CARE HOMES FOR OLDER PEOPLE
DYSTLEGH GRANGE 40 Jacksons Edge Road Disley Stockport SK12 2JL Lead Inspector
David Jones Announced. 3 August 2005 10:47 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. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Dystlegh Grange Address 40 Jacksons Edge Road Disley Stockport Cheshire SK12 2JL 01663-765237 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 Brian Robinson Mr Brian Robinson Care Home 40 Category(ies) of PD - Physical Disability (5) registration, with number OP - Old Age (40) of places DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The total number of Service Users must not exceed 40 2 3 40 of the Service Users may be OP 5 of the Service Users may be PD Date of last inspection 22 February 2005 Brief Description of the Service: Dystlegh Grange is a privately owned care home, located close to the centre of Disley. There are a variety of shops, churches and other facilities nearby. There are adequate car parking facilities available at the home. Formally two private dwellings the home has been extensively altered and extended to provide care to older people in 37 single suites. Accommodation is provided on two floors. Access between floors is via one of two shaft lifts or the stairs. Each of the suites comprise a bedroom with a large sitting area, a kitchenette, en-suite toilet and bathing facilities and where possible a patio or balcony. Some of the suites have a separate lounge. There are a number of communal areas within the home that are available for residents. Furnishings and interior decoration are of a high standard. There are sufficient numbers of toilets and bathing facilities. Aids to facilitate independence are in evidence throughout the home; these include bath hoists fitted in individual en-suite bathing facilities as required, grab rails and an emergency call system. There are both communal gardens and a number of personal patio areas available to residents. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was a routine announced inspection. It took place on the 3rd of August 2005 between 10.47 am and 8.30 pm. Twelve residents and five members of staff were spoken with during the inspection. We looked at some parts of the building, inspected some records and read the case notes of four residents. What the service does well:
Dystlegh Grange is well managed and run in the best interests of residents. Residnets, visiting relatives and associated health care professionals were unaminious in their praise of the home and the exempalry standards of care, accommodation, facilities and services provided. Residents identify with Dystlegh Grange and present with an air of self-respect in association with it. Many of the twelve residents spoken with during the inspection described their suites as home. Their suites reflect their characters and personalities. They are furnished and decorated in accordance with individual needs and personal preferences and aids to promote independence are provided where required. Staff do not enter a resident’s suit without first knocking and seeking permission to enter and the sanctity of the resident’s domain is acknowledged and reinforced. A number of residents said that Dystlegh Grange had enabled them to create their own home within a safe and secure environment. It was clear that residents were aware as to how staff were to support them and provide personal care where required. The admission procedures make sure that residents and their representatives are aware that the home can meet their needs before they move in. Residents are actively encouraged to visit and test drive the home and compare and contrast it to other residential homes, which they are also encouraged to visit. This promotes choice and puts the new resident at the centre of decisionmaking. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 6 Care is provided through a process of care partnership, between the management staff and the resident. The home’s care planning systems are based on good practice. They make sure that residents’ needs are known and planned for. Senior staff work closely with other health and social care professionals and residents are assured that there health care needs will be addressed. District nurses describe staff as well organised, always carrying out instructions and referring as appropriate. Residents are assured that their health care needs will be addressed. There is a skilled and dedicated team of staff who were seen to be caring and considerate in their approach. There is an effective staff training and development programme in place. The majority of care staff had acquired or were studying for an NVQ in care at level two or above. 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. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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 DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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) 3 and 5. New residents are admitted to the home on the basis of a full assessment undertaken by persons with appropriate training. Assessment and admissions procedures put the new resident and their representatives at the centre of decision-making. They are able to visit the home before they make any decisions about moving in. EVIDENCE: Reading of case records and discussion with residents and staff confirmed that the home used appropriate assessment and admissions procedures that involve the new resident and their representatives. All new residents have their needs assessed by senior staff and are advised as to the home’s suitability to meet their needs. Residents are actively encouraged to visit and test drive the home and compare and contrast it to other residential homes, which they are also encouraged to visit. This promotes choice and puts the new resident at the centre of decision-making. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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, and 10. The home’s assessment and care planning systems ensure that residents’ identified and developing needs are met. The home works closely with other health and social care professionals and residents are assured that their health care needs will be addressed. Residents are treated with respect and there rights to privacy are upheld. EVIDENCE: Residents identify with Dystlegh Grange and present with an air of self-respect in association with it. All spoke highly of the home describing it and the facilities and service provided with a range of superlatives from brilliant to amazing. Many of the twelve residents spoken with during the inspection described their suites as home. Their suites reflect their characters and personalities. They are furnished and decorated in accordance with individual needs and personal preferences and aids to promote independence are provided where required. Staff do not enter a resident’s suit without first knocking and seeking permission to enter and the sanctity of the residents domain is acknowledged and reinforced. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 10 Care is provided through a process of care partnership, between the management staff and the resident. Care needs are set out in appropriate detail within a document known as the personal development file. This is ordinarily kept in individual suites to ensure that both residents and staff can access it readily. One resident said that they have the balance between care and support and promoting independence just right. He gave a scenario in which he had been encouraged and enabled to improve his mobility and so maintain his independence. The home’s physiotherapist had provided specialist support and advice and staff had provided assistance in a consistent manner. This had enabled him to progressively regain mobility to a point where he no longer required walking aids. Other residents gave examples of how the care partnership works. A number of residents said that Dystlegh Grange had enabled them to create their own home within a safe and secure environment. It was clear that residents were aware as to how staff were to support them and provide personal care where required. Reading of case records and comment cards received from a visiting GP and District Nurses confirmed that contact is made and maintained with residents’ health and social care professionals where required. Dystlegh Grange is referred to as a super home with excellent facilities. District nurses describe the staff as well organised, always carrying out instructions and referring as appropriate. Residents are assured that their health care needs will be addressed. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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, 13, 14, and 15. The lifestyle in the home reflects the expectations and personal preferences of residents and choice is promoted. Visitors are made welcome, the standard of catering is good and residents have access to a range of appropriate activities. EVIDENCE: The atmosphere in the home is relaxed and convivial and at times positively vibrant. Residents advised that there was always something to do and somewhere to go. There is an active programme of events, which met and in many instances exceeded residents’ expectations. A number of residents said that Dystlegh Grange had enabled them to create their own home within a safe and secure environment. They lived fulfilling lives with access to a range of opportunities for social interaction and social inclusion on their doorstep. Residents visitors were made welcome and residents were able to entertain their guests in the privacy of their own rooms or the many communal areas of the home. One resident advised that her many friends from the local area were able to visit without using the front entrance to the home because there was a side door to her suite that they could use. This reinforced the fact that her suite is her home.
DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 12 Residents were unanimous in their praise for the standard of catering in the home. A varied and nutritious diet was on offer, which reflected individual preferences, and special dietary needs. Fresh fruit, snacks and beverages were readily available. Catering staff regularly discuss food with residents and there is a facility for them to make suggestions. One resident advised that she had suggested Beef Bourguignon for the menu and was pleased that her suggestion had been taken on board. Wine is served with some meals on special occasions. Meals are served in the home’s dining areas all of which are very pleasant and congenial. A choice of vegetables is served in individual tureens; enabling residents to serve themselves and control portion size. Resident’s guests are welcome to join them for a meal, which may be taken in the privacy of their suite or in the communal dining areas. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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 and 18. Arrangements for the protection of residents and for making complaints are appropriate. Residents views are taken seriously and they have protection from abuse. EVIDENCE: The home’s complaints procedure provide appropriate guidance and information as to how to make a complaint. Information provided indicated that no complaints had been received since the last inspection. Robust procedures for responding to suspicion or evidence of abuse or neglect were in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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 standard(s) 19, 24, and 26. Residents live in safe, well-maintained accommodation, which meets and exceeds their expectations and the national minimum standards. EVIDENCE: DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 15 The accommodation exceeds the national minimum standards in all areas of provision including communal and private facilities. The location and layout of the home is suitable for its stated purpose. There are garden areas and a number of individual patios that are accessible and beautifully maintained. Residents stated that the facilities including their suites exceeded all expectations. Their suites reflect their characters and personalities. They are furnished and decorated in accordance with individual needs and personal preferences. Aids to promote independence are provided where required. The 37 suites include a bedroom with a large sitting area, a kitchenette, en-suite toilet and bathing facilities and a patio or balcony where possible. Seventeen of the suites have a separate lounge. There are a number of communal areas, some equipped with beverage and snack making facilities. Furnishings and interior decoration are of a high standard. There are sufficient numbers of toilets and bathing facilities and there are aids to promote independence around the home. Residents and visiting relatives advised that improvements to the home were continually being made including interior decoration. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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 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) 27, 28, 29 and 30. Staff were employed in appropriate numbers and skill mix sufficient for the well being of residentss. Care must be taken to ensure that staff are only employed in the home after approprite criminal record checks have been completed. Without these checks residents are not afforded the protection provided them under the regulations. EVIDENCE: An examination of the staffing rotas showed that the home was meeting the previously agreed staffing levels. This is as follows: • • • • Morning – Afternoon Evening – Night – Two/three care staff – Two/three care staff Two/three care staff Two/three care staff One of the above is the designated person in charge; this can be the principal care director or one of the care managers. The registered person/manager, and ancillary staff, including domestic and kitchen staff members’ hours are in addition to the above levels. The staff team comprises a range of ages, skills, training and experience. Many of the staff members have been employed at Dystlegh Grange for some considerable time and staff turnover is low. Care staff members are all over the age of eighteen years, and senior staff all over twenty-one years.
DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 17 Residents advised that there were always a sufficient number of staff on duty. Staff were said to be competent and confident in their approach. Staff were seen to interact with residents in an appropriate and good-humoured manner. The Principal Care Manager and the Training Care Manager have the NEBSS (National Examining Board for Supervisory Studies) Diploma in management and are qualified NVQ assessors. Nine of the sixteen care staff have an NVQ in care at level two or above in addition to a number of other qualifications. The home conducts a thorough induction programme for new members of staff that includes an assessment of competencies in line with “Skills for Care Criteria” Staff files indicated that the home employs appropriate recruitment procedures with the exception that in one instance a member of staff had commenced employment in the home on the 18th of June 2005 prior to the Manager’s receipt of the POVA Fist Check on the 8th July and The Criminal Records Bureau enhanced disclosure (CRB) on the 18th of July 2005. See requirement 1. The Training Care manager advised that this was an oversight. As noted above the home’s induction procedures are very thorough. New staff are not left unsupervised until the CRB has been received and they are deemed competent and fully inducted. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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) 33.The home is run in the best interests of residents. EVIDENCE: An annual development plan, the Business plan which is based on a systematic system of planning action and review, refelecting the desired aims and outcomes for residents. The home also has the “Investors in People” award, which is based upon seeking the views of residents and the auditing of standards and staff support systems. The most recent review of this took place in September 2004. Residents, visiting relatives and associated helath care professionals were unaminious in their praise of the home and the exempalry standards of care, facilities and services provided. DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4
COMPLAINTS AND PROTECTION 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x x DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 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 OP29 Regulation 19 Requirement The registered persons must ensure that all required criminal records checks are in place before a member of staff is employed in the home. Timescale for action Immediate and ongoing. 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 Good Practice Recommendations DYSTLEGH GRANGE F51 F01 S6619 Dystlegh Grange V231628 030805 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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