Inspection on 21/03/07 for Grange Care Services Limited

This inspection was carried out on 21st March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Grange Care Services Limited Grange Care Services Limited 27 Flamstead End Road Cheshunt Hertfordshire EN8 OAJ Lead Inspector Mrs Yoke Lan Jackson Unannounced Inspection 21st March 2007 08:30 Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 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 Care Services Limited DS0000068014.V333834.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 Adults 18-65. 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 Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Care Services Limited Address Grange Care Services Limited 27 Flamstead End Road Cheshunt Hertfordshire EN8 OAJ 01707 646567 01707 651010 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) Grange Care Services Limited Mr Andrew Gilbert Fernandes Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Not applicable Brief Description of the Service: Grange Care Services is a new service that was registered with the Commission for Social Care Inspection in July 2006. The home is registered for six service users with learning and physical disabilities in the Younger Adults category. The home is situated in a residential area in Cheshunt, Hertfordshire. The building is a converted eight-bedroom house with a large garden to the back of the building and a parking area in the front. The ground floor has a lounge, laundry room and a large kitchen/dining area. Although the home is registered for six service users, only five bedrooms are in use and these are all on the ground floor. One bedroom, situated on the first floor, is being used temporarily as the staff sleep-in room. The administrative office and the storage room for medicines are on the first floor. The home has no lift. At the present time, service users have no access to the first floor. The home charges £950 - £1600 per week. Further information can be obtained from the home’s Statement of Purpose and the Service User Guide. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection since the home was registered. The inspection included a site visit. The registered manager, the deputy manager and the director of care were all present during the site visit. There are four service users in the home and there are two vacancies. The inspection began with an observation of the early morning routine and staff interaction with the service users in their care. The inspector was introduced to the service users before they left for their respective day care centres. The inspection included a tour of the building. The members of staff who were present were interviewed. Documents were checked and the inspection ended with further discussion with the management team present. (See below for details of the inspection findings) What the service does well: What has improved since the last inspection? (Not applicable as this is the first inspection since registration). Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about the service. A trial period is arranged. New service users are admitted only on the basis of a full assessment. EVIDENCE: Currently there are four service users in the home. They were formally under the care of the Hertfordshire Partnership Trust before they were transferred to Grange Care Services residential home in October 2006. The home adopts the single Care Management (health and social services) assessment integrated with the Care Programme Approach (CPA) for people with learning disability. The home has a Statement of Purpose and this is available in an alternative format if required. Each service user was given a Service User Guide in a picture format. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assisted to make informed choices and they are supported in all aspects of life in the home. Confidentially is maintained under the Data Protection Act 1998. There is a comprehensive care plan for each service user. EVIDENCE: Service users are supported in all aspects of personal, health and social care needs. Some of the carers, including the deputy manager, were originally part of the care team in their previous accommodation, 305 Ware Road, a community residential placement centre run by Hertfordshire Partnership Trust. The Trust and Hertfordshire Social Services were involved in the transfer arrangements. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 10 Since their admission into the home, all four service users are the direct responsibility of Hertfordshire Social Services. They have had their threemonth reviews of their care needs. Their parents and Hertfordshire Social Services were involved in these reviews. The current care plan is a copy of the single care plan based on the Care Management assessment, integrated with the Care Programme Approach. Risk was assessed prior to admission according to the health and social service protocols. The results were recorded in the care plans. The management team will be revising the care plans over the next few weeks. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have close links with their families. They integrate into the community through the outdoor activity programme. Service users are encouraged to have a healthy diet. EVIDENCE: Some of the service users have complex needs and verbal communication is very limited. However, they are encouraged to get involved in the daily routine in the home. They have close links with their families. Their parents assisted them during the time of their transfer from hospital surroundings to a residential home. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 12 Each service user has a planned weekly activity programme which is documented. During weekdays, each service user spends their time at their respective Day Care Centre from 9am to 4pm. Currently three service users are involved with the programme arranged by the Geddings Day Centre, (provided by Hertfordshire County Council). One service user spends her weekdays at the Grange Day Centre. Group activity programmes are planned for weekends and evenings. Members of staff assist the service users at mealtimes. A dietician was involved in the planned menus examined. Service users’ preferences were taken into account. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. Overall, quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are given personal care as required under the Care Programme Approach. However, current staffing levels lead to less than adequate care practice and therefore exposed service users to risk. There were shortfalls in the administration and recording of medicines. EVIDENCE: The staffing level from 7am till 9am consisted of one waking night staff and one sleep-in member of staff. Routinely, service users are woken up at 7am and staff assist them to get ready for breakfast before their transport arrives to take them to their respective Day Care Centre. (Transportation is between 08.15 and 08.45 am). Some service users require two carers to assist with their personal care. The two members of staff are also involved in the administration of medication before the service users leave the premises. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 14 The routine described by the two members of staff (present on the day of the inspection) clearly indicated that some of the service users might be hurried in order to get them ready on time. It also indicated that those service users who are already in the lounge before breakfast will be left unsupervised while the two staff are busy attending to the personal care of other service users in their bedrooms. On the morning of the inspection site visit, a tray of medicines was seen to be left on a table in the kitchen, where there were two service users present. It was later established that one of the carers had forgotten to lock them in the storage cupboard after administration. Although medicines were given to each service user, the MAR chart was left unsigned. Both carers had “forgotten to sign them” as they were “busy getting service users ready” before the transport arrived. In addition, staff stated that did not realise that the immediate signing of the MAR charts is part of the process of the administration of medicines to a service user and they did not realise that they should not sign the MAR charts later. The gaps in MAR charts should be left once they occur and should be referred to in contemporaneous notes to be written, dated and signed at the back of the MAR chart. It was noted that medicines that were supplied and received by a member of staff were not recorded, signed and dated in the appropriate section on the MAR chart. It was further noted that containers of medicines that had been opened had no opening date written on the container. Although all staff have had training that was provided by the supplying Pharmacist, it is recommended that all management staff and carers have accredited training on the administration of medicines through an approved education college. It is recommended that the home manager obtain a copy of the Guidelines on The Administration of Medicines in Care Homes and Children’s Services from The Royal Pharmaceutical Society of Great Britain. (See Statutory Requirements and Recommendations) Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a Complaint Policy and Procedure. The home’s policies and practice ensure service users are protected from abuse, neglect and self-harm. EVIDENCE: Service users and their relatives have access to the home’s Complaint Policy and Procedure. Since registration, the home has not received a complaint about the service provided. Staff are aware of the Whistle Blowing Policy. The home follows Hertfordshire Social Service’s Adult Protection Procedure. However, not all the staff are familiar with the procedure. It is recommended that all staff have the appropriate training as soon as possible. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and comfortable. However the safety of service users have been compromised. EVIDENCE: Prior to the admission of service users, there had been input from various professionals to ensure that the premises meet the legal requirements of the local fire service and the environmental health department. Aids, hoists and assisted bathrooms and toilets were installed with guidance from the occupational therapist. All the bedrooms that are in use have en-suite facilities. Both the service users and their families were involved in choosing the décor and furnishings of the bedrooms. On the morning of the site visit, it was noted that none of the bedrooms had been cleaned. The daily routine is that members of staff on the afternoon shift (3pm) will tidy the rooms before service users return from the day centres at Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 17 4pm. To ensure proper hygiene and infection control, it is recommended that all bathrooms and toilets in the en-suite bedrooms be cleaned immediately after use. The home is not carpeted. The flooring throughout is laminated flooring, which may present a slipping hazard. It is recommended that the management review the laminated flooring. Currently, there is one service user who has an unsteady gait when walking. To date there has been no fall incident. There were loose pictures and mirrors on the floor and leaning against the wall, waiting to be fixed to the wall. Some rooms and bedrooms have loose floor mats, rugs and trailing cables that are slipping hazards. It was noted that several doors, including the kitchen door, were kept wide open with wedges and floor mats. This exposes the home to fire hazards. All fire doors should be kept closed at all times. However, some doors may have to be kept open to allow easy access for service users, wheelchair users and for the convenience of staff. If doors are to be kept open they must be kept open only with automatic hold-open door devices, approved by Hertfordshire Fire and Rescue Authority. Since the site visit by the CSCI Inspector all tripping hazards and door wedges have been removed. (See Statutory Requirements and Recommendations) Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported and protected by the home’ s recruitment policy and practices. However, the number of staff in the morning busy period is inadequate. Both managers and staff require further training on Medication, Infection Control and Health and Safety to ensure the safety of service users in their care. EVIDENCE: It was noted during the site visit that two carers during the busy morning routine is not sufficient to provide adequate care and supervision for the four service users, some of whom require the help of two carers for personal care. The staffing level must therefore be increased to ensure that there are sufficient numbers of staff on duty during the busy morning period to meet the needs of the current group of four service users. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 19 The training programme indicated that some members of staff have not received Infection Control or Health and Safety training. Although all staff have had training on the Administration of Medication, it is recommended that further training be arranged for all staff. (See Statutory Requirements and Recommendations) Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. However, the safety and welfare of service users have been compromised due to unsafe working practices. EVIDENCE: The home was registered in July 2006 and the admission of the service users took place in October 2006. Currently there are four service users and two vacancies. The Registration Certificate and the home’s Liability Insurance Certificate were on display on the wall. All policies and procedures have been updated. Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 21 However, the management (and staff) need greater awareness of health and safety issues. (See Statutory Requirements and Recommendations) Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 x 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 2 X 3 3 2 3 Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 23 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. 1. Standard YA20 Regulation 13(2) Requirement The registered manager must ensure that all medicines in the care home are handled in accordance with the Medicines Act 1968, Guidelines from the Royal Pharmaceutical Society and the Requirements of the Misuse of Drugs Act 1971. (Rectified) All MAR charts must be signed immediately after the medicine has been given and taken by the service user. Any gaps in MAR chart recording must be left and must be referred to in contemporaneous notes to be written, dated and signed at the back of the chart. Medicines that were supplied and received by a member of staff must be recorded, signed and dated in the appropriate section on the MAR chart. The opening date must be recorded on the front of each container when it is first Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 24 Timescale for action 21/03/07 2. YA20 13(2) 21/03/07 opened. 3. YA24 13(4)(a)(c) (Rectified) The registered manager must ensure that all parts of the care home to which service users have access are so far as reasonably practicable free from hazards to their safety. (Rectified) Staff numbers must be increased during busy times of the day to ensure that the needs of the current group of four service users can be met. 21/03/07 4. YA33 18 (1)(a) 30/04/07 5. YA42 12(1)(a)(b) The registered manager must 21/03/07 ensure that the care home is 12(3) conducted so as: (a) to promote and make proper provision for the supervision of service users at all times. (b) To ensure that service users are not being hurried during personal care and mealtimes. 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 YA20 Good Practice Recommendations It is recommended that all management staff and carers have accredited training on the administration of medicines through an approved education college. (The Provider is arranging the date for training) It is recommended that the home be provided with a copy of the Guidelines on The Administration of Medicines in Care Homes and Children’s Services from The Royal DS0000068014.V333834.R01.S.doc Version 5.2 Page 25 2. YA20 Grange Care Services Limited 3. 4. YA24 YA27 Pharmaceutical Society of Great Britain. (Rectified) It is recommended that the management review the parquet flooring, which could present a slipping hazard. To ensure appropriate hygiene and infection control, it is recommended that all bathrooms and toilets in the ensuite bedrooms be cleaned immediately after use. It is recommended that all staff receive training on Health and Safety, Infection Control and the Hertfordshire Adult Protection Procedure. (Training Arrangements have been made for Health and Safety and Infection Control – 25/04/07; Adult Protection Procedure – 02/04/07 5. YA32 Grange Care Services Limited DS0000068014.V333834.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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