Inspection on 01/10/08 for Alexandra Grange

This inspection was carried out on 1st October 2008.

CSCI 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

Alexandra Grange 05/10/06

Alexandra Grange 17/01/06

Alexandra Grange 04/08/05

Alexandra Grange 16/11/04

Alexandra Grange 27/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra Grange Howard Street Pemberton Wigan Lancashire WN5 8BD     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: Michael Murphy     Date: 0 1 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Alexandra Grange Howard Street Pemberton Wigan Lancashire WN5 8BD 01942215222 01942735555 judithmelling@cuerden.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Judith Melling Type of registration: Number of places registered: Mr Keith Lowe care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The home is registered for a maximum of 52 service users to include: Up to 28 serviceusers in the category of nursing DE(E) Up to 24 service-users in the category of DE(E) Within the total of 52 service-users up to 2 in the category DE aged between 60 and 65 years of age. The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Alexandra Grange is a care home situated within the Pemberton area and is close to local shops and other facilities nearby. Public transport is easily accessible. Access to the motorway network is also nearby. The home is purpose built and all personal accommodation is provided in single rooms each with an en suite facility. Accommodation is provided on two floors with a passenger lift allowing access to the upper floor. The home provides personal care and nursing care for male and female Care Homes for Older People Page 4 of 26 Over 65 52 2 Brief description of the care home service users over the age of 60 with dementia. The current fees are from #376.23 to #415.00 (information provided by the home) Care Homes for Older People Page 5 of 26 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 quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This inspection which included a site visit that the home did not know was going to take place was carried out over a seven hour period on the 3rd of October 2008. The process of inspection included observing what went on in the home, talking to residents, relatives, staff, visiting health and social care professionals and the home manager, looking round the home, and examining some important records. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they Care Homes for Older People Page 6 of 26 did well, and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form was completed in well. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 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 26 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. Before being admitted to the home residents have their care and support needs assessed to ensure the home is able to meet their needs. Evidence: Before being admitted to the home a senior member of the nursing or care staff carry out an assessment of the prospective resident’s needs. In particular they talk to the prospective resident, their relatives and health and social care workers who may be supporting them where they currently live. The assessment is done to help the prospective resident (and their relatives) in deciding how appropriate a placement at the home would be and help the nurse or care worker doing the assessment to see if the home will be able to properly meet the person’s needs. Discussion with resident’s relatives revealed that the process of admission was dealt with sensitively and that they felt that were consulted at all stages and also that their views were taken into account in relation to the possible admission of their relative Care Homes for Older People Page 10 of 26 Evidence: into the home. All newly admitted residents have their placement formally reviewed within about 6 weeks of admission and relatives said they and their relation were included in these reviews. Care Homes for Older People Page 11 of 26 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. The health and personal care needs of residents including specialist health needs were being appropriately met. Evidence: 5 residents care records were inspected on this occasion. Care records were organised in a standard format throughout the home. All contained detailed assessments that were done before and after admission to the home and they clearly detailed the care and support that needed to be given. All areas of the resident’s life are assessed including their physical, mental and social needs. All care records contained a life and social history of the resident. This helps staff to relate the care and support they provide to an individual resident who is a unique person and not just ‘one of many’. Care plans clearly identified how resident’s assessed needs (including their religious and cultural needs) were to be met by identifying exactly what actions and support needs to be provided to care for these residents properly. They also gave particular attention to resident’s mental health needs. Care plans were reviewed at least monthly Individual risks are ‘risk assessed’ on a regular basis to protect resident’s health and Care Homes for Older People Page 12 of 26 Evidence: safety. Examples of such risk assessments included those completed in relation to preventing pressure sores, mobility and moving and handling and nutrition (including regular weight monitoring). All residents are registered with a local GP and it was evident that all were helped to access opticians, chiropodists, district nurses and other specialist services that individual resident’s require (such as community psychiatric nurses and psychiatrists). Relatives spoken to said they were kept informed of all significant changes in their relation’s health. Comments made included ‘they are very good and always ring if there is any change in my dad’s condition’, ‘the doctor is called when my sister is not well and they tell us what is happening, we are confident that she is being well looked after and gets medical attention when she needs it’, ‘the staff listen to you when you say you think your relation is not well and do something about it’. The way medicines were managed at the home was appropriate and safe. The qualified nurses on the first floor and the unit manager and senior care staff (who have undergone appropriate training) on the ground floor are responsible for all aspects of looking after resident’s medicines in the home. Medicine records had been completed properly. Discussion with residents, relatives and staff revealed that residents were treated well, with respect and that their privacy was maintained as much as possible. Comments made included; ‘all the staff are very good’, ‘we visit a lot at different times and the residents all appear to be well looked after and are treated in a kind way’, ‘if we have any issues they are dealt with quickly and in a nice way’, ‘mum is always well dressed and groomed every time we have come and she seems very content here’. Discussion with individual staff revealed that they were aware of the importance of treating residents with respect and protecting their dignity – particularly when they were being given personal care. These issues are a common theme in the training staff are provided with from the start of their employment. Care Homes for Older People Page 13 of 26 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. Residents are able to enjoy a stimulating lifestyle with an extensive variety of social and leisure activities to engage in. Residents are helped to make as many personal choices in their daily lives as possible, and the general view of food provision is very positive. Evidence: A wide range of suitable social and leisure activities are provided by the home. These are arranged by the full time activities co-ordinator employed there who divides her time between the residential and nursing units. She is supported in her work by the nursing and care staff. Outings are organised on a regular basis to a variety of places of interest or entertainment. Various examples of arts and crafts produced by residents and staff were seen throughout the home – particularly in the lounge areas, corridors and the ‘enchanted’ garden area that provides a safe and pleasant area for residents in good weather. Activities are usually participated in by small groups of residents but some individual activities also take place. This aspect of life in the home is well equipped and resourced with arts and craft materials, board games, books, DVD’s etc. Also regular themed social events are held within the home and photos of these were seen displayed throughout the home. Residents were seen to be fully participating in Care Homes for Older People Page 14 of 26 Evidence: these events. Residents and their relatives said that there continues to be no unreasonable restrictions to visiting at the home. The only time restrictions would be imposed is when requested by residents. Relatives spoken to during the inspection said they were always made welcome at the home and were able to see their relatives in the privacy of their own rooms. Residents wishing to maintain their religious links are enabled to do so - various clergy visit the home regularly and residents are supported to attend church services away from the home if desired. Observation of care practice and information in care plans indicated as far as possible residents are encouraged to make choices. For example what time they like to get up/go to bed. While some residents chose to sit in the lounge areas within the units a number were observed to spend time in their own rooms. Meals are cooked on site in the home’s kitchen. Meals are varied, balanced and the menu provides choice – 3 meals a day plus supper provided are provided – also snack food/drink is available at all times on all units. Meals are prepared in a central kitchen on site. Menus were prominently displayed on both units (including a picture format). There are appropriate and comfortable dining areas on each unit. Lunch was observed on the day of inspection (on the residential unit) – this was a substantial meal, providing choice, good portions and residents were appropriately/sensitively supported by staff. Staff wore disposable aprons and residents clothing was suitably protected. Residents can choose to eat in their own room if preferred. Medical/religious/vegetarian diets were being catered for. The consensus view from all is that the food is good and that an alternative to the menu can always be obtained if requested. Care Homes for Older People Page 15 of 26 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. Relatives knew how to make a complaint if they felt it necessary. Written guidance and training arrangements ensure that staff members have knowledge of abuse and protection arrangements and safeguards were in place to protect the welfare of residents. Evidence: The complaints procedure was prominently displayed. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the home. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the manager always responds within the agreed timescale. The home learns from complaints, and it is rare that a complaint about the same issue is made twice. The home operates safeguarding and whistle-blowing policies that seek to protect residents. In addition, a copy of Wigan’s Inter agency protection procedure is held on site. Staff spoken to confirmed that they had safeguarding training (this was reflected in training records maintained by the home) and were aware of the whistle-blowing policy. Appropriate preemployment checks are conducted on all staff to ensure suitable people look after the resident’s. There have been complaints and safeguarding issues since the last key Care Homes for Older People Page 16 of 26 Evidence: inspection. These have been managed appropriately within the complaints and safeguarding procedures operated at the home and by the local authority. The home manager has alerted the appropriate authority promptly of any suspected safeguarding issues. Care Homes for Older People Page 17 of 26 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. The home provides a clean, pleasant, comfortable and suitably adapted environment for residents. Evidence: The building appeared to be in a good state of repair and decoration. Lounge and dining areas were clean, appropriately and adequately heated, comfortably and appropriately furnished and provided a suitable and safe environment for resident’s to be cared for and supported properly. Televisions, music centres and other leisure equipment was available in the lounge area. Residents are also helped – when the weather is suitable - to access the pleasant garden areas within the grounds of the home. One particular area – the ‘enchanted’ garden – provides a safe and secure outside space for residents and it features art and craftwork that residents have helped produce. Suitably adapted bathing/shower areas are provided. The home has generally been suitably adapted and equipped to meet the needs of residents in relation to specialist equipment. For example the adequate provision of hoists, grab rails and handrails and other equipment. Individual resident’s specialist needs are met following referral of the individual resident to the relevant health care professional. Resident’s bedrooms that were inspected were very clean, suitably furnished and equipped and in many cases very personalised. All bedrooms are provided with en-suite WC and washbasin. The home was very clean and generally malodour was being managed Care Homes for Older People Page 18 of 26 Evidence: well. However the communal lounge area on the ground floor of the home was malodorous at the time of this inspection. The malodour appeared to be originating from the floor covering in this room. Clearly this needs to be addressed to ensure this lounge area is the same standard as the rest of the home. Suitable arrangements and equipment were in place to manage resident’s laundry. And appropriate measures were being taken to minimise the potential spread of infection within the home such as adequate hand washing facilities and the provision of protective clothing for staff as well as appropriate cleaning practices within the home. Care Homes for Older People Page 19 of 26 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. The recruitment, provision and training of staff employed at the home are being managed appropriately. This is important to ensure that residents are cared for adequately and appropriately by staff able to deliver this support safely and competently. Evidence: Staffing records showed that qualified nurses were on duty at all times on the nursing unit and a unit manager/senior carer on the ‘residential’ unit and that, in addition to nursing and care staff, the home employs a registered manager, administrative staff, catering staff, laundry staff, maintenance and other staff to ensure that residents needs can be met appropriately. Inspection of staffing records, discussion with relatives, the home manager and staff revealed the care and support needs, of the 52 residents living at the home at the time of this inspection appeared to be being met. The home continues to make progress in the provision of NVQ 2 and 3 training. At the time of inspection in excess of 80 of the care staff had received such training. 3 staff recruitment files were inspected on this occasion. They contained evidence of CRB checks (including POVA first checks), 2 written references, criminal convictions declarations, proof of identity, (but not a current photograph) and completed application forms – these included a detailed work history and a declaration relating to the prospective employees health status. Checks are made and recorded in respect of Care Homes for Older People Page 20 of 26 Evidence: the status of registered nurses with their registered body. Training records and discussion with staff indicated that they were provided with induction training on commencing employment. There was also documentary evidence that staff had been provided training in moving and handling, safeguarding, fire safety and basic food hygiene and other relevant topics. Care Homes for Older People Page 21 of 26 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 registered manager was managing Alexander Grange extremely effectively in the interests of residents. Evidence: The home manager is registered with the CSCI and is a very experienced registered nurse and has completed an NVQ4 in management. Discussion with residents relatives and staff employed at the home indicated that the manager is very accessible, approachable, provides excellent leadership, is supportive and is very aware of what is happening in the home. She is supported in her role by her senior nursing and care staff. Those spoken to said the manager and her senior staff operate an ‘open door’ policy that enables people to raise and discuss any areas of concern quickly. Discussion with some residents, their relatives and staff indicate that the manager is accessible and visits both units of the home regularly. Discussion with residents, their relatives, staff and visiting professionals revealed that the manager adopts an Care Homes for Older People Page 22 of 26 Evidence: approach that enables issues to be easily discussed with her and that emphasis is placed on operating the home in the best interests of the residents. Residents, their relatives and staff can also affect the way services are delivered at the home at the more formal regular meetings with the manager. Management policies are effectively implemented and monitored. The manager and her management team operates procedures that seek to ensure the quality of the service provided is high – and where it is identified as not being up to standard takes appropriate action to rectify the situation. The manager and her team regularly conduct formal audits of various aspects of systems and procedures operated by the home. For example residents care records are periodically checked to ensure they properly reflect the care and support needed by residents and also demonstrate care and support is delivered. Information provided to us be the manager prior to the inspection indicated that the arrangements to service/inspect fire safety equipment, electrical equipment/appliances, gas appliances, lifting equipment, clinical waste (including waste medicines) removal, and the regulation of water temperatures were satisfactory. Standard 35 was not inspected on this occasion as we were informed that documentation relating to residents monies were being audited at the time of this inspection. This standard will be looked at in the near future when the adjacent sister service is inspected. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 20 16 That action is taken to 31/01/2009 eliminate the offensive odour in the main lounge on the ground floor of the home that appears to be coming from the floor covering To eliminate/minimise offensive malodour in this are and thereby improve the comfort of residents in their daily life. 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. 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