Care Home: The Grove

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What the care home does well We did not look around all of the home, however the areas that were seen were all clean and tidy. The two lounges we saw had views over the gardens, with a distant view of the sea. Furniture was of a good standard and the tables in the dining room were well laid. We asked people about the food and they told us that it was enjoyable and that there was a choice. We found that the recruitment system had improved, although we still noted areas where further improvements are required. There is now a clear system where two references are taken before and individual starts employment. We also found that checks of people criminal records and suitability had been made. Information about people`s employment history had been sought, however we found that where there were gaps there was no record of these being checked. We also found that for one person a reference had been given that would indicate that they were not suited to the work. We were told that this had been followed up, however there was no written evidence to show that this was the case or that it had been taken into account in a decision to employ this individual. A requirement had been made at the previous inspection regarding the provision of a controlled drugs cabinet that complied with current legislation. We found that such a cupboard had been provided. We spoke with the Activities Co-ordinator about the things people are offered to do, she explained that they are offering a range of activities. They monitor the uptake to see what is enjoyed. During the inspection day we were aware that a "Pets as Therapy" dog was visiting the home, and also that there was an armchair exercise session being held. Information about what was happening at The Grove was on a notice board, and also in a Newsletter. We were shown a copy of the Newsletter that had been produced in large print, specifically for people who had a degree of visual impairment. The staff we spoke with said that they enjoyed working at the home. There were no rules about the times people had to get up or go to bed. We were also told that there was good communication and a supportive team. What the care home could do better: We looked at the records of two people who had moved to the home in recent months, we found that an assessment of their needs had been done before they moved, as is required. However, no care plan had been completed for either of these individuals. The Registered Manager told us that they wanted to wait until people had settled into the home before completing such a plan. Also that in the case of people who stayed for only a few weeks this would be a lot of work, and so it was not done. Care Plans are essential for everyone who moves to a care home, however long they stay. If there is insufficient information to write a care plan, then the individual should not be admitted, unless in an emergency. It is recognised that people change in there first few months in a care home, however this is more of a reason to have good records rather than none at all. The care assessment is the document that will define a persons needs- for example in terms of continence. However, it is the care plan that will provide the detail guidance on how these needs are to be met. We looked at one care plan for a person who had lived at the home for some time and found that care plan lacked detail. This was of particular concern as the individual concerned had seizures. There was no information as to the nature of these seizures, or any detailed guidance as to the actions staff are to take to monitor the seizures. We also discussed with the manager the value of having a system that monitors the frequency of seizures so that it is possible to analyze whether the frequency of such episodes is increasing or decreasing. One of the individuals who had recently moved to the home had difficulties with mobility, and a further condition that would have significant implications if the person suffered a fall or injury. We found that there was no moving and handling risk assessment, or any other risk assessment. We looked at the record of accidents and found that in previous months one individual had had a number of falls. We found that there was evidence that the individual had attended a "falls clinic", to investigate the reasons for this. This is an appropriate response however we could see no evidence that there had been any monitoring or analysis of falls, that might have provided useful information as to the reason behind them. We discussed the "Falls Clinic" with the Manager. We were told that they do not received any feedback from this service, and therefore any guidance on any preventive actions to take to avoid falls. We suggested that the Manager contacts the Clinic and discusses this, as whilst individual`s confidentiality needs to be respected, the home needs to know what actions to take. As part of this visit we looked at the way medication was managed. Much of the medication is provided in "blister packs" by the pharmacist. We found that the medication was generally in good order, however there were some areas where improvements are required. We found that the controlled drugs book had been incorrectly completed, so that it was extremely difficult to check and confirm that there were the correct amount of medication in stock. We do not believe that medication was missing, however the poor record keeping meant that an audit was very difficult. Medication had not always been entered into the book on the day it had been received. We found that "tipex" had been used to alter the medication administration records onone occasion, and that it was not clear how many tables had been administered where there was a variable dose. Some of the people who live at the Grove, self administer some or all of their own medication. It was noted at the last inspection that there was no comprehensive risk assessment in relation to self medication, and that auditing and record keeping for those self-administering was discussed with the management team. We found that there had been no improvement in this area. Some individuals had "medication consent" forms in their files, however there were no assessments of the individuals competence and capacity. We also found that there were no proper records of medication given to individuals to self medicate, and therefore it was not possible to audit the medication use. We found that some items had gone missing from the home- there had been investigations, and where appropriate action had been taken. However we found that a concern had been raised about some missing items by a relative, and whilst we were told that this matter had been investigated there was no proper record of action being taken. Random inspection report Care homes for older people Name: Address: The Grove 181 Charlestown Road St. Austell Cornwall PL25 3NP one star adequate service 22/05/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Helen Tworkowski Date: 1 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Grove 181 Charlestown Road St. Austell Cornwall PL25 3NP 0172676481 0172667457 thegrove@fastmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Suzanne Dennis Type of registration: Number of places registered: Conditions of registration: Category(ies) : Venetian Healthcare Ltd care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 38. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Grove is a care home registered to provide care and accommodation for up to thirty-eight people who have care needs within the categories of Old Age, not falling within any other category (38), and either gender. Care Homes for Older People Page 2 of 11 2 2 0 5 2 0 0 9 Brief description of the care home The Grove is not registered to provide intermediate care or nursing care. It does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. The Grove also offers respite care for older people to have a short break, and day care for local older people The Grove is situated within its own grounds, on the main road into Charlestown. It is a large home that has been successfully modified over the years to provide residential care. Some of the bedrooms have a sea view, a balcony or a patio. The majority of the bedrooms have an en-suite toilet and wash hand basin. Some have an en-suite bathroom. There is a shaft lift and stairs to access the bedrooms on the first floor. The home has a large garden that the people using this service can use. Car parking is available in the grounds of the home. The current scale of residential fees is £350.00 to £ 640.00 depending on assessment of care needs, room size, facilities and location within the home. These fees do not include hairdressing, chiropodist, telephone, newspapers and magazines, toiletries and personal sundries. Information about additional charges is available in the Service Users Guide (brochure) provided by the home. This information was given to the Commission for Social Care Inspection (CSCI) in May 2008. Care Homes for Older People Page 3 of 11 What we found: This inspection was a random inspection and therefore did not look at all aspects of life in the home. Because the inspection did not look at all aspects of the service the homes current rating does not change. This inspection visit was unannounced and carried out by one inspector. The visit took place between 10 a.m. and 4 p.m. on the 10th May 10. As part of the inspection process we looked at the care provided to two people who have recently moved to the home, and in part at the care of one person who has lived for some time at The Grove. We looked at the documentation that guides the care provided, at the medication system, and at the way accidents are managed. We also looked at the recruitment records relating to two staff who have recently started work at The Grove. We spoke with two people who live at the home, and three of the care staff. The Registered Manager, Suzanne Dennis, was present in the home throughout the inspection visit. What the care home does well: We did not look around all of the home, however the areas that were seen were all clean and tidy. The two lounges we saw had views over the gardens, with a distant view of the sea. Furniture was of a good standard and the tables in the dining room were well laid. We asked people about the food and they told us that it was enjoyable and that there was a choice. We found that the recruitment system had improved, although we still noted areas where further improvements are required. There is now a clear system where two references are taken before and individual starts employment. We also found that checks of people criminal records and suitability had been made. Information about peoples employment history had been sought, however we found that where there were gaps there was no record of these being checked. We also found that for one person a reference had been given that would indicate that they were not suited to the work. We were told that this had been followed up, however there was no written evidence to show that this was the case or that it had been taken into account in a decision to employ this individual. A requirement had been made at the previous inspection regarding the provision of a controlled drugs cabinet that complied with current legislation. We found that such a cupboard had been provided. We spoke with the Activities Co-ordinator about the things people are offered to do, she explained that they are offering a range of activities. They monitor the uptake to see what is enjoyed. During the inspection day we were aware that a Pets as Therapy dog was visiting the home, and also that there was an armchair exercise session being held. Information about what was happening at The Grove was on a notice board, and also in a Newsletter. We were shown a copy of the Newsletter that had been produced in large print, specifically for people who had a degree of visual impairment. The staff we spoke with said that they enjoyed working at the home. There were no rules about the times people had to get up or go to bed. We were also told that there was good communication and a supportive team. Care Homes for Older People Page 4 of 11 What they could do better: We looked at the records of two people who had moved to the home in recent months, we found that an assessment of their needs had been done before they moved, as is required. However, no care plan had been completed for either of these individuals. The Registered Manager told us that they wanted to wait until people had settled into the home before completing such a plan. Also that in the case of people who stayed for only a few weeks this would be a lot of work, and so it was not done. Care Plans are essential for everyone who moves to a care home, however long they stay. If there is insufficient information to write a care plan, then the individual should not be admitted, unless in an emergency. It is recognised that people change in there first few months in a care home, however this is more of a reason to have good records rather than none at all. The care assessment is the document that will define a persons needs- for example in terms of continence. However, it is the care plan that will provide the detail guidance on how these needs are to be met. We looked at one care plan for a person who had lived at the home for some time and found that care plan lacked detail. This was of particular concern as the individual concerned had seizures. There was no information as to the nature of these seizures, or any detailed guidance as to the actions staff are to take to monitor the seizures. We also discussed with the manager the value of having a system that monitors the frequency of seizures so that it is possible to analyze whether the frequency of such episodes is increasing or decreasing. One of the individuals who had recently moved to the home had difficulties with mobility, and a further condition that would have significant implications if the person suffered a fall or injury. We found that there was no moving and handling risk assessment, or any other risk assessment. We looked at the record of accidents and found that in previous months one individual had had a number of falls. We found that there was evidence that the individual had attended a falls clinic, to investigate the reasons for this. This is an appropriate response however we could see no evidence that there had been any monitoring or analysis of falls, that might have provided useful information as to the reason behind them. We discussed the Falls Clinic with the Manager. We were told that they do not received any feedback from this service, and therefore any guidance on any preventive actions to take to avoid falls. We suggested that the Manager contacts the Clinic and discusses this, as whilst individuals confidentiality needs to be respected, the home needs to know what actions to take. As part of this visit we looked at the way medication was managed. Much of the medication is provided in blister packs by the pharmacist. We found that the medication was generally in good order, however there were some areas where improvements are required. We found that the controlled drugs book had been incorrectly completed, so that it was extremely difficult to check and confirm that there were the correct amount of medication in stock. We do not believe that medication was missing, however the poor record keeping meant that an audit was very difficult. Medication had not always been entered into the book on the day it had been received. We found that tipex had been used to alter the medication administration records on Care Homes for Older People Page 5 of 11 one occasion, and that it was not clear how many tables had been administered where there was a variable dose. Some of the people who live at the Grove, self administer some or all of their own medication. It was noted at the last inspection that there was no comprehensive risk assessment in relation to self medication, and that auditing and record keeping for those self-administering was discussed with the management team. We found that there had been no improvement in this area. Some individuals had medication consent forms in their files, however there were no assessments of the individuals competence and capacity. We also found that there were no proper records of medication given to individuals to self medicate, and therefore it was not possible to audit the medication use. We found that some items had gone missing from the home- there had been investigations, and where appropriate action had been taken. However we found that a concern had been raised about some missing items by a relative, and whilst we were told that this matter had been investigated there was no proper record of action being taken. 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 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be a 01/08/2010 comprehensive and detailed care plan for each person who stays at the home. This must provide detailed guidance to identify how the identified needs of people will be met. There must also be a moving and handling assessment, which must provide guidance as to the help required in this area. This is to ensure that peoples needs will be met, however long they are staying in the home. 2 8 13 Risks to the individuals must 01/07/2010 be assessed, and action plan drawn up as to how these will be managed. Falls and other accidents must be monitored and risk assessments amended to reflect such incidents. Risks must be managed to help keep people safe. 3 8 13 Where people wish to self 01/07/2010 Page 8 of 11 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 medicate, a self medication risk assessment must be carried out. This should include details of plans and actions to support the individual with their medication. An auditable record must be kept of any medication provided to an individual to self administer. Medication must be managed in a safe manner. 4 9 13 An auditable record must be 01/07/2010 kept of all medication, including Controlled Drugs, so that it is possible to account for all medication in the home. Where a variable dose of medication is to be administered there must be a record of the circumstances of how the dose is to vary, and how much is administered. Medication must be managed in a safe manner. 5 16 22 A record of all complaints must be kept, including any actions taken in response. People should be confident that where they raise an issue it will be dealt with appropriately. 01/07/2010 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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