Inspection on 04/08/05 for Alexandra Grange

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 17/01/06

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 WN5 8BD Lead Inspector Bernard Tracey Announced 4 August 2005 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 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 F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Alexandra Grange Address Howard Street Pemberton Wigan WN5 8BD 01942 215222 01942 735555 Telephone number Fax number Email 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 CRH Care Home with nursing 52 Category(ies) of DE Dementia - 2 registration, with number DE(E) Dementia over 65 - 52 of places ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 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 of DE aged between 60 and 65 years of age 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 16th November 2004 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 F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was made aware that this inspection was to take place. Several weeks before the inspection questionnaires were sent out to doctors, social workers and district nurses, as well as to the residents of the home and their relatives. The questionnaires asked what people thought of the care and services provided by the home. The Inspector spent 7 hours in the home. During this time he looked at care records to ensure that health and care needs were being met. He also examined files that contained information about how residents’ and relatives’ complaints were dealt with. The Inspector spent time speaking to 6 residents and also spoke to 5 care staff, 2 nurses, the manager and the deputy manager. The Inspector toured the building and took the opportunity to look at the communal facilities as well as residents’ own rooms. Not all the National Minimum Standards were looked at on this visit. During the next inspection, which will be unannounced, the Inspector will look at the rest of the Standards that are considered to be important for resident safety and wellbeing, staff recruitment and the management of the home What the service does well: The home had some care staff that had worked at the home for a long time and the residents said that they liked the staff and felt safe in the home. Comments such as “everyone is very good to me, if I can’t be at home I wouldnt go anywhere else,” and “Im very happy here, they are so lovely” were made to the Inspector. Meals and mealtimes are considered to be an important part of the residents’ day. The dining rooms are nice places to sit, eat and meet with other residents. The residents said that they really enjoyed their meals. They were satisfied with the choice of meals and the way they were cooked and served. Residents said they were really pleased with the newly created garden, which they said was lovely to go and sit in, or just look out on. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 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 F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 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 standard(s) None of the key standards were examined. EVIDENCE: The key standards were not inspected on this occasion. They will be inspected at the next inspection. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7 8 10 There is a clear and detailed care planning system in place, which provides the staff with the information needed to meet the needs of the residents. Personal preferences and routines are recorded, in particular for those residents who are unable to articulate their wishes, so that residents’ preferences are known and can be upheld at all times. EVIDENCE: ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 10 Individual care plans are in place for each resident. The care plans of five residents were examined in detail during this inspection. The home promotes and maintains the residents’ health and ensures access to specialist care services to meet their assessed needs. The residents’ psychological health is monitored regularly and preventive and restorative care is provided, in conjunction with the Community Mental Health team. The Consultant Psychiatrist visits the home and advises on treatment regimes. Residents are assessed to identify those at risk of, or having developed pressure areas, and appropriate interventions are made and recorded in the care plan. Equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores was seen to be in use. Nutritional screening was seen to be in place in the care plans and the nurse in charge informed the Inspector that she was aware of how to seek dietetic advice if it was deemed necessary for an individual. The care plans, although reviewed regularly, did not clearly demonstrate evidence of the involvement of residents, or more usually their representative, being involved in the drawing up of the care planning and review of care. A discussion with the residents on the residential unit showed that they had access to other healthcare professionals, such as dentists, opticians, chiropodist and district nurses. Evidence of these visits was kept in the residents’ individual files. The unit manager told the Inspector that the homes’ relationship with the district nurses was extremely good. All the residents spoken with felt well cared for and comfortable in the home. One said she felt the staff “do well for you and you never have to worry about them”. Another resident said the staff were always cheerful and she was never made to feel embarrassed when she needed help. All members of staff receive instruction and training in preserving the privacy and dignity of residents on induction, and a signed form indicates acceptance that the training has been given and received during the induction process. Medical examination and personal treatment is provided in the privacy of the resident’s own room. Relatives and friends are encouraged to visit as often as possible and the home operates an open visiting policy. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 14 15 The social activities on the residential unit, provides the residents with enjoyment and interest. The dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets the residents’ tastes and choices. EVIDENCE: The dining tables were appropriately set for the lunchtime meal. The meal was taken in a relaxed environment, soft music playing in the background, with staff and residents regularly interacting with each other. Time was taken for residents to eat their meals and staff would ask each person if had they finished or would like a further helping. Staff were observed to assist those residents requiring help in a caring, sensitive and unhurried way, gently encouraging the resident to continue with their meal until they had finished eating. Menus were nutritious and balanced and included a good variety of meat, fish, fresh vegetables and fruit. Should a resident request something that was not on the menu, alternative meals were available. Residents said they were asked in the morning what they would like from the choices for lunch and tea ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 12 and all felt this was a good idea. One resident said she preferred to make her choice ‘on a daily basis as I can’t remember what I ordered the day before’. The routines of daily living and activities are flexible and varied to meet residents’ needs and capacities. Residents’ interests are recorded within their care plan and they are given opportunities for stimulation through leisure and recreational activities in and outside the home, with appropriate consideration given to needs of residents who have dementia. The home employs an activities co-ordinator who was seen to be involved with the residents on the residential unit. In discussion with the inspector she was able to describe how she provided time for one to one activity, such as walking to the local shops, as well as group activities, depending on each person’s needs. The manager has recently advertised for an activities person to work on the nursing unit, which will enable a more varied an individual programme on the upper floor of the home. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 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 standard(s) 16 18 The complaint system in place enabled the residents to feel that their views were listened to and acted upon. Staff do not have had a sound knowledge and understanding of adult protection procedures thereby increasing the possible risk of harm or abuse. EVIDENCE: The complaints procedure is displayed in the reception area and a copy is attached to the service user guide. The Home’s manager assured the inspector that all residents or their representative received a copy of the complaints procedure along with the service user guide on admission to the home. The complaints procedure is easy to understand and gives an assurance that complaints will be responded to within 28 days. Details are included to inform the complainant how to progress the complaint if they are not satisfied with the care homes’ response, including information on how to contact the relevant statutory bodies. The majority of residents at Alexandra Grange are not able to make an informed choice and therefore require an advocate acting in their best interests. In the main residents have relatives that will act on their behalf. Those who do not have relative involvement generally have Care Managers representing their interests. The service user guide that was available contained a list of advocacy agencies that could be accessed if required. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 14 The inspector was able to examine the record of complaints received, held by the manager. These records were detailed and gave a good account of the actions taken by the home to resolve the complaint and a record of the outcome was made. The home manager has recently reviewed the Whistle blowing policy and a copy was available for inspection. A copy of the Local Authority Vulnerable Adults Procedure was in place; however a discussion with the senior staff identified that they were not fully aware of the procedure to follow in the event of an allegation of abuse being made in the home. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19 26 The majority of the bedrooms and all of the bathrooms do not present as an attractive and homely environment for the residents to live in. EVIDENCE: The Unit managers informed the inspector that they have compiled an inventory of decoration and refurbishment requirements for each unit as well as a ‘wish list’, that is now with the Provider for consideration. All of the shortfalls identified by the inspector, were confirmed to be included in the inventory. The majority of residents’ personal accommodation has been re-painted, with little consideration given to individuality or personalisation. The rooms visited on the inspection, although not posing a risk, did not provide a pleasant and homely environment in which to live. The bathrooms would benefit from shelving and appropriate storage cupboards to provide a more homely setting ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 16 The carpet in the lounge on the ground floor is heavily stained despite having been cleaned by the domestic staff on a regular basis. If the stains and marking cannot be removed by industrial style cleaning this carpet must be replaced. A very attractive garden area has been provided to the rear of the building, by the care staff, in which residents said they were able to enjoy the flowers and relax on the seating provided. Work is in progress to tidy other areas surrounding the building. The home was clean and free from odours. Hand washing in each resident’s bedroom, toilets, bathrooms, sluices, areas. Procedures are in place to ensure that clinical appropriately and infection control procedures facilities are in place laundry and clinical waste was handled are adhered to. ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: The key standards were not inspected on this occasion. at the next inspection. They will be inspected ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: The key standards were not inspected on this occasion. at the next inspection. They will be inspected ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x x ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? 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 18 Regulation 12 Requirement Training must be given to ensure that all staff are aware of how to respond to suspicion or evidence of abuse or neglect. The carpet in the lower ground floor lounge should be adequately cleaned or replaced. The personal accommodation must meet individual need in a comfortable and homely manner. A plan to refurbish the personal accommodation must be provided by 30th September 2005. The bathrooms must be provided with suitable shelving and storage facilities. The care plans must be drawn up and reviewed with the involvement of the resident or their relative. Timescale for action 30th September 2005. 30th September 2005. 30th October 2005 2. 3. 19 19 23 23 4. 5. 19 7 23 15 30th September 2005., 30th September 2005., RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 21 ALEXANDRA GRANGE 1. None ALEXANDRA GRANGE F56 F06 S5667 Alexandra Grange V221144 040805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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. 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