CARE HOMES FOR OLDER PEOPLE
Grange Bank Cross Lane Wigton Cumbria CA7 9DL Lead Inspector
Nancy Saich Unannounced Inspection 27th March 2006 10:30 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 Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Grange Bank Address Cross Lane Wigton Cumbria CA7 9DL 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) 016973 45411 Mr Tom Ferguson Mrs Margaret Beasley Care Home 17 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (17) of places Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 17 service users to include: up to 17 service users in the category of DE(E) (Dementia over 65 years of age) 1 named service user in the category of DE (Dementia under 65 years of age) may be accommodated within the overall number of registered places. Bedroom number 18 must not be used to accommodate service users. The home should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 7th December 2005 2. 3. Date of last inspection Brief Description of the Service: Grangebank is an older property set in its own grounds in a residential area of Wigton. The home is on two floors and has been adapted to accommodate residents in the above categories. The home is owned by Tom Fergusson who owns two other homes in the Allerdale area. Margaret Beasley manages the home on his behalf. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit by Nancy Saich, the lead inspector for the home. The visit started around ten in the morning and lasted until mid afternoon. She had sent out questionnaires some weeks before the visit and had received a good number of these back. The manager had also sent in her business plans for next year. She met with all of the residents, spent time with the manager and the proprietor and the staff who were on duty. She met some relatives and friends of the residents and visiting health care professionals. She had a look around all of the bedrooms and the laundry and the kitchen. She spent time just sitting with residents in the lounge and had lunch with them. She looked at documents and other papers that backed up what was said and what she saw. This home has changed its registration since the last inspection and now only caters for older people who have dementia (apart from the named person as stated above). The inspector feels that this change has been managed well but she is aware that the staff team need time to settle into the work of the home. The home has only been reopen since September and the inspector was pleased to see that things were running smoothly. What the service does well:
This home is good at making sure that they only take new residents who have had a diagnosis of dementia and who they will be able to care for. They are also careful that any new person will fit in with the other people in the home. The home is good at writing down all the things that residents want and need. These written ‘care plans’ were up to date and gave details of all the things that are helpful for people who have problems with memory. The staff said they used the care plans to make sure they worked properly with the residents and that following them made things more comfortable for residents. The residents of Grangebank get regular checks on their health and have good attention when they are unwell. The home is in contact with specialists who care for people who have serious memory loss or problems with understanding what is gong on around them. The questionnaires showed the inspector that the residents and their relatives and friends were happy with the way the staff group cared for them. The inspector saw the staff working well with the residents. The manager provides Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 6 a very good role model for the way they work and is developing the staff both as individuals and as a team. The home had received no complaints and the staff were aware of how to protect the residents from any harm. The home was clean, warm and nicely decorated and furnished. The provider has invested in making improvements both inside and out. The residents said that the home was always clean and tidy and everyone’s clothes were clean and properly ironed. Bed linens were clean and fresh in every room. One or two residents had suffered from a sickness bug but the staff had been careful about how they cared for them that this hadn’t spread to others. The home has enough staff to ensure that residents get good levels of care and services. The manager was taking on new staff and this was being done properly. The manager has a staff training plan set up for the next year and this covers all the things staff need to do their job properly. She also makes sure that she sees each staff member on their own so that they can talk about their work and get advice and help from her. The manager has a lot of experience in caring for people with dementia and in managing people and resources. The home was running very well and any ‘teething problems’ had been dealt with quickly and efficiently. The inspector saw a number of documents that showed that the manager is keen to keep a check on the quality of care and services. This ‘quality assurance’ has been used to write a very good business plan and a training plan for staff. The home was safe and secure for people with dementia and things like fire and food safety were being followed properly. The manager keeps a good check on the health and safety of residents and staff. What has improved since the last inspection?
The home only reopened in September 2005 and the manager has made sure that things have improved as the staff team have got used to new residents. The manager has set up some training for herself so that she can continue to train her staff in how to help residents who have mobility problems. The inspector felt that the staff group were still settling into working with people with dementia and she could see that the manager was leading them very well as they learnt more about the disorder. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 7 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. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 8 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 Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 9 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): 1,2,3 The home is good at giving people enough information so that they can be sure Grangebank is the right place for them or their relative. EVIDENCE: The manager has written a very good resident handbook and a statement for professionals that describe what the home can offer. The inspector spoke to some people about how they came to the home. She also saw evidence in files that showed that the manager had gone out to see the new person and they, or their family, had been able to visit before they made a decision about coming into the home. She also saw social work and psychiatric assessments for all the residents. This is important, as people with dementia need to have a proper assessment to rule out any other problems. In this home this is done before the person comes in and is ongoing for all of the residents. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents in this home get very high levels of care that meets their needs. EVIDENCE: The inspector read all of the residents’ files. Each person has a written plan (the care plan) that shows staff how the person likes to be cared for. These are written with the person or their family and all of them told staff how to cope if a person’s dementia makes their behaviour a bit of a challenge. All the risks and opportunities of the residents’ lives were recorded in detail. Some of the residents could talk about these plans and a number of relatives said they had signed them on behalf of the older person. The daily notes showed that the residents received health care when they were ill and that certain steps were taken to help people stay well. Residents said they saw the doctor or nurse when they were ill. A nurse was visiting on the day and she was happy with the way things were in the home. The inspector had questionnaires that also said that health care professionals and relatives were happy with the health care provided. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 11 The inspector checked on the medicines kept for residents. These were being stored and given out properly. Staff had received training on how to do this and all the paperwork was up to date. The inspector had received questionnaires that said the staff treated residents with care and respect. She also sat with the residents and watched as staff worked with them. They were kind and considerate and treated people respectfully. The manager said she was concentrating on helping her staff to make sure they were approaching people with dementia in the right way. This will make sure that residents are as settled as possible and that staff understand how best to help them. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Residents in this home have a lifestyle that suits their needs and lessens the effects of dementia. EVIDENCE: On the day of the inspection some residents were already up and dressed when the inspection started. Other people were taking their own time to start the day. The staff made sure that people were aware of the time and were kept right when they were unsure of where they were or what was happening next. There were a number of visitors in the home during the inspection and the visitors’ book showed that there was a good level of visitors every day. The home has good contacts with local groups and hopes to build on this as things develop. The inspector shared a very well cooked lunch with the residents. Residents said the food was nice and everyone enjoyed a homemade cake with their afternoon tea. The inspector also looked around the kitchen and found it to be clean and orderly. She saw the menus and the food stored in the kitchen. There was a good variety of nutritious food available. Residents looked healthy and well fed. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Residents in this home are protected from harm and can make their concerns known to the manager. EVIDENCE: The home has a good complaints procedure that tells people what to do if they have a worry. It was available around the home and visitors said they had a copy of this. The residents said they would just tell the manager or the provider who visits every day and knows all the residents in the home. Staff said they could help residents or their relatives to make a complaint. They also felt that they or the manager asked people about their concerns or opinions. They felt confident that they could pick up when anything was wrong. There had been no formal complaints made to the home. Staff had received training in how to protect the residents from abuse. Further training was planned. The home has a good written guide to managing any abusive situation. Residents said there was nothing worrying in the home and people who found communication difficult responded well to staff and there was nothing that made the inspector consider that residents were at any kind of risk. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26 Grangebank’s residents were comfortable and relaxed in a home that meets their needs. EVIDENCE: Grangebank is an older property that has been adapted to meet the needs of older people. It is on two floors with a passenger lift. The home has special door latches that help stop people from wandering unsafely. All the outside doors are alarmed so that staff would know if someone leaves the building. The home has all sorts of equipment that help residents who have problems with their mobility. The home is nicely furnished and decorated. Every person has his or her own room and own toilet and wash hand basin. The bedrooms were all arranged to suit the people who lived in them and reflected their personalities and tastes. The residents have two shared areas where they spend their time. They can also choose to spend time in their own rooms. Residents can safely use the secure garden and there are plans to make this area larger.
Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 15 The home was clean and tidy in all areas and there were work records showing when rooms were cleaned. Two residents had suffered with a sickness bug but good hygiene and care had stopped this spreading. There was evidence around the home to show that the staff are good at stopping any illness spreading. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home has enough well trained staff to care for residents properly. EVIDENCE: The inspector saw the rosters for the previous month. She also spoke to staff and residents about staffing numbers. She judged that there were enough staff to make sure residents were safe and well cared for. The manager said she was planning to increase numbers of staff as the resident numbers grew. She was in the process of taking on new staff. This was being done properly. Staff files showed that checks were made to make sure that no one with a criminal record or a poor employment history was taken on. The inspector spoke to staff about their training and they were happy with the training they had received and were looking forward to doing more training on caring for people with dementia. The training plan for the home showed a good range of practical training in things like manual handling and health and safety and on things like how to approach people and how to make sure they are protected from harm. Staff showed a good knowledge of the needs of older people and were keen to keep on learning. The inspector thought that the manager was a good role model for staff and she gave a lot of ‘on the job’ training which helped residents to get the best care. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 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): 31,33,36,38 Grangebank is a well managed home that has the best interests of its residents at the heart of the management systems. EVIDENCE: Margaret Beasley has managed the home through its closure and its’ reopening with a changed group of residents. Through all of this she has impressed the residents with her common sense approach, good use of systems and management of staff. She has a lot of experience in working with older people and makes it a priority to know all of her residents and their families. She has arranged things in the home so that everything runs smoothly and so that residents’ views are at the heart of all her planning. Staff said that the manager saw them on a one to one basis and talked to them about their work. They felt she helped them to be better workers and to understand the needs of the residents. The inspector saw good records of this
Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 18 staff development. The manager talked about her plans to continue to help staff to settle into their role. She sent the inspector her business and financial plan and her staff-training plan. She had also completed a review of quality matters in the home. There was lots of evidence to show that she checked on how the home was running on a daily basis. All of these things help the home to run as well as possible and she has sound skills for planning the future care of residents. The inspector thought that she paid good attention to matters of health and safety. She saw the files that showed the checks had been completed and she also saw things in the home that proved that these systems work for staff and residents alike. Staff were aware of their role and understood their part in keeping residents safe, happy and well. Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 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 3 3 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 4 STAFFING Standard No Score 27 3 28 X 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 Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action 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 Grange Bank DS0000022694.V283527.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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