Inspection on 05/10/06 for Alexandra Grange

This inspection was carried out on 5th October 2006.

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexandra Grange Howard Street Pemberton Wigan Lancashire WN5 8BD Lead Inspector Mike Murphy Unannounced Inspection 5th October 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.V290607.R01.S.doc Version 5.2 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.V290607.R01.S.doc Version 5.2 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.V290607.R01.S.doc Version 5.2 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. 17th January 2006 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. The current fees are from £376.23 to £415.00 (information provided by the home) Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection visit took place over a period of eight hours. The inspection included discussion with some residents, relatives, a tour of the premises, inspection of care and other records maintained at the home, and discussion with the registered manager and staff. The home was being appropriately managed and provided residents with a clean and comfortable environment in which to live. Residents were supported and cared for appropriately and encouraged to make personal choices and retain as much personal independence as possible. What the service does well: What has improved since the last inspection? What they could do better: There are no requirements or recommendations on this occasion. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 6 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.V290607.R01.S.doc Version 5.2 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.V290607.R01.S.doc Version 5.2 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): 1,3,4,5. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. No prospective residents are admitted to the home without their care and support needs being assessed appropriately. EVIDENCE: Prior to residents 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 consultation with the resident, their relatives and relevant health (for example doctors) and social care professionals (for example social workers). The purpose of such an assessment is to assist the prospective resident (and their relatives) in their considerations of how appropriate a placement at the home would be and enable the nurse or care worker conducting the assessment to determine if the home will be able to meet the prospective resident’s needs appropriately. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 9 A statement of purpose and service users guide is provided and contains information that assists prospective residents and their supporters to make informed choices about the suitability of the home. 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 regarded as being important and that they felt they were part of the decision making process. The placement of all residents is subject to ongoing review and relatives reported they were included in these reviews. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 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): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health and personal care residents at the home receive appears to be suitable and appropriate and is meeting the expectations of residents and their relatives. EVIDENCE: Alexander Grange provides care and accommodation for elderly residents who require such support because they are suffering from conditions that significantly impair their memory and ability to live independent lives safely. Care is provided on 2 separate units within the home. On the ground floor care is provided to residents who require ‘personal’ and ‘residential’ care but not ‘24 hour nursing’ care (any periodic ‘nursing’ needs these residents may have are met by the District nursing service). The first floor provides care to those residents who require continual ’24 hour EMI nursing care’ where nurses employed by the home provide care at all times. 6 residents care records were inspected – 3 from each floor. Care records were organised in a standard format throughout the home. All contained detailed pre and post admission assessments that clearly identified the care needs of residents. All areas of the resident’s life are considered in Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 11 such assessments including their physical, mental and social needs. All care records contained a life and social history of the resident. This enables 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. Care plans were formally reviewed at least monthly Particular areas of risk are formally ‘risk assessed’ on a regular basis to protect resident’s health and 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 enabled 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 (and in pre inspection questionnaire responses) indicated they were kept informed of all significant changes in their relation’s health. The procedures for the receipt, recording, storage, handling, administration and disposal of resident’s medicines were 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 relatives and staff revealed that residents were treated with respect and that their right to privacy was upheld. Comments made included; ‘the staff are nice and polite’, ‘I have been asked what my relative’s likes and dislikes are’, ‘the residents always look like they have been properly cared for whenever I have visited – which I do often and at different days and times’, ‘the doctors examine all our residents in their own room when they come to visit’. During the inspection staff treated residents with respect, kindly, protected their dignity and assisted them properly. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were very well supported by staff to participate in social activities and are able to as far as possible retain the ability to make personal choices. EVIDENCE: Discussions with some residents, staff (including the activities organiser who has been appointed since the last inspection) and residents relatives indicated that residents are provided with a suitable stimulating programme of leisure and social activities that they can participate in if they wish. A timetable of activities is prominently displayed in the home. The home is very well equipped with a wide variety of games, books, arts and crafts and other recreational equipment. The leisure and social activities programme also included trips out into both the local community and places of interest – and numerous photographic displays documenting these outings were displayed throughout the home. Also displayed were numerous collages and themed displays of the art and crafts produced by residents at the home. Residents on both floors of the home are supported both individually and as a group to engage in the Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 13 activities on offer with the activities organiser dividing her time between the two areas. Relatives consulted confirmed that they experienced no unreasonable restrictions to them visiting their relation at the home and that visits could be conducted in the privacy of the resident’s room or a quieter area of the home. The general consensus was that meals were of a good quality. Meal times are reasonable and residents were served and assisted with their lunch appropriately on the day of inspection. Menus are balanced, varied and provide choice. Residents likes and dislikes are established directly and through discussion with residents relatives are taken into account. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 14 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): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Relatives spoken to felt comfortable enough to and knew how to make a complaint if they felt it necessary. Written guidance and training arrangements ensure that staff members have a good knowledge of abuse and protection arrangements and safeguards in place to protect the welfare of residents. EVIDENCE: The complaints procedure was prominently displayed and also is available in the ‘Service users guide’ that is provided for resident’s and their relative’s information. Relatives said that any concerns or worries brought to the manager’s attention are responded to quickly and rarely become formal complaints. A complaints log is maintained. Complaints and incidents are managed appropriately. Alexander Grange operates protection of vulnerable adults and whistle blowing policies that seek to protect elderly people. In addition, a copy of Wigan’s Inter agency protection procedure is held on site. Staff spoken to confirmed that they had received adult protection training (this was reflected in training records maintained by the home) and were aware of the whistle-blowing policy. Appropriate pre-employment checks are conducted on all staff to help ensure that residents are being cared for by suitable staff. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 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 the following standard(s): 19,20,21,22,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home appeared to be structurally well maintained throughout and provides a suitable and comfortable environment for the care of residents. EVIDENCE: The home was in a good state of repair and decoration throughout. Communal lounge and dining areas were clean, suitably heated, comfortably and appropriately furnished and provided a suitable and secure environment for resident’s to be cared for and supported properly. Appropriate provision of televisions, music centres and other leisure equipment has been made. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 16 Residents are also supported – when the weather is suitable - to access the pleasant garden areas within the grounds of the home. Appropriately adapted bathing/shower areas are provided. The home has generally been suitably adapted to meet the needs of residents in relation to specialist 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 free of malodour at the time of this unannounced inspection. Suitable arrangements and equipment were in place to manage the laundry requirements of residents at the home. And appropriate measures were being taken to minimise the potential spread of infection within the home. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 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 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The recruitment, provision and training of staff employed at the home are being managed appropriately. This is important to ensure that residents are being cared for adequately and appropriately by staff who are able to deliver this support safely and competently. EVIDENCE: Inspection of staffing rotas provided by the home indicated that staffing provision at the home complied with the current minimum requirements that apply to care homes for older people. Discussion with the manager and other senior staff at the home indicated that they were of the view that current staffing levels at the home were appropriate to meet the dependency levels of resident’s. Inspection of 3 staff personnel files revealed that these contained an application form (including health declaration), 2 written references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity and evidence of induction training and further training. NVQ 2, 3 and 4 training in health and social care is being provided for staff. At the time of inspection over 50 of care staff had achieved or were in the process of achieving the NVQ 2 qualification or above. Also a wide range of Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 18 appropriate and ongoing training in moving and handling, abuse, basic food hygiene, fire safety and other relevant topics are provided to staff at the home. The home employs a senior person who manages the training needs of staff and quality assurance issues within the home. Discussion with this person revealed that training within the home has been reviewed and amended to comply with the new standards in respect of induction and further training recently introduced by the Skills Council. Training provided to individual staff is recorded in detail and reviewed at frequent intervals. Staff spoken to felt their training needs were being addressed. And many felt this not only made them more competent but also made them feel more valued in their work. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 19 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): 31,33,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Alexander Grange is well managed by the very experienced manger, a qualified registered nurse with many years of experience in general nursing and care of the elderly. 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. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 20 A wide range of quality assurance systems are in place to ensure the home is run in the best interests of residents – these include resident/relative meetings, staff meetings, internal audits, and regular satisfaction surveys. Residents relatives and staff report that the manager and her senior staff operate an ‘open door’ policy that enables people to raise and discuss any areas of concern quickly and comfortably. Records in respect of fire safety equipment, fire drills, electrical safety, gas safety, safety of lifting equipment, clinical waste (including waste medicines) removal, and the regulation of water temperatures were inspected. These were found to be satisfactory. Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 21 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS; None on this occasion 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS; None on this occasion 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 Alexandra Grange DS0000005667.V290607.R01.S.doc Version 5.2 Page 23 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.V290607.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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