to date and the procedures and records were in excellent condition and information is easily found for all areas of the home. There are written policies and procedures in place that cover areas including concerns and complaints, bullying, dealing with aggression and missing persons. As previously stated, appropriate systems are in place for dealing with any personal finances. The home undertakes regular quality monitoring through the issue of questionnaires and also by having regular discussions with residents in the home. The home continues to inform us of any incidents that take place in the home and also works closely with other professionals and with families, friends and advocates to fully support residents. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 (2) (a) (b) All people using the service (c) must have an up to date, detailed care plan that is regularly reviewed. This will ensure that they receive person centred support that meets their needs. 13.2, 13.4 01/02/2008 2 20 People who use the service 01/02/2008 must have medicines prescribed on a p.r.n. (as required) basis given to them by staff only when clinically justified and this can be demonstrated by record keeping practices, such as care planning. This will ensure that people do not receive medicines unnecessarily. People who use the service 01/02/2008 must have medicines safely administered to them by staff in line with prescribed instructions at all times and this can be demonstrated by record keeping practices. This will ensure that people will receive the correct levels of medication. Errors in the record of daily administration of medicines need to be identified and 01/02/2008 3 20 13.2,13.4 4 20 13 Care Homes for Older People Page 22 of 25 followed up at the earliest opportunity. This is a repeat requirement. 5 20 13 The registered person must 01/02/2008 ensure that medication is only administered to those persons whose name is on the prescribed medication. This is a repeat requirement. 6 24 2 (b) The manager must ensure that the dining room floor is maintained and safe at all times. 01/02/2008 Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 That a more useful format is developed for the recording of all care plan notes, particularly those relating to daily records. To allow a fuller picture of the person to be developed that can inform all areas of support and reviews. To follow good practice, the home needs to ensure that any audit or spot checks are undertaken by a person who does not deal with the finances. 2 18 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!