CARE HOMES FOR OLDER PEOPLE
Charlotte Grange Residential Care Home Flaxton Street Hartlepool TS26 9JY Lead Inspector
Belinda Parker Unannounced Inspection 4th September 2006 08:45 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 Charlotte Grange Residential Care Home DS0000021740.V308987.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. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Charlotte Grange Residential Care Home Address Flaxton Street Hartlepool TS26 9JY 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) 01429 860301 01429 222472 charlottegrange@c..c.co.uk www.c-i-c.co.uk. Community Integrated Care Ms Julie Cowen Care Home 46 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (24), Physical disability (10) of places Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 10 people with a physical disability who are 55 years of age and over. Date of last inspection 16th November 2005 Brief Description of the Service: Charlotte Grange is in a quiet residential area in Hartlepool and is owned by Community Integrated Care (CIC) and is registered to provide care and accommodation for up to 46 people with the categories of dementia (12), Old age not falling within any other category (24) and Physical disability (10). Internally the home is divided into units with a central forum area at the entrance. Each unit has a lounge and additional seating areas as well as a dining area. Residents can choose to eat their meals in the dining area or in their own rooms. Kitchenettes are provided in each unit where snacks can be made. The home has a central kitchen, which serves all the units. Residents are able to personalise their own rooms and relatives and friends are welcome to visit at any reasonable time. Fees range from £338 - £360 depending on level of care required. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 04/09/06 over a period of 8:5 hours. During the visit time was spent talking to service users, relatives, staff and other health care professionals. Responses were also received from surveys sent out prior to the visit and one comment card was returned from a doctor who visits the home. Two requirements made at the last visit to the home have not been met. What the service does well:
On entering the home the atmosphere was found to be relaxed and friendly. Throughout the day service users and staff were seen chatting and laughing together. In the afternoon staff and many service users were observed taking part in a lively game of skittles in the central reception area. One service user was helping a staff member to put away clean laundry. Refurbishment within the home continues. This will improve the standard of comfort for the people who live there. During the visit we spoke to service users, staff, relatives and other health care professionals visiting individual service users. All those spoken to commented positively on the friendliness of the manager and staff as well as being satisfied with the standard of care provided to the people who lived in the home. Comments from service users included, “Very nice here”, “Staff very good, friendly”, “ Manager is good”. Comments from visiting health care professionals included, “ Service users well presented. Seen to be happy and content”, “ Would book a bed here myself”, “ Good relationship between service users and staff”, “ Nothing is any trouble. You can always find a member of staff”, “ Staff actually listen to what you say”, “No pressure sores due to good care”. Staff comments included, “ When I go home, I feel that I have helped in making someone’s life better”, “ I always go to the manager if anything concerns me”. A relative spoken to said, “The food looks good. My relative certainly enjoys it”. Responses from surveys sent to people who lived in the home included, “ Staff meet my needs, have input from other professionals”, “ Varied menu”, “ I
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 6 participate in some but not all activities”, “ I have got a copy of the complaints procedure. It is also in the contract”. The majority of records examined were up to date. Some records for the protection of service users required further development. In specific areas to ensure that staff had the necessary information to meet the changing needs of the people who lived there. 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. Charlotte Grange Residential Care Home DS0000021740.V308987.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 Charlotte Grange Residential Care Home DS0000021740.V308987.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): 3, Standard 6 not applicable (The home does not provide intermediate care) Quality in this outcome area is “Good”. This judgement has been made from evidence gathered both during and before the visit to the service. The manager involves prospective service users in the assessment process. This ensures the home can meet their individual needs. EVIDENCE: Four care plans examined included a pre-admission assessment. Information recorded in this section was found to be incomplete in some areas. This may result in staff not having all the necessary information to compile the plan of care for individual service users. The manager said she visits all prospective service users where they live to carry out the pre-admission assessment. The manager provides prospective service users with an information pack about the home. This enables prospective service users and their family to make a decision as to whether the individual wishes to move into the home. A service user spoken to said he and his family had been involved in the assessment process and had been given plenty of information about the home.
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is “Adequate”. This judgement has been made from evidence gathered both during and before the visit to the service. The current care plan process does not provide staff with the necessary information to meet the changing care and health needs of service users. The medication in this home is well managed. Promoting the good health of service users. The staff treat service users and other visitors to the home with respect. EVIDENCE: The quality of the information recorded in four care plans examined was found to be inadequate in some areas. The care plans were disorganised with no regular evaluation of care and health needs. One person had a care plan in place with regard to meeting dietary needs. But the plan of care did not include a nutritional assessment. Since the last visit to the home risk assessments and risk management strategies for service users who required bedrails were now included in the care plans.
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 10 The manager provided evidence of a new care plan. This care plan is currently in draft form. Which the company intends to implement shortly. The new care plan will provide a clear process for staff to follow when recording information. This will ensure staff have the necessary up to date information to meet the changing needs of individual service users. Three health care professionals visiting the home commented positively on the caring attitude of staff. One person spoken to said, “ The staff always listen to what needs to be done to help the service user. And communication between the staff and us is very good”. “ If I had to choose a home for myself, I would want to live here”. Medication held in the home is well managed. Examination of medication recording sheets showed that hand written entries had not been signed by the staff member responsible for receiving the medication into the home. The procedure for the safe handling and recording of Controlled Drugs was adhered to by staff. Service users, visitors and other health professionals spoken to during the visit said the staff were very friendly and treated them with respect. Comment cards received from relatives prior to the visit confirmed this. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is “Good”. This judgement has been made from evidence gathered both during and before the visit to the service. The home provides a socially fulfilling activity programme for service users to participate in if they so wish. The routine in the home is flexible. Service users are encouraged to maintain contact with family and friends. Service users are encouraged to lead an independent lifestyle with support provided by staff if required. The dietary needs of service users are met. EVIDENCE: The home does not employ an activities co-ordinator but staff organise a range of activities for service users to participate in if they so wish. The home had a newsletter displayed on the main notice board in the foyer. This newsletter highlights recent and forthcoming events in the home. During the visit we spent time watching a large group of service users and staff taking part in a lively game of skittles in the main reception area. There was a lot of laughter
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 12 and chat between service users and staff. The manager provided evidence of a new social activity record that has been implemented recently. Further development will include individual activity records to be kept in service users’ care plans. Relatives spoken to said they could visit at any time. The staff were always welcoming and friendly. Service users spoken to said they keep in regular contact with their friends and family. The routine in the home is flexible. A service user was observed having a late lunch as he had decided to have a lie in. Another service user was assisting a staff member with putting laundry away. Staff spoken to said they encourage service users to do as much for themselves as possible. But will provide support when required. Since the last visit to the home the menus have been revised. They now offer a wider choice and variety of meals. Service users spoken to and comment cards received prior to the visit were complimentary towards the quality and variety of food offered. A relative said their family member who is resident in the home enjoys all the food and has put on weight since coming to live there. Sandwiches sampled during the visit were fresh and tasty. The dining areas in each of the four units were comfortable and spacious. A kitchenette is available in the individual units to enable staff to prepare hot and cold drinks. A risk assessment is in place for the use of this facility. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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): 16 and 18 Quality in this outcome area is “Good”. This judgement has been made from evidence gathered both during and before the visit to the service. Service users and their relatives are given the opportunity to make their views known about the service delivery. Service users are protected from abuse. EVIDENCE: The home has a complaints policy and procedure in place. A copy of the complaints procedure is displayed in the foyer and copy is included in the service user’s care plan for information. Complaints received by the home were recorded along with the outcome. Service users and relatives spoken to during the visit said they were aware of the complaints procedure. But would speak to the manager if they wished to make their views known. The home follows a thorough recruitment process for staff to ensure service users are protected from abuse. Policies are in place to protect vulnerable adults. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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 and 26 Quality in this outcome area is “Adequate”. This judgement has been made from evidence gathered both during and before the visit to the service. The environment is accessible and fit for its stated purpose. But continued refurbishment is required to improve standards of comfort for the people who live there. EVIDENCE: On touring the home we observed that further refurbishment is required both internally and externally to improve the standard of comfort for service users. The manager had evidence available to show that the continued renewal of carpets in service users personal accommodation is ongoing. A relative spoken to said the carpet in their family member’s room required renewal. But he was aware that carpets were gradually being replaced throughout the home. Service users said they were satisfied with the accommodation provided. Many had their rooms personalised in their chosen style. Service users were observed during the visit moving freely around the
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 15 home. The courtyard garden area was untidy. Floor pots were upturned and flowerbeds overgrown. This did not provide an attractive outlook for service users. The home in general was clean and well ventilated. Two bedrooms viewed had an offensive odour present. The manager said the domestic staff endeavour to eliminate any odour. But renewal of carpet will address this problem. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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 and 30 Quality in this outcome area is “Good”. This judgement has been made from evidence gathered both during and before the visit to the service. The home employs competent staff in appropriate numbers to meet the collective needs of the service users. Thorough recruitment procedures ensure service users are protected from abuse. EVIDENCE: Duty rotas examined and discussion with staff, service users, relatives and health professionals confirmed that staff are employed in appropriate numbers to meet the needs of the people who live there. The company is committed to staff acquiring the skills and abilities to enable them to deliver a good standard of service to the people who live in the home. Almost all of the care staff have achieved NVQ2 in care or above. The manager had evidence to show that an annual training matrix is in place for all staff. Staff demonstrated that they attend training on a regular basis. Some staff had attended training on care of people with dementia. The home follows a comprehensive staff recruitment process to ensure service users are protected from abuse.
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 17 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, 35 and 38 Quality in this outcome area is “Good”. This judgement has been made from evidence gathered both during and before the visit to the service. The manager is competent in her role. And runs the home in the best interests of the people who live there. EVIDENCE: The manager has many years experience in working with older people. The home has a quality assurance and monitoring system in place. This will ensure service users are given the opportunity to make their views known. Service users financial rights are protected. Money held on behalf of service users by the home was recorded accurately and stored individually in an appropriate locked facility. Two signatures are recorded for all financial transactions.
Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 18 Health and safety is promoted by the home. Certificates are available for the servicing and maintenance of all major systems and disability equipment in the home. Since the last visit to the home risk assessments and risk management strategies for individual service users and the environment have been implemented and updated. Fire training for staff has been carried out. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 x x x x x x 2 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 3 x 2 3 Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14 Requirement Timescale for action 2 OP7 OP8 14,15 3 OP9 13(2) The registered manager must ensure the information recorded 01/12/06 in the pre-admission assessment form is complete. In the event of an emergency admission to be completed within 24hrs. This information is necessary for staff to compile a plan of care to meet the individual needs of the service user. The registered manager must 01/12/06 ensure the information included in the plan of care for individual service users is complete. The plan must be kept under review and revised at every time necessary. This will provide staff with the necessary information to meet the changing care and health needs of individual service users. The registered manager must ensure staff responsible for 01/10/06 receiving medication into the home, sign for handwritten entries on individual service user’s medication recording sheet. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 21 4 OP19 23 5 OP26 23 The registered provider must continue with the programme of refurbishment. Redecoration of communal, personal accommodation and carpet renewal. Attention must be given to internal courtyard garden to provide a more pleasing outlook for service users. This will ensure service users live in a well maintained and comfortable environment. The registered manager must ensure all areas in the home are kept free from offensive odours for the comfort of service users. 01/03/07 01/10/06 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 OP7 Good Practice Recommendations Care plans should be clear, task specific and instruct staff in the detail of how people choose to have their care delivered. Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Charlotte Grange Residential Care Home DS0000021740.V308987.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
