Care Home: The Grove Residential Home

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What the care home does well The Grove care home provides a clean and warm environment for people to live in. Visitors are made to feel welcome and people coming into the home have the opportunity to discuss their care needs before admission. People gave positive comments about their care and felt their health care needs were being met. One person told us `I love living here` and relatives spoken to told us they were very happy with the care their relatives receive. Most people told us they were satisfied with the activities provided and they were happy to do things when they wanted. The majority of staff have worked at the home for a number of years and there was a good atmosphere in the home. Staff are trained and supervised and people told us they get on with the staff and feel they are treated with respect. The home is being well managed, the manager was appointed in October 2007 and was registered with us in March 2008. She had previously managed the home for a number of years and had subsequently retired. People spoken to told us the manager was `supportive` and `approachable` and they were very pleased she had come back to work in the home. Staff told us they were `now getting the training needed` and no one raised any concerns. What has improved since the last inspection? The manager had taken action to address the requirements and recommendations given during the previous inspection. Medication records were generally up to date, since the last inspection a pharmacist has been visiting regularly offering advice and the manager is undertaking regular medication audits. Records are being kept of personal effects and people felt that their privacy and dignity was being respected. Within the last twelve months the Statement of Purpose and Service User guide have been updated and a monthly newsletter is written and given to people living at the home to inform them of forthcoming events. A programme of re-decoration and refurbishment continues and within the last twelve months improvements included: the roof being insulated and re-tiled, all windows have been repaired and painted and the lounge has been redecorated. What the care home could do better: Care plans should contain more information about how people want their care providing, as well as their abilities and include reference to the Mental Capacity Act and the effects it has upon people`s lives. They should be clear and show that people are given the opportunity to be involved in their reviews. There must be monthly reports available for inspection to show areas of the service are being monitored to ensure the health and welfare of people living there are promoted. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grove Residential Home The Grove Residential Home West Ashby Horncastle Lincolnshire LN9 5PR     The quality rating for this care home is:   one star adequate 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: Elisabeth Pinder     Date: 0 6 0 4 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 27 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 27 Information about the care home Name of care home: Address: The Grove Residential Home The Grove Residential Home West Ashby Horncastle Lincolnshire LN9 5PR 01507522507 01507522507 meeds654@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Highgrove Care Ltd care home 19 Number of places (if applicable): Under 65 Over 65 19 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Grove cares for older people in a non-smoking environment in a large detached property situated in the village of West Ashby, which is two miles from the market town of Horncastle. The home used to be a country house and is set in its own mature grounds and walled gardens with car parking facilities to the front and rear. The house is a listed building and therefore any changes to the facade must involve a planning process. The home has three floors and there is a passenger lift to the bedrooms on the first floor and a stair lift to the second floor. The rooms on the second floor have been created from attic accommodation and all four have traditional sloping ceilings. On the first floor there are four stairs to negotiate to access three of the single bedrooms. Thirteen of the bedrooms are single, two of them have an en-suite toilet. There are two toilets on the ground floor, two bathrooms with toilets and one single toilet on the first floor and a shower room on the second floor. Care Homes for Older People Page 4 of 27 Brief description of the care home The current fee range is £348:00 - £431:00 per week. Additional charges are made for hairdressing and chiropody. There is no charge for escorting people to the hospital or the GPs surgery. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. From 1 April 2009 the duties of The Commission for Social Care Inspection (CSCI) will be taken over by the Care Quality Commission (CQC), the new independent regulator of all health and social care in England. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted just over five hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own Care Homes for Older People Page 6 of 27 assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service, one member of staff, the manager and three visitors. Before our visit questionnaires had been sent to 4 people using the service and to 4 staff, those returned to us will be mentioned throughout 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 Care Homes for Older People Page 8 of 27 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 admission procedure includes an initial assessment, which helps to make sure that the home can meet the needs of people admitted. Evidence: A review of all information available prior to the visit and the content of peoples care records, showed that people are not admitted before an assessment of their needs has been completed. A member of staff told us that either the manager or team leader visits people to discuss their care needs and then passes information to the staff team about forthcoming admissions. Records of two people who had recently been admitted were looked at and these showed information had been gathered prior to admission, either by the manager or the persons care manager. Letters confirming that after their assessment the home could/could not meet their needs had not been sent out to people who were receiving short term care and the manager agreed to action this. Two relatives spoken to told us they had seen information about the home. Care Homes for Older People Page 11 of 27 Evidence: Information about the service is written in the Statement of Purpose and Service User Guide, both documents tell people how they can access our reports and a general discussion was held with the manager regarding the duties of CSCI being taken over by the Care Quality Commission, which is the new independent regulator of health and adult social care in England. The manager agreed to change all relevant documents to reflect this change. Two surveys were received from people living at the home prior to our visit and both told us they had received contracts and they had received enough information about the service before moving in. During the visit one person told us they loved living here and relatives said they were satisfied with the care being provided. The service does not cater for people with intermediate care needs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and health care needs are being met by staff who understand their needs and deliver care in a respectful manner. However, some care plans do not record enough detail to show that individual needs and preferences are always fully met. Medication procedures are not always followed putting people at risk. Evidence: We continued to case track a further person and looked at three care plans and risk assessments. One person did not have a care plan written and the manager told us staff were using the care plan obtained from Social Services as the person was only staying for a period of respite care. Limited information was written in the other care plans looked at and the manager told us she had been visited by Lincolnshire County Council Contracting department on 23rd March 2009 who had also raised concerns regarding the lack of information in care plans and had scheduled another visit in May 2009. Care Homes for Older People Page 13 of 27 Evidence: Records did not give staff clear guidance about the action they should take to meet needs, or record social stimulation, wishes regarding death, or whether people wish to practise their religion. None of the records looked at made reference to the Mental Capacity Act and the manager told us she did not have the code of practise for this legislation but agreed to obtain a copy. She told us she had completed some training and was booked to attend a course on Deprivation of Liberty but to date staff have not had training. During the visit one issue relating to the Mental Capacity Act was raised and this was referred appropriately to Lincolnshire County Council and we have since received information from Lincolnshire County Council telling us they have given the manager information and guidance concerning the legislation. Not all care plans showed that, where able, people had been given the opportunity to be involved in writing their plan of care or their subsequent reviews, but they told us they felt their care needs were being met and felt staff treated them with respect and their privacy and dignity was maintained. Records of visiting professionals were written in the daily notes showing people are able to access other healthcare services when necessary. Two surveys from people living at the home were received prior to the visit, one person felt they always received the right care and support, the other usually. Both felt they always received the medical support needed. Information taken from the AQAA told us that policies and procedures concerning the receipt, storage, administration and disposal of medications were available including a homely remedies policy agreed and signed by one of the GPs (General Practitioner) in December 2008. Since our last visit the service has received regular visits from their pharmacist and the last report dated 27th January 2009 recorded that there was much improvement. During our visit we observed a staff member giving people their medicines during lunch and this was not carried out in a safe way and a discussion was held with the manager who agreed to take the necessary action to address this. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to choose how they spend their time and maintain contact with family and friends. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information taken from the AQAA told us that improvements within the last twelve months had included a wider choice of activities being offered to reflect peoples choices and a newsletter is written telling people whats going on in the home. During our visit some people were having their hair set, others were reading and one person was knitting. They told us they were able to spend their time as they liked and felt their rights and independence were respected, however, some peoples comments were there is nothing to do and I just sit here all day and sleep. This was discussed with staff who told us they always ask people what they would like to do but generally they do not want to do anything, although some often play dominoes and most people join in armchair exercises each Friday. Records looked at showed people had been given the opportunity to take part in exercises, manicures and dominoes and attend church services. The manager told us she had bought various craft materials but most of the time people do not want to do anything. The service does not employ a Care Homes for Older People Page 15 of 27 Evidence: designated activity co-ordinator, this role is undertaken by staff on duty and therefore depends on how busy they are as to how much time they have to spend doing activities. Staff spoken with told us there are busy times during each day but they always have time to spend with people. Visitors told us they were always made to feel welcome and confirmed there were no restrictions on the times they could visit. Two surveys from people living at the home were received prior to our visit and both told us that activities were always available that they could take part in. During our visit people were observed having their lunch in the dining room and were chatting to each other and staff whilst they ate. The main meal of the day was roast pork, apple sauce, mashed potato, cauliflower and leeks, followed by fruit crumble and custard or cheese and biscuits. Alternatives and specialist diets, such as a diabetic diet were also available. Tables were nicely laid with placemats/napkins and condiments and people told us they had enjoyed their meal. Surveys received prior to our visit told us one person always liked the meals provided and one usually. Care Homes for Older People Page 16 of 27 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. People are protected by the procedures in place for handling complaints and allegations of abuse. Staff have received training in these subjects to help them protect the people they support. Evidence: Information taken from the AQAA tells us that a clear complaints procedure is available and is included in the service user guide and this was confirmed during our visit. It was also on display in the reception area of the home. People told us they feel able to raise issues with their relatives or manager and felt these would be taken seriously. Surveys received prior to the visit indicated people know how to make a complaint and who to speak to if they were unhappy. Within the last twelve months no complaints have been received and no referrals made to Lincolnshires Safeguarding Adults team. Training records verified staff had undertaken training relating to safeguarding adults in July 2008 and staff spoken to had a good understanding of the types of abuse and the correct procedures to take to report any incidents. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well-maintained, clean, comfortable and homely environment. Evidence: Information taken from the AQAA told us that regular checks are carried out to ensure people have the right facilities and they are encouraged to make suggestions about improvements to the home. One person told us they felt more emergency call bells should be available in the lounge area and the manager said the providers recognise the need to prioritise a new system. Within the last twelve months the roof has been insulated and re-tiled, all windows have been repaired and painted and the lounge has been redecorated. During the monitoring visit made by Lincolnshire County Council Contracting department recommendations were made that window restrictor should be fitted to all rooms and a full audit should be undertaken of the premises. The manager told us that window restrictors are being fitted as soon as possible and she has commenced an environmental audit. The Environmental Health Officer last visited on 11th July 2008 and gave the service a three star excellent rating. Some recommendations were made and the manager told us they had all been addressed. Communal areas were bright and nicely decorated and there were no unpleasant odours Care Homes for Older People Page 18 of 27 Evidence: in the home. People told us they liked their rooms and felt very safe in the home and both surveys received prior to our visit from people living at the home told us the home is always fresh and clean. Care Homes for Older People Page 19 of 27 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. There is enough staff on duty to meet the needs of the people currently living at the home. People are generally protected by staff recruitment procedures and staff have access to training and support to ensure they are knowledgeable and equipped to meet peoples needs. Evidence: On the day of the visit 18 people were living at the home. Duty rotas looked at for the past two weeks showed that there were three care staff from 07:00 - 08:00 and 18:00 - 20:00. Two care staff throughout the remaining day time hours, one awake night staff and one sleep-in staff. However, the person sleeping in helps between the hours of 21:30 - 22:30 and 06:00 - 08:00. In addition to this the manager generally works Monday - Friday. There is also a cook and a cleaner/laundry person. Two surveys received prior to our visit from people living at the home told us that staff are always available when needed, no specific comments were written. Observation of care practises during the visit showed staff to respond to people when needed and in an appropriate manner. The manager had recently recruited a member of staff to cover holidays and sickness and their recruitment records were looked at and were found to contain inadequate documentation to show that the person had been recruited using safe robust Care Homes for Older People Page 20 of 27 Evidence: procedures. The manager told us that two references and a C.R.B. (Criminal Records Bureau) check had been requested and the person was only working in a supernumerary capacity under the supervision of a mentor, however, the manager acknowledged that checks should have been carried out prior to this staff member commencing work and agreed to take them off shift until relevant documentation was received. The manager has since contacted us to inform us that this documentation has been obtained. There are two team leaders and both have achieved a nationally recognised vocational award, level III in care and are currently undertaking level II in team leading. The manager told us the laundry/domestic staff are currently undertaking an award in housekeeping and she is planning for staff to receive training regarding customer care in the near future. Staff spoken to confirmed they had received training in health and safety, food hygiene, safeguarding adults, fire safety, Parkinsons disease, mental illness and medication training. As previously highlighted staff did not have knowledge of the Mental Capacity Act and the manager told us she would ensure training is made available. Care Homes for Older People Page 21 of 27 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. This home is well managed and the staff are generally supported and supervised in carrying out their roles. The audit and policy systems ensure that peoples views are listened to and acted upon. Evidence: The current manager was appointed in October 2007 and was registered with us in March 2008, however, she had previously managed the home for a number of years and had subsequently retired. People told us the manager was supportive and approachable and they were very pleased she had come back to work in the home. They told us they were now getting the training needed and no one raised any concerns. The manager had taken action to address the requirement given during the previous visit regarding accurate records being kept of peoples valuables. Staff supervision records were looked at and these were generally up to date, however, the manager Care Homes for Older People Page 22 of 27 Evidence: herself had not received any formal supervision from the providers and she agreed to speak with them about this. Discussion and records showed that there are some systems in place to monitor the quality of the service being provided. This includes seeking the views of people living at the home about specific topics such as, birthday celebrations, laundry facilities and outdoor entertainment. Questionnaires are also sent to relatives regarding the admission process and the choice of home. A discussion was held with the manager regarding sending questionnaires to staff, GPs, district nurses and any other people who use the service and completing a report once all the questionnaires have been collated and she agreed to do this. The provider or a representative had visited the home at least once a month to monitor and evaluate how the home is running, the last visit was carried out on 27/02/09, however, reports of their findings were not kept in the home and the manager agreed to speak with the provider to ensure a copy was available for inspection. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed in 2008. We were also told of equipment maintenance and service dates. Environmental risk assessments were currently being written. Ten staff have recently undertaken training in prevention and control of infection and the manager agreed to obtain a copy of the Department of Health Essential Steps and use the publication to assess their infection control practices. No financial records of the people case tracked were held in the home. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain 25/05/2009 more information about how people want their care providing, as well as their abilities. To ensure staff provide the right level of care and support. 2 9 13 Robust procedures must be followed for the administration of medication. To ensure people receive their medicines safely. 25/05/2009 3 37 17 There must be monthly reports available for inspection to show areas of the service are being monitored. To ensure the health and welfare of people living there are promoted. 25/05/2009 Care Homes for Older People Page 25 of 27 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 It is strongly recommended that care plans include reference to the Mental Capacity Act and the effects it has upon peoples lives. Care Homes for Older People Page 26 of 27 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). 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