Care Home: Thyra Grove Care Home

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What the care home does well Detailed reassessments were included in the two files we looked at. One person told us she had been involved in planning her own support and had signed parts of her plan. Personal preferences were stated in the plans and we observed staff offering choices and communicating with people effectively and in a respectful manner. People who live at this home are enabled to choose from a range of individual activities and to maintain relationships. A person living at the home told us she enjoys going to the cinema and told us about holidays. There was an activities room within the home with equipment and materials to engage people in various craft and practical activities.There was a range of healthy options on the menu, illustrated with photographs so that people could see and choose what they wanted to eat. The complaints procedure on the wall was an "Easy read" version with line drawings to help people to understand what to do if they are unhappy about something. A clean and comfortable environment is provided to meet people`s individual and shared needs. People are supported by a sufficient number of trained staff. One person told us "I`m happy here - they know when to help and they are kind". People living in the home benefit from a well managed service that promotes safety. What has improved since the last inspection? What the care home could do better: The registered manager should request that clear instructions are always given by medical staff who prescribe medications, so that staff clearly know the dosage to be given. Information and documents relating to all persons working in the care home must be obtained in order to ensure people living in the home are fully protected. This also applies to people employed by a person or organisation other than the registered provider of the home, for example agency staff. The manager should arrange regular supervision meetings at least six times a year, so that staff receive full support and supervision they need to carry out their jobs. CARE HOME ADULTS 18-65 Thyra Grove Care Home 11 Thyra Grove Mapperley Nottingham NG3 5GY Lead Inspector Meryl Bailey Unannounced Inspection 5th September 2008 12:30 Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 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 Thyra Grove Care Home DS0000002257.V371294.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 Adults 18-65. 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. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thyra Grove Care Home Address 11 Thyra Grove Mapperley Nottingham NG3 5GY 0115 844 3736 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) violet.priest@ncha.org.uk www.ncha.org.uk NCHA Miss Jennifer Norma Foran Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning disability - Code LD. The maximum number of service users who can be accommodated is 4. 2. Date of last inspection 12th June 2007 Brief Description of the Service: Thyra Grove is an adapted Victorian property situated in a quiet cul de sac just off Woodborough Road, north of Nottingham. The accommodation is registered for up to four people who have a learning disability. The accommodation is over three floors with no lift. Bedrooms are situated on all three floors and the ground floor bedroom is accessible for anyone not able to manage the stairs. All four bedrooms are single. There are shops, churches and bus stops into the city of Nottingham, nearby on Woodborough Road. Information about the service is provided through the service user guide and statement of purpose. A copy of the most recent inspection report from the Commission for Social Care Inspection is available at the home on request. The weekly fee ranges from £332 to £343. There are additional charges for transport for leisure trips. Thyra Grove Care Home DS0000002257.V371294.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. This key inspection involved one inspector. The site visit was unannounced and took place during 5 September 2008. We were able to see all four of the people who currently live there. Inspections focus on outcomes for people that use the service and in order to do this, the main method of inspection used at the site visit was ‘case tracking’. This meant two people were selected and their support was tracked through some discussion with them. Also, we checked their care records and observed their interactions with staff. We had discussions with two of the staff. A sample of staff records were looked at to make sure staff members are checked before commencing employment and are trained to meet people’s needs. The registered manager was available throughout the inspection visit for discussion and feedback. Information about a home that is collected before the site visit is also used as evidence to make judgements. Services are now required to fill in a document called an AQAA (Annual Quality Assurance Assessment) in which the registered manager identifies from their own quality monitoring what the service does well and what they need to improve. We received a completed AQAA form in April 2008. This has been useful in planning the visit and the information has been taken into consideration within this report. What the service does well: Detailed reassessments were included in the two files we looked at. One person told us she had been involved in planning her own support and had signed parts of her plan. Personal preferences were stated in the plans and we observed staff offering choices and communicating with people effectively and in a respectful manner. People who live at this home are enabled to choose from a range of individual activities and to maintain relationships. A person living at the home told us she enjoys going to the cinema and told us about holidays. There was an activities room within the home with equipment and materials to engage people in various craft and practical activities. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 6 There was a range of healthy options on the menu, illustrated with photographs so that people could see and choose what they wanted to eat. The complaints procedure on the wall was an “Easy read” version with line drawings to help people to understand what to do if they are unhappy about something. A clean and comfortable environment is provided to meet people’s individual and shared needs. People are supported by a sufficient number of trained staff. One person told us “I’m happy here - they know when to help and they are kind”. People living in the home benefit from a well managed service that promotes safety. What has improved since the last inspection? What they could do better: The registered manager should request that clear instructions are always given by medical staff who prescribe medications, so that staff clearly know the dosage to be given. Information and documents relating to all persons working in the care home must be obtained in order to ensure people living in the home are fully protected. This also applies to people employed by a person or organisation other than the registered provider of the home, for example agency staff. The manager should arrange regular supervision meetings at least six times a year, so that staff receive full support and supervision they need to carry out their jobs. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 7 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. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of people who live at the home are assessed in detail. EVIDENCE: There have been no new admissions since the last inspection. Detailed reassessments were included in the two files we looked at. These led to clear action plans to direct staff about how to meet the assessed needs. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a system in place to ensure the needs and choices of people living in the home can be appropriately met and respected by staff. EVIDENCE: We looked at the files of two people who live at the home and found detailed support plans. The plans were also held on computer. Detailed risk assessments were used and resulted in clear information about agreed action for staff to take. One person told us she had been involved in planning her own support and had signed parts of her plan. There were staffing records that showed some staff had completed Support Planning training and Person Centred Thinking. The manager demonstrated the procedure for updating support plans on computer. The review information remains on computer but she explained that, when there are any changes, the revised plans are dated and printed. Staff told us that the person updating a plan puts a note in the communication book so that all staff will know they need to read the revised plan. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 11 Personal preferences were stated in the plans and we observed staff offering choices and communicating with people effectively and in a respectful manner. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People who live at this home are enabled to choose from a range of individual activities and to maintain relationships. A healthy diet is promoted. EVIDENCE: Two people were at two different day centres when we arrived at the home. The manager told us that one person attends a local church regularly. A person living at the home told us she enjoys going to the cinema and shopping. She was preparing to start a new college course and was also doing some voluntary work. Another person had additional support from staff, which enabled him to go out to shops and the local pub. Activities were individually arranged to meet people’s needs and choices. One person told us about a caravan holiday with staff and another had a separate holiday in Norfolk. One person was preparing for a barge holiday. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 13 There was an activities room within the home with equipment and materials to engage people in various craft and practical activities. Support plans detailed contact arrangements with family members. People were supported to maintain contact with family members. For example one person was helped in writing a letter using signs and symbols to request a date to visit a family member. We observed one person preparing the menu from a range of healthy options illustrated with photographs so that others could see and choose what they wanted to eat. Staff told us people are always given a choice of meals and in the care planning we saw assessments and action plans relating to nutrition and eating and drinking. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People receive planned, individual support with all health and personal care. EVIDENCE: We saw detailed plans relating to personal and health care needs. There were daily records of visits to General Practitioners, specialist health clinics, dentists, visits from Social Worker and others. One person told us she received some support from staff when she wanted it, “I’m happy here - they know when to help and they are kind”. Staff spoken with were aware of individual health care needs and preferences. They described the different levels of support and respectful practice when assisting with bathing. Medication was looked after for people and was stored securely. One of the staff was responsible for re-ordering stock and generally checking storage. The Medical Administration Record Sheets (MARs) were well organised and staff had recorded when they had administered medication. There was, though, some confusion with one item that was prescribed for one person with complicated instructions about the varying amounts to be given. One of the Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 15 staff had inserted a question mark on the record and the amount in stock did not help to determine if this had been given as prescribed. The instruction meant that the staff had to make an assessment about how much of the medication should be given. However, staff may not have sufficient information to make this assessment. More specific instructions were needed from the person prescribing this medication. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Views and concerns are listened to and action is taken to safeguard people from abuse. EVIDENCE: We saw the complaints procedure on the wall. It was an “Easy read” version with line drawings to help people to understand what to do if they are unhappy about something. One person told us that she would tell a member of staff or the manager if she wanted to complain. There were no recent complaints recorded. There were records to confirm that, since the last inspection, all staff had received training in “Safeguarding – the alerter’s role”. Staff on duty told us they would take immediate action to keep people safe if there were any suspicions and they were aware that is was the Adult Social Care team’s responsibility to lead investigations into any allegation. Earlier in the year there had been an allegation and records clarified that this was appropriately dealt with. We examined the financial records for two people and found them to be satisfactory. All receipts were kept to show transactions. Individual financial records were held for each resident providing detail of overall expenditure and balances. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A clean and comfortable environment is provided to meet people’s individual and shared needs. EVIDENCE: The kitchen, lounge and dining room were well maintained and pleasantly decorated and furnished. Bedrooms were furnished to individual choices and needs. None of the bedrooms had ensuite facilities but toilets were on each floor so that they were shared by no more that two people. A bath was available on the first floor and there was a level access shower room on the ground floor. Handrails were in place where needed to assist with mobility, particularly for the steps at the rear if the building that led to a neat and tidy garden, with space to sit. All areas were clean and the laundry was suitably equipped. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a sufficient number of competent staff. EVIDENCE: Photographs of the staff on duty were provided on a notice board. There were two staff during the day from 7.15am to 9.15pm. Then one staff member was awake all through the night. In addition there was another support worker from an agency who is employed provide 1:1 support to one of the people living in the home. For the greater part of the day this meant that there were three staff to support two people, as the other two were at day centres. Increased support was needed before and after day centre. The manager told us that the provider organisation also employed a relief team to cover staff sickness and holidays. If staff were still needed they would use another agency. Eight of the twelve permanent staff had completed a National Vocational Qualification in care at level 2. Two of the staff said that the staff team were very supportive of one another. A sample of staffing records of staff on duty on the day of the inspection each contained identification, next of kin details, together with evidence that Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 19 references and Criminal Records Bureau disclosures were obtained prior to the staff starting work at the home. However, the manager held no information at all in the home on the additional support staff person that was employed by another agency. There was no clear plan of training for the whole staff group, but there were individual records of staff training, which included the following courses during the last 12 months: Level 2 Food Safety, Cultural Awareness, Equality and Diversity, Bullying and Harassment, Manual Handling, computer Awareness, Safeguarding Adults and Support planning. The manager and Deputy were responsible for holding 1:1 supervision meetings with staff. Records showed that these had taken place, but only three or four times per person during the last year. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a well managed service that promotes safety. EVIDENCE: The manager is registered with the Commission and has attained the National Vocational Qualification Managers Award. She has told us through the Annual Quality Assurance Assessment (AQAA) form that surveys are used once a year with people who live in the home and sent to their family members and day centres. Information is gathered in this way to make improvements to the service. Staff have increased their use of communication tools as a result of listening to the views of people. There were House meetings every two weeks and an easy read summary has been kept of what was discussed at these meetings. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 21 Staff had completed Food Safety and Manual Handling within the last year. The AQAA includes information that nine staff have received training in Infection Control. During the inspection visit we records of weekly temperatures taken at water outlets and of fire equipment checks. Incidents and accidents were recorded on computer and the manager demonstrated how this was done. The process included checking who needed to be notified of the incident. Our records show that the manager has appropriately notified the Commission of serious incidents. Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 23 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. 1. Standard YA34 Regulation 19 Requirement Information and documents relating to all persons working in the care home must be obtained in order to ensure people living in the home are fully protected. This also applies to people employed by a person or organisation other than the registered provider of the home. Timescale for action 31/10/08 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. Refer to Standard YA20 Good Practice Recommendations The registered manager should request that clear instructions are always given by medical staff who prescribe medications, so that staff know the dosage to be given. Arrange regular supervision meetings at least six times a year, so that staff receive full support and supervision they need to carry out their jobs. 2, YA36 Thyra Grove Care Home DS0000002257.V371294.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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