Inspection on 16/08/05 for Grange Cottage Home For Elderly Persons

This inspection was carried out on 16th August 2005.

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 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 Cottage Home For Elderly... 18/07/07

Grange Cottage Home For Elderly... 05/06/06

Grange Cottage Home For Elderly... 28/11/05

Grange Cottage Home For Elderly... 03/11/04

Grange Cottage Home For Elderly... 17/05/04

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

CARE HOMES FOR OLDER PEOPLE Grange Cottage Home for Elderly Persons Albert Road Grange-Over-Sands Cumbria LA11 7EZ Lead Inspector Ray Mowat Announced 16 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Grange Cottage Home for Elderly Persons Address Albert Road Grange-Over-Sands Cumbria LA11 7EZ 015395 33122 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Michael Frois Mr Michael Frois CRH - Care Home 9 Category(ies) of OP - Old Age (9) registration, with number DE(E) - Dementia Over 65 (2) of places Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) The home is registered for a maximum of 9 service users to include: up to 9 service users in the category of OP (Older People) up to 2 service users in the category of DE(E) (Dementia over 65 years of age) Date of last inspection 03 November 2004 Brief Description of the Service: Grange Cottage is registered to provide residential services for nine older people two of whom may have dementia.The registered owner manager is Mr Michael Frois. The home is situated in a residential area of the town of Grange-over-Sands, Cumbria. The home is a large victorian semi-detached property with a purpose built bungalow within the grounds adjacent to the home. The home has also been extended and a conservatory added. The main house has six single bedrooms, two on the ground floor and four on the first floor, these are accessed by a staircase, which also has a chairlift. On the third floor is a private flat that is used by live-in staff. In addition there is a lounge area, dining room, kitchen, a shower room with toilet and a laundry with a sluice facility. The bungalow has three en-suite rooms, a lounge /dining room and a bathroom with toilet. All the rooms are connected to the call bell system. The home is well situated for the local amenities in the centre of Grange. There is wheelchair access to the front of the home, where there is a well kept garden with seated areas. There is also pedestrian access to the rear of the home, which leads to the town. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 16th August 05. The inspector met with all of the residents during the day, including the “case tracking” of three residents care plan files. This involves meeting the resident and the staff that support them and then examining their care plan files. Resident’s comment cards and relative’s and visitors comment cards were also returned, providing further feedback. During the course of the inspection, the inspector also spoke to visitors to the home, including family members and a GP. The inspector spent time in all areas of the home talking to residents and staff, in addition to formally interviewing management and care staff on duty. What the service does well: What has improved since the last inspection? What they could do better: The business and development plan identifies planned improvements for the home, however some of the identified work was not specific, therefore a requirement has been made relating to the replacement of a carpet in room 4. Medical records must be maintained, so that all relevant information is clearly recorded. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 6 Although care plan information has improved the addition of a pen picture is recommended, to provide staff with an insight to people’s life experiences and therefore increase their understanding of individuals. Daily diary recordings were inconsistent and should be more specific about the care delivered each shift, thus ensuring consistency. Activities provided by the home for people who require more intensive staff support, should be reviewed, to identify opportunities for participation. 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 Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5. The admission process provides prospective residents with clear information and the opportunity to visit the home, ensuring they can make an informed choice. EVIDENCE: Based on discussions with residents and visiting families, residents were issued with suitable information and had the opportunity to visit the home, enabling them to make an informed choice about choosing to live in the home. The inspector examined the care plan files of residents. These contained detailed assessments, including specialist needs, thus ensuring the home was able to fully meet the individual needs of residents. People spoke about the “small scale of the home” and the “friendly and family like atmosphere”. There was evidence the home had worked closely with other professionals and families, to ensure needs were fully assessed and other relevant documentation completed, to support the staff in supporting residents. The home has developed and issued to all service users a clear statement of terms and conditions, these were examined by the inspector and were held on personal files. These were all signed and agreed by service users or their Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 9 representatives and contained all the relevant information as required by this standard. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10. Although care plan recording systems have improved, with needs and actions required clearly identified, daily diary recordings were inconsistent. EVIDENCE: The home has developed new care plans based on current assessments of need. These included key areas such as pressure care, manual handling, personal care and mental health. These were easy to follow and provided staff with clear information to support them in their role. There was evidence of monthly reviews ensuring changes in needs were recorded and actioned. Staff complete a daily diary record to handover information between shifts, however these recordings were inconsistent and could result in a breakdown in the continuity of care. It is recommended the home now develop individual pen pictures as part of the care plan, to provide staff with a better understanding of resident’s life experiences and who they are and what is important to them. This increased knowledge will support staff in providing a personalised service that values and respects the individual. The inspector met with all the residents, in addition to receiving feedback and comment cards. There was a high level of satisfaction with the service provided and the attitude and support provided by staff. One person when Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 11 describing the staff support said “they are always there for us, they will do anything for us”. All the residents were registered with a GP of their choice and there was evidence on file of regular contact with a range of health professionals when needs are identified. The inspector spoke with a visiting GP who confirmed this. The inspector examined the Medical Record sheets (MAR charts) and the contents of the medication cabinet. It was evident there were gaps on some MAR charts with no explanation or code being used to explain the reasons. This could result in errors occurring. The home must ensure appropriate codes are used on MAR charts, to clarify what medication has been administered. The information relating to Wafarin and its side effects, should be held with MAR charts so that it is readily accessible to staff. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15. Grange cottage encourages and supports people to lead fulfilling and active lifestyles of their choosing. A review of activities provided by the home is recommended. EVIDENCE: Some of the residents lead very independent lifestyles accessing a range of community facilities on a daily basis, with staff providing discreet support. It is very important to them to maintain this autonomy and is an aspect of life in Grange Cottage that they value highly. They are maintaining links with family and friends and continue to pursue their interests outside the home. As described, staff provide discreet support to maintain this independence and ensure the safety of residents, without encroaching on their chosen lifestyle. The home also provides support for people with more complex needs or people who require higher levels of “hands on” staff support. It is recommended the home review the activities it can provide for this group of residents. Some residents had interests and activities plans within their care plan, which provided guidance for staff in personal preferences and how they can be achieved, which is good practice. The home was currently working with the social work team, to assess and support a new resident to access community transport, to keep in touch with family and friends, which was important to them. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 13 The menus examined reflected a varied and nutritional range of food being provided. Special diets and individual choices were recorded, which confirmed the very flexible and personalised approach. The inspector joined a group of residents for lunch, who also confirmed that the choice and quality of food was good and consistent. The lunch provided was freshly prepared and well presented. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 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 standard(s) 16, 17, 18. The home’s policies and practice ensure residents are safeguarded and their rights protected. EVIDENCE: Through induction and NVQ training, in addition to specific training relating to mistreatment and abuse, the home ensures staff are aware of their responsibilities and appropriate reporting procedures. Staff spoken to during the inspection displayed a sound knowledge of relevant policies and procedures. Since the last inspection the Commission have received two written complaints, one relating to the heating of the home and the other relating to care practices, these have been fully investigated and the relevant reports are attached. The home maintains a complaints log to record all complaints and their investigation. The home was currently dealing with an issue raised by a family member, for which a meeting had been arranged to resolve the issue. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26. Grange Cottage provides a safe and homely environment, with suitable facilities to meet the needs of the current residents. EVIDENCE: On the whole the environment is safe and well maintained, with the home producing a business development plan, to ensure repairs and maintenance are planned and the standard of facilities remain. Some of the décor is dated however it is serviceable and a clean and hygienic environment is maintained. The carpet in room four however has become worn and could be a tripping hazard if left, so it must be replaced as a priority. In addition cork tiles around two of the toilets should be replaced as they are permeable and cannot be adequately cleaned. Mr Frois was aware of the need to replace the tiles and had planned their replacement imminently. The driveway and parking area were being resurfaced with Tarmac on the day of the inspection, which will improve access and egress to and from the building. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 16 Throughout the home it was evident specialist equipment had been provided when needs were identified, with the home liaising with relevant professionals for advice and guidance, to ensure equipment was appropriate for individuals. These included pressure care equipment, manual handling equipment and equipment and resources for people with visual impairments. The garden and patio areas and seating to the front of the home had been improved and provided a pleasant environment for residents to enjoy the summer weather. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. Staff training has improved and the staffing levels are under review, ensuring they are adequate to meet the needs of the current residents. EVIDENCE: The home was in the process of reviewing it’s staffing levels between 4pm and 7pm, as this was proving a particularly busy time. The home will notify the inspector regarding the outcome of this review. The home has sound recruitment procedures that safeguard residents, however two staff only had standard CRB disclosures, which had been applied for by mistake. This situation had been rectified with enhanced disclosures applied for and the staff were not working unsupervised. All staff had now completed their induction training as required, additional core training had also been identified. One staff with language difficulties was receiving specific training to support them in their role and was not working unsupervised, so that appropriate support could be provided when difficulties occurred. Training activity within the staff team had increased and two staff are registered for their NVQ in September 05. Staff training and development was being recorded on staff files, with records of achievement maintained. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 38. The management of the home are committed to providing a safe and comfortable living environment that responds to individual needs. EVIDENCE: Based on discussions with residents, visiting relatives and staff, the home provides a relaxed living environment that many residents felt was unique, due to the small size of the home. The majority of residents and relatives comment cards also reflected this. There is a core group of residents and staff that have been at the home a long time and have a good understanding. The business and development plan produced by the home will ensure the effective and efficient management of the home in the near future. The deputy manager Ms Kate Meadows has completed her registered manager award, with a view to increasing her input in the management of the home. The requirements of appointing a new registered manager and the role of the responsible individual were discussed with Mr Frois. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 19 The home consults formally with residents on an annual basis, using a resident’s questionnaire. This was planned to take place in September, with the home notifying the commission of the outcome. Formal supervision of staff was now taking place and records of this were examined. These included training and development needs and practice issues and were signed by both parties. Staff felt they were beneficial in addition to the day-to-day informal support they received. Records relating to the health, safety and welfare of residents were also examined. Recent inspections by the fire service and environmental health were satisfactory, with no issues arising. Routine maintenance had taken place, including all moving and handling equipment. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 x 2 Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 13 Requirement The home must ensure only appropriate codes are used on MAR charts to clarify what medication has been administered. The carpet in room 4 must be replaced to prevent it becoming a tripping hazard. Timescale for action 25.8.05 2. 19 13 1st October 05 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. 2. 3. Refer to Standard 7 7 12 Good Practice Recommendations Daily diary recordings should be more specific about the care delivered during the shift. It is recommended the home develops individual pen pictures, as part of the care plan. It is recommended the home review the activities provided for people who require more intensive staff support. Grange Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 22 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 Cottage Home for Elderly Persons F58 F10 s22643 grange cottage v238085 160805 Stage 4.doc Version 1.40 Page 23 - 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. 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