Inspection on 07/11/07 for Grange Cottage Residential Home

This inspection was carried out on 7th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Residential Home 07/04/09

Grange Cottage Residential Home 29/04/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Grange Cottage Residential Home 6 Grange Road Sutton Surrey SM2 6RT Lead Inspector Michael Williams Key Unannounced Inspection 7th November 2007 9:30 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.V343938.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.V343938.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 NO EMAIL 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.V343938.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. 3rd August 2007 Date of last inspection Brief Description of the Service: Grange Cottage is a small residential home registered for eleven service users over the age of 65, 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. There are nine single bedrooms and one shared room. All the bedrooms have washbasins but no other ensuite facilities. There is parking to the front of the property and a garden to the rear. The home is well served by public transport. The range of weekly fees is between £410 and £450 as at November 2007. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. To monitor all aspects of this service the inspector ‘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 arrangement for 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 and feedback noted. The Commission has also attended a number of meetings arranged by the local Social Service Department which, in addition to routine reviews of residents’ care has also been investigating a number of serious concerns about the quality of care provided and the management of the home. 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? Improvements have been made to the environment including windows and the front door. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grange Cottage Residential Home DS0000061844.V343938.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.V343938.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: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available 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: The documentation used to assess and record information about residents is quite adequate although some forms are headed ‘nursing notes’. This could be misleading as the home is not registered to provide nursing care. 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.V343938.R01.S.doc Version 5.2 Page 9 and provide information that would be helpful to a prospective resident and their representatives. Areas of strength include the updated statement of purpose and residents’ guide and as no requirements arise on this occasion this section about choice we assessed as good but we recommend the heading ‘Nursing’ is deleted from forms in the residents’ notes. Grange Cottage Residential Home DS0000061844.V343938.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, 8, 9, and 10: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available 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 are not always treated with respect and dignity. 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. 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 Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 11 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. There is evidence in the care plans of general health care needs. Although the care plans are quite detailed unfortunately the junior care staff, who are the ‘key-workers’, did not seem at all familiar with this documentation and conceded a lack of familiarity with care plans when we interviewed them. Staff provide little encouragement to enable residents to be independent – on the contrary 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. The views of residents are sought; for example a resident meeting was held on the day we visited in November 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 visited. The home has a medication policy which is accessible to staff. The medication records were not checked in detail on this occasion other than to note that the care plans provide information about residents health and the medication profile. Both owners of Grange Cottage, Mr & Mrs Halkoree, have a nursing background and understand the need to comply with the administration, safekeeping and disposal of drugs including controlled drugs. Staff should be aware of the need to treat individuals with respect and to consider dignity when delivering personal care but we identified lapses. Staff said they would “make residents sit in the lounge” (in preparation for an activity for example) - whilst they were not we think implying restraint it demonstrates a poor understanding of English and of residents’ choice not to engage in activities of they so wish. “Encourage residents to join in” would have shown a better understanding of English and of residents’ right to a dignified approach by carers. Areas of strength include the documentation outlining health and social care needs of residents; 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 poor because of the poor communication skills of staff and the undignified manner in which they sometimes refer to residents and their lack of background knowledge of residents and their care plans. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available 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 and nutritional content residents need. 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. There are sometimes staff shortages as on the day of inspection and some staff work excessively long hours, again this was noted on the day of inspection. As a result 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. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 13 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 say about life in Grange Cottage “it’s a bit boring” and “I am trying to read, I have one book I am making stretch”. The activity programme for the day of inspection included ‘arts and craft’ as listed on the activity programme. When staff were asked to show what materials were available for this activity the only materials were a large sketch-pad and a set coloured pencils. Table top games such as dominoes are also available. When asked if residents get the support they need one said “yes, I get a bed and food”. This rather exemplifies the minimal approach to social care in this home, the basics are provided but residents feel little else is catered for. 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 one resident said. 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 and so forth. The 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. 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 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 those they care for. The midday meal was prepared from tinned tuna fish, dried pasta with packet sauce. This was made up into the main meal of the day ‘Tuna pasta bake’. We note that nothing was added to compliment this - such as additional sauce or vegetables or salad. Not surprisingly the pasta looked boring on the plate we were offered to sample. It also likely that packet food will be high in salt and sugars and not as nutritional as residents can expect. We were given the explanation that some residents can’t cope with salad. Alternate ready cook meals are offered if residents request it. In reviewing the menus we note that several meals during the week are similarly pre-prepared foodstuffs rather than home-made meals. 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. The dining room is not very large and the freezer in one corner does not lend itself to a ‘congenial setting in which to eat’ as this section recommends. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 14 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 poor. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 15 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: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available 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 information it provides 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 - other than a general sense of boredom and meals that were sometimes not of high quality. Information about how to complain is contained in the residents’ guide. A number of anonymous complaints have been made about the proprietors of this home. The complaints are wide ranging and some may be unfounded and malicious but the local authority (London Borough Sutton) and the Commission take such matters seriously and so these have been investigated by the local authority care managers. Whilst some issues Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 16 cannot be resolved and some not substantiated other elements of the numerous complaints will need further investigation and monitoring over a period of time including for example issues of staff recruitment and staffing arrangements in the home. As the procedures for dealing with complaints and safeguarding are acceptable this section is assessed as good. Grange Cottage Residential Home DS0000061844.V343938.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 22 26: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. This is a small, domestic setting, it is reasonably well maintained, but it is not entirely safe nor is it ideally suited for the two client groups it is registered for. The home is clean and tidy. So residents cannot be assured this care home is both safe and suitable for them. EVIDENCE: The accommodation is provided over two floors but there is no lift and the premises are not well adapted for people with physical disabilities or people who use wheelchairs. There are nine single bedrooms and one shared room. All the bedrooms have washbasins but no other ensuite facilities. There is parking to the front of the property and a small garden to the rear. There is no separate smoking area so with the recent changes to the law residents who Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 18 wish to smoke, and there are several, have to smoke in the garden or on the lounge doorstep so other residents and staff do not have to ‘passively smoke’. The home does not employ a cleaner but one resident likes to do much of the vacuuming, tidying and laundry work. The owners say they aim to employ a cleaner/laundress in the future. Despite the absence of ancillary staff the home is kept reasonably clean and tidy. Not all residents have dementia and therefore losing mental faculties some residents have long term mental health problems and but the home is not adapted nor suitable for supporting residents to regain daily living skills – the laundry is very small and unsuited to working with resident, the kitchen whilst domestic in scale appears not be be used to help residents in cooking skills and meals are taken communally with no indication any residents are developing independence. A number of problems were identified with the premises. Storage is clearly one problem with materials being stored inappropriately in residents’ bedrooms. A stockpile of pads in one instance, a box of paper towels and a glass fronted notice board were other examples. Continence aids left in the bathroom and items of clothing left in soak in the laundry look unsightly and possibly unhygienic. Some fire hazards were noted including the use of a deadlock on the front door because the digital locking mechanism was not working properly in the new front door. Use of a mortice deadlock impeded escape in the event of an emergency. This was the most urgent matter and was corrected within 24 hours. There were two instances where doors were not effectively sealed against the ingress of smoke; in one instance the door-stop (frame) was missing and in the other a large hole was left after the door handle was removed. The removal of the door handle also meant it was difficult to open the door. Décor was poor in some areas such as the bathroom where screw holes were left unfilled and the bath-mat is very crumpled and uneven. Wallpaper is peeling, particularly noticeable in the lounge. In one bedroom the hot water tank was within a wardrobe and needed to be partitioned. It looked unsightly and residents might tamper with it. A tap was very loose in one of the sinks. The plasterwork around a door frame was damaged and needs repair. Not all radiators have protective covers. It is to be noted that the owners hope to extend the home and so they see much of the minor work being corrected when the major work is underway but no timescale was given for the works. Areas of strength include the participation of a resident in the daily chores; the general homeliness of the premises is also an asset but the lack of viable alternative seating and dining (and smoking) areas for the two groups of residents means residents have little choice about where and with whom they spend the day. The several maintenance issues also mean that this section about the premises is assessed as poor; the safety issues are dealt with under the management heading as health and safety matters. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 19 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 is poor. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of critical problems were identified during this unannounced inspection in November 2007. When the inspector arrived on the premises one of the staff was absent and had not been replaced until later in the morning. One of the owners was on duty working on the premises and had just completed a waking night shift in Grange Cottage. The member of staff who later returned had a very poor grasp of English and was not familiar with the residents’ care plans – not even the residents for whom she acted as ‘key worker’. We also note that this worker was in fact the only ‘carer’ on the premises, she is only bank and not permanent member of staff and the other two persons providing care were the owner Mr Halkoree and the owner/manager Mrs Halkoree – who each have responsibilities other than the direct care of residents. The recruitment process was faulty; in particular the application form submitted by a member of staff was incomplete, for example her work history. The references for this person were not clear which establishment was to provide the second reference and was not clear as to the authority of the person responding. One of the references was quite improbable, possibly Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 20 fraudulent, in so far as the member of staff claims to have been in the country for several months when she applied for work. This person’s application form indicates that the person is still quite young who has only ever worked in a shop in her home country yet a local (UK) referee, who described herself as “senior care officer”, describes the applicant as a “hard worker… for 18 months… with service users”. Mr Halkoree as one of the Directors of Grange Cottage conceded that he had failed to check this detail when he appointed this applicant. The closeness in family relationships hints at nepotism and collusion that may have lead to a serious lowering of recruitment standards and checks in this instance. Other checks, such as the health check and police check [CRB], were in place and the member of staff (who’s records were checked in detail) said s/he did not need to have a permit to live or work in the UK. The staff file also included other details such as training and her disciplinary record. In the home’s own documentation Mr Halkoree lists only 4 of his 10 staff as having a relevant qualification in care. A detailed check of the duty roster indicated that Mr Halkoree, as well as being one of the owners of Grange Cottage also works there as carer. He confirmed this and we observed that he was providing care to residents throughout the inspection day. He conceded that he was working ‘back to back’ shifts, which is an unsafe practice. Having been on waking night duty on the night on 6th/7th November he continued to work throughout Wednesday the 7th November. Mr Halkoree’s duties as listed on his duty roster which he confirmed had been compiled by himself and agreed with his wife (the owner/manager of Grange Cottage) were as follows: Night duty Sunday 4th, long day Monday 5th, night duty Monday 5th, no shift recorded for Tuesday 6th, night duty Tuesday 6th, long day Wednesday 7th, no further night shifts indicated this week but an early shift on Thursday 8th. This means for example that Mr Halkoree worked from 8 pm on Sunday evening continuously until 8 am on Tuesday morning a total of 36 hours without an adequate rest period. There is no indication that any of the shifts were replaced by other workers. Either Mr Halkoree worked these hours which is unsafe for himself and his residents or he did not work these hours, in which case the home was not adequately staffed which is equally unsafe. It is not surprising that some residents thought Mr Halkoree was the manager rather than Mrs Halkoree - who is the registered manager. Areas of strength are difficult to identify, there were three staff on duty but one had worked excessive hours, one member of staff was absent for part of the morning then went off sick and was eventually replaced; this person in any case only a bank member of staff and not a permanent worker; this could compromise continuity of care. None of the care staff share the background and culture of current resident group; recruitment practice very is poor; the staff roster is unacceptable. This standard can only be assessed as being very poor indeed. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 21 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, 34, 37 and 38: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident that the providers of this care home are fit to be in charge because they are failing to demonstrate that they are running the home 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 a safe and suitable care home. EVIDENCE: The poor recruitment practices identified in the staffing section indicate that the providers of Grange Cottage are not discharging their responsibilities as they should. Mr Halkoree is working excessively long hours and Mrs Halkoree as the manager is condoning this poor and unsafe practice. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 22 The poor recruitment processes also indicate that some aspect of the home’s record keeping is very poor in so far as the staff records do not comply with Schedules 2 and 4 which list the various pieces of information the managers should obtain - and check - when recruiting staff. The manager is failing to ensure that care staff, who provide the day to day care, are familiar with residents case files which makes those records virtually pointless. In view of the many shifts Mr Halkoree (as an owner) is working the Commission is requesting the owners supply the Commission with detailed accounts so we can monitor the viability of this care home. A number of hazards were identified during this inspection. This included the front door, which was being deadlocked – although this point was rectified within 24 hours it indicates that the manager could not be relied upon to keep residents safe. In the event of an emergency this lock would have impeded evacuation and should never have been used to solve the problem of the unreliable digital lock. Two bedroom doors do not have smoke protection and should have been dealt with promptly; this demonstrates a lack of awareness about keeping fire doors in good working order. Some radiators are still not covered to prevent the possibility of residents scolding themselves; whilst the radiators were not easily accessible when we visited it would take only a rearrangement of furniture to make them unsafe and so they should be protected. A hot water tank is located in a bedroom wardrobe and is not isolated from the resident’s half of the unit - so again there is the possibility of the resident interfering with the water tank and adjacent equipment. Areas of strength are again difficult to identify on this occasion; it is evident that the providers intend this to be a homely and friendly service but it still needs to be run professionally and with honesty and integrity and the Commission cannot be sure that this is the case at present. A suitable self auditing (quality assurance) system is required to ensure all aspect of the national minimum standards and care regulations are being complied with to ensure residents are being ell cared for and their best interests are being provided for. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 23 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 3 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X 1 1 Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 24 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 Staffing: The registered person must ensure that staffing numbers and skill mix of staff 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 remains an outstanding requirement from 23/05/07 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. This remains an outstanding from 23/05/07. Care, education and supervision of residents: The registered provider must make proper provision for the care education and supervision of residents by ensuring that there are adequate DS0000061844.V343938.R01.S.doc Timescale for action 30/12/07 2. OP27 18 (1)(a) 30/12/07 3. OP8 12(1)b 30/12/07 Grange Cottage Residential Home Version 5.2 Page 25 4. OP8 12(1)b 5. OP10 12(4)a 6. OP10 12(4)a 7. OP12 12(1) 16(2)m and n numbers of staff on duty all times so residents know the individual needs can be met and they are being safely supported. Care, education and supervision of residents: The registered provider must ensure that staff working in the home do not work continuous shifts without a suitable rest period so as to render themselves unsafe to be providing care. This so that residents know they are being cared by staff who are not exhausted by continuous employment in this and/or other settings. Privacy and dignity: All residents must be treated with regard to their right to privacy and dignity this includes the manner in which they are addressed and referred to by staff. Privacy and dignity: All residents must be treated with regard to their right to privacy and dignity this includes bedroom doorlocks. Where door handles have been broken or removed they must be replaced suitable alternate ones and of the manager identifies that it would be unsafe to fit door lock then this must be recorded in the resident’s care plan in accordance with the new Mental Capacity Act (in respect of capacity to make choices and decisions). This is to maintain residents’ right to privacy unless it is unsafe to provide bedroom door lock. Care, education and rehabilitation of residents: The registered provider must provide suitable occupation, recreation and education and support for residents so as to meet their DS0000061844.V343938.R01.S.doc 30/12/07 30/12/07 30/12/07 30/12/07 Grange Cottage Residential Home Version 5.2 Page 26 8. OP12 12(1)b. 16(2)- f, h, m and n. 9. OP15 16(2)i 10. OP19 23(2)b 10. OP19 23(2)b 11. OP22 12(1)b. 16(2)- f, h, m and n. expectations and lifestyle so that residents can be assured they can their maintain skills and interests for as long as possible. Rehabilitation of residents: The registered provider must provide suitable occupation, recreation, education and rehabilitation for residents so as to maximise their capacity for independence. This is so that people with mental ill health know that they will be supported to regain skills they may have lost. 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. Premises, maintenance: all parts of the premises used by staff or residents must be maintained in a good state of repair and decoration including bedrooms and communal spaces such as lounge and dining rooms for the safety and comfort of residents. Premises, maintenance: all parts of the premises used by staff or residents must be maintained in a good state of repair and decoration including toilets and bathrooms for the safety and comfort of residents. Rehabilitation, facilities and equipment: The registered provider must provide suitable equipment and facilities so residents that are able to do so can learn or relearn skills of daily living and other skills that will support them in being independent. DS0000061844.V343938.R01.S.doc 30/12/07 30/12/07 30/12/07 30/12/07 30/12/07 Grange Cottage Residential Home Version 5.2 Page 27 12. OP27 18(1)a 13. OP28 18(1)a 14. OP28 18(1)b 15. OP29 19(1)b and Schedules 2 and 4. 16. OP31 7(1) 17. OP31 8(1) 18. OP33 24(1) and (2) Staffing: The registered provider must demonstrate that it can ensure residents will be ‘safe in their hands’ by ensuring no member of staff, including the owners, works continuous shifts without suitable rest periods. Staffing: The registered provider must demonstrate that it can ensure residents will be ‘safe in their hands’ by ensuring staff, at least 50 , are suitably qualified. Staffing, temporary or bank staff: The registered provider must ensure that temporary staff such as bank staff can still provide continuity of care residents might reasonably expect. Staff recruitment: The registered provider must ensure that all steps in the recruitment process are followed and will safeguard residents including the completion and checking of the application form and references. Owners: The registered owners must demonstrate that they are fit to run Grange Cottage. This includes staffing arrangements; the conduct of the owners when working in Grange Cottage, for example the hours they work. They must be honest and of good integrity. Manager: The registered owners must demonstrate that they are fit to run Grange Cottage includes all aspects of staffing and recruitment. Quality assurance system: The registered provider must put in place a quality assurance system so as to monitor all aspects of the home including the environment, staffing and care of residents. A copy of the report must be provided to the DS0000061844.V343938.R01.S.doc 30/12/07 30/03/08 30/12/07 30/12/07 30/12/07 30/12/07 30/04/08 Grange Cottage Residential Home Version 5.2 Page 28 19. OP33 24A 20. OP34 25 21. OP37 17 and Schedules 1 to 4. 13(4)c 22. OP38 23. OP38 13(4)c 24. OP38 13(4)c 25. OP38 13(4)c 26. OP19 23(2)m Commission. Improvement Plan: an improvement plan must be submitted to the Commission within the given timescales. (A format for doing so will be provided by the Commission as part of the final report). Accounts: The registered providers must supply the Commission with the last set of audited accounts for the home and the business plan that includes budgeting for the home; this is so that the Commission can evaluate the viability and financial practices of Grange Cottage and the owners. Records: all records in particular staff records must be completed in detail and in accordance with Schedules 1 to 4 Health and safety: Doors on fire escape routes must not have mortice deadlocks that would impede evacuation. Health and safety: Fire doors must be kept in good repair so that residents will not be subject to smoke entering their rooms in the event of a fire. Health and safety: Radiators must be covered so as to prevent risk of residents being scolded. Maintenance: The care home must be kept in a good repair including décor such as wall paper; damage to walls; loose fittings such as taps and so forth. This is so residents can live in safe and comfortable setting. Storage: residents areas such as bedrooms and bathrooms must not be used as storage areas. 30/12/07 30/12/07 30/12/07 30/12/07 30/12/07 30/12/07 30/12/07 30/12/07 Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Documentation at time of admission: It is recommended that the manager remove any references to “Nursing” in the heading of documentation so as to avoid any ambiguity and inference that this home provides nursing care when it is not registered to do so. Grange Cottage Residential Home DS0000061844.V343938.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Aylesbury Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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.V343938.R01.S.doc Version 5.2 Page 31 - 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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