Inspection on 29/04/08 for Grange Cottage Residential Home

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Adequate service.

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 Residential Home 07/04/09

Grange Cottage Residential Home 07/11/07

Grange Cottage Residential Home 02/05/06

Grange Cottage Residential Home 15/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Grange Cottage Residential Home 6 Grange Road Sutton Surrey SM2 6RT Lead Inspector Michael Williams Unannounced Inspection 29th April 2008 10:00 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 Residential Home DS0000061844.V361287.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 Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Cottage Residential Home Address 6 Grange Road Sutton Surrey SM2 6RT 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) 020 8642 2721 F/P 020 8642 2721 grangecottage@blueyonder.co.uk Grange Cottage Residential Home Vijayantimala Halkoree Vijayantimala Halkoree Care Home 11 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11) Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow four specified service users under the age of 65 to be accommodated until such time that the home is unable to meet their assessed needs or their placement terminates. 7th November 2007 Date of last inspection Brief Description of the Service: Grange Cottage is a limited company, Grange Cottage Ltd., it is a small residential home registered for eleven older service users, who suffer from long-term mental health problems including dementia. The accommodation is provided over two floors; there is no lift and the premises are not well adapted for people with physical disabilities or people who use wheelchairs. Currently there are nine single bedrooms and one shared room. All the bedrooms have washbasins but no other ensuite facilities. Accommodation is to be extended and improved this year. There is limited parking to the front of the property and a garden to the rear. The home is well served by public transport. At the time of this inspection, in April 2008, the home was being extended to improve current facilities and add new rooms. The range of weekly fees is between £450 and £525 as at April 2008. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. To monitor all aspects of this service we ‘tracked’ the care provided to a sample number of residents and cross checked the information by speaking to or observing the residents, and where possible meeting with their visitors; by examining the documentation supporting care; by observing the meals provided; by checking the arrangements for administering medication, handling money, records of complaints and accidents. Staff providing care were interviewed including, carers and ancillary staff as well as the owner/manager and her husband Mr Halkoree who is joint owner of this care home. Questionnaires were also distributed to residents, visitors, staff and owners and feedback has been noted. In compiling this report the Commission has also taken account of any other information such as the incident reports sent to the Commission and the AQAA [Annual Quality Assurance Assessment] – which is a new self auditing tool each home is required to complete. What the service does well: What has improved since the last inspection? What they could do better: Considering that there are nine frail and vulnerable residents living in Grange Cottage the building works have not been well managed whilst the work is Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 6 underway. Areas have not been isolated whilst builders knock down walls and are rewiring rooms. We arranged with the owners and building team that areas under construction be kept safe and isolated form residents and extra care staff be employed during the main building works so that residents can be supervised and supported to keep them safe from the various hazards around the home. Another matter of safety was the poor standards if hygiene in the kitchen, whilst accepting that some items, such as worn kitchen cabinets, can wait for the new kitchen general standards of cleanliness have been allowed to lapse and this is not acceptable, the walls and floor were particularly dirty. Ancillary staff remains a problem in so far as the manager has not employed temporary cleaning staff whilst the home’s cleaner is absent. There were no cleaning or laundry staff on duty when we inspected this home despite the considerable dust and mess caused by building works. The revised menus are better but the evening meal is advertised as sandwiches or a hot meal and it is sandwiches are being served quite frequently throughout the monthly cycle of menus. As the midday meal was Lamb Hotpot served with cauliflower cheese as the vegetable we have asked the manager to review all meals to ensure they reflect the cultural expectations of residents. We have also required the home to record in adequate details the meals provided. In respect of diversity, we also note that both male and female staff are employed so this gives residents choice but there is no such choice for residents in respect of the staff’s cultural and ethnic background as none of the carers reflect the European background of the typical resident in this care home. We are recommending that the owners review their registration categories and conditions when they submit their application register the extra rooms to be provided in the extension. We also note that the home is not currently suited to residents who may have mobility problems (however, this is not a nursing home and it does not ordinarily admit residents with mobility problems). Although staff recruitment procedures are satisfactory not all staff have a copy of the GSCC [General Social Care Council] code of practice. We also recommend that all staff are given a copy of the home’s ‘whistle-blowing’ policy and a summary of the local authority’s safeguarding adults referral procedures. 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 Residential Home DS0000061844.V361287.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 Residential Home DS0000061844.V361287.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): NMS 3: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The home can assess prospective residents’ needs and works with placing authorities to ensure assessments are undertake and available to the home at the time of admission so as to ensure residents will know their needs can be met. Standard 6 does not apply in this care home. EVIDENCE: We checked a sample of three of the residents case files; we spoke to the manager, to staff and to the residents themselves. We also checked the statement of purpose and resident guide. The documentation used to assess and record information about residents is adequate although some forms were headed ‘nursing notes’. This could be misleading as the home is not registered to provide nursing care so the manager has now started deleting this heading. The assessments cover the usual range of care needs including mobility, disabilities, specific health matters, skills for daily living such as the ability to climb stairs or make a cup of tea. The assessments also include known risks such as the risk of falling or getting lost if the resident is very forgetful. The statement of purpose and resident guide are now to an acceptable standard Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 9 and provide information that would be helpful to a prospective resident and their representatives – but these two documents will need to be revised as part of the application to registered extra room and change the physical layout of the premises, the owners are also likely to revise their scale of charges to reflect improved facilities and this must be made clear in their documentation. Areas of strength include the assessment information, the statement of purpose and residents’ guide and as no requirements arise on this occasion this section about choice is assessed as good but we recommend the statement of purpose and resident guide be updated to reflect changes to be made to the service this year. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: People using this service experience adequate quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are set out in detailed care plan notes; they have access to community health services; all residents receive support in taking their medication. So in many respects residents are receiving the support they need but residents care plans do not reflect realistic assessments nor a wide enough range of social, emotional and diversity issues to ensure they can lead fulfilling lives. EVIDENCE: Residents have access to personal care within the home and receive health care support from the local community service such as the Community Nurse and General Practitioner services and well as hospital services and specialist support from Opticians and Dentists. Health needs are monitored and appropriate action and intervention taken for example the General Practitioner is consulted if residents fall ill and the Community Nurse is consulted about wound care. A visiting Community nurse confirmed that she was happy with the way health care was managed so far as she could judge by her regular Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 11 visits to individual residents. We were advised the CPNs [Community Psychiatric Nurses also visit the home as necessary. This home is not well adapted for people who have disabilities; there is no passenger lift; bathrooms and toilets are quite small; the dining room is not spacious and is further spoiled by having a large chest freezer in the room; there is only one lounge with the usual serried ring of chairs against the walls and there is room for little else. There is not a lot of room for people with dementia to wonder and smokers now have to use the rear garden since changes in the law. The new extension and improvements to the existing building will improve matters in some respects. There is evidence in the care plans of general health care needs. We examined a number of care plans and the assessments and on this occasion we identified that the assessments were not always very realistic, for example one resident was rated as low risk in the 28 areas assessed by the home. There would seem to be little point for his admission if this was the case, instead this resident does have risks associated with failing memory and these are not reflected in the assessment nor the care plan. It is to be noted that if the assessment tools currently in use do not reflect Grange’s resident group then a more refined assessment tool is needed. Only hygiene is emphasised as a care need in the single care plan. The case notes now include notes on family and personal history but as before the key-worker, junior care staff, did not seem at all familiar with this documentation and conceded a lack of familiarity with care plans when we interviewed staff – despite having been key-worker for six months. It was clear as I watched a member of staff search for the care plan in the resident’s case file that he was not familiar with the documentation and location of the care plan – a document that should have been very familiar to him. Regrettably this paucity of forward thinking and care planning leads to daily notes that reflect little purposeful activity in a resident’s day. Entries are not infrequently, “ slept well”, “had a good day”, “diet and medication taken”., and so forth. The care plans lack any interventions that may help the resident to lead a more fulfilling life. Staff provide little encouragement to enable residents to be independent – on the contrary the last time we visited we saw a member of staff discouraging residents from even walking around but not otherwise engaging residents in any meaningful activity – other than watching television. On this occasion we did see staff playing cards with residents but otherwise residents had little to occupy or engage them for most of the day. The views of residents are sought; for example resident meetings are held but as most residents have dementia there is little scope for them to plan ahead and make clear their wishes and preferences; this relies upon staff knowing their residents better than they demonstrated when we visit. For this reason we have emphasised the need for residents to be offered choices at the appropriate time eg choice of meals just prior to service of the meal. The home has a medication policy which is accessible to staff. The medication records were checked on this occasion and we found the medicine charts and storage of medicines to be satisfactory. Both owners of Grange Cottage, Mr & Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 12 Mrs Halkoree, have a nursing background and understand the need to comply with the administration, safekeeping and disposal of drugs including controlled drugs. A simplified ‘monitored dosage system’ [MDS] is in use and seems to be well managed. During my examination of documentation it was evident that the manager has improved personal details available and this includes information about last wishes and the Rights and Customs the residents wish to be observed at the end of their life. Details of family and representatives are included and details such as preferred disposal and beliefs if any. Areas of strength include the general documentation outlining the health needs and the residents’ access to health care from community resources and no lapses in medication procedures were found on this occasion. However, this section, about health and social care, can only be assessed as adequate because some assessments are not realistic and the care plans arising from them not detailed enough and staff, ‘key-workers’, still lack detailed knowledge and understanding of residents they are supposed to get to know. Despite this residents are content and appear mentally stable and so this section is not judged poor but adequate. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 13 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): NMS 12 to 15: People using this service experience adequate quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. This home cannot provide the lifestyle that residents might expect but they can be supported in maintaining contact with family and friends. Meals in this home are not as homely and ‘home-made’ as residents might expect and so do not provide the quality of meals and mealtimes residents should expect. EVIDENCE: The home is registered to provide care for two distinct groups of residents, those with dementia and those with mental health problems, but the home has just one lounge and one dining area this leaves residents very little choice as to where and with whom they sit each day and there appears to be little distinction in the delivery of care to each group of residents and little seems to have changed since I previously visited in November 2007. On this occasion however I note that the building works have a considerable impact upon daily life in the home at present and with the bigger building and more space and with a promise of an activity coordinator we accept that care and social life in this home is likely to improve in future months. In the past we have noted that there are sometimes staff shortages as on the day of inspection. We also noted in a resident’s care plan that activities outside the care home can only be offered if, “When time permits and staff are available”. This indicates that this service is not lead by residents need instead Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 14 it is service lead with no guarantee residents wishes an expectation will be met. It is no surprise therefore that the daily notes of residents indicate that staff are limited in what they offer. Other than personal hygiene such as washing, bathing and so forth, “care” is largely in the form of supervising residents as they sit all day in the lounge or dining room. AS we have noted before in our reports, one resident has for a long time assisted with laundry tasks and tells us she enjoys doing so. This demonstrates that people with enduring mental health problems often have practical skills that can and should be developed but this is not the case in Grange Cottage. Residents have told us that life in Grange Cottage “can be a bit boring”. Table top games such as dominoes and cards are available and were being used when we visited in April. There is little scope for enabling people with mental health problems to improve their daily living skills or enjoy anything other than a rather “quiet and sometimes boring life” as a resident has told us. Neither residents, nor staff, gave any indication that some residents might retain or even develop daily living skills or improve their social life. Choice is limited to choices about small daily milestones such as what clothes to wear, what meals, when to bath. When to have a cigarette and so forth. This home tends to foster dependency with little scope for ‘moving on’. This may be as a result of mixing the two categories of resident within a small setting where residents receive a common form of care and support that is not tailored to individual needs; there is little prospect of progress and development, at best residents will be comfortable but not develop as this section about lifestyle would direct. As we have also noted before, this sense of boredom and limited social care is probably compounded by the fact that several staff have a poor grasp of spoken English and English culture and history and therefore their communication skills with English speaking residents is inevitably compromised. Communication is limited to basic aspect of care. Staff do not share a common culture, background or history with residents and so staff are not in a position to prompt residents’ memories about every day events as they unfold around them. Reminiscence is hardly possible if staff don’t know the history and background of what residents might reminisce about . The midday meal was lamb hotpot served with cauliflower and a cheese sauce. This seemed and unusual combination and not a common English dish but the manager was not aware how odd this combination appeared as she is from Mauritius and admitted she ate little English food herself and therefore as manager was not in a position to understand that norms of British meals. In reviewing the menus in November we noted that several meals during the week are similarly pre-prepared foodstuffs rather than home-made meals. Menus are now more often ‘home-made’. The home should provide at least two distinct choices for the main meal of the day and as residents have very poor memories the two choices should be available just prior to service so they can see and choose at the table. On this occasion we also noted that two choices are given for the evening meal but in infrequently sandwiches are offered as on the day of our visit. The dining room is not very large and the freezer in one Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 15 corner does not lend itself to a ‘congenial setting in which to eat’ as this section recommends. In the environment section of this report we also refer the very poor hygiene standards in the kitchen. Areas of strength include the quiet, friendly and peaceful atmosphere in the home but this is rather soporific. Meals and mealtime need to be enhanced. As there is little sense of a purposeful day for anyone this section, about daily life, is assessed as adequate. It is to be hoped that an enlarged service will give scope to a better daily social life for residents. We recommend that the cook develop her skills in preparing sauces more appropriate for each meal and that sandwiches are to be a second option not first for evening meals. We reiterate a requirement to improve care planning in respect of daily life and activities and ensure that staff numbers and how staff are deployed is arranged to meet residents’ needs and not the other way round. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 16 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): NMS 16 and 18: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. This is a relatively small care and the arrangements for complaining are informal and clear to all. The owners are clear about the local authority’s procedures for dealing with allegations of poor care practices or abuse so residents can feel protected by these procedures. EVIDENCE: As a demonstration of the home’s wish to make the information clearer to all there is a sign in the hall that is translated in picture form to assist those who may have lost the skills to read. Although pictures are of more value to learning disabled people than older people with dementia or mental health problem it is commendable that the home is considering alternate methods of communicating with residents and visitors. Large formats and short simple wording may be of more value to the current client group. No specific complaints were drawn to the attention of the Commission whilst we inspected the home. Information about how to complain is contained in the residents’ guide. Staff we interview did not have copy of the GCSS [General Social Care Council] Code of Practice nor were they very clear about the term ‘whistle-blowing’ (reporting abuse). We therefore recommend staff are given copies of the Code of Practice the policy of whistle-blowing and a summary of the local authority’s safeguarding procedures with contact numbers. As the home’s procedures for dealing with complaints and safeguarding adults are acceptable and as staff were well aware of their responsibilities to safeguard residents and report abuse this section is assessed as good. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 17 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): NMS 19 and 26: People using this service experience poor quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. This care home is being extensively modified, however the management of the refurbishment does not ensure the safety of residents. EVIDENCE: The building works in this home have been poorly managed; builders are working in numerous locations within the premises including many areas still occupied by residents such as bedrooms and communal areas. These areas have not been isolated to make them safe for residents and to reduce disturbance for residents. The owners agreed to do two things immediately; first, to increase staff support and supervision of residents and secondly to ensure the builders are properly supervised and make safe each area they work in. In addition to this general point the kitchen was dirty and needs a thoroughly cleaned whilst it remains in use to prepare residents meals, so staff need advice on infection control. This section is assessed as poor. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 18 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): NMS 27 to 30: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. Recruitment practices have improved and are now safer for residents; staffing levels and the deployment of staff is now also safer for residents; the skills mix of staffing is also improving so residents can now be confident staffing in this care home has improved from poor to adequate. EVIDENCE: Staff recruitment practices now seem safer; all necessary checks have been made before staff are being employed and that includes references and police checks as well as checks about identity and permits to work. Staff are now either training to achieve NVQ [National Vocational Qualification] or are booked to do so later this year. This commitment to training is very laudable. The staff we spoke during our visit well informed and thoughtful about care practices but it was disappointing to note that staff were not really very familiar with the history and background of the residents they support as ‘key-worker’ – a role that requires them to get to know certain residents and their families. It was also disappointing to read in the (very limited) care plans that a resident may be “taken out for walks, or shopping trips when time and staff available”. The regulations require that the home employ enough staff, including ancillary staff, to meet residents’ needs and not to curtail activities for want of adequate numbers of staff. The staff roster suggests staff are no longer working excessive hours. Although the current team of staff does not reflect the cultural diversity of the residents, who are European, the improvements to staffing is noted. In view of staff numbers and lack ancillary staff this section is assessed as poor. Not all staff have had fire drill training and some did not have a copy of the GSCC [General Social Care Council] Code of Practice. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 19 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): NMS 31, 33, 35, 37 and 38: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be confident that the providers of this care home are running the home safely and in the best interests of the residents. Records are not all to an acceptable standard and some aspects of the environment are unsafe so again residents cannot be assured that this is a safe and suitable care home. EVIDENCE: The main emphasis of this visit by the Commission was to observe how the owners, Mr & Mrs Halkoree are managing the service whilst major building works are underway. We also wished to check what improvements if any had been made to the management of staffing in particular recruitment and the deployment of staff, that is, how many hours they work in the course of a week or month. Recruitment is now much improved and staff are being properly vetted before being employed. We confirmed this by checking the documentation for a Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 20 number of applicants seeking employment in Grange Cottage. We also checked by speaking to existing staff to re-check their employment documentation and permits to work We checked the procedures for handling residents’ money. We identified that in one case a proper record had not been made for money returned to a residents but by speaking to the member of staff and to the resident it was clear this was an oversight and not indicative of fraudulent practices. In other respects that record and procedures for handling residents;’ monies was satisfactory. Other records we checked included Visitors’ book; menus; staff records, residents case files, accidents, complaints, fire records. Two requirements arise; one is to ensure that all staff receive fire drill training each year and the other is for the home provide the Commission with a monthly owners’ report (known as the Regulation 26 reports). Health and safety was seriously compromised by the manner in which building work was being conducted in this home whilst nine residents continue to occupy the premises. Work was underway throughout the home in many bedrooms, in communal areas, and the main extension. We saw voids in floors, hanging wires, work tools, building materials; in effect a building site. None of these areas were being isolated from residents who were free to wander into unsafe areas. The owners, and in particular Mrs Halkoree as manager, advised us that the Foreman was expected to keep all areas under construction safe but this was not happening and as the manager she was not dealing with this. The manager agreed to correct this without delay by employing more staff to supervise residents and by requiring the builders to keep each area they work in safe and isolated from residents. In view of these hazards and the general disruption to residents’ life this area is assessed as adequate; but we acknowledge that this is a temporary matter and the building works are likely to bring improvements to both the quality of the premises and to the quality of life in the home. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 22 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 OP27 Regulation 18 (1)(a) Requirement Timescale for action 30/06/08 2. OP27 18 (1)(a) 3. OP8 OP12 12(1)b Staffing: The registered person must ensure that staffing numbers are appropriate to the assessed needs of the service users at all times so that residents will know that their needs will be met and they will be cared for in a safe manner; this is so as to protect residents during building works. 30/06/08 Ancillary staff: The registered provider must ensure that ancillary staff are employed as appropriate and that their hours are kept separate from staff providing care to residents so that residents will know that enough care staff are on duty to meet their needs. Whilst this is outstanding from 2007 cleaning staff are employed but they were not on duty to keep the residents’ areas clean and tidy. Care, education and supervision 30/06/08 of residents: The registered provider must make proper provision for the care education and supervision of residents by ensuring that the residents care plans cover all those aspects of DS0000061844.V361287.R01.S.doc Version 5.2 Grange Cottage Residential Home Page 23 4. OP15 16(2)i 5. OP19 23(2)b 13(4)a 6. OP19 23(2)d 7. OP37 17 8. OP38 23(4) & (4A) 9. OP30 13(6) care residents might expect to enjoy a comfortable and active lifestyle in the home.. Meals: the registered provider must ensure that meals of a suitably high standard nutritionally and in appearance. A minimum of two distinct choices must be offered for the main, midday meal so at to ensure residents can enjoy wholesome and nutritional food in the home. This repeats an earlier requirement; there have been improvements so residents do benefit from slightly improved menus. Premises: all areas of the home to which residents have access must be maintained safe from hazards; this is so residents are not put at risk during building works. Kitchen hygiene: the kitchen must be kept thoroughly clean so residents’ are not put at risk of food poisoning. Records: food and complaints records must be maintained with greater detail so residents are protected by records that can be used to evaluate food and complaints. Fire safety: Staff must received periodic fire training by fire drills so residents will know staff can respond appropriately in the vent of fire. Staff: each member of staff must be given a copy of the General Social care Council’s code of practice, a copy of the home’s whistle-blowing policy and summary of the local authority’s contact details for reporting abuse. 30/06/08 30/06/08 30/06/08 30/06/08 30/06/08 30/06/08 Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP26 OP1 Good Practice Recommendations Hygiene: it is advised that staff receive advice and guidance on infection control including standards of hygiene and use or personal protective equipment. Registration categories and conditions; it is recommended that when Grange Cottage updates its certificate to reflect extra bedrooms it also consider requesting a revision of the categories and conditions included in their certificate. Grange Cottage Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Residential Home DS0000061844.V361287.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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