Inspection on 07/07/09 for Grange, The

This is the latest available inspection report for this service, carried out on 7th July 2009.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grange, The 07/09/06

Grange, The 31/10/05

Grange, The 23/06/05

Grange, The 16/12/04

Grange, The 22/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grange, The 33-34 Woodside Grange Road North Finchley London N12 8SP     The quality rating for this care home is:   three star excellent 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: Duncan Paterson     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Grange, The 33-34 Woodside Grange Road North Finchley London N12 8SP 02084465378 02084464827 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr David Skeath,Mrs Lena Margaret Skeath,Mr James Richmond Skeath care home 28 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 28 28 dementia old age, not falling within any other category Additional conditions: 0 0 Limited to 28 people Who fall into the category of old age (OP) and who may have dementia (DE (E)) Date of last inspection Brief description of the care home The Grange is a privately run residential home for 28 elderly people, some of whom may have dementia. The care home was originally two houses, which have been converted into a single home. Bedrooms are provided on three floors. There are a range of lounges and dining rooms. All the floors are accessible via a shaft lift. There is a large well-tended garden with a patio accessible through French windows. The Grange is situated close to public transport services and other amenities such as shops and churches. Care Homes for Older People Page 4 of 25 Brief description of the care home The aims of the home are: to provide its service users with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. Fees charged at the home range from £500 -£540 per week. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 key unannounced inspection was carried out on 7th July 2009. The inspection involved a whole day spent at the care home talking with residents, the manager and staff, inspecting a sample of care, staffing and other records held at the home as well as inspecting the physical standards. The service sent us their Annual Quality Assurance Assessment (AQAA) before the inspection visit and this was taken into consideration. Surveys were also returned to us by ten residents and three visiting professionals. These were also taken into consideration. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements in place to assess peoples needs before they move to the home as well as meet their needs when they become resident. The manager and staff are focused on their task of caring for residents. Clear written information about the service is provided. Evidence: The statement of purpose has recently been reviewed and there is a new version dated June 2009 available for residents, relatives and others interested in the home. The statement of purpose provides clear details about the aims of the service and the facilities provided. There have been three recent residents admitted to the home. Two of the care plans and assessments for these residents were inspected. There was a range of assessment information which provided details about peoples needs as well as risk assessments Care Homes for Older People Page 9 of 25 Evidence: relating to the care provided. The assessments were clear and easy to follow. One of the new residents was spoken with. The feedback was that the introduction to the home had been, wonderful and staff excellent. The new resident also confirmed all the details in the assessment and care plan such as use of a hoist with two staff assisting and that activities took place as planned. Ten of the residents were spoken with either in their bedrooms by invitation or in the lounge. There was positive feedback. One resident referred to the home as, a very nice place. A general theme from residents was that there was a sociable atmosphere at the home and that staff were kind and pleasant. Positive, friendly interactions were observed between staff and residents. The door to the kitchen was open allowing a freedom of movement of staff into one of the communal areas. This helped to produce the friendly atmosphere. There were positive indicators that the home is able to meet peoples needs. Health professionals responding to our survey reported that the service was good at, identifying changing needs of residents and acting upon them. Another response was that, the manager is always helpful and co-operates with the district nursing service. In addition, staff were knowledgeable about residents needs and were able to describe how they were working with individual residents. There is a deputy manager who assists the manager to supervise the provision of care. Intermediate care is not provided at this service. The AQAA returned to us provided details of equality and diversity work that has been undertaken. The main emphasis has been on making sure that relevant policies and procedures are in place, providing staff with training and designing care planning to raise awareness of issues. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are well ordered and written and provide staff with clear guidance as to how to meet peoples needs. Minor improvements can be made to make them even better. Medication arrangements are well organised. Staff have created a caring culture where residents are treated kindly and with respect. Evidence: A sample of five care plans were inspected. Overall, there is a good standard with clear, up-to-date care plans in place for each person. Typically, each care plan has a detailed section with objectives which have been clearly set out and agreed with the resident. Residents usually sign that they have agreed the objective. The objectives are simply written but convey the details of what is required such as needs for manual handling or prevention from risks of developing pressure ulcers. In addition to this the care plans include section on activities, a range of risk assessments, health care records, and an assessment in relation to the recently introduced Deprivation of Liberty Safeguards. Residents confirmed that they had been consulted about their care plans and that care was being provided as planned. A sample of local authority reviews Care Homes for Older People Page 11 of 25 Evidence: of residents needs were seen which indicate that residents are having an external review of their needs on a regular basis. There are also detailed health care records. Each care plan seen contained records of monthly visits from the GP as well as details of preventative health care provided and monthly records of weights. Some care plans also contained relevant health care paperwork where applicable, such as physiotherapy details. There were three areas identified which need to be reviewed by the manager and staff. One, the manual handling risk assessment form used is now relatively old and the ones seen had been photocopied many times. There are manual handling risk assessment forms available that are more detailed and may be more suitable for use. A newer, more detailed form should be considered. Two, there was a range of detail about pressure area care and risk assessing this. It was clear, from talking to the manager, that the risk assessments had lead to safeguards being provided such as pressure relieving equipment. However, it was difficult to find records of how risks were being addressed. It is therefore recommended that more recorded detail is provided so that the home can evidence the good practice in this area. The third point is about confidentiality of records. The style in use at the home is to keep records in the kitchen area. This allows staff to base themselves in this area and be close to residents. There are considerable advantages to this. A pleasant, friendly atmosphere has been created with staff able to interact freely and positively with residents. However, it does mean that records are not always secure. Having said that, the manager advised that there have been no problems with this system which has been in operation for many years. However, this arrangement should be reviewed to make sure that records are kept safe at all times. The medication administration records and storage arrangements were inspected. These were well ordered. The deputy manager takes the lead for medication management. She completes the ordering and then receipt into the home of medication. There were no gaps in medication, the records were clear and there was an audit trail available including records of receipt of medication into the home and returned to the pharmacy. The Boots system is used. There were also daily temperature records available. There are some controlled drugs being used and the records of these were viewed. Accurate records were being kept with two staff signing for them. Feedback from residents provided evidence that there was a caring, warm atmosphere Care Homes for Older People Page 12 of 25 Evidence: provided at the home. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a range of activities for residents and staff have created a friendly, calm environment where residents feel comfortable. This is a good base for developing activities, particularly for people who may have dementia. Food provided is varied and the kitchen well organised. Evidence: On the day of the inspection (which was a wet summers day) all the residents were inside. There are a range of communal rooms and residents were sitting in each room or moving between them. Some residents chose to spend time in their bedrooms. Some residents sat in the dining area where there was music playing. Usually, residents can go into the garden which is a large attractive area. There was no organised activity in the morning but in the afternoon an external person came to provide a group exercise and movement activity. The manager said that there are lots of other activities provided such as music sessions and there were posters and adverts around the home about this. Residents confirmed that the activity sessions happened and that musical entertainers came to the home. Residents were spoken to about activities. The majority of people were happy with Care Homes for Older People Page 14 of 25 Evidence: what was provided although one person said, I get a bit bored, and, would like to do more. There was some feedback from visiting professionals about activities. One person said that an area in which the home could do better would be to, take residents out of the home more such as walks and trips and offer a more stimulating environment. This was discussed with the manager who advised that staff did in fact take residents out of the home, for example up to the local shops. The home is well located for this type of short trip. In addition, the staffing levels are reasonably good for it should be possible for staff to take residents out on a regular basis. Observation during the inspection revealed that there is a positive atmosphere at the home which should assist in the general well being of residents. Staff have time to talk with residents and the culture at the home is one of encouragement and kindness. There are a number of residents who have cognitive impairments such as dementia and this may be an area which the home could develop. Providing more activities for people who may have dementia would be a positive way forward. The home is well set to do this as each resident has details of activities and personal preferences on their care plans. The serving of lunch was observed, residents were spoken with about food, the chef was interviewed and records of food provided were viewed. Overall, there are good kitchen facilities. Earlier in 2009 Barnet Council carried out a food safety inspection and the home was awarded four stars. The highest available is five stars. The chef works closely with other staff to prepare meals, snacks and drinks for residents and he is knowledgeable about residents diets and their wishes. The meal on the day of the inspection was an oven ready pie and frozen vegetables. However, the chef said that usually he cooked meals from scratch and used fresh vegetables. The menus showed that there was a range of meals provided and the manager said that the menus had recently been drawn up in consultation with residents. Residents said that the food was good and that they enjoyed it. Observation of the serving of the meal confirmed this with residents clearly enjoying their meal. Staff served people carefully and assisted where needed. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are competent complaint and safeguarding arrangements in place. Evidence: The complaints records were inspected. There have been three recorded complaints in the last year. These were relatively minor matters and all have been resolved. Information as to how to make a complaint is provided in the statement of purpose as well as being on display at the home. The safeguarding arrangements are good. There is a policy and procedure available for staff which is comprehensive and links with the local authority safeguarding procedure. Staff said they had received safeguarding training and this was confirmed through sight of staff training records. The service has been proactive in carrying out Deprivation of Liberty Safeguard (DOLS) risk assessments for each resident. This duty came into law on 1st April 2009. The assessments are clear and reflect the considered approach taken by the home. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good physical standards are provided and adaptations made to assist people with mobility difficulties. Evidence: A tour of the premises was carried out during the inspection. A selection of bedrooms were seen as there has been work carried out to decorate bedrooms and provide new furniture. Bathrooms and toilets were visited as well as the lounge, dining areas, kitchen and laundry. The manager said that there has been a programme of renovation and refurbishment at the home including the roof having been replaced, a new carpet and the decoration of many of the bedrooms. Further work is planned to decorate the remaining communal areas. Overall, good physical standards are provided for residents. The property is a converted building and the building retains some pleasant features as well as adaptations, such as ramps, to assist residents with mobility. There is a shaft lift serving all floors of the home. The premises tour identified some areas that need to be attended to. These include a Care Homes for Older People Page 17 of 25 Evidence: sticking fire door and a sticking toilet door as well as a bathroom which needed a new bath surround as well as a new toilet seat. In addition, the dining area will need some review as one of the chairs was worn and a table top was unsteady. The manager said that there were plans to replace tables and chairs in this room. In addition to the adaptations described above there are two mobile hoists in use at the home. These were viewed during the inspection and copies of recent maintenance checks were seen. The laundry is on the second floor of the building and is equipped with two washing machines and two dryers. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care from a motivated and well trained team of staff. Staffing levels are good and the management structure allows effective staff support and guidance. Evidence: Staff recruitment and training records were inspected as well as interviews held with staff and the manager. Overall, recruitment is carried out well. A sample of three newly appointed staff recruitment files were inspected and four staff were interviewed. Evidence was provided from the inspection of files that recruitment was carried out thoroughly. There were references and application forms as well as Criminal Record Bureau (CRB) checks. However, copies of staff identification were not being retained on file following the CRB check. Copies of identification should be kept and a requirement is given about this. The staff training records provided evidence that staff had completed a range of training. Staff said that they had received relevant training and the training certificates on staff files confirmed this. A sample of records were viewed so that a cross section of staff training records were seen. The manager said that there was a need for new staff to receive manual handling and medication training and there were plans in place to Care Homes for Older People Page 19 of 25 Evidence: provide this. Staffing levels are good. On the day of the inspection, in addition to the manager, there were five staff on duty in the morning and four in the afternoon. There were 26 people resident at the time. At night there are three waking night staff. In addition, the management arrangements are robust with the manager present as well as deputy manager who takes a lead role in making sure care is provided properly. Staff had many positive things to say about working at the home. A number of the staff said that teamwork at the home was good and that the manager provided good support. A typical comment from staff was that the best thing about working at the home was, commitment to work and the way staff help each other provide care. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a well organised and effective management system in place. A considered position is taken which ensures that there are efficient systems in place for managing the quality as well as the safety of the home. Evidence: The manager is also the joint owner of the home and brings to the service experience gained from managing this home for a number of years as well as experience of running other care homes in the past. The managers family also run other registered care homes. The manager is well liked and respected by staff as well as by external professionals. There was positive feedback from these groups. A proactive stance has been taken by the manager. For example, arrangements have been put in place to address new legislation and there is a business plan available setting out the approach the home is taking for the year ahead. The business plan has included work to improve the Care Homes for Older People Page 21 of 25 Evidence: physical standards. A similar proactive stance has been taken to quality assurance work. A report on the quality assurance initiatives has been made for the 2009 period. This refers to surveys which have been returned to the home. These were viewed. A largely positive response had been received. Similarly, the approach to looking after residents money has been considered. Where possible, local authorities have been asked to take responsibility for money with the home receiving the weekly allowance to look after. A sample of records in this area were inspected with good attention to detail identified. There were also clear records relating to fire safety and the maintenance of a safe environment. Certificates of the servicing of the homes equipment were seen as were reports from the local authority for food hygiene. Care Homes for Older People Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 Repair all sticking fire doors so that they shut properly. This will assist with providing a safe environment for residents. 14/08/2009 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 2 7 8 Consider introducing new, more detailed manual handling risk assessment forms. Provide more written information on care plans about the actions taken to address residents assessed pressure area care needs. Review the arrangements for retaining confidential records in the kitchen area. Repair and replace the broken bath surround and toilet seat and consider replacing worn dining room tables and chairs. 3 4 10 19 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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