Inspection on 17/01/06 for Alexandra Grange

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Alexandra Grange 01/10/08

Alexandra Grange 05/10/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra Grange Howard Street Pemberton Wigan Lancashire WN5 8BD Lead Inspector Bernard Tracey Unannounced Inspection 17th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alexandra Grange Address Howard Street Pemberton Wigan Lancashire WN5 8BD 01942 215222 01942 735555 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Keith Lowe Judith Melling Care Home 52 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (52) of places Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 52 service users to include: Up to 28 service-users 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. 04th August 2005 2. Date of last inspection Brief Description of the Service: 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 service users over the age of 60 with dementia. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a four-hour period. The home was not notified that the inspection was going to take place. The following records were read; residents’ records relating to how the care of residents was planned and carried out, medication records, staff rosters, accident records, training records and staff files. The Inspector spoke to numerous staff members, the manager and also spoke at length to five residents and more during the tour of the home. All of the residents spoken with said they had no concerns. They said that the staff were “very helpful and prompt to give assistance”. They said that “the home is comfortable and the food very good”, Residents said that they were pleased with their bedrooms and en-suites. What the service does well: This is a care home where residents are well looked after. The staff team work well together and show a good understanding of the needs of the people living at the home. Care documentation was well written and very comprehensive. A number of the residents spoken to have lived in the home for many years and they said that they would not want to live anywhere else”. One resident said that their relative had chosen the home for them and the resident felt that “ it is lovely and the staff are excellent”. The assessment and ongoing review of care is thorough, which makes sure that the residents’ care needs are being met. The care plans are well written and contain details of any specific intervention required. All care plans are reviewed monthly or more frequently if there are changes to the needs of the residents. The staff team are well trained and confirmed that they are supported by the management and felt valued. A good level of staff training was in evidence and required staffing levels are consistently maintained. Residents are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is free from odour. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply. Assessment of individual need is made before each resident moves into the home to ensure that the home can provide the care needed by the individual EVIDENCE: Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 9 The assessments of three residents were examined: two residents were receiving social care whilst one was assessed as requiring nursing care. It was identified that each of the residents had a detailed assessment undertaken by the Registered Manager or Care Manager prior to admission. The pre admission assessment includes a detailed pen portrait of the residents, more often obtained from their representative, which provided details of significant events in the residents’ life, including work and home experiences. A summary assessment and care plan for an individual referred through Care Management arrangements was evident and had been utilised in formulating the individual care plan. A copy of the care plan produced by the Community Mental health team was evident and provided a foundation for care and an aid to future care planning. There was also evidence that residents had recently been seen by members of the Mental Health team. The staff spoken to were well aware of the care needs of the individual residents and this was confirmed during the inspection through observations of the care practices being carried out. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 79 The home is not consistently good at involving residents or their representative in the development or review of care plans. The medication system in place ensured that the residents received their medicines safely and correctly. EVIDENCE: Individual records are kept for each resident and contain comprehensive information relating to all aspects of health, personal and social care needs of the residents. From this information gathered, an individual plan of care is drawn up. Significant events had been recorded and daily entries made setting out the care given, The records of three residents were looked at in detail and these clearly described the healthcare needs of the residents. Evidence was seen of the monthly reviews carried out to ensure that the care plans continue to meet individual needs. There was clear evidence of the involvement of the Mental Health services in the planning and review of individual care. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 11 Not all care plans provided written evidence of residents or their representatives being involved in the drawing up and review of individual care plans. Risk assessments were in place and covered such areas as moving and handling, nutrition, pressure care, the use of bed rails and falls. The residents were weighed at least on a monthly basis and the weight recorded on a chart kept in their care plan. The medications system was safe. Medications were securely stored; the prescription administration sheets were filled in accurately and there was an accurate record of medicines received into the home and returned back to the pharmacist. Designated and appropriately trained staff administered medicines. It is recommended that when it is necessary to hand transcribe prescriptions on to the medicine administration sheet, the entry is checked and signed by two members of staff to avoid errors. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Visiting arrangements at the home are informal and family and friends of residents are encouraged to maintain contact promoting personal relationships EVIDENCE: Visitors are made very welcome and although the Inspector was unable to see any visitors on the day, previous involvement with a large number of visitors provided evidence of the friendly way in which they related to the management and staff. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Senior staff had a good knowledge and understanding of adult protection procedures thereby reducing the possible risk of harm or abuse to residents. EVIDENCE: Policies and procedures regarding the protection of the vulnerable adult are robust and ensure residents are protected at all times. Induction and foundation training ensures staff are aware of their responsibilities to protect vulnerable adults in their care. A discussion with members of staff demonstrated an awareness of the procedure to follow in the event of an allegation of abuse. Senior staff had recently attended the launch of the recently published Wigan MBC Protection of Vulnerable Adults policy and evidence was seen that training in the above was being rolled out throughout the home to included every member of staff. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 26 The standard of the environment within this home has improved since the last inspection providing residents with an attractive and homely place to live. The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely and safe environment. EVIDENCE: Following requirements made at the last inspection the home has implemented a programme of routine maintenance and a programme of renewal of the fabric and decoration within the home. The home has had a number of bedrooms and communal areas redecorated since the last inspection and all areas seen were bright, clean and odour free. Four residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 15 feel more homely’. All bedrooms are supplied with door locks and lockable storage space to ensure resident’s valuables are kept safe. Staff have a master key, which can be used to gain access in an emergency. There are four lounges including a designated smoking area. On the day of the inspection the carpet in the lower lounge was being industrially cleaned. Smoking is not allowed in the dining rooms or bedrooms. The communal areas provide comfortable and domestic style furnishings. There are accessible toilets for the service users, clearly marked, close to the lounge and dining areas and each service user has an en suite facility as part of their private accommodation. The bathrooms now benefit from shelving and appropriate storage cupboards to provide a more homely setting for residents when bathing. The en suite facilities provide accessibility to service users who may use wheelchairs, or other aids to their mobility. There are adequate numbers of assisted baths. There is a lift within the home and all communal areas are accessible. Grab rails are fitted to toilets and showers and baths are assisted. Nurse call bells were seen to be available and accessible. The home was clean and free from odours. Hand washing facilities are in place in each resident’s bedroom, toilets, bathrooms, sluices, laundry and clinical areas. Procedures are in place to ensure that clinical waste was handled appropriately and infection control procedures are adhered to. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Staff are well trained to ensure they have the competencies to meet residents needs. There is sufficient staff to meet the needs of residents. The homes recruitment procedures are robust and these provide safeguards for the protection of residents. EVIDENCE: Information in the staffing rotas shows that there is two nurses and seven care staff on duty during the day shift and one nurse and four care staff at night. Extra staff are called in to cover for taking residents to appointments and additional ancillary staff are on duty throughout the day. The manager said that she has assessed the number of staff on duty at night against the tasks to be completed and is satisfied that sufficient numbers are in place. Residents spoken to are very happy with the amount of staff on duty and said ‘they are always helpful and available to see to anything you need doing and nothing is too much bother’. The home has a comprehensive recruitment policy and procedure and when three staff files were checked it was evident that the manager follows the procedure, and ensures the interview process, Pova / CRB checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. One staff member whose file was looked at is from another country and has undergone all checks necessary for overseas workers including work permits, passport and immunisation records. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 17 Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Training is very high on the agenda and very comprehensive records are kept of the training undertaken by staff, competently overseen by the Quality and Training Coordinator. Staff spoken to informed the Inspector of the training that they had done. One staff member said that ‘the training here is excellent, I am doing a distance learning course on Dementia and want to learn more in the future’. Another member of staff was pleased that ‘the home helps us to retain our nursing registration by offering courses to keep up our PREP’. Staff members stated that they are encouraged to attend courses and given the time and support to do this. The Inspector observed the positive manner of the coordinator and her skill and enthusiasm in obtaining training opportunities for the home. Staff spoken to said that they were clear about their role and work well as a team to ensure the individual and collective needs of the residents are met. Training places have recently been acquired for forty staff to receive training in the needs of residents with dementia, overseen by Ormskirk college tutors. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 38 The manager is supported by the senior staff in providing clear leadership throughout the home, with all staff demonstrating an awareness of their roles and responsibilities. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents, staff and relatives. EVIDENCE: Feedback is sought from the residents and relatives through regular meetings and satisfaction questionnaires. Policies and procedures are up dated and reviewed as an ongoing practice and action is taken to ensure the requirements of the inspection reports are met. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 19 The home completes in-house audits of its service on a monthly basis, and the Quality and Training Coordinator competently oversee this. The home has recently been awarded 4 stars by the Residential and Domiciliary Benchmarking (RDB) an external quality monitoring service. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. Residents and staff agreed that they are able to express ideas, criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Staff supervision files show that individuals receive formal supervision with their line managers on a regular basis and staff appraisals are also completed each year. Records required for the protection of residents and the running of the business are in place, reviewed and up dated as required. Residents are aware that they can access their personal records as and when they wish to do so. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Timescale for action The care plans must be drawn up 01/03/06 and reviewed with the involvement of the resident or their relative. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Hand transcribed medication should be witnessed by two staff members to avoid errors. Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra Grange DS0000005667.V268774.R01.S.doc Version 5.1 Page 23 - 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. 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