Please wait

Inspection on 22/07/09 for The Grange Nursing And Residential Home

Also see our care home review for The Grange Nursing And Residential Home for more information

This is the latest available inspection report for this service, carried out on 22nd July 2009.

CQC found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Grange is spacious, with plenty of room for people to move around, and plenty of storage space. Outside there is a pleasant courtyard with raised beds and a water feature, where people can sit and relax. People who live at the home who were spoken with, and a relative who was also spoken with, made positive comments, and observations showed a relaxed and friendly atmosphere. Among the comments received directly and in questionnaires were: "My mother`s needs and level of care change, and the care staff adapt very well. They provide an excellent level of day care, and an adequate level of night care. They communicate with us and always listen and act (if appropriate) on our concerns." "Since my mother bacame a resident at the Grange I have been very impressed by the care she has received. Also the support we as a family get from the manager and care staff. They do an excellent job, and I have no concerns about the level of care being given." "The food is really very nice, and I can have what I want for dinner." and " very nice, very nice indeed" and "I have no complaints whatsoever."

What has improved since the last inspection?

At the last key inspection six statutory requirements were made. These related to: administration of medication, medication administration records, food storage, confidentiality, clutter in the corridor and the quality assurance system, these have now been met. In addition: There has been an increase in staffing numbers, due to working on a 1:1 basis with certain individuals. A new deputy manager has been appointed. A new water feature, raised beds and paving have been installed in the garden. Some of the carpets have been replaced. There has been some redecoration in some areas. A new smoking room has been created and equipped. New hoists have been purchased. The reception area has been upgraded. A new wall mounted wide screen TV has been bought. There has been an increase in the administrative support hours. The activity co-ordinator`s hours have been increased from 20 to 40 hours per week.

What the care home could do better:

No statutory requirements have been made as a result of this key inspection. however four good practice recommendations have been made, relating to: Carrying out assessments and completing documentation in respect of the Mental Capacity Act (2005) and the Deprivation of liberties safeguards. Producing specific care plans regarding people`s wishes at the end of their life. In the light of one comment from a person who lives at the home about the quality and choice of food, check that people are happy with the quality, quantity and choice of food on offer. All staff should receive a minimum of six formal supervision sessions per year.

Key inspection report Care homes for older people Name: Address: The Grange Nursing And Residential Home Field Drive Shirebrook Nottinghamshire NG20 8BS     The quality rating for this care home is:   two star good 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: Rob Cooper     Date: 2 3 0 7 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 27 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 27 Information about the care home Name of care home: Address: The Grange Nursing And Residential Home Field Drive Shirebrook Nottinghamshire NG20 8BS 01623747070 01623746513 thegrange@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Management Limited care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1 place for (YA) for named person, (identified in the proposal notice), for as long as they are accommodated at the home. 16 places for (DE) when all the requirements made in the site visit report of 08/08/05 have been satisfactorily met. Date of last inspection Brief description of the care home The Grange Care Centre is situated in village of Shirebrook, near to local shops, pubs and public transport. The home provides personal and nursing care and accommodation for up to 49 older people, including 16 people with dementia, plus 1 place for a named person under the age of 65. All residents are accommodated in single rooms with en-suite toilets. The home has lounge and dining areas suitable for use by small or larger groups of residents. There is a large garden area with patios accessible to residents and a car park to the front of the home. Information about the home, including care Quality Commission inspection reports, is available from the Care Homes for Older People Page 4 of 27 16 0 Over 65 0 50 Brief description of the care home home. Fees at the home range from £487.24 to £536.94 per week for nursing, and £353.92 to £436.87 per week for residential. This information was provided by the homes manager on 22nd July 2009. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of the key inspection process, so that no one at The Grange knew that the inspection visit was going to take place. The visit took approximately eight hours over two days, with one inspector present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the last inspection report, the inspection record, considering any complaints or concerns that have been made about the service, and reviewing any notifications made relating to incidents that affect the well being of people living at the Grange. The methods used during this key inspection and visit were to visit the home, where a Care Homes for Older People Page 6 of 27 method called case tracking was used; this involved identifying six people who live at the care home and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was followed by a partial tour of The Grange, looking at the activities on offer, and talking to two people who live there, one relative and three members of staff about the quality of the service, and their experiences of living, visiting and working at The Grange. Due to the high level of needs that some people living at the Grange have, and their diagnosis of dementia, the level of input that people living at the home had into the inspection process was limited, and emphasis was put onto non-verbal communication, body language and mood where appropriate. We also sent out an Annual Quality Assurance Assessment (known as an AQAA), which allowed the home to carry out a self-assessment; and provide a range of information relating to their service. Information provided by The Grange helped to form the judgements in this report. We also sent out five surveys asking for views and information to people who live at the home, five to relatives and five to staff. Of these we received three surveys from people living at the home, two surveys from relatives and two from members of staff, which also helped with the judgements that we made. The registered manager Angela Flavell provided much of the information during this key inspection visit. On the day of this inspection there were forty-seven people living at The Grange. People who might want to live at the home can obtain information direct from them, and this would include seeing previous inspection reports prepared by the Care Quality Commission. In addition information about The Grange and the services it provides can be found at the following web site: www.schealthcare.co.uk. Care Homes for Older People Page 7 of 27 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 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 Care Homes for Older People Page 8 of 27 order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, have access to detailed information about the services on offer, they have contracts or a service agreement. They receive a comprehensive assessment, which allows them to make an informed decision about whether the home can meet their needs. Evidence: Both the statement of purpose and service user guide for the Grange were seen. These documents contained a great deal of useful information about the care home, and were available in a large print format. The information available would allow people living at the care home, and those who might wish to in the future, to make an informed choice about living there. Copies of the service user guide were seen in the peoples bedrooms. The foyer of the home has copies of the last inspection report on display. In addition anyone who is interested can visit Southern Crosss web site at: www.schealthcare.co.uk., which also gives details of the services on offer, and has a link to the Granges latest inspection report produced by the Commission. Care Homes for Older People Page 11 of 27 Evidence: As part of the case tracking process six people who live at the care home were identified, and their files were seen, each one contained a copy of the terms and conditions of residence which had been signed by relatives, and an agreement from Social Services to fund their placement, was seen in a seperate file. Each of the six files contained a formal assessment of need. These were in-house assessments, based on the Roper, Logan & Tierney Activities of Daily Living model, although four also had FACE assessments completed by a Social Worker. All of the assessments had been completed before the person moved into the home. In addition to the basic needs assessments, there were additional assessments covering areas such as: Continence, Nutrition (with copies of the Malnutrition Universal Screening Tool - MUST), Moving & Handling, Deprendency and Pressure ulcer risk assessments. In their AQAA they said: All prospective Service Users are assessed prior to admission using a formal pre-admission assessment document. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care given in a professional and caring manner by the staff, which means that individuals are having their care needs met. Evidence: Each of the files that were seen contained a plan of care, which identified personal goals and identified peoples needs and how to meet them. Evidence was seen that care plans were being reviewed monthly with an annual review by both the care home and Social Services. None of the files currently have any assessments or documentation related to The Mental Capacity Act which became fully implemented in April 2009. For a number of people living at the home there are restrictions on their movements on the grounds of safety, by the use of keypads and doors they cannot open, but there is no documentation related to the Deprivation of Liberties safeguards (part of the Mental Capacity act 2005) to cover this. All of the files that were seen contained health care plans. The plans included information relating to health care professionals such as visits to the doctor, or by the nurse, and any hospital visits. Vison Call a mobile optician provides a service to people Care Homes for Older People Page 13 of 27 Evidence: living at the home, although some people do exercise personal choice and use their own private optician. Documentation related to opticians visits and prescriptions was seen in the files. The home also makes use of a local dentist who is mobile, and comes in to see and treat people at the home, and this was also recorded within the files. Most of the people use the local Doctors surgery, and there is a good relationship with them, as they will visit people 90 of the time at the home, rather than having to get to the surgery. In addition a doctor routinely calls in every Thursday to pick up on any acute needs, and carry out medication reviews. Two people were asked about seeing the doctor, and they both said that the staff would get them a doctor if they were unwell, and if they needed one. Boots the chemist provides the Grange with their medication. An inspection of the medication systems showed that medication is handled safely, and observation of the lunch time medication round did not highlight any issues. Administration records were seen and found to be complete. No one living at the home currently self-medicates. All aspects of the medication procedures that were seen showed a clear audit trail for medication, and indicated that people living at the care home were safe. Two requirements made at the last key inspection related to medication practices were found to have been met. Two people were spoken with, and they both said they were very happy with their care. Many of the people who live at the Grange have some degree of dementia, which made discussions with some people difficult, however observation of the staff working with people and observation of body language and mood showed that the staff treated people with respect and dignity. This included observing staff knocking on peoples doors before entering, and speaking in a respectful manner. generally there was a relaxed and calm atmosphere throughout the home, and there were no signs of anyone being distressed or upset. In their AQAA they said: We support individuals to be involved in their own care and to make their own decisions wherever possible on the clothes they wear, the toileteries they use etc. Of the six files that were seen, four had an end of life care plan, covering different aspects of the individuals wishes at the end of their life. In some cases there were general statements such as: inform the family. this was discussed at some length with the manager, and the difficulties and limitations of such general statements were identified. The evidence did show that for some people there were care plans in place, although the quality of the information varied. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a lifestyle that reflects their cultural, social and religious interests, and needs, and there is clear evidence that their social care needs are being met. Evidence: Discussions with two people identified that there were plenty of activities arranged, these ranged from activities in the home such as bingo, quizzes and table topped activities (games and puzzles), and occasionally outside entertainers. There are now two activity co-ordinators working at the home, which has seen an increase in organised activities since the last inspection. Discussions with one of the activity coordinators identified that there was a mixture of group activities and individual one to one sessions. Southern Cross have a minibus which is booked on an occasional basis to take people out into the community. During the inspection visit a lively game of Bingo was being held in an upstairs lounge. In one of the questionnaires returned by a person living at the home they said: We need more activities, like exercise and gentle physio to stop older people becoming overweight, and more active. Comments received from two relatives through the questionnaires included: Theres always a good deal of activity going on. They try very hard to stimulate people, and organise activities. In their AQAA the home said: Offer a variety of social activities and outings. This includes painting, drawing and colouring, bingo, dominoes, baking cakes Care Homes for Older People Page 15 of 27 Evidence: and buns, making fruit salads and smoothies, light gardening - potting up plants, planting out and watering the garden. Going for walks around the area including visits to the village market or to watch a cricket match. One of the rooms at the home has been consecrated and a local vicar comes in on a regular basis to hold religious services. One relative was spoken with during this inspection visit, they were positive in their comments, and said that they were made to feel welcome, and that the staff were friendly and approachable. They said that they were very happy with the care provided for their relative, and had nothing but praise for the staff. In addition comments received via two questionnaires that were retrned included: My mothers needs and level of care change, and the care staff adapt very well. They provide an excellent level of day care, and an adequate level of night care. They communicate with us and always listen and act (if appropriate) on our concerns. Since my mother bacame a resident at the Grange I have been very impressed by the care she has received. Also the support we as a family get from the manager and care staff. They do an excellent job, and I have no concerns about the level of care being given. Staff were observed to see how well they interacted with the people living at the home, and whether choices were being offered. A great deal of positive activity was observed with choice offered particularly around drinks and activities. Staff working in the kitchen demonstrated how choices were offered and recorded at meal times, and the activity co-ordinator talked about how activities were organised, and choice was offered. Discussions with two people indicated that they both thought they had control over a lot of things in their lives. Days prior to this inspection visit the cook left. This was in response to several complaints from people living at the home in relation to food, and choice. A new cook had just started working at the home, and had immmedately carried out a review of the menus, and introduced more variety and choice. On the day of this inspection visit there was a good choice of meal on offer including a vegetarian option if required, and further alternatives such as baked potato and filling should none of the main choices appeal. Information related to peoples likes and dislikes was seen in the kitchen. The food was well presented, with the dining room attractively laid out for people. Care had been taken over the place settings, with tablecloths, napkins and flowers to add to the dining experience. All of the people spoken with said good things about the food with comments such as: The food is really very nice, and I can have what I want for dinner. and very nice, very nice indeed and I have no complaints whatsoever. One comment within a questionnaire from people living at the home related to food: Listen to residents complaints about the food quality and act upon them. This Care Homes for Older People Page 16 of 27 Evidence: comment may have related to the previous cook. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safe, as a result of the policies, procedures and systems that are in place, and people living at the care home and their relatives are confident that their complaints will be taken seriously and dealt with. Evidence: The Grange has received three complaints since the last key inspection in September 2007, two of which were identified in their AQAA. A review of the complaints showed that they had been dealt with in line with the homes complaints procedure, which is on display in the foyer, and also forms part of the service user guide. Discussions with two people who live at the home, and one relative indicated that they knew who to complain to, and how to complain, although none of them had ever needed to. In their AQAA the home said: Minimal complaints. Families are aware that they can come with any concerns and raise these with the Manager and that they will be dealt with promptly. The home have made no referrals under safeguarding procedures in the last twelve months. A review of the staff training records in relation to safeguarding adults, and a review of the statistics showed that forty-seven out of fifty seven staff had undertaken this training in the last twelve months, with a number of courses arranged throughout the year. Three members of staff were asked about safeguarding adults training and they were aware of the issues, and the procedures, and had undertaken this training. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean, well maintained and comfortable home, with their personal possessions around them, this means that people are living in homely surroundings that meet their needs. Evidence: A partial tour of the Grange showed that it was very spacious, well decorated, comfortable and well maintained, with good quality fixtures and fittings. Two requirements made at the last key inspection had been met, as had the good practice recommendation. Currently only one of the people living at the home smokes, and a small smoking room has been created upstairs for their use. Discussions with two people who live at the care home showed that they thought that it was comfortable and meets their needs. Several bedrooms were seen, and these were well personalised, and homely, all of the people who were spoken with said they felt they had everything they needed, and that they thought their bedrooms were comfortable and the home was well equipped. Outside there are pleasant sitting areas. A courtyard with a water feature and raised flower beds provides a quiet, sheltered outdoor area. This has been created since the last key inspection with money provided from a Community grant. Domestic staff were seen cleaning in different parts of the building during this inspection visit, and discussions with staff showed that there were systems in place for Care Homes for Older People Page 19 of 27 Evidence: cleaning, and that there was a good supply of cleaning materials. The building was found to be clean, tidy and smelt fresh, with no bad odours. In relation to cleaning they said in their AQAA: Maintain a clean, bright environment, there is significant attention paid to keeping the Home free from odours. Fresh flowers are provided in Reception and lounge rooms. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have been recruited professionally, and are competent and trained to do their jobs, which means that the people who live at the care home are safe, and have staff who are able to meet their needs. Evidence: The staffing rota was seen and this showed that there were enough staff currently employed to meet peoples needs. Two people living at the care home were asked about staffing levels, and they said that they thought there were enough staff, and the relative who was spoken with, also said that: they didnt think staffing levels was an issue. Three members of staff who were asked, said that they thought there were enough staff to meet peoples needs. The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the staff training records showed that currently there are thirty-three care staff, of whom there are sixteen staff with NVQ level II, and in addition there are six qualified nurses working at the care home. The files of six members of staff were seen, to check that they contained all of the information that would show that staff had been recruited in a safe manner, namely that applicants had filled out an application form, provided two written references and Care Homes for Older People Page 21 of 27 Evidence: had had a Criminal Records Bureau check. The documentation showed that the recruitment policy and procedure had worked to protect the people living there. Discussions with three members of staff about their recruitment showed that they had gone through all of the pre-employment checks, and had not started working until those checks had been completed. The staff training records showed that staff were receiving the training necessary to help them to do their jobs. Discussions with three staff members provided evidence of the training courses staff had attended, including the mandatory training in fire safety, moving & handling and health & safety etc. Evidence of training courses attended was seen on the computer, and copies of certificates and other training material was seen in staff files. In a staff questionnaire that was returned a staff member said: In my opinion I think the home gives good care to all residents. Good training is provided, and if I need any more training it is always provided. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a safe, well-managed care home with good systems for ensuring its quality in place, which means that people living at the home have their needs met by the staff. Evidence: Angela Flavell is the Registered Manager. She is suitably qualified and experienced being a Registered General Nurse, and she has been judged by the Care Quality Commission to be a fit person to run a care home. Angela became the Registered Manager of the Grange in March 2005. The Granges quality assurance system relies on questionnaires being filled in by people living at the home, relatives and visitors, together with regular audits of its systems and practices by the manager. Copies of questionnaires were seen together with evaluation of the results. The manager said that meetings for the people who live at the home, have not been taking place on a regular basis due to the level of needs of the the people, and in some cases, their choice not to attend. Meetings for relatives have been arranged, however the same small number of people attend, which renders Care Homes for Older People Page 23 of 27 Evidence: them redundant, as the manager has an open door policy, and relatives raise issues directly with her as they arise. Regulation 26 visits (these are monthly audits by a representative of the owners management team) are taking place, with copies of reports seen; these also form part of the homes quality assurance system. The Grange has a system for peoples small cash needs. This is operated on behalf of some of them by the staff (dependent on individual choice and their ability to manage their money, or relatives involvement). Four peoples finances were checked at random. All of the cash tallied with the records, and receipts were seen, which enabled a clear audit trail of the individuals financial expenditure to be followed. Documents had two staff signatures, and regular checks are being carried out. The Grange has a formal staff supervision system in place, in which staff receive supervision, either with the manager or with one of the other senior members of staff. This is usually in a one to one meeting. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. Three members of staff were asked about formal supervision, and they all said they felt well supported, and were receiving regular supervision sessions. However seven staff supervision records were seen, and a review of the documentation showed that staff were not receiving six supervisions a year as recommended by the National Minimum standards. Different health & safety records were seen, including the fire safety records, water temperature checks and the Control of Substances Hazardous to Health (COSHH) records, all were found to be correct and up-to-date, which shows that people are living and working in a safe environment. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 People living at the care home should have assessments of their capacity carried out, and recorded as appropriate, and where individuals are having their movements restricted, there should be an assessment and documentation in place related to the Deprivation of Liberties safeguards. Everyone living at the care home should have a specific care plan related their wishes at the end of their life. these care plans should be detailed enough to offer staff clear guidance on what actions they should take to meet peoples wishes, while also reflecting the familys involvement, which may vary depending on individual family circumstances. In the light of one comment received in a questionnaire, efforts should be made to check that people living at the home are happy with the quality, quantity and choice of food on offer. All members of staff should receive formal supervision a minimum of six times a year, with a record of the meeting kept, and available for inspection. 2 11 3 15 4 36 Care Homes for Older People Page 26 of 27 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 27 of 27 - 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!