Inspection on 10/08/09 for Morris Grange Nursing Home

This is the latest available inspection report for this service, carried out on 10th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Morris Grange Nursing Home Great North Road Middleton Tyas Richmond North Yorkshire DL10 6NX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bridgit Stockton     Date: 1 1 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 24 Information about the care home Name of care home: Address: Morris Grange Nursing Home Great North Road Middleton Tyas Richmond North Yorkshire DL10 6NX 01748826266 01748824074 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Grange Property Holdings Limited care home 71 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 69 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE - Mental Disorder excluding Learning Disability and Dementia Code MD Date of last inspection Brief description of the care home Morris Grange is a one-storey nursing home situated in large grounds in a rural position off the A1 trunk road near Richmond. There is parking provision at the front of the home. It is divided into two adjoining units. It is registered to provide nursing care, and care for people with dementia. Care Homes for Older People Page 4 of 24 69 15 0 Over 65 0 0 69 Brief description of the care home Bedrooms are fitted with telephone sockets, and service users can have a private telephone. Some of the bedrooms have a private conservatory. There are also communal conservatory facilities. A brochure about the home is sent out whenever an enquiry is made. Information about the home is also given to people within the service users guide and Statement of Purpose. The inspection report will be available for those who wish to look at it. There has been a change of ownership since the last key inspection. The home is now owned by Grange Property Holdings Limited. They have appointed a new manager who is now registered with the Commission for Social Care Inspection. Care Homes for Older People Page 5 of 24 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: The purpose of this inspection was to assess the quality of the care and support received by the people who live at the home. The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. I looked in detail at the care and records of four people, examined other records and looked around the home. I spent six hours at the home. The manager also completed some paperwork for us called an Annual Quality Assurance Assessment (AQAA). This provides valuable information to help me form a judgement about the quality of service offered at the home Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? At the last inspection we asked that the staff be trained in infection control and first aid. This training has now been completed. In addition the home has recruited a head of House Keeping who makes sure that the home is kept clean and tidy, cleaning schedules have been introduced and some extra equipment purchased for the cleaning staff. We also asked that the home set up a quality assurance system to ensure that it listened and acted upon what people thought of the service . This has also been done. In the AQAA the manager wrote We have refurbished many areas, including new carpets to our reception area and corridors, following comments and suggestions from our returns Your opinion counts. We have an ongoing refurbishment programme in place. The manager also told us in that they had replaced bed linen, towels, laundry equipment and curtains. They have totally refurbished a fifteen bed challenging behaviour unit, and added a conservatory and sensory room. This unit offers a specialised service to the residents. In addition to this the dementia care unit has been relocated to another part of the home that is more suitable enviroment and location to the people who live in the unit. Documentation has been further improved to ensure that all possible risks are highlighted and assessed accurately. Care Homes for Older People Page 7 of 24 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 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 8 of 24 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 9 of 24 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. Peoples needs are properly assessed prior to admission to the home. Evidence: The care plans I looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the persons needs. A senior member of staff usually the manager or deputy manager visits the person at home, or in hospital to discuss their care needs. People are welcome to visit the home before reaching a decision. I talked to one person who had recently been admitted to the home. They described how the manager had visited and explained about the home and what it had to offer. They said I was really pleased Jimmy (the manager) came to see we and we got on really well, he explained all about this place. Care Homes for Older People Page 10 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Excellent systems are in place to ensure that health care needs of the people are met. People can be confident that their privacy and dignity is protected and that they are treated with respect at all times. Evidence: I looked at four care plans in detail, to make sure that peoples health and personal care needs are being met in the way the person prefers. I found the plans to be comprehensive and very well written. Careful and thoughtful strategies to address particular needs or problems were well documented and sensitively written. The plans demonstrated that people are in receipt of individual planned care and support. Risk assessments were in place and included management plans on such things as moving and handling, nutrition, the prevention of pressure sores, dealing with aggression and the risk of falls. These all ensure that people know their limitations in a risk assessed environment. Staff are aware of what equipment to use and aware of how to promote independence safely. There was evidence of involvement of specialist healthcare people such as the community psychiatric nurse, the dietitian and continence nurse. A healthcare professional wrote the staff have a very good knowledge of all the Care Homes for Older People Page 11 of 24 Evidence: residents, the care plans are a brilliant reference for us. The residents are stimulated and happy, the home provides an excellent care service. During my visit I looked at how peoples medication was looked after by the staff at the home. Administration of medication is carried out properly and audited by the manager on a regular basis. Staff need to make sure they record all stock of tablets that are in the home so that audit is easier. People were treat with dignity and respect. Care is carried out discreetly and staff are very aware of how people should be treat in order for peoples dignity to be protected. Relatives confirmed that they were kept up to date with any changes or incidents that effected the care of their relative. One relative said the staff are always welcoming and polite we are kept very well informed about our relative. Care Homes for Older People Page 12 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recreational and social needs of people are excellently catered for, which enables them to make daily choices and promotes independence. Evidence: During my visit the atmosphere in the home was friendly and welcoming, with visitors coming and going throughout the day. Some people were enjoying chatting with each other whilst having a drink before lunch, some were listing to music or else reading. Some were taking a walk with staff in the grounds of the home. An activities program was on display. The program was varied and included church services, craft sessions, visiting musicians and trips . The AQAA said We have involved local voluntary agencies, for example, Care Aware, Advocacy services in Richmond, Alzheimers Society and St. Vincent de Paul. These have improved quality of life for residents who do not receive visitors on a regular basis. We are part of student work experience placements from both Catterick and Richmond Schools and educate students re care of the elderly and Dementia care. People told me that the food was lovely another person wrote the food is excellent well cooked and very well presented. Most people ate their meals in the communal dining areas. Care Homes for Older People Page 13 of 24 Evidence: One person said they could have a sleep in when ever they liked and another person said I can do as I please, the staff are here when I need them. Its all very relaxed and pleasant, I more or less please myself. Care Homes for Older People Page 14 of 24 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 can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse Evidence: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirmed they were aware of these. Staff knowledge of these helps ensure that they are able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told me they would speak to the manager or any of the staff if they had any concerns or complaints. Staff told me that training has taken place in the protection of vulnerable adults in abuse. I looked at four personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Care Homes for Older People Page 15 of 24 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 safe, clean and comfortable environment. Evidence: All the bedrooms that I saw reflect the persons individual preferences and taste. There is a programme of redecoration for the bedrooms, as well as for the rest of the home. Several bedrooms and some communal areas have recently been redecorated and look fresh and attractive. The bedroom doors all have locks, and there is a lockable storage space in the bedrooms. This means that people can keep their belongings private and secure. During the inspection it was identified that the tiling in the assisted shower facility requires work. The manager said he would would ask the maintenance man to repair this area straight away. The AQAA told us that quite a number of bedrooms and communal areas have been painted and re carpeted and new curtains put into place. We have decorated a sun lounge in our Dementia Unit and added kitchen cupboards to the dining area. Picture signs have been put in place to promote understanding in the Dementia Care unit. Bird tables have been purchased for our patio areas which the residents enjoy looking out onto. Our pond has also been repaired and re stocked. Computer equipment has been purchased for the Dementia Care Unit and the Challenging Behaviour Unit. Care Homes for Older People Page 16 of 24 Evidence: The home was exceptionally clean and well presented. Several people commented that their bedrooms are cleaned thoroughly everyday. A domestic supervisor has been appointed to the home. He makes sure that cleaning schedules are adhered to and that the home is kept clean, tidy and fresh. Care Homes for Older People Page 17 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are knowledgeable, skilled and on duty in sufficient numbers to meet the assessed needs of people who live at the home. Evidence: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. One relative wrote staff are always available when you need them they answer the buzzers quickly. Another person wrote The staff are excellent and devote themselves to mums care. The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. The manager told us We continue to support our staff undergoing NVQ 2 and 3 training and give the opportunity to registered nurses to keep up to date with their prep requirements and support them in any training needs that are warranted. One person wrote The nurses in charge set out very high standards of care and this is carried out by the carers. Mandatory training has taken place in the protection of vulnerable adults, infection control and first aid. Staff were currently being trained in safe moving and handling procedures. Some staff files were inspected they demonstrated that staff had been recruited Care Homes for Older People Page 18 of 24 Evidence: properly and appropriate checks had taken place before they were accepted to work at the home. Staff who were spoken to during the inspection said that they felt that the training they received was good and relevant. Care Homes for Older People Page 19 of 24 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. The home is safe and very well managed, people who live and work at the home can contribute to the decision making processes. Evidence: The manager has the qualifications and the skills to manage the home effectively. Residents and relatives meetings are held, and are well attended. The home sends out questionnaires to relatives, in order to gain information about how people view the service and what improvements they would like to see. The operational manager visits the home and carries out audits, to make sure the home is operating to company policy. People told us that the homes manager is very good and approachable. One person wrote the manager has a wonderful knowladge of all his residents. Some peoples finances are managed by the home. These were checked and found to be in good order, with receipts for all transactions kept. Policies and procedures are kept up to date; to make sure they provide relevant Care Homes for Older People Page 20 of 24 Evidence: information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people who live at the home is promoted and safeguarded. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 9 It is recommended that the stock balance of all tablets are recorded, this will make auditing of peoples medication easier. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!