Inspection on 18/07/07 for Grange Cottage Home For Elderly Persons

This inspection was carried out on 18th July 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 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... 05/06/06

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

Grange Cottage Home For Elderly... 16/08/05

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 Jenny Donnelly Unannounced Inspection 18th July 2007 11:00 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 Cottage Home For Elderly Persons DS0000022643.V341399.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 Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Cottage Home For Elderly Persons Address Albert Road Grange-over-Sands Cumbria LA11 7EZ 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) 015395 33122 Mr Michael Frois Mr Michael Frois Mrs Jane Frois Care Home 9 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (9) of places Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 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) 5th June 2006 Date of last inspection Brief Description of the Service: Grange Cottage is registered to provide residential services for nine older people two of who 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 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. The previous Inspection report is displayed in the entrance hall in the home, and a Grange Cottage information pack is available. Current fees range from £373 to £434 per week. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For the purpose of this inspection I made an unannounced visit to Grange Cottage between the hours of 11am and 2.30pm. During the visit I toured the building, talked to the people who live there and to staff. I looked at care and medication records, observed lunch and looked at staff and maintenance records. In the weeks before this visit I collected written information from the homeowner and sent out survey cards to people living in the home, of which five were returned. What the service does well: What has improved since the last inspection? What they could do better: The management of medicines that are classed as controlled drugs needs to improve, and a requirement is made about this. Good practice recommendations are made about respecting the privacy of peoples’ bedrooms, improving the general décor of the home, planning and providing staff training and supervision, and improving the quality monitoring systems. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 6 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 Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides written information telling people about the service offered at Grange Cottage, and peoples care needs are assessed before they are offered a place in the care home. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which provide good information about the services offered at Grange Cottage. There was evidence that peoples’ care needs had been assessed before they were offered a place in the care home. Assessments included information from social workers and other relevant healthcare professionals. Three of the people I spoke to say they had visited Grange Cottage to look around before they moved in and had made a positive choice to live there. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were happy with the personal care they received, and had good access to outside healthcare services. The management of medicines needs to improve. EVIDENCE: People had individual care plans in place, which detailed their health, personal and social care needs. These care plans had been reviewed and updated regularly and there was evidence of input from other professionals in these reviews. Since the last inspection staff had completed social history information sheets with each person, to capture the important events in their lives and note peoples’ interests and hobbies. People said they were “well looked after”, and that they received “all the help needed” with their personal care. One person said she had a weekly shower, another said she had a proper bath. One man commented that “the place is all right, better than where I was before like”. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 10 There was evidence that people had regular access to outside health professionals including the doctor, chiropodist, and district nurse. There was liaison with the intermediate support team and community psychiatric nurse where appropriate. People say there are treated with respect by staff, made to feel at ease and their bedroom is their own space. However, it was noted that staff used one person’s bedroom as a general thoroughfare to the office, despite a notice on door saying not to do so. The management of medicines in the home was adequate. There was secure storage and reasonable record keeping. However, there was one medicine that staff did not realise was a “controlled drug” and were not recording running stock checks. This medicine was prescribed to be given every three days, and on some occasions it had been administered at two and four day intervals, meaning the person was not receiving a constant dosage as the doctor intended. The medicine strength was not recorded on the administration record, and should be. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were satisfied with the individual activities on offer, and were able to exercise their choices. People said the food was good, and they enjoyed their meals, although there was no choice of menu. EVIDENCE: Grange Cottage does not provide any structured activities as such, opting to meet peoples’ social needs on an individual basis. There had been a music appreciation group, but this had stopped over time due to lack of interest. Two people attended day centres for one or two days each week, and a third person went out periodically with a member of the intermediate support team. The homeowner said he occasionally takes people either individually, or in small groups, to the pub or to the Lakeside hotel for coffee. A couple of people were physically able to go into town by themselves, and others were assisted by staff to go to the shops. One person liked to do crosswords, and care staff spent time with her every afternoon to do this. People were satisfied with the level of activities saying, “The staff take me round the shops when I want to go” “I go out in a taxi every week and meet with a group to play cards” Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 12 “I like to sit here and watch telly, and go out round the town when the weather is nice”. People were unsure whether they had access to religious services, although one person said they kept contact with their vicar and could phone him if they wanted to. The meals were home cooked and people said, “the food is good”, “I enjoy the meals”, “and they will cook something special if you ask”. People were able to eat together in the dining room, or privately in their bedrooms as they wished. Nutritional assessments had been completed, peoples weight was monitored and the home catered for specialist dietary needs. There was no choice of menu and people said they didn’t know what the meal was until it arrived, but said it was always something nice. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People knew how to make a complaint and felt confident that matters would be addressed satisfactorily. EVIDENCE: The home has a complaints procedure on display and those people spoken to say they know how to complain if needed. For advocacy some people living in the home had relatives who could support them in decision-making; others had access to social workers or members of the intermediate support team. Staff had received training on safeguarding adults’ procedures, and although this was over two years ago, an appropriate referral had recently been made to social services and the police for investigation. There were guidelines for staff to follow in the case of any allegation being made; these included what is adult protection, whistle blowing and a CSCI information pack. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Grange Cottage provides a homely environment, which is warm and comfortable, although the décor is rather worn and dated. EVIDENCE: Grange Cottage is situated in a residential area in the town of Grange-overSands. The home is a large Victorian semi-detached property with an adjacent modern bungalow. The main house has six single bedrooms, two on the ground floor and four on the first floor, which are accessed by a staircase with a chair lift. The second floor is occupied by live in staff. The main house has a dining room, lounge, conservatory, shower room and bathroom. It also houses the kitchen and laundry. The bungalow has three single ensuite bedrooms, a dining lounge and one bathroom. Since the last inspection some work has been done to improve the condition of the external fire escape, two bedrooms and a dining room have been painted and the hallway re-carpeted. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 15 A new carpet has been ordered for one bedroom and there are plans to refurbish one bathroom. Residents were happy with the accommodation, although the décor is generally quite worn and dated in places. There is a seating area in the front garden. People said their bedrooms were vacuumed and dusted regularly, and the home was clean and fresh throughout. Care staff were responsible for cleaning, cooking and laundry tasks. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were cared for by properly vetted staff who had received some training on how to support people, and there were enough staff to meet peoples current care needs. EVIDENCE: There is a total of seven staff employed at Grange Cottage including Mr Frois the owner. Information provided by Mr Frois states two staff have an NVQ (National Vocational Qualification) in care and two are working towards this. There are two staff on duty during the day, and one at night with the ability to call on the live in staff if needed. There had been one new staff member since the last inspection and records showed that correct procedures had been followed in respect of pre- employment checks. There is no annual training plan for staff and no plans in place for updates of health and safety training such as moving and handling and fire. Some training has taken place as follows; two staff have a current first aid certificate, two staff attended mental health capacity act training, three staff attended a dementia training day, and four staff attended adult protection training but this was in 2005. People said the staff were “kind and helpful” and it was clear that people got on well and enjoyed the staffs company. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Grange Cottage has stable hands on management, which takes on board and tries to accommodate the views of people living in the home. Oversight of staff supervision, training and quality assurance is less well managed. EVIDENCE: Mr Frois the registered provider and manager of Grange Cottage is very experienced in his role and has completed a level 4 NVQ in management. Mr Frois spends a lot of time in the home working alongside staff, but is currently working night shifts, which reduces his opportunities for this. Mr Frois consults with people living in the home both formally through periodic questionnaires and informally through discussion. This allows people an opportunity to put forward their views and make suggestions. At present there is no consultation Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 18 with external professionals, such as doctors or district nurses about the quality of service provided at Grange Cottage. There is no formal quality audit process of care delivery, care planning or medicines management. Neither Mr Frois nor the staff have any dealings with peoples money, although Mr Frois will provide support and guidance if asked for. Records show that formal staff supervision remains inconsistent with the last recorded session for some staff being in summer 2006. The majority of policies and procedures had been reviewed in 2006 and were satisfactory. In line with new regulations, the home has purchased a Fire Risk Assessment for Residential Care Homes Guide and produced a new fire risk assessment based on this. The fire log was up to date showing that weekly alarm tests were taking place, as well as regular fire drills. Further to the last inspection water temperature records were being maintained and Mr Frois had taken some advice in respect of prevention of Legionnaires disease. A satisfactory inspection by the Environment Health Officer took place in December 2006. Staff had received training in safe moving and handling and fire safety in the past, but there were no plans to keep this updated. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 2 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 3 2 Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Running stock checks must be kept on medicines that are classed as “controlled drugs” to ensure their safekeeping. Medicines must be given at the time intervals prescribed, to ensure the person receives the maximum benefit. Medication charts must show the dose of the medicine to be given, to ensure this is correct. Timescale for action 01/09/07 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 OP10 OP19 OP30 Good Practice Recommendations It is recommended that people’s bedrooms should be treated as private and not used as a general thoroughfare by staff. It is recommended that work to improve the standard of internal décor be continued. It is recommended that an annual training plan be DS0000022643.V341399.R01.S.doc Version 5.2 Page 21 Grange Cottage Home For Elderly Persons 4. OP33 5. OP36 developed to ensure training for all staff is up to date. It is recommended that a quality audit process be implemented that monitors the working systems within the home, and gathers the views of external stakeholders such as professional visitors. It is recommended the home complete regular supervision sessions with all staff to identify development and learning needs. Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. Extracts may not be used or reproduced without the express permission of CSCI Grange Cottage Home For Elderly Persons DS0000022643.V341399.R01.S.doc Version 5.2 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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