Inspection on 05/06/06 for Grange Cottage Home For Elderly Persons

This inspection was carried out on 5th June 2006.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

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 Ray Mowat Unannounced Inspection 5th June 2006 3:45 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.V291156.R01.S.doc Version 5.1 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.V291156.R01.S.doc Version 5.1 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 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.V291156.R01.S.doc Version 5.1 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) 28th November 2005 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 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. The previous Inspection report is displayed in the entrance hall in the home. Current fees range from £360 to £390. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in the evening to enable me to see the evening routines of the home and meet with different staff. I met with all the residents and there were nine resident’s comment cards received. I also met with three of the staff on duty and received three visitors/relatives comment cards. I also got information from the questionnaire completed by the home before the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home needs to record more detailed information about resident’s needs and other relevant information to help staff to provide appropriate support. Storage of hazardous substances must now be improved as a matter of priority. Some records in the home are not being kept up to date including supervision of staff, also records should be signed and dated when reviewed. The home must ensure protective equipment for staff is supplied and used by them to stop the spread of infections. The home should provide a more varied choice of regular activities based on the choices of residents. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 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. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 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.V291156.R01.S.doc Version 5.1 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 the following standard(s): 2,3,4,5. Quality in this outcome area is adequate. The home must ensure when admitting new residents their assessed needs can be met and they are clearly documented and agreed with them in a plan of care. This will ensure residents understand how their needs will be met by the home and will reduce the potential for misunderstandings to occur. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home issues a contract of terms and conditions to all new residents ensuring they understand their rights. Residents spoken to had been supported by family or social workers in choosing the home. For some this had involved a visit prior to deciding to move in. One resident said, “I chose to come here, it suits me”. Another said they had visited with their son before moving in, they said “its nice and homely here, not too big”. There was evidence of the home completing their own assessments in addition to Social Work and other specialist assessments. Despite this there was one resident whose needs the home was struggling to meet, however this had been acknowledged and social workers were involved in looking at the alternatives Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 9 available. The home must ensure prior to admission that as far as practicable it is able to meet the needs of prospective new residents. Where specialist needs are identified these must be assessed and well documented and included in a care plan to be agreed with the new resident. This enables any potential conflicts regarding the style and type of care required to be agreed at the start of a placement and will reduce the possibility of it breaking down. A disclaimer had been signed by some residents about not using the stair lift, however some care plans had not been agreed and signed as to how the home would meet mobility needs and there was no risk assessment in place for this activity. Although specialist needs had been identified through the assessment process they had not been incorporated into a detailed care plan. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. The content of care plans have been reviewed and have improved, however where specialist needs are identified more detailed guidance for staff must be recorded and agreed with residents, to ensure a consistent and good quality service is maintained. This judgement has been made using all available evidence including a site visit. EVIDENCE: The content of the care plan files had been reviewed and more current and relevant information was contained. There was evidence of needs being reviewed on a monthly basis. However where specialist needs had been identified more detailed information is required to guide staff practice and ensure a continuity of care. It is also recommended the home develops a pen picture/social history which captures valuable information about the resident’s life and what is important to them. This document would be valuable for staff in gaining a better understanding about the person and valuing and respecting them as a unique individual. This type of work is good practice and it is recommended it be developed for all residents in the home. The completion of manual handling risk assessments and general risk assessments was inconsistent and must be improved, particularly for people Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 11 with complex needs. Nutritional and pressure care assessments were good and regularly reviewed. One file examined contained an appropriate referral to the physiotherapy service. This had resulted in a programme being developed for staff to follow, which was recorded in the care plan. Some residents spoken to were leading very independent lifestyles and were able to access appropriate health services with minimal support. However staff are aware of individual needs and assisted other residents to access services. The home also has contact with the District nursing service on a regular basis. I checked the contents of the medication cabinet against the medical records (MAR charts) for the home. On the whole these were up to date and accurate, although there were some blank spaces on a MAR chart where a code should have been used. It is recommended all staff are made aware of procedures and those responsible for administering medication receive appropriate training. Based on discussions with staff they were aware of the need to respect individual’s rights and privacy and to support them to lead independent lifestyles. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Although some people enjoy and thrive on the independent lifestyle other residents require more structure to be provided to ensure they are stimulated appropriately and skills are maintained. This judgement has been made using all available evidence including a site visit. EVIDENCE: Based on discussions with residents and feedback from resident’s surveys a number of people would like to participate in more structured activities or social gatherings. One person was more specific and said they would “like to go out for a meal or a ride”. Residents enjoy the music appreciation group each week and some are able to access local community activities such as coffee mornings and a local day centre independently. It is recommended more structured activities are provided by the home based on feedback from residents. Church services are held in the home and special occasions are celebrated, which residents appreciate. There was evidence of frequent visitors to the home with resident’s confirming that they are made welcome. Staff had a good understanding of individual needs and preferences and provide unobtrusive support to people to maintain their independence and Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 13 dignity. A number of the residents said that they chose the home because of the “small size, friendly atmosphere and independent lifestyle”. A sample of menus was examined which reflected a balanced and nutritional diet. Nutritional assessments and weight are monitored on a regular basis. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is adequate. On the whole residents are safeguarded from abuse and their legal rights are protected. Information for relatives and representatives regarding how to complain should be improved to ensure they all know the home’s policies and procedures relating to concerns and complaints. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home respects people’s legal rights and a record is held on file relating to their needs and preferences regarding their affairs. This involves the home liaising with families, advocates and solicitors. The home maintains a complaints record to document any concerns and complaints and their investigation. There have been no recorded complaints since the last inspection. Residents spoken to said they were aware of how to complain and who to complain to. Two relatives comment cards said they were not aware of the home’s complaints procedure. It is recommended the home make relatives and representatives aware of their policy and procedure for handling complaints. Based on discussions with staff they had a good awareness of what constitutes mistreatment or abuse and had received training to guide their practice. They were aware of the home’s policy and the correct reporting procedures. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. Grange Cottage provides a homely environment that on the whole is well maintained. At present the storage of hazardous substances such as cleaning fluids compromises the safety of residents and must be improved to safeguard all residents. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home has completed some re-decoration and replaced flooring in five bedrooms. One bedroom has had an en-suite facility upgraded. Access to the front of the home has improved with a tarmac driveway and improved parking facilities. A ramp with a handrail has been installed to improve access to the extension. In some areas of the home the décor is dated but clean and serviceable. Residents said how they had brought some of their own furniture to the home, which was important to them and as one person said “makes it feel a bit more like my own home”. Other routine maintenance has taken place with the central heating system being recently overhauled. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 16 Grab rails and handrails are fitted to assist people with mobility around the home. There was evidence on file of the home liaising with other agencies to ensure individual needs are assessed and appropriate aids and adaptations are in place. COSHH substances are stored in the laundry. On the day of the inspection this door was left unlocked and the hasp of the lock was bent resulting in the door not being able to be locked. In addition a COSHH substance was being stored on top of a cupboard in a bathroom, which is also inappropriate. COSHH substances must be securely stored at all times. This is subject to a requirement. The front garden has a seating area and was well maintained providing a pleasant environment, which residents enjoy. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. Since the random visit on the 4th May recruitment procedures and staff information have been reviewed and updated in line with good practice. Staff receive appropriate training to support them in their role and ensure they have the appropriate skills and knowledge to meet resident’s needs. This judgement has been made using all available evidence including a site visit. EVIDENCE: Based on examining the home’s rotas and discussions with residents and staff there are sufficient numbers of staff on duty in the home. New staff have completed their induction and foundation training, with some now working toward their NVQ award. There was records of other training taking place as needs are identified or courses become available. Requirements relating to the recruitment of staff were made after a random visit to the home on the 4th May. These have been responded to with all staff checks now in place. The content of staff files have been reviewed and are now in line with the National Minimum Standards. Discussions with residents and feedback from resident’s surveys confirmed that they have a ‘good rapport with staff’ and that staff respect their rights and dignity at all times. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. Quality in this outcome area is adequate. Records relating to the running of the home were inconsistent and must be reviewed and updated to ensure the safe operation of the home at all times. There is both formal and informal consultation with residents ensuring the home is run in their best interests. Management of COSHH substances was poor putting residents at risk. This judgement has been made using all available evidence including a site visit. EVIDENCE: Mr Frois is suitably experienced and knowledgeable regarding his role and responsibilities. He spends a lot of time in the home and at times works alongside staff. He has a good understanding of the needs of different residents. He believes that residents should have the autonomy to influence all aspects of home life and encourages a high degree of independence, which a number of the residents particularly enjoy and benefit from. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 19 The home consults formally with residents on an annual basis using a questionnaire. Also more informal consultation takes place on an ongoing basis on a 1 to 1 or in small groups as issues arise. Residents meetings are also called to discuss specific issues. The home does not get involved with resident’s personal finances but will provide support and guidance to them. Supervision records of staff were examined and found to be inconsistent. Some records related to the last supervision being in January 06. The home is required to ensure staff receive regular supervision that is recorded and signed by both parties. Although some records had improved the home is required to ensure all records required by the Care Home Regulations and National Minimum Standards are up to date and accurate. This must include a review of risk assessments, particularly in relation to new residents and ensuring that all hazards and potential hazards have been identified. The electrical wiring certificate is due for renewal, records relating to hoists and lifting equipment were also due for renewal. The home should also have COSHH data sheets for all hazardous substances stored in the home. The fire risk assessment had recently been reviewed and updated and the fire log and water temperature checks were up to date. It is recommended that when policies and procedures are reviewed they are signed and dated. COSHH substances were not securely stored in the home as described previously, which is subject to a requirement. It was noted staff were not wearing protective aprons when carrying out personal care after which staff were preparing food in the kitchen. On discussion with them staff were aware of the risks of cross infection and the correct procedure they should be following. The home must at all times ensure suitable infection control procedures are followed and protective equipment is provided. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 2 3 N/A 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 Standard No Score 16 2 17 3 18 3 3 3 X 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 2 Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14(1) c Requirement The assessed needs of new residents must be agreed with them and incorporated into a care plan. The home must provide regular supervision to all staff that is recorded and signed by both parties. The home is required to ensure all records required by the Care Home Regulations and National Minimum Standards are up to date and accurate. COSHH substances must be securely stored at all times. (This is an outstanding requirement previous timescale of 28.11.05 was not met) The home must at all times ensure suitable infection control procedures are followed and protective equipment is provided. Timescale for action 01/07/06 2 OP36 18(2) 01/08/06 3 OP37 17 01/10/06 4. OP38 13(4) a 06/06/06 5 OP38 13 01/07/06 Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 22 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 4 5 Refer to Standard OP7 OP7 OP12 OP16 OP37 Good Practice Recommendations It is recommended specialist needs identified through the assessment process and how staff will support residents with these needs are recorded in detail in the care plan. It is recommended the home develop personalised care plans for all residents including a personal profile/social history. It is recommended more structured activities are provided by the home based on feedback from residents. It is recommended the home make relatives and representatives aware of their policy and procedure for handling complaints. It is recommended that when policies and procedures are reviewed they are signed and dated. Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grange Cottage Home For Elderly Persons DS0000022643.V291156.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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