Inspection on 03/11/06 for Grange Bank

This inspection was carried out on 3rd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Grange Bank 31/10/08

Grange Bank 27/03/06

Grange Bank 07/12/05

Grange Bank 18/11/04

Grange Bank 13/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Grange Bank Cross Lane Wigton Cumbria CA7 9DL Lead Inspector Nancy Saich Unannounced Inspection 3rd November 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.V304207.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. Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 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 19 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (19) of places Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of19 service users to include: up to 19 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. The home should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 27th March 2006 2. 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 another home in the Allerdale area. Margaret Beasley manages the home on his behalf. The home cares for older people who suffer from some form of dementia. The cost for staying at the home is as follows • £422 per week. Further information and a home’s brochure can be obtained from the manager at the above address and number. Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the main or ‘key’ inspection of the year. The lead inspector gathered evidence about the home and then made an unannounced visit. She met with the residents, staff, visitors and the manager. She talked to them and spent time with them in the home. She walked around the building, read files and documents that backed up what people said and what she saw. This home reopened last year with a change to the resident group. The registered manager had developed the home within the last year to provide a very good home for people with dementia. What the service does well: The manager makes sure that she goes out to see new people and that they get the chance to visit the home. She gets information from social workers and health care professionals to make sure the new person will fit into the home and that the staff can care for them properly. Every resident had a written plan that helped staff to understand the person’s needs and wishes. The inspector read the plans and found that they were detailed and up to date. They were very clear about what staff should do if a person was distressed. One or two residents said that the manager had explained these plans to them. Relatives said they had been asked about preferences if the resident couldn’t fully express himself or herself. Residents said they saw the doctor or nurse when they were unwell. The files showed that the residents did see them and people like chiropodists and opticians. The residents also have regular contact with psychiatrists or specialist nurses who care for people with dementia. The medicines in the home were checked on by the inspector and these were being looked after properly. Residents and relatives were very happy with the staff team: • • • • • “They are good workers – every one of them” “The staff are very obliging – and always make me feel welcome when I visit” “ I think of them as my helpers and my friends.” “Very happy with the way I am looked after.” “The staff helped me to settle in …and help me when I feel worried”. Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 6 • • “I can relax about my relative…I know he is well cared for and staff keep me informed of any changes.” “Couldn’t have found a better place to call home…better than anywhere else I have been.” Residents said they could go out if they wanted and they were encouraged to go out with their families. Staff arranged activities on a daily basis. The home has an activities organiser and he works with both groups and individuals. The home is good at listening to peoples concerns. There were no complaints on the day and no formal complaints had been received. Staff were aware of how to protect residents from harm. Residents and relatives said that there was nothing worrying going on in the home. Grangebank is a comfortable home and the residents were very relaxed in their own environment. All parts of the home were clean and tidy. The home is furnished and decorated in a homely and comfortable way. The inspector saw the rosters for the last month and spoke to visitors, residents and staff. Together this showed that there were enough staff on duty to make sure everyone gets good levels of care and services. The manager is careful to only employ staff after she has checked that they are the right kind of people to work with vulnerable older people. The inspector checked the staff files and these were all in order. Staff are trained and developed properly so that they know what is expected of them. Staff said that they appreciated the fact that the manager often worked alongside them, guiding and supporting them. The home had been closed for some time and the last year has been spent opening the home to new residents and building up management systems that give residents a relaxed and happy home. The inspector looked at the management systems and found that these were operating very well to the benefit of residents, their families and the staff. What has improved since the last inspection? The provider has changed the upstairs lounge into a very comfortable bedroom and has replaced carpets. Things like decorating and replacement of furniture and curtains has been ongoing. The provider has done some work on the grounds. Trees and shrubs have been pruned and this has given residents a better outlook and has improved parking for visitors. The manager has improved the laundry facilities and this area is now a pleasant place to work. The manager continues to improve all of the systems that help the home to run smoothly. Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 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.V304207.R01.S.doc Version 5.2 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.V304207.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. This home is good at only taking new residents who will fit in with the existing group and who they know they can care for. EVIDENCE: The inspector met with some residents who had only been in the home for a short time. Some of them could talk about visiting the home and deciding to come in. their files showed that they had been seen by a social worker and by health workers who confirmed that they needed the specialist care that the home provides. The staff said that the manager always went out to see new residents and gave them the chance to visit to see if they would settle in the home. Grange Bank DS0000022694.V304207.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. This home is good at giving people the right levels of care so that they can be as well as possible. EVIDENCE: Every person in the home has a written plan that tells staff how to care for them, what their needs and preferences are and how to help with some of the behaviours that may come with dementia. The inspector read all of them and found them to be up to date and detailed. They explain all of the things that are important to the person involved. She also spoke to residents and some of them were aware of their plans and had been involved in writing them. She met relatives who had been part of this planning. Staff said they read the plans regularly and the manager made sure that any changes were included in the plans. These show that the staff team consider how to get the best outcomes for people and try to put this into practice on a daily basis. Residents said they saw the doctor or nurse when they were unwell and that they had chiropody and could see the dentist or optician when they needed. Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 11 The files showed that any health care needs were dealt with promptly. The files also showed that residents saw specialist dementia care professionals on a regular basis. The inspector checked on the medicines kept on behalf of residents. These were in order. She noted that the residents were not given sedative medicines unless a psychiatrist had recommended this. All the medication was checked out by doctors on a regular basis so that the residents’ care is improved by giving the right kind of medicines. The inspector felt that although there was a good system in place for giving residents “as required” medicines the manager needs to put a little more detail in the records. The inspector watched the way staff worked with residents. She saw that they were respectful and kind and that they treated people in a patient and gentle way. Residents and their relatives said that the staff were kind and very good with people who were forgetful or distressed. The staff treated the residents as people with opinions, needs and hopes. Grange Bank DS0000022694.V304207.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. Grangebank provides residents with a relaxed and fulfilling lifestyle. EVIDENCE: Residents said they got up and went to bed when they wanted and that they had plenty of choices about what they did during the day. During the visit the inspector saw that this was the case and she also saw that people were helped to understand what was going on around them. The visitors’ book showed that lots of friends and relatives came to the home. The inspector spoke to a number of visitors on the day and they said they were always made very welcome. Various groups come to the home and representatives of local churches come to see the residents. Many of the residents have problems about choice and control because they have dementia. However the inspector noted that staff tried at every opportunity to follow each individual’s wishes. When people were trying to make choices that were unsafe or inappropriate the staff gently helped them by distracting them or offering them alternatives. It was accepted in the home Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 13 that as one member of staff said “residents come first…we are here to help them get what they need”. The inspector shared a very pleasant lunch with residents. The meal was relaxed and residents were helped without any fuss. It was nice to see that they were encouraged to help themselves at the table. The cook was very knowledgeable about nutrition and food safety. Grange Bank DS0000022694.V304207.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 good. This judgement has been made using available evidence including a visit to the service. The home is good at listening to residents and protecting them from harm. EVIDENCE: No one on the day had any complaints but everyone said they would talk to the manager if anything weren’t to their liking. Relatives said they would be able to take any complaints out of the home but they also said that things would never get to that stage. Both relatives and residents said they saw the provider regularly and would complain to him if they were unhappy. The staff spoken to knew how they should handle any situation where residents were in danger of being abused. They had good procedures to follow and were confident that they understood how to prevent and how to deal with anything of this nature. The residents and relatives said that there was nothing worrying going on in the home and they were confident that the manager would deal with any abuse properly. Grange Bank DS0000022694.V304207.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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Grangebank is a comfortable home where residents are safe and relaxed. EVIDENCE: The inspector looked around the home. She spent time in the shared areas and saw some of the residents’ bedrooms. She also checked on the kitchen and the laundry. She found that the home was well maintained, clean and tidy. The residents have single bedrooms with ensuite toilet and wash hand basin. They said they were encouraged to make these rooms as personal as possible with their own possessions. There is a large lounge where most of the residents like to spend time together. It is set out so that people can talk together or spend time following Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 16 their interests and hobbies. The dining room is next door and it also has easy chairs. People have their meals in either room and can sit where they choose. These shared areas, the entrance hall and the stairs have benefited from new carpets and there are plans to renew other corridor carpets. There is access to an enclosed garden and residents said they spent a lot of time outside in the summer. Some people enjoy walking in the grounds with staff. The provider has opened up the grounds providing more space for car parking and access. The bushes and trees have been pruned and cut back so that residents can see out into the grounds. The laundry is in one of the outhouses and this has been improved recently and staff said this makes their job easier. Residents said that their clothes and bedding were always clean and fresh. The staff said they knew how to keep infection at bay and all around the home there was evidence of good hygiene in all areas. The kitchen area was neat and clean and all the checks on food safety were being completed. Grange Bank DS0000022694.V304207.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. This home has a good staff team who are dedicated to the care of the residents. EVIDENCE: The inspector saw the rosters for the previous month. She spoke to staff and residents. They felt that there were enough staff to care for them and to do the housekeeping and maintenance of the home. The inspector judged that there were enough staff on duty at any one time. The inspector checked files for two new starters. She saw that the manager got references and checked that they didn’t have a criminal record and hadn’t been sacked from any other care situation. All the information was well organised and easy to follow. The staff files showed that once they were taken on they were trained to understand what was expected of them on a day-to-day basis. They also attended training on all the things that make them able to care for residents properly. A number of staff have qualifications in care at level 2 or 3 NVQ. The inspector spoke to two members of staff who said that the manager was ‘very hands on’ and that they learnt along side her. They felt that they worked well as a team under her leadership. The senior on duty was confident and Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 18 knowledgeable and said she felt that as a team they made sure they all worked to the same high standard. Grange Bank DS0000022694.V304207.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): 31,33,35,36,38 The systems in the home make sure that residents live in a home that runs smoothly and allows them to get the best possible care. EVIDENCE: The manager of this home is an experienced person who is trained in the care of older people. She has a lot of knowledge of how to care for people with dementia. The inspector saw that she had very good systems in place that make sure that everything in the home runs as smoothly as possible. When asked for any information she could give the inspector written details. Her systems make sure that the complex business of running a home is made to seem very simple. The manager sends the inspector monthly updates of her system for making sure the residents have good quality care. She is planning to look at an annual update of this ‘quality assurance’ system and from this she and the provider will be writing a new business plan that will help them look at the way they Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 20 want the home to develop. She agreed to send this to the inspector when it was finished. The manager said she had no cash belonging to residents. Some residents look after their own money or have their relatives help them out. The manager will pay for things like hairdressing and then will send the bill to the person who looks after their money. The staff in the home said they were given the opportunity to sit down with the manager on a regular basis to talk about their work with residents and their training and development needs. The staff files showed that these ‘supervision’ meetings were being held regularly and that the manager discussed the way they cared for residents in a lot of depth. She also carries out ‘group supervision’ so that teams who work together have a chance to talk about how thinks work on their shift. The home is well maintained and there were detailed records available. Things like fire safety and food hygiene were being done properly. Grange Bank DS0000022694.V304207.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 4 X 3 X 3 4 X 3 Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that a little more detail is included when residents have ‘as required’ medication. Grange Bank DS0000022694.V304207.R01.S.doc Version 5.2 Page 23 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 © 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 Grange Bank DS0000022694.V304207.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. 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. 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