Inspection on 04/09/07 for Grange Court

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Court 05/03/09

Grange Court 25/03/08

Grange Court 09/08/06

Grange Court 28/02/06

Grange Court 08/09/05

Grange Court 02/03/05

Grange Court 11/02/05

Grange Court 20/12/03

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

CARE HOMES FOR OLDER PEOPLE Grange Court Station Road Baildon Shipley West Yorkshire BD17 6HS Lead Inspector Lynda Jones Key Unannounced Inspection 4 & 5 September 2007 10:15 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 Court DS0000001244.V342582.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 Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Court Address Station Road Baildon Shipley West Yorkshire BD17 6HS 01274 531222 01274 531222 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) Michael Stephen Berry Anita Anne Berry Belinda Cook Care Home 30 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (30) Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2006 Brief Description of the Service: Grange Court is a family run concern, providing care and support for thirty older people. It is situated on the outskirts of the village of Baildon, Shipley West Yorkshire. Grange Court is a former coaching inn, with parts of the building dating to the fifteenth century and it still retains many of the original features. Over the years various alterations have been undertaken to make the home more accessible. All bedrooms are located on the first and second floors, the upper floors can be reached by passenger lift. There is a mix of double and single rooms available with disabled access via a ramp to the front of the building. The weekly fees range from £397 to £477. There is a different price for different rooms. Fees cover the costs of full accommodation, care and laundry facilities, but do not include chiropody, hairdressing, personal copies of newspapers and other personal requirements. People may bring in furniture and electrical items, though appliances are inspected for safety before use. All meals can be served in bedrooms or in the dining area. Support services are in place with a choice of General Practitioners, chiropodist, dentist and optician. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection of the home took place on 9 August 2006. We have not made any visits to the home since then. This inspection was carried out to assess the quality of care provided to people living at the home. Two inspectors carried out the inspection over two days. On the first day we spent 7 hours at the home, we talked to people who live there and to visitors who called in. Discussion also took place with staff on duty. We observed care practice, looked at various records and looked round the home. On the second day we met with the home owners and the manager to give them some feedback on the previous days’ visit. One of the home owners completed a self assessment form which provided us with some very detailed information about the service. We have used some of that information in this report. We sent surveys to a sample of people who live at the home and their relatives, and to the local GP practice. We received replies from 4 people who live there, 9 relatives and the GP practice. The surveys provide an opportunity for people to share their views on the service with us. Information provided in this way is shared with the home without identifying who has provided it. The comments we received have been used in this report. What the service does well: People are always assessed before they move into the home to make sure that all of their needs can be met and it is the right place for them. People are receiving health care from a range of people such as doctors, district nurses, chiropodist and opticians. Healthcare records are good, they make it easy to track the treatment people are receiving. Generally, people look well cared for. Medication is well managed and people are given their medication as prescribed. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 6 The home is comfortable and well maintained throughout. Bedrooms are personalised and people can take personal possessions with them when they move in, if they wish. Relatives have a lot of regard for the hardworking, helpful and caring staff. People are being protected by good staff recruitment procedures. Appropriate checks are carried out to make sure new staff are suitable to work with older people, before they start work. These are some of the comments we received when we asked what the home does well: “I would recommend Grange Court 100 ” “Staff usually pull together well as a team and assist each other where possible” “Most important are the staff - I am grateful for the quality of care they provide” “The premises and furnishings are in good condition” “The staff are very helpful and friendly” What has improved since the last inspection? What they could do better: Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 7 People who live at the home and their relatives, should be consulted about their care. They should be given the opportunity to say if it suits them or could be improved in any way. Information in the care plans should give clear instructions to staff about what they must do to make sure people’s needs are met. Specialist advice and information needs to be obtained so that the needs of people suffering from Parkinson’s Disease can be met. Staff need to make sure that people maintain a dignified appearance at all times. Moving and handling practices must improve. Failure to use the correct moving and handling equipment could result in injury to people who live at the home and to staff. The home should provide some stimulating activities for people to take part in. People are spending most of their days sitting in the lounge with nothing to occupy them. There should be sufficient time set aside for staff to be able to chat to people as well as focusing on their daily tasks. The menu for the day should be on display so that people know what is on offer to them. Lunchtimes need to be better organised so that people are not sat waiting for a long time for their meal to be served. A complaints log should be set up. Details of the complaint, any investigation and action taken needs to be recorded. Staff need to be provided with adult protection training so that they are aware of their responsibility to protect the people they care for and report any poor practice that they see. People living at the home must be treated with patience and respect at all times. Staffing levels need to be reviewed. Relatives do not think there are always enough staff on duty to meet the needs of the people who live there. There is not always a member of staff on hand in the lounge, this means that people are left unsupervised and this could be a risk to their health and safety. We asked relatives how they thought the care home could improve. These are some of the comments we received: Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 8 “Employ more staff” “Employ more housekeeping/cleaning staff” “Employ more catering staff so that a wider menu can be offered” “The food should be more varied” “Stop staff taking their breaks at the same time” “More outings and daily activities” “Staff need to spend more time “caring” for residents, as opposed to running around constantly due to being short staffed”. 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 Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 9 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 Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 5 (standard 6 does not apply) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People receive information about the home before they move in and they can visit to see if the service can meet their needs. People are always assessed before they move in to make sure that all their needs can be met at the home. EVIDENCE: The statement of purpose and service user guide is available from the home. These documents give people lots of information about the home. We saw some of them in the bedrooms we looked at. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 11 In the surveys, people told us they were given information about the home and this helped them decide if it was the right place for them. People confirmed that they were invited to visit the home to look at the accommodation. Relatives sometimes do this, if their family member is unable to visit themselves. The home offers a 5 day room reservation policy allowing people time to view other potential homes before making a final decision about which home will best suit their needs. Two people said they had been given a contract; two people were not sure. Contracts are important because they tell people about their rights and responsibilities and those of the home owners. When we asked the home owners about this we were told that everyone is given a contract. We looked at some of the care plans and we saw that people are assessed before they move in. This is done to make sure that the home is the right place for them and that all of their needs can be met. The home does not provide intermediate care. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The care plans do not always contain enough information about people’s needs. This means that people’s health, personal and social care needs are not always being met. People are not always being treated with the dignity and respect they are entitled to expect. Moving and handling practices are unsafe and could result in injury to people living there and to the staff. Medication is well managed. EVIDENCE: Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 13 We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. We could see from the plans that people are receiving health care from a range of people such as doctors, district nurses, chiropodist and opticians. These records are good, they make it easy to track the treatment people are receiving. The care plans should provide staff with information about people’s needs and tell them what they must do to meet their needs. We felt that the plans we looked at needed to be more detailed. These are some of the points that we fed back to the owners and manager at the end of the inspection: • We looked at a care plan for someone who is using continence aids but there was no continence plan in place. This means that staff are either passing information by word of mouth or that this person’s needs are not being met in this area. We saw a note from an eye test that one person had in 2006 that said she needed to look to the side of objects to see them. This important information had not been added to the care plan and means that staff may not know how to help this person to see things more easily. We saw that a pressure ulcer risk assessment had been carried out. A score had been arrived at to determine the risk but there was no explanation of how to manage the risk on the care plan. We did not think the staff had sufficient information about Parkinson’s Disease to provide specialist help to one person. There was not enough information in the care plan about the sort of problems people suffering from Parkinson’s Disease may have and about the sort of assistance that may be needed. This means that this person’s needs are not being fully met in this area. We noted from the daily records that one person had a dressing reapplied to their sacral area but we could not find a plan relating to this. This means that this person may not always be receiving the treatment that they need. • • • • We asked relatives if the care home met the needs of their family member. 5 said “always”, 3 said “usually” and 1 person said “sometimes”. People living at the home said “always” and “sometimes” when we asked if they received the Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 14 care and support they needed. One person told us that some of the staff are not very respectful “some people treat me as if I am confused” Relatives told us they had not seen a care plan and didn’t know what a review was. We thought the way the care plan reviews are written at the moment is misleading. It looks as though people who live there are involved in reviews, but when we asked them they didn’t know that any meetings had taken place. People should be consulted about their care. Some people living at the home are able to say if the care and support they receive suits them or if it can be improved in any way. Other people suffering from dementia may not be able to comment, but some have relatives who visit regularly who may wish to be involved. At the feedback meeting we asked the owners and the manager to address this. With one or two exceptions, most people looked well cared for. People were well dressed and had had their hair done. One person had dirty glasses and the front of his shirt was wet and stained, another person had the remains of medication round her mouth and on her skirt. We also noted that one person was wet and smelled strongly of urine. This individual was assisted to the toilet and her clothing was changed when she returned to the lounge. Staff need to make sure that people maintain a dignified appearance at all times. The manager told us that all staff have received moving and handling training. According to the training records, nine staff have received their training within the last year but we witnessed some moving and handling practices that we considered to be unsafe. We saw one person being pushed in a wheelchair that was tipped backwards, there were no footrests on the chair. This could be disorientating for the person in the chair and could result in an accident. During the course of the day we saw staff moving people by lifting them under the arms. We saw two staff supporting the entire body weight of one individual by standing either side and lifting her under the arms to place her higher up in a chair. We did not see any moving and handling equipment in use at any time. These practices are unsafe and could result in injury to people living there and to the staff. Medication is generally well managed at the home. It was good to see information on some of the care plans which tells staff what a particular medication is for and what side effects it may have. We did not find this information on all the plans we looked at. There are no guidelines for the use of PRN medication (this is medication that is given only when it is required). It is important that there are clear instructions in the care plan about when staff may need to give ‘as required’ medication. This will make sure that medication is only given when necessary and not left to the judgement of individual members of staff. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 15 We were told that the medication trolley is usually kept securely chained to the wall in the office while it is not in use. But when we looked round the building in the morning, we noticed that it had been left in the reception area. This practice is unsafe. The trolley must be kept securely at all times when not being used. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There is a lack of stimulating activity within the home and staff do not have time for much meaningful interaction with people. This means that individuals can be left for long periods without moving about and without anyone talking to them. People have very little control over their own lives, they tend to “fit in” with the routines of the home. EVIDENCE: On the plans we looked at we could not find much information about the sort of life experiences people have had and the sort of daily routine that they prefer. This information is useful because it helps staff understand something about people’s backgrounds, families, work experiences etc. It also helps staff to make conversation with people and to make sure they continue to live their day to day life as they want to. Most of the information on the plans started with the circumstances leading up to the move into the home. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 17 The self assessment that was sent to us before the inspection told us that a new social care section had been added to the plans, but we didn’t see this part of the plan on our visit. We were told staff were still gathering information. In the self assessment we received before the inspection, we were told “Grange Court provides opportunities for social contact and mental stimulation through a range of activities…..” We could find no evidence of any activities taking place at the home. There were no records of anything taking place and no one could recall any activities being offered. The lack of stimulating activity is one of the areas that received most comment in the surveys that were returned to us. On the notice board there is a list of activities that are supposed to take place each day. One person said “it is almost complete fiction”. We were told the only thing that takes place with any regularity is the “Pat a Dog” visit every Thursday. One person said “there are organised parties only eg. Christmas and summer garden parties – nothing else throughout the year” Relatives did not think the staff had enough time to talk to people. These are some of the things they said: “I wish the staff would take my relative out for a walk or have a conversation sometimes” “There seemed to be more staff when I went for a look round. I thought they would have had more time for interaction and personal care” “The under staffing is responsible for the lack of activities and the lack of supervision in the lounges” “I would have expected more time to be devoted to my relative – just a few minutes now and again for a chat” “Most of the time the staff are so busy doing tasks, they have no time for residents’ emotional needs” “More daily activities and outings are needed to stimulate” While we were there the staff were very busy. When breakfast was over they served mid morning drinks. Later they assisted people to the toilet and helped people to the dining room. In the afternoon they served drinks and then prepared for a buffet to celebrate a birthday. They passed in and out of the lounge frequently but did not appear to have time to stop and talk to people. The approach of the staff on duty was variable, some engaged with people as Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 18 they went about their duties, others did not talk. One person told us that the time set aside for activities is between 2pm and 4pm. This is the time that staff are usually serving drinks and having their own breaks, this means they have no spare capacity to organise activities over this period. When we discussed this with the home owners and the manager after our visit they told us they planned to improve performance in this area by recruiting an activities organiser to address this issue. There are two dining rooms, one tends to be used by people who need assistance from staff, there were eighteen people in this room at lunchtime. People who are more independent use the other, smaller dining room. Lunchtime was not well managed. Most people were sat at the table waiting for their meal for 30 minutes. The first meals that came from the kitchen were for staff to deliver to those people who were eating in their rooms. Three people in the large dining room fell asleep while they were waiting. One person with a sight and hearing impairment was scooping at her placemat trying to eat but her meal had not been delivered. One person said “I’ve been sat here for ages, sometimes by the time you get your meal it’s gone cold”. None of the staff knew what was on the menu, which meant that they were unable to talk to people about the meal while they were waiting. A three weekly cycle of menus is on display in the hallway but they are in small print and not easy to read. People also need to know which week it is to find the correct menu for the day. It would be helpful if the menu for the day was written up and displayed in the dining room so that everyone could see what was available. We sat in different dining rooms at lunchtime and the mealtime experience was very different. In the small dining room, it was much more of a social occasion with people sitting, chatting to each other. The inspector in this room was offered a cup of tea, resulting in a conversation about what people like to drink with their meals. Some people said they would like the option of a cup of tea but they are never offered anything but juice. We mentioned this to the home owners and they said they would make sure that a choice is available in future. People in this room said their meal was cold when it arrived. The meal time in the large dining room was not a very dignified occasion. Everyone eating wore a plastic apron, which was put on them without explanation. The drinking glasses were plastic and only juice was offered with lunch. There was no choice of meal for anyone in either room, everyone had the same to eat. In the large dining room, people were asked if they wanted help to cut up their food. Some people in this room seemed to struggle to keep their plates from slipping about on the glass table mats. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 19 Medication was given out at lunchtime in an insensitive manner, showing little consideration for people who were eating. Just as everyone had been served with their meal after a long wait, a member of staff came crashing through the dining room doors with the medication trolley, startling everyone. Medication administration then took precedence over the meal and people had to stop eating to take a drink and swallow their medication. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People can not be confident that if they raise concerns about the service they will be acted upon. Sometimes people do not feel that their concerns are being listened to and taken seriously. People are not fully protected as staff are not clear about the procedures to follow for safeguarding adults. EVIDENCE: In the surveys we asked people if they knew how to complain if there is anything they are unhappy about. Everyone said that they knew what to do, some people qualified this by saying they would ask to speak to the person in charge. Some people told us they had not needed to complain about anything. According to the self assessment, no complaints have been received by the home in the last 12 months. At present there is no complaints log where details of complaints, investigations and any action taken can be recorded. We discussed this at the feedback session and the home owners said they would set up a record for complaints. While we were at the home we saw a statement made by one member of staff about the practice of another member of the team. We did not think that this Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 21 matter was investigated thoroughly and the documentation of the matter was poor. We talked to the home owners and manager about this after the inspection. Some relatives said they had raised issues with senior staff but felt their concerns were “trivialized”. We could find no record of any concerns that had been passed to the manager. We were told that some staff seem less compassionate than others. Some staff were said to “show less patience with the lesser able residents” and to sometimes speak sharply to people. One person who contacted us told us about a member of staff shouting at someone. From the returned surveys these observations seem to relate to a minority of staff. The overwhelming response from people who contacted us was one of praise and admiration for the work the staff do. We have asked the home owners and the manager to investigate this further. We have recommended that all staff receive additional adult protection training so that they are aware of their responsibility to protect the people they care for and report any poor practice that they see. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is comfortable, safe and well maintained. EVIDENCE: The home is well maintained and there is a programme for redecoration and refurbishment. One of the owners told us that bedrooms are always redecorated when they become vacant. We looked round the home and looked at some of the bedrooms during the visit. All the rooms are personalised, many people brought some of their own furniture and other personal possessions with them when they moved in. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 23 The bedroom doors have a glass panel in them, which is covered by a net curtain. Staff need to ensue that the curtain is always drawn to protect people’s privacy. The floor covering in bedrooms is polyfloor, although we were told that carpets can be fitted if that is what individuals prefer. People who live at the home who completed surveys said the home was always clean and fresh. One relative said “the premises and furnishings are in good condition and clean”. The communal areas are comfortably furnished and the large dining room has been decorated recently. There is a pleasant patio area outside with outdoor furniture for people to use. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are not always enough staff on duty to meet the needs of the people using the service and this is having an impact on their welfare. EVIDENCE: Eight out of nine relatives who completed surveys mentioned their concerns about staffing levels at the home. They do not think there are enough staff on duty to meet the needs of the people who live there. These are some of the comments they made: “The care and welfare of the residents is good considering what appears to be a shortage of staff” “They struggle to maintain a consistent labour force” “The staff should have the time and inclination to interact with residents” “More staff would help the staff already working there” “The under staffing is responsible for the lack of activities” Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 25 The manager needs to make sure that the duty rota accurately reflects who is working in the building. Two people who were in the building were not on the rota, one person was on the rota but was not in the building. One member of staff is regularly working very long hours. Over a three week period this individual had worked 75 hours, 64.5 hours and 75 hours. Many of these shifts were 9pm to 8am on waking night duty, followed immediately by domestic duty between 8am and 12pm, a total of fifteen hours on duty. This is unsafe practice that could put the health and safety of people living at the home at risk. According to the staff rota there are usually 4-5 care staff on duty in the mornings; 3-4 care staff in the afternoon and evening and two care staff on duty during the night. People who work there told us there have been times when these staffing levels have not been achieved and they have struggled to provide the care people need. People living at the home said: “ No one has time to sit and talk” “Sometimes I have to sit and wait, at other times I feel rushed” When we talked to the home owners about this they said they were unaware of the home being short staffed. They said the figures that they had available to them indicated that the home was always appropriately staffed. Two people told us that the staff sometimes take their breaks at the same time, leaving people in the lounge without supervision. We were told that a visitor once had to pick someone up off the floor in the lounge and then summon help from staff. This is unsafe practice and could result in people who live there injuring themselves. We are aware that the home is large and bedrooms are spread out. It is possible that visitors to the home do not always see all of the staff on duty, they may be working in different parts of the house. We have asked the home owners to look into this and to make sure that the home is appropriately staffed at all times so that people receive the care and support that they need. Relatives have a lot of regard for many of the staff at the home. These are some of the comments we received “They are loyal and hardworking” Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 26 “They remain cheerful and caring at all times” “They are to be admired for their efforts” “The staff are very helpful and friendly” We looked at some of the records relating to recently recruited staff to see if staff are appropriately checked before they start work at the home. Recruitment procedures are good, references are always taken up and checks are always made with the Criminal Records Bureau to ensure that new staff are suitable to work with older people. This means that people who live there are being appropriately protected. We asked about staff training and we were told that various courses such as infection control, first aid, fire safety training and moving and handling training have taken place over the last twelve months. This should mean that the staff are skilled and equipped to carry out their work safely. Four staff have achieved NVQ level 2 and a further five staff are working towards it. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home owners need to take a more active role in the way the home is being run so that they are aware of any shortfalls in the service provided. They need to talk to people who live there and their relatives to get their views about the home. EVIDENCE: The manager is registered with the Commission and has several years experience of caring for older people. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 28 The Area Manager has recently left the company, this person had line management responsibility for Grange Court. The home owners now need to take a more active role in how the home is being run. Arrangements must be made for reports to be made by them on a monthly basis about the conduct of the home. The manager is supported by an effective administrative team. People who live at the home are given feedback questionnaires so that they can say what the home does well and what areas can be improved. The home owners intend to issue questionnaires to 25 of people every quarter so that there is continuous feedback on the performance of the home. People are also asked for their opinions at residents/carers meetings. We were told “they are supposed to be every month but it’s more like every four months” and “suggestions have been made but nothing ever comes of it”. People who live at the home and their relatives need to be consulted more about their care so that say whether it suits them. The home does not hold money on behalf of people who live there. The health and safety of people who live there is being placed at risk because moving and handling equipment is not being used and people are being moved inappropriately. Equipment such as hoists, lifts, portable electrical equipment and the emergency call system are regularly tested and serviced. Dates of servicing were provided with the self assessment information. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 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 1 17 x 18 1 3 X X X 3 3 3 X STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Timescale for action 30/11/07 2 OP7 15 People who live at the home or their representatives must be consulted about their care plans. This will give people the opportunity to comment on the care and support provided and say if it could be improved, 30/11/07 Care plans must be reviewed to make sure they a) Contain up to date information about people’s needs. b) Indicate clearly the action that staff need to take to meet people’s needs. This will make sure that individual needs are met appropriately. Moving and handling plans must be reviewed to make sure they are up to date and relevant, so that people are assisted safely and appropriately. The medication trolley must be kept secure when it is not in use so that medication is safe and people are not put at risk. Staff must treat people who live DS0000001244.V342582.R01.S.doc 3 OP7 13 19/10/07 4 OP9 13 12/10/07 5 OP10 18 Grange Court Version 5.2 Page 31 at the home with dignity and respect. 6 OP12 16 12/10/07 Activities must be provided that 31/10/07 meet the range of needs and abilities of the people who live there. Wherever possible people must be consulted about the sort of activities they wish to be involved in. This will enable them to take part in activities of their choice. A record must be kept of all complaints made which includes details of investigation and any action taken. This is so that people can know their complaints will be taken seriously and acted upon. All staff must have adult protection training so that they and the people who live there are not to put at risk. Staff must be available at all times in sufficient numbers to meet the assessed needs of people who live at the home. This is to make sure that the needs of each person will be met. Staff must use the correct moving and handling equipment for each person as outlined in individual moving and handling plans. This is to ensure that the health and safety of staff and people living at the home is not placed at risk. The home owners must make arrangements to carry out monthly visits to the home and make monthly reports available about the conduct of the home. DS0000001244.V342582.R01.S.doc 7 OP16 Schedule 4 12/10/07 8 OP18 13(6) 30/11/07 9 OP27 18 31/10/07 10 OP38 13 19/10/07 11 OP33 26 31/10/07 Grange Court Version 5.2 Page 32 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 OP15 Good Practice Recommendations The mealtime arrangements need to be better managed so that people do not have to sit waiting for their meal for a long time. Grange Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Court DS0000001244.V342582.R01.S.doc Version 5.2 Page 34 - 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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