Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Grange Bank Cross Lane Wigton Cumbria CA7 9DL The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nancy Saich
Date: 3 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home
Name of care home: Address: Grange Bank Cross Lane Wigton Cumbria CA7 9DL 01697345411 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Beasley Type of registration: Number of places registered: Mr Tom Ferguson care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 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. Date of last inspection Brief description of the care home 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. Margaret Beasley manages the home on his behalf. The home cares for older people who suffer from some form of dementia. The cost per week is 449 pounds. Further information and a brochure can be obtained from the manager at the above address and number. 1 Over 65 19 Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the main or key inspection for the year. The lead inspector, Nancy Saich, asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the the last inspection and for the plans for the coming year. This was completed promptly with plenty of detail. We then sent out postal surveys to the staff group and to visiting professionals. On the day of the visit we gave out surveys to residents and relatives. We had a good response to these surveys and we quote from them in the report. The responses were very positive and gave us a good picture of what its like to live and work in the home. Care Homes for Older People
Page 6 of 26 We toured the building, sat in lounges and shared a meal with residents. We also looked at files and documents that backed up what was said and what was seen. What the care home does well: This home only takes new residents in once they are sure that they can care for them correctly and that the person will fit in with the existing group. People in the home and their relatives were extremely satisfied with the levels of care provided. The staff are competent and very caring. Everyone is very kind and considerate. I am happy with the levels of care of my relative gets in this home. During our visit we could see that people who live in the home were relaxed, well groomed and given appropriate levels of support to help them combat the effects of dementia. There are very good written plans of care in place, people get the right kind of health care support and medication is managed well. A health professional told us: Staff support residents above and beyond their role. Staff and management are eager to learn so that they can provide the best levels of care. We had evidence to show that staff have the experience and skills and the right kind of attitude and approach to deal with vulnerable older people. We judged that the manager is a very good role model for the staff team. This home provides regular activities and entertainments for residents. We had evidence to show that these were tailor-made for each person and that any particular preferences were acknowledged and responded to. People can choose their own lifestyle but the staff team also help people who may become disorientated about where they are or what time it is. We were in the home at lunchtime and shared a very pleasant meal with residents. We saw that people were well nourished, could choose what they wanted to eat and staff helped them to eat well. There had been no formal complaints made about this home and staff and relatives told us that the manager makes sure that any concerns are dealt with straight away so that they dont become complaints. I can approach the manager about anything and this is a comfort when you have a relative with dementia. We asked residents, relatives and staff about how people in this home are protected from abuse and harm. We had plenty of evidence to show that suitable safeguards are in place and that there is nothing abusive happening in this home. This home is staffed by an experienced and well-trained team. We were pleased to see that the manager arranges regular training that covers all the things carers need to know to do their job well and give people the highest levels of care. A member of staff told us: We work as a team always putting clients first in every way. We have regular staff discussions and meetings with the manager and plenty of training days. Care Homes for Older People Page 8 of 26 We checked on new recruits and we discovered that thorough background checks are completed before they are allowed to start work in the building. This home has a well-trained, experienced and competent manager. Staff, residents, relatives and visiting professionals speak very highly of her and the way she organises the service. There is a simple but effective system in place that allows her to check on the standards in the home. Both she and the provider regularly update us about the outcome of these quality checks. On the day of the visit we had access to records and policies and procedures. These were well organised and in order. We also had sight of accounts for the home and we could see that this provider has invested a lot of money in improving the home. We checked on things like food and fire safety in the home and on maintenance and health and safety matters. Again all of these things were in order. We were pleased to see that they had been awarded five stars by environmental health for their catering operation. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service makes sure it only admits new people who they know will fit in with the existing group and who they will be able to care for properly. Evidence: This home has an up-to-date Service Users Guide and a detailed Statement of Purpose. Together these things give prospective new residents plenty of detail about the home. We spoke to a number of residents who were relatively new to the home and we looked at their files. We also spoke to some visitors about this. They said that they were visited by the manager before they came into the home and that she asked them about their needs. Residents said that the staff had helped them to settle into the home and had been very understanding and caring. Care Homes for Older People Page 11 of 26 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home have the right kind of care so that the detrimental effects of dementia are minimised and they are treated as unique individuals. Evidence: We read a number of the written plans that help staff to understand the needs and wishes of people who live in the home. These Care Plans were detailed and up-todate and showed the kind of support people needed but they also gave details of things that people were good at or were interested in. We were pleased to see that a number of plans gave very detailed descriptions of what staff should do if a person with dementia were upset or showing challenging behaviour. This level of detail was also available for things like helping people with their mobility or supporting people through ill-health. People in this home also have detailed plans that helped staff to understand their preferred routines at night. The care plans contained details of peoples health care needs and these showed that suitable specialist health carers were involved in the residents care. For example people in the home had not only seen their GP and the local district nurses but had
Care Homes for Older People Page 12 of 26 Evidence: also had specialist input from people who understand the care of people with dementia, and from physiotherapists, speech therapists, chiropodists, opticians and dentists. We also looked at the medicines in the home that are kept on behalf of the residents. We noted that all medicines are fully reviewed once a year and that every month the staff ask the GP to review the medicines for each person. We noted that people in this home do not have sleeping pills or sedative medicines and the manager said that they much preferred to rely on keeping the home calm and in responding to each individuals needs. We saw a number of examples where people had been helped to reduce the reliance on these kind of medicines after they came into the home. All medicines were accounted for, suitably stored and administered correctly to residents. We spent time with the residents in the lounge and watched how staff interacted with them. We saw staff treating people with kindness and affection and also giving each individual their respect and dignity. We saw that residents responded warmly and positively to staff. Humour and affection were used positively by staff and we had examples of the manager leading by example. Our surveys show that relatives and residents are very happy with the way staff treat them. We heard from the manager, the staff and visitors that the people who work in this home treat the residents as people first and they approach the care in an individual way. One person was able to explain that they felt they were respected and their wishes followed and that no one dismissed their rights just because they had a diagnosis of dementia. Care Homes for Older People Page 13 of 26 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the service are helped to have the kind of lifestyle they need and prefer Evidence: When we arrived at around 10 a.m. most people were up and dressed and having coffee in the lounge. When we read the care plans and the daily notes we found that some people got up quite early and others did not; sometimes individuals found it hard to settle at night and other times people slept quite well. We could see that the staff responded to individual needs about daily living patterns. We had evidence to show that these things were handled in a suitable way and this allowed people to retain their individuality. We saw that staff support them when their illness led them into being disorientated about time or place. Most people in the home like to spend time together in the lounge but the care plan allows for people to spend time in their own rooms or to go outside or to sit quietly on their own. Each individual care plan explained the preferences of the person and gave some background into each persons life story. Hobbies, interests and activities are built around each persons personality. There are regular activities and entertainments in the home and on the day of the visit residents were preparing for a line dancing party
Care Homes for Older People Page 14 of 26 Evidence: and had been making hats for the do. We sat with residents at lunchtime and they enjoyed a well-prepared and nicely presented meal. Staff gave assistance in a subtle way but allowed people to manage things for themselves. Each table had condiments and drinks so that people could help themselves. We looked at the menus and checked on the food available in the kitchen and this was in order. We asked staff about special diets and they were knowledgeable about this. The home had received a five star rating for food hygiene from the local Environmental Health officer. Care Homes for Older People Page 15 of 26 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this service are suitably protected from harm, are listened to and their wishes are acted upon. Evidence: We had received no formal complaints about this home in the last year. The manager said that there had been no major complaints and that she tried to deal with any concerns or worries before they became complaints. Every bedroom had a copy of the complaints procedure with up-to-date details about how to contact outside agencies. Relatives spoken to said that they were confident that the manager would deal with any problems and that they too had copies of the complaints procedure. We spoke to staff about their understanding of abuse and how to safeguard people. We also spoke to the external trainer for the home and she explained that she told people what abuse was, explained the local arrangements and gave them information about how to report any abuse. We checked this out with staff and we made a judgment that staff in this home received good training about safeguarding and they have good levels of knowledge about how to prevent and report anything of the sort. We checked on this by looking at the daily notes and by speaking to and observing residents, talking to relatives and staff and we did not find anything of concern in this home. We could see that the secure and calm environment and careful monitoring of people
Care Homes for Older People Page 16 of 26 Evidence: meant that there had been no incidents of challenging behaviour in the service. Care Homes for Older People Page 17 of 26 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Grangebank provides residents with a relaxed, clean, safe and comfortable environment where people feel at ease. Evidence: Grange bank is an older property that has been adapted for people with dementia. Accommodation is in single en suite rooms. Bedrooms are on the ground and first floor and there is a shaft lift and a stair lift. The manager says that some people prefer a stair lift as they find a passenger lift too enclosed. The home has a large lounge that looks out over the garden and a smaller dining and sitting area. Outside there is an enclosed yard to the rear of the property and a secure garden that is designed so that people can walk in safety in the open air. The house is set in wooded grounds and has ample parking at the front of the property. It is within walking distance of the railway station and has limited public transport but is only a short distance from the centre of Wigton. On the day of the visit the home was clean, orderly and odour free. Residents bedrooms and shared areas were well decorated and furnished. Residents were very relaxed in their surroundings and changes had been made to the environment so that things are less confusing for people who may be disorientated. For example there is a new lounge carpet that has no pattern as staff felt that the old carpet with a swirling pattern caused people to misinterpret things around them.
Care Homes for Older People Page 18 of 26 Evidence: The manager gave us a list of the money spent on the environment in the last year and this came to a substantial sum. Their spending included new beds and bedding, work on the garden, new dining room furniture, new carpets and curtains, new chairs and upgrades to flooring and to the main kitchen and bathrooms and shower rooms. Most of the windows have been repaired or replaced. The manager also shared plans for further improvements in the next year. We spoke to staff about arrangements in place for maintaining good levels of hygiene and we looked at the routine worksheets for staff that make sure that every area and every bedroom is kept as clean as possible. We judged that staff had a very good understanding of their responsibilities in terms of preventing cross infection. There are very good systems in place to minimise any risk of outbreaks of infectious disease. We had evidence to show that these work very well in practice due to high levels of routine cleaning and maintenance. Care Homes for Older People Page 19 of 26 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has a well-trained, experienced staff team who put the people who live in the home at the centre of all they do. Evidence: We looked at four weeks worth of rosters and we spoke to residents, relatives and staff about staffing levels. We judged that this home has enough staff to deliver good levels of care. We asked about some changes to the roster and the manager told us that she would change peoples shifts so that she always had the right mix of skills and experience in the staff team at any one time. Our surveys showed that people were happy with the staff available. Most of the staff in this home have qualifications at level 2 National Vocational Qualification in care and staff told us that a number of people are now working on level 3. We checked on the last recruitments of new staff. We looked at their files and talked to the manager about this. We could see that new staff are only taken on after all the appropriate checks are completed. The manager makes sure that new staff are the right kind of people to work with vulnerable people with dementia. On the day of the inspection most of the staff team were in the home completing a training course on first aid. We spoke to the trainer who explained to us that she delivers a complete training programme for care staff that includes first aid, manual
Care Homes for Older People Page 20 of 26 Evidence: handling, managing medication, health and safety, adult safeguarding, principles of care and understanding dementia. We looked at the records of training completed and the training plan for the next year and we could see that not only did everyone undertake this training package but that there were opportunities to do special oneoff courses. We talked to the manager about the possibility of expanding their training by using some of the research based networks so that the service could further develop their understanding of dementia care. She agreed to look into this. Care Homes for Older People Page 21 of 26 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has good systems in place, operated by a capable manager that allows things to run smoothly and gives residents a settled lifestyle. Evidence: We had lots of positive responses in our surveys about the manager of this home. She has been responsible for the development of the home since it re-opened as a specialist unit for people with dementia. We saw residents responding to her with warmth and trust. Staff showed obvious respect for her and several people said that she was fair and had very high standards. We also spoke to relatives who were very complimentary and who trusted her advice. She has the Registered Managers Award at NVQ level 4, has years of experience working with older people and people with dementia and in managing residential care homes. She updates her training on a regular basis and uses other professionals to support the work she does. The AQAA was completed with plenty of detail, showing that she is working towards improvement in the home all the time.
Care Homes for Older People Page 22 of 26 Evidence: The manager and the owner have a simple quality monitoring process in place that works for this home. They send us regular updates to this and share these with people who use the service and their relatives. We were told that the home does not manage anyones money and that families and solicitors do this. We saw good records of supervision sessions held with staff and these gave examples of how the manager developed individual team members and made sure that they worked to the philosophy of the home. We looked at the records of maintenance for equipment and services in the home and these were well documented and up-to-date. We checked on fire safety and this was in order. The catering operation in the home had been inspected by environmental health and they were given the highest rating of five stars. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!
