Care Home: The Grove

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What the care home does well The home offered the people living there comfortable surroundings, which were clean, free of offensive odour, safe and well maintained. The home carried out pre-admission assessments that gave them sufficient information to enable the home to make a decision about whether they can meet the person`s needs or not. A letter was sent to the person to let them know about the outcome of the assessment. Care plans provided sufficient information to enable residents care needs to be met. Religious, emotional and social needs were included in these person centred plans. They had been reviewed monthly and there was evidence that The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 6the resident and/or their representative had been involved in devising the plans. Residents on going health care needs are met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist, psychiatrist and Community Psychiatric Nurse. Visits from health care professionals were recorded separately and were easy to track and cross reference to changes in care needs. In a survey completed on behalf of a resident a relative wrote, "The optician comes in and checks if (relative) needs glasses, has chiropodist at 6 weekly sessions. The doctor`s surgery is only over the road and is always available to be seen." Staff spoken had a good awareness of residents` needs and the care that they required. In a completed survey a resident said, "The care has always been first class." Medication procedures and practices safeguarded residents` well being. Interaction with residents was respectful and those residents spoken with confirmed that they were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. Residents were occupied and stimulated by varied and numerous activities that included outings such as the theatre, the cinema, the local pubs, Solihull shopping centre and the Butterfly Farm at Stratford. In a completed survey a relative said, "the activities are good. They have been taken to some first class shows and even the ballet at the Hippodrome." "they enjoy making crafts... they had a lovely garden party in July complete with hats." "Christmas is wonderful, all invited and lovely food and drinks" All residents answered "always" or "usually" to the question, "Are there activities arranged by the home that you can take part in?" The meals were enjoyed by the people living at the home and were varied, nutritious and offered choice. The cook regularly consulted residents about the menu and their likes and dislikes were considered and taken into account in The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 7the weekly menu planning. A choice of what was served on their plates was also given at the table. The home supports residents to maintain links with family and friends, which included emailing relatives abroad. The home has appropriate policies and procedures to safeguard residents. All recruitment practices safeguard residents from the employment of unsuitable people and appropriate financial practices protect residents` financial interests. The bedrooms viewed were comfortable clean and free of offensive odour. Each room had been personalised with photographs, ornaments and some small items of furniture. Responses to the question about whether the home is fresh and clean included, "I can go anytime or any day and The Grove is always the same, well run." "Very good standard - never experienced any problems." and all of the surveys returned by residents answered, "always" or "usually" to this question. Good infection control measures were in place in order to protect residents and staff from cross infection. There are enough senior, care and ancillary staff to meet the needs of the people who live here and to maintain standards of hygiene, food and safety at the home. More than 50% of the care staff had achieved the National Vocational Qualification (NVQ) Level 2 showing that they were assessed as being competent in their role. Other staff have also had the opportunity to achieve NVQ with catering staff having achieved National Vocational Qualification Level 2 and 3. The training records, discussion with the manager and with the staff show that training has a high profile at The Grove with the manager accessing as much relevant training for the staff as possible. This gives them the skills and knowledge they need to carry out their job and to meet the general and any more complex needs of the people living at the home. The manager who has been in post for eleven years and has nursing, management, teaching and counselling qualifications, is highly competent and the home benefits from her leadership, knowledge and experience.Residents, staff and residents` representatives have opportunities to give feedback and to affect the way the services are provided at the regular meetings held and in the surveys distributed. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. There were no health and safety concerns identified. What has improved since the last inspection? All requirements and recommendations from the previous inspection had been met. All residents had an up to date care plan that are signed by the resident or their representative, ensuring that the needs of the people living at the home are met. All handwritten medication administration recordings had two staff signatures to ensure the accuracy of the recording. A home remedy policy had been devised and manager and deputy manager met with the GP after the inspection and showed how the agreement would be person centred. The manager advised that this was therefore to be put into practice enabling residents to receive `over the counter` remedies for minor ailments in a safe way. The minimum, maximum and current temperature of the medical fridge had been taken and recorded daily and were within levels required for the safe storage of the contents. Staff no longer draw up or administer insulin and the district nurses now do this. The home has access to a part time handyman who visits the home when there are maintenance tasks to carry out. This ensures that maintenance tasks are carried out more promptly preventing issues of lack of safety or comfort. All pre admission assessments and care plans viewed were signed and dated. Steps had been taken to address the concern of food taken to the lounge not being at a high enough temperature. After the inspection the manager informed us that the home had purchased a heated tray from which the evening meal will be served when taken to the lounge. More activity materials had been purchased following consultation with people living at the home. The number of hours where there is activity support has been increased, giving more time for outings. The home had introduced the role of fire marshal, which resulted in an improvement in fire training and the relevant documentation. Garden furniture had been replaced and was in use at the time of the visits. The annexe part of the home had been redecorated and lighting made more domestic in nature and some bedrooms had been redecorated and some bedroom furniture replaced. A bathroom had been refurbished and large flatscreened televisions had been provided in the two lounges. What the care home could do better: CARE HOMES FOR OLDER PEOPLE The Grove 48 Lode Lane Solihull West Midlands B91 2AE Lead Inspector Lesley Beadsworth Key Unannounced Inspection 10:45 10 July & 18th August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grove Address 48 Lode Lane Solihull West Midlands B91 2AE 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) 0121 705 3356 0121 713 2110 grovesolihull@yahoo.co.uk The Grove Residential Home (Solihull) Mrs Lyndon Green Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2007 Brief Description of the Service: The Grove is a mid Victorian building with an extension added. It consists of three storeys and is located on the main route to the Coventry Road from Solihull. Solihull town centre is easily accessible from the home. The home is near places of worship and is on a main bus route. There are two main lounges, a small/lounge visitor’s room and a dining room. The home caters for 30 older adults and all bedrooms are of single occupancy. Access for wheelchairs is available with ramps at the front and rear of the building. The homes garden is accessed by a ramp from one of the main lounges. Fees are £385.00 a week and exclude newspapers, hairdressing and chiropody. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers and was returned on time with the information we had asked for. The AQAA informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users and were completed and returned to us. Information contained within the AQAA, the surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place over two visits on 10th July between 10.45am and 5.45pm and 18th August between 12md and 3.30pm. What the service does well: The home offered the people living there comfortable surroundings, which were clean, free of offensive odour, safe and well maintained. The home carried out pre-admission assessments that gave them sufficient information to enable the home to make a decision about whether they can meet the person’s needs or not. A letter was sent to the person to let them know about the outcome of the assessment. Care plans provided sufficient information to enable residents care needs to be met. Religious, emotional and social needs were included in these person centred plans. They had been reviewed monthly and there was evidence that The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 6 the resident and/or their representative had been involved in devising the plans. Residents on going health care needs are met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist, psychiatrist and Community Psychiatric Nurse. Visits from health care professionals were recorded separately and were easy to track and cross reference to changes in care needs. In a survey completed on behalf of a resident a relative wrote, “The optician comes in and checks if (relative) needs glasses, has chiropodist at 6 weekly sessions. The doctor’s surgery is only over the road and is always available to be seen.” Staff spoken had a good awareness of residents’ needs and the care that they required. In a completed survey a resident said, “The care has always been first class.” Medication procedures and practices safeguarded residents’ well being. Interaction with residents was respectful and those residents spoken with confirmed that they were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. Residents were occupied and stimulated by varied and numerous activities that included outings such as the theatre, the cinema, the local pubs, Solihull shopping centre and the Butterfly Farm at Stratford. In a completed survey a relative said, “the activities are good. They have been taken to some first class shows and even the ballet at the Hippodrome.” “they enjoy making crafts… they had a lovely garden party in July complete with hats.” “Christmas is wonderful, all invited and lovely food and drinks” All residents answered “always” or “usually” to the question, “Are there activities arranged by the home that you can take part in?” The meals were enjoyed by the people living at the home and were varied, nutritious and offered choice. The cook regularly consulted residents about the menu and their likes and dislikes were considered and taken into account in The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 7 the weekly menu planning. A choice of what was served on their plates was also given at the table. The home supports residents to maintain links with family and friends, which included emailing relatives abroad. The home has appropriate policies and procedures to safeguard residents. All recruitment practices safeguard residents from the employment of unsuitable people and appropriate financial practices protect residents’ financial interests. The bedrooms viewed were comfortable clean and free of offensive odour. Each room had been personalised with photographs, ornaments and some small items of furniture. Responses to the question about whether the home is fresh and clean included, “I can go anytime or any day and The Grove is always the same, well run.” “Very good standard - never experienced any problems.” and all of the surveys returned by residents answered, “always” or “usually” to this question. Good infection control measures were in place in order to protect residents and staff from cross infection. There are enough senior, care and ancillary staff to meet the needs of the people who live here and to maintain standards of hygiene, food and safety at the home. More than 50 of the care staff had achieved the National Vocational Qualification (NVQ) Level 2 showing that they were assessed as being competent in their role. Other staff have also had the opportunity to achieve NVQ with catering staff having achieved National Vocational Qualification Level 2 and 3. The training records, discussion with the manager and with the staff show that training has a high profile at The Grove with the manager accessing as much relevant training for the staff as possible. This gives them the skills and knowledge they need to carry out their job and to meet the general and any more complex needs of the people living at the home. The manager who has been in post for eleven years and has nursing, management, teaching and counselling qualifications, is highly competent and the home benefits from her leadership, knowledge and experience. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 8 Residents, staff and residents’ representatives have opportunities to give feedback and to affect the way the services are provided at the regular meetings held and in the surveys distributed. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. There were no health and safety concerns identified. What has improved since the last inspection? All requirements and recommendations from the previous inspection had been met. All residents had an up to date care plan that are signed by the resident or their representative, ensuring that the needs of the people living at the home are met. All handwritten medication administration recordings had two staff signatures to ensure the accuracy of the recording. A home remedy policy had been devised and manager and deputy manager met with the GP after the inspection and showed how the agreement would be person centred. The manager advised that this was therefore to be put into practice enabling residents to receive ‘over the counter’ remedies for minor ailments in a safe way. The minimum, maximum and current temperature of the medical fridge had been taken and recorded daily and were within levels required for the safe storage of the contents. Staff no longer draw up or administer insulin and the district nurses now do this. The home has access to a part time handyman who visits the home when there are maintenance tasks to carry out. This ensures that maintenance tasks are carried out more promptly preventing issues of lack of safety or comfort. All pre admission assessments and care plans viewed were signed and dated. Steps had been taken to address the concern of food taken to the lounge not being at a high enough temperature. After the inspection the manager informed us that the home had purchased a heated tray from which the evening meal will be served when taken to the lounge. More activity materials had been purchased following consultation with people living at the home. The number of hours where there is activity support has been increased, giving more time for outings. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 9 The home had introduced the role of fire marshal, which resulted in an improvement in fire training and the relevant documentation. Garden furniture had been replaced and was in use at the time of the visits. The annexe part of the home had been redecorated and lighting made more domestic in nature and some bedrooms had been redecorated and some bedroom furniture replaced. A bathroom had been refurbished and large flatscreened televisions had been provided in the two lounges. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 10 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 Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. All of them had a pre-admission assessments which were carried out using a format that included all the necessary headings and sufficient detail to decide if the home could meet the person’s needs or not. The assessments had been signed, dated and the location that the assessment had taken place recorded. Others involved, such as the social worker, district nurse or family were identified. One of the resident’ notes gave a diagnosis of dementia but the person showed that they were in the very early stages of dementia and was not their main reason they needed a residential care. The home is unable to admit anyone to the home whose main reason for requiring care is that they have dementia due to their registration conditions. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 12 All the care files looked at included evidence that a letter had been sent to the person to inform them of the outcome of this assessment. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care plans are written and reviewed in sufficient detail and with the involvement of the resident. All residents have access to health care professionals and are cared for in a respectful manner. The medication process safeguards the residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. All three files contained a care plan as a result of the assessments and all areas of assessment needs were addressed. Progress had been made in improving the format and the content of the care plans. They set out the care required in sufficient and up to date detail to ensure that all aspects of the health and personal health needs of residents would be met. A Gold Standard questionnaire was also included which gave information regarding any end of life wishes that the person may have. A resident with dementia had information and plans of care regarding their mental health needs. However another resident who had presented with challenging behaviour on one occasion did not have any instructions of how The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 14 staff should manage this behaviour if it reoccurred. However this was written in the review of the care plan. To assist care staff to be able to easily access information they require without having to cross reference this should be transferred to the care plan. A person still grieving following the death of a partner had a care plan related to their grief and how staff could support them, indicating that the home considers and meets the emotional needs of the people living at the home. All care files had reference to the person’s religious needs and how these could be met. Previous reports show that the home had met more diverse religious needs in the past although currently there were no residents who required this. Care plans had been reviewed monthly and there was evidence that the resident and/or their representative had been involved in devising the plans. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist, psychiatrist and Community Psychiatric Nurse being identified in the care files looked at. Visits from health care professionals were recorded separately and were easy to track and cross reference to changes in care needs. In a survey completed on behalf of a resident a relative wrote, “The optician comes in and checks if (relative) needs glasses, has chiropodist at 6 weekly sessions. The doctor’s surgery is only over the road and is always available to be seen.” The manager was able to give an example of when a resident’s health needs had been brought to the attention of hospital staff by her and a serious medical condition was identified as a result. Records for falls, pressure areas, weight, bathing and nail checks were in place within the files looked at. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These would help to minimise any risk. Risk assessments for individual risks were in place, for example regarding being provided with a key for their bedroom door, were in place. Preventative measures such as pressure relieving mattresses and cushions were in use and the manager advised that she had purchased an airflow mattress so that this could be put in use promptly if required. The manager told us that no current resident had a pressure sore and that staff were aware that any sign of skin concerns or risk of pressure sores developing must be reported. The district nurses were advised of anyone at risk of developing or suspected of developing a pressure sore. Staff receive in house training from The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 15 the manager and other staff regarding skin care/pressure sore prevention from the induction stage onwards. It is recommended that all senior and care staff undertake formal training to ensure that they have up to date knowledge. Staff spoken with and observed showed that they had a good awareness of residents’ needs and the care that they required. In a completed survey a resident said, “The care has always been first class.” The home’s medication system was inspected. A multi dose system (MDS) was in use where the pharmacist, in named bubble packs, dispenses medication. Some medication and all liquids cannot be dispensed in this way and they are provided to the home in their original packages. All current medication was stored in the large and portable trolley. Medication, creams and ointments not being used at the immediate time were stored in a lockable cupboard in a locked room. Internal and external medications were stored separately. All creams were dated once opened and discarded after 28 days if they contained an active ingredient or 3 months if they were an emollient as they can become unstable after this period. All eye drops were also dated on opening and discarded after 28 days. The home has a lockable medication fridge that is stored in the kitchen and staff record the minimum, maximum and current temperatures each day to ensure that the contents are stored safely. The medication administration procedure was observed and the Medication Administration Record Sheets were, correctly signed after the resident had taken the medication. The trolley was kept in the view of the person administering the medication or locked if left unattended. This procedure safeguards residents and the security of the medication. A random selection of Medication Administration Record Sheets were checked. These were clearly printed with all handwritten entries signed by two staff to ensure the accuracy of the recording. There were no unexplained gaps in the Medication Administration Record Sheets and appropriate codes had been used. A home remedy policy had been devised and manager and deputy manager met with the GP after the inspection and showed how the agreement would be person centred. This is to be put into practice enabling residents to receive ‘over the counter’ remedies for minor ailments in a safe way. Terms of preferred address were on the residents care plan and heard to be used by staff. Interaction with residents was respectful and those residents The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 16 spoken with confirmed that they were cared for in a respectful manner and this ensured that their dignity and self-esteem were maintained. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a designated person who is responsible for supporting residents to be occupied and to provide activity every Wednesday, which can include a visiting entertainer as well as crafts, music, sing a long and dancing. This person is also a cook at the home and said that her involvement in the activity and social side of the residents’ well being helped in providing meals that they enjoy and menus to which they had given input. The deputy manager had maintained a ‘celebration’ album, which had a very large collection of photographs of the people living at the home that had been taken over the last months at parties and other events. Both of the main lounges had been provided with large, flat screen televisions enabling easier viewing for those using the lounges. At the time of the second The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 18 visit residents were watching with interest the Olympic Games with staff interacting as they passed through. Outings are arranged when possible and recent trips included the theatre, the cinema, the local pubs, Solihull shopping centre and the Butterfly Farm at Stratford. The home also provided regular organised entertainment which included Movement to Music every Tuesday, a visiting vocalist, a demonstration of live birds of prey, beetle drives. Care staff support the residents with other activities such as weekly quizzes, table games, skittles and jigsaws. A new innovation shared with residents involves the use of a map to create conversation about residents’ travels, transport and their holidays. The manager said that this has successfully produced nostalgia and reminiscence sessions. In a completed survey a relative said, “the activities are good. They have been taken to some first class shows and even the ballet at the Hippodrome.” “they enjoy making crafts… they had a lovely garden party in July complete with hats.” “Christmas is wonderful, all invited and lovely food and drinks” All residents answered “always” or “usually” to the question, “Are there activities arranged by the home that you can take part in?” and one resident commented, “I take part in most activities, if I can’t walk I am provided with a wheelchair!” Visiting is at any reasonable time. A visitor spoken with said that they had always been made welcome, spoke positively and was complimentary about the manager and staff and the care provided to their relative. In the afternoon of the first visit, family members of a late resident were holding the funeral tea at the home. The home supports residents to maintain links with family and friends. One resident has a relative who spends considerable time overseas and the home ensures that communication is maintained by the use of frequent emails between them. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 19 activities or not and where to spend their time. Residents were obviously comfortable in their surroundings and their interaction with the manager and staff. The breakfast and midday meal were served in the main dining room in two sittings. Here was flexibility in who sat at which sitting. The manager explained that this enabled the residents who need assistance to have more attention and residents were able to enjoy their meals in a less crowded environment. However one resident spoken with said that the only concern with the home was that there was a long time to wait at the dining table before the meal was served. This was not noted on the days of the visits. The same resident also said, “the food and the cook are lovely” and the cook “tries to do something different every day.” Plans were in place for the dining room to be decorated and test patches of paint were on the walls so that residents could be involved in the choices. The tables were attractively set and the main meal was brought into the room and served individual with residents being offered choices of what was put on their plate. Condiments and water were on the table for residents to help themselves. Assistance was available and offered in a sensitive manner. On the first visit the menu consisted of a choice of vegetable bake or cottage pie served with vegetables. The food looked tasty and was well presented. Residents spoken with said that they enjoyed the meals at The Grove. Good choices of desserts were taken around the tables on a trolley. The menus were devised on a weekly basis and were varied and nutritious. The cook advised that rewriting them each week rather than having a few weeks cycle enables the menus to include meals that have been requested by residents and to ensure that they have a meaningful input. The kitchen was visited and found to be clean and organised. Environmental Health had recently inspected the kitchen and the Food Safety First Certificate issued to the home by them stated, “in recognition of the commitment to food hygiene management and high standards found by the Council’s inspection team”. On the first visit the home had not been provided with fly screens at the external kitchen door. However these had been fitted by the time of the second visit thus preventing the entry of flying insects that could contaminate food and work surfaces. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was on display in the reception area. Copies were also included in the Statement of Purpose folder that is given to each resident. A complaints log was kept and this was viewed. There had been one complaint made but the complainant later withdrew this. In response to the question, in the surveys, “Do you know who to speak to if you are not happy?” all said “always”. Two residents spoken with said that they knew who to go to if they had any concerns and comments added included, “The staff are always on hand to answer any of my questions. I have no complaints at all.” “Never had much to speak about being unhappy.” “Find it easy to talk to staff that are around.” “Yes - Mrs. Green (The manager) or senior in charge.” The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 21 The home had appropriate policies and procedures related to Protection of Vulnerable Adults (safeguarding) including the local authority version. Staff had attended training and those spoken with were aware of what they needed to do if the suspected or witnessed abuse taking place. All recruitment practices safeguard residents from the employment of unsuitable people. Financial policies, procedures and practices safeguard residents’ financial interests. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a mid Victorian building located on the main route from Solihull to Birmingham and is reasonably close to such amenities as, places of worship, public houses, shops and public transport. Accommodation is provided on three floors. Residents have access to all parts of the home by means of a passenger lift to floors and ramps to the front and rear of the home. People living at the home have comfortable, odour free and clean surroundings that were mainly well decorated and furnished in a domestic style. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 23 There were two large lounges, both having patio doors, which open onto the attractive, and well maintained garden. There is a ramp from one of these exits. These lounges are well furnished and decorated with armchairs positioned in smaller groups. Large flat-screened televisions were provided in each room and on both visits were being enjoyed by the people choosing to use the lounges. A smaller adjacent lounge was used by one resident who preferred to sit alone on occasions and by visitors. The two lounges retained many original features such as coving and fireplaces. The reception also had traditional features, including original stained glass surrounding the residents’ telephone kiosk. A resident spoken with said how attractive they found these features. All communal areas had good quality, attractive non-slip floor covering. The décor in the first and second floor corridors would benefit from improvement, as it was fairly basic with areas of patchy repainting. However a damaged area of paintwork was well repaired between the two visits. Responses to the question about whether the home is fresh and clean included, “I can go anytime or any day and The Grove is always the same well run.” “Very good standard - never experienced any problems.” and all of the surveys returned by residents answered, “always” or “usually” to this question. The bedrooms viewed were comfortable, clean and free of offensive odour. Each room had been personalised by such possessions as photographs, ornaments and some small items of furniture. The door of one bedroom visited did not fit fully into the frame and apart from a potential risk in the event of fire this also meant that the door could not be locked. The person who occupied the room said that they did not want a key at present, this should be lockable in case there was a change of mind or for any other person who might occupy the room in the future. All communal hand washing areas where staff and residents were expected to wash their hands had the appropriate facilities of soap dispensers and disposable towels in order to maintain infection control. Laundry facilities were inspected and found to be well organised, clean and hygienic. Two washing machines had the right washing temperatures of 65°C. and there was an industrial tumble drier. A sluice room off the laundry housed a disinfector for washing and disinfecting commode pots. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 24 Disposable gloves and aprons were readily available for staff in order to maintain infection control. The deputy manager advised that after the first inspection visit a procedure was introduced to ensure that colour coded mops were laundered and stored appropriately so that infection control was maintained. Staff had undertaken Infection Control training to give them the necessary knowledge and skills. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. There are sufficient care and ancillary staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota showed the hours worked by staff and the their role. It also included a key to the codes used. The rota showed that the usual care staff on duty were four in the mornings from Monday to Friday, three each evening and on weekend mornings and two night care staff from 9pm to 7.15am. In addition to the care staff there is always a senior care assistant on duty each shift. Care staff are supported other staff who ensure that the cooking and cleaning of the home are maintained. There are enough senior carers, carers and ancillary staff to meet the needs of the current residents and to maintain standards of hygiene, food and safety at the home. More than 50 of the care staff had achieved the National Vocational Qualification Level 2 showing that they were assessed as being competent in their role. Other staff have had the opportunity to achieve National Vocational The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 26 Qualifications with catering staff achieving National Vocational Qualification Level 2 and 3. Comments made in completed surveys about the staff included, “I have always found the staff very friendly and helpful.” “We generally have a good chat between us.” “I had a dream 4am that (relative) had fallen out of bed – rang the Grove and they went and checked. She was fast asleep --- no problem.” “They are just there for us (the family) and my (relative).” Three staff files were looked at and all records showed that recruitment practices safeguard residents from the employment of unsuitable people. A new member of staff spoken with gave details of the induction training and records; the person’s file confirmed that appropriate training had been provided. The member of staff was impressed with how much training had been offered and had been pleased to have the opportunity to develop her knowledge and skills. Training records show that staff have all recently undertaken mandatory training including, manual handing, hoist and handling aids, first aid, health and safety, food handling and fire prevention, nutrition, reporting and recording. Other recent training undertaken by all or the majority of them included dementia care, infection control, control of substances hazardous to health (COSHH), violence and aggression, communication skills, challenging behaviour, continence care, Protection of Vulnerable Adults and palliative care and bereavement. Staff responsible for medication have also undertaken relevant training. The training records, discussion with the manager and with the staff show that training has a high profile at The Grove with the manager accessing as much relevant training for the staff as possible. This gives them the skills and knowledge they need to carry out their job and to meet the general and any more complex needs of the people living at the home. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. A person with the appropriate qualifications and who has extensive management experience manages the home. Monitoring and auditing of the service and practices to ensure that all services operate in the best interests of residents. Health and safety practice protect residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had held the post for eleven years. She is a registered nurse and has the Registered Managers Award, a Diploma in Management and also teaching and counselling qualifications. She is highly competent to run the home and it benefits from her leadership and knowledge of the Trust’s plans, finances and systems. The Trust’s Board are supportive and available. In the AQAA the manager states that she has kept herself up to date by attending The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 28 training. She demonstrated a good knowledge of the residents and staff and an awareness of the areas of the service that needed to improve. The deputy manager, who is also knowledgeable and familiar with all aspects of the service, supports her in the management role. Staff spoken with considered them both approachable and supportive, and residents spoken with agreed that they would be listened to. There are also three senior care staff and other care staff who are also part time senior care assistants. There is always at least one of the senior staff in the home throughout both the morning and evening shifts. In the AQAA, and in discussion, the manager spoke of the improvements in communication and delegation of tasks with the senior staff in the last year, due to more senior staff meetings, and how well the delegation of responsibilities was working. For example one senior care assistant had undertaken a fire service training course and was now in charge of fire safety in the home. The senior care had taken this seriously and had ensured that the manager was as up to date as the rest of the staff. Another member of staff had responsibility for checking the home for maintenance requirements and there were records to show that this had been carried out thoroughly. Discussion with the manager indicated that the manager and/or the deputy manager meet with the home’s GP and that a recent meeting had been held to discuss the need for a person centred homely remedy policy, which resulted in a satisfactory outcome. Staff meetings were also held and residents and relatives met regularly at ‘Focus Groups’, all of which gave staff, residents and relatives the opportunity to have input and give feedback on the services provided. Minutes were available for these meetings. The home has a Quality Assurance programme that includes surveys sent to residents and relatives in order to gain feedback on the services provided. A representative of the Trust makes monthly visits to the home when they will ensure that the home is run in the best interests of the people living at the home. These systems indicate that the home is monitoring the service in order to enable growth and improvement. Some monies are held for safekeeping on behalf of residents. This is kept in a secure location and all transactions are recorded appropriately. A random sample of transactions and cash balances were audited and found to be accurate. Records and discussion with the manager showed that the staff supervision was up to date with all staff receiving supervision six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and issues related The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 29 to the philosophy of the home. It is also another opportunity for staff to contribute to the way that the service is delivered. Training records showed that staff had undertaken the required mandatory training related to health and safety. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. There were no health and safety concerns identified. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 30 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 X X 3 X X 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 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 31 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. Refer to Standard OP8 OP19 OP19 Good Practice Recommendations Staff should undertake up to date training related to tissue viability/pressure sore prevention. The bedroom door and doorframe identified should be repaired. Consideration should be given to redecorating to a good standard the corridors on the first and second floors. The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grove DS0000004519.V370220.R01.S.doc Version 5.2 Page 33 - 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. 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