Inspection on 05/03/09 for Grange Court

This inspection was carried out on 5th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grange Court 25/03/08

Grange Court 04/09/07

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Grange Court Station Road Baildon Shipley West Yorkshire BD17 6HS Lead Inspector Caroline Long Key Unannounced Inspection 5th March 2009 10:30 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 Court DS0000001244.V374516.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.V374516.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 stevewiggins@btinternet.com 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.V374516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th March 2008 Brief Description of the Service: Grange Court provides personal 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 £405 to £507. 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. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This is what we used to write this report: • • • We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual quality assessment questionnaire (AQAA). We sent surveys to people living in the home and the staff and to health professionals. Five people living in the home, four staff and one health professional returned their surveys. One inspector visited the home unannounced. This visit lasted over six hours and included talking to the staff and the registered manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live in the home and two relatives and a health professional who were visiting. We looked at four people’s care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home, as well as matters, which were raised at the last inspection. • • • • What the service does well: Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 6 Following our last inspection the home has made many improvements, such as increasing the number of staff and the opportunity for people to take part in more activities. We have received many positive comments about the home from the people who live at Grange Court and from their relatives. Examples are:My relative will have been in Grange court for two years. The care and attention they receive is very satisfactory. They are very happy when I visit I have never once had any reason to fault. It has a lovely warm and cheerful feel all of the time. We would recommend Grange Court to anyone we find it is very good, all of the staff are very good. They look after my relative very well and are always good with us when we visit. Very happy here. People are given enough information about the home before they move in. Someone from the home visits them and they are offered the opportunity to visit Grange Court for a look around and to ask questions about how the service is delivered. This enables them to make an informed decision as to whether the home is the right place for them to live. When staff come for a job at Grange Court all the right references and police checks are completed, this means that it is less likely that unsuitable staff are employed to work at the home. What has improved since the last inspection? What they could do better: Although the registered manager has started to review the care plans and risk assessment more needs to be done to be sure they are fully reflecting peoples health, personal care and social needs. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 7 More could be done to make the mealtimes a less rushed and more pleasurable. Further training should be offered to staff to be sure they are able to meet everyones needs fully. 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.V374516.R01.S.doc Version 5.2 Page 8 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.V374516.R01.S.doc Version 5.2 Page 9 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): Standards 1 and 3. People who use the service experience Good quality outcomes in this area. People will be assessed before moving into the home to make sure the staff have the necessary skill and the home has the necessary equipment to care for them properly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four people in their surveys confirmed information was made available to them before they moved into the Grange Court. One commented: The residential home gave us a comprehensive leaflet and other relevant information. When we visited Grange Court we were made very welcome and supported, the manager was very kind and showed much empathy. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 10 Also two relatives told us they had visited the home before their relatives moved in and one described how their relative stayed for tea at the home before she moved in. The files of two peoples who had recently moved into the home were looked at in detail to see if an assessment of their needs had been carried out before they moved into Grange Court. From the dates on the assessments it was difficult to establish whether or not they had been carried out before they moved in. They were also very brief and would have benefited from more information. However these were supported by assessments from the social services care manager, which had been faxed to the home. Both the pre-assessment and information from the social services care manager would have enabled the registered manager to make an informed decision about whether the home has the staff skills and equipment necessary to look after the person properly. The staff records showed and staff confirmed they had the necessary training and induction to enable them to look after people properly. The home does not offer intermediate care Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 11 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): Standards 7,8, 9 and 10 People who use the service experience Good quality outcomes in this area. People do generally receive the health and personal care they need however the record keeping needs to improve to make sure that people’s needs are not overlooked. The principles of respect, dignity and privacy are generally followed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Five surveys received from people living in the home and those spoken with during the visit indicated that Grange Court always provides people with the support needed. Examples of comments made were: Very happy here, staff come as soon as they can. She loves it the staff have been very caring. Its been absolutely perfect. People living in the home said staff generally respected their privacy and dignity. Staff were mostly observed providing support in a kind and helpful Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 12 manner and people were clean and dressed in co-ordinating clothes. Three relatives confirmed this was always the case. However we saw staff entering peoples rooms without knocking and people were unable to recollect whether staff knocked on their doors when they entered At the previous inspection to make sure that individual needs are met appropriately we asked the registered manager to review the care plans regularly to make sure they contain up to date information about people’s needs. And to indicate clearly the action that staff need to take to meet people’s needs. This is particularly important when caring for people with dementia because they are not always able to express their needs. So we looked at four peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We found the registered manager was in the process of reviewing all the care plans and introducing a new format however only one of the four care plans we looked at had been completed. This care plan did have most of the necessary information the staff needed to look after people safely and properly but the information contained some general terms such as assist, or use pressure area care equipment but did not say what equipment. The use of general terms does not accurately inform staff what help people need, for example how many people need to assist and how do they assist. The other three care plans had been reviewed but not changed to the new format and not updated with necessary information. Examples were: Where the care manager assessment had implied the person might display challenging behaviour this was not part of the care plan or risk assessments. One person with dementia shared a room with a person who was in frail and in bed. Staff told us that the person with dementia does not use the room during the day. However this was not reflected in the care plans or the risk assessments. The registered manager needs to make sure the care plans and risk assessments are reviewed and updated as peoples needs change. However talking with the registered manager, the deputy manager and the staff evidenced they are fully aware of peoples care needs and personal preferences and are proactive about identifying any changes and consulting with health professionals. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 13 We talked to two health professionals who made very positive comments about the staff and the standard of the care people receive. They were also able to tell us that the staff were quick to contact them to carry out assessments about peoples skin integrity or if they are prone to falling. People’s health care needs are promoted and maintained. The records showed people were accessing health care professionals, such as General Practitioners, Chiropodists, and District Nurses. Five people in their surveys stated they always receive the medical support they need. Three relatives also confirmed this and a general practitioner told us they have a good relationship with the home and they do keep them informed. Medication is kept in a locked trolley, which is kept in the medication room, which is locked. At present there is no one who self-medicates, however locked cabinets are available in their rooms to enable them to do so. The registered manager explained there is a stock control system in place and the pharmacy carry out regular checks. A sample of the medication was checked and was correct. Staff told us only staff who have completed medication training administer medication. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15. People who use the service experience Adequate quality outcomes in this area. Some people are supported in exercising choice and control over their daily and are provided with the opportunity to carry out social activities. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Grange Court has two new activities co-ordinators, this means that on most days someone is available to carry out activities with people in the home. One explained their routine is to make sure there is music in the main lounge in a morning for people to listen to, whilst the co-ordinators spend some time with people who prefer to remain in their bedrooms. Then in an afternoon they will carry out a group activity in the lounge. They will also arrange entertainers and group outings. One explained they are at present discovering what peoples likes and dislikes are and what group activities worked well and what people enjoyed. They also explained they do have the use of a mini bus which they use to take people out. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 15 During our visit we found most people sat in the lounge area asleep, in the morning there was music for people to listen to and in the afternoon people were encouraged to play with a ball by the activities co-ordinator. We were also shown photographs of people making cards, various outings and Christmas and Halloween parties. We saw one person who has dementia was encouraged to stay in the same chair for about one and half hours who became agitated. They constantly asked a neighbour if they could go home, although staff did greet them when they passed, no help was offered by staff and they did not look for ways to deflect their attention or relieve their boredom. People had an occupational profile completed, which described what they had done in the past and what their preferred leisure activities were. Three relatives told us about how there were plenty of activities for people living in the home. One said There is plenty going on and they do drawing and painting and singing and have birthday parties. Three people who returned their surveys told us there were always activities arranged by the home which they could take part in and two told us there usually were. Comments made were:Christmas and New Year activities all made welcome. Family invited to eat with relative at any time. I was invited and enjoyed Christmas and New Year lunch. Grange Court has many parties and other functions throughout the year, and entertainment staff are always around. We attend most of them and it is so good to see everyone enjoying themselves. People told us they could sit in communal lounges or spend time in their rooms and can rise and retire as they wish. One person told us how they choose to spend their days in their bedroom. However two others told us there were not many activities of their choice happening in the home. Visitors told us how they were made very welcome by the staff and were kept well informed. There is a menu displayed near the dining room. The cook explained there is an alternative available for people to the main menu and they were made aware of the different diets people needed. The housekeeper/activities coordinator asks people what they want for lunch, some people choose to eat in their rooms and other prefer to eat in the dining room. For lunch people had chicken casserole and sponge and custard and three people said the food was very good. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 16 At the last inspection the home were asked to ensure that people receive their meals safely and in a dignified manner. Also for people who need assistance to eat to receive support on a 1:1 basis from staff. So we observed lunchtime and we found people were using plate guards and mats, which helped them to eat independently. However the lunchtime experience was chaotic and rushed staff shouted to people to ask whether they had they finished eating and appeared very rushed. One member of staff knelt by the side of the person and did not tell them what the food was just said right and started to assist them to eat. Also we saw one person was asked if they had finished, when they did not respond they were asked again following no response the staff removed the food despite them still holding their fork. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 People who use the service experience Good quality outcomes in this area. People are able to express their concerns and are safeguarded from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four people who returned their surveys, and three people we talked to during our visit and three relatives, all told us they would feel able to make their views known if they have any concerns or complaints. We saw the registered manager talking with relatives during our visit. One person commented on their surveys: Usually speak to the carer in charge, messages always get passed on. There are regular meetings in the home where people can make their views known. The registered manager keeps a record of all concerns in a book, when she has investigated them she records all her findings on individual sheets, which she keeps within peoples records. She explained the book enables her to look at a glance at the concerns raised so she can quickly identify any patterns. Although this it is very good practice to review all concerns regularly to enable any patterns to be identified so improvements can be made, the book does not meet data protection guidelines and an alternative way of keeping these records should be found. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 18 There has been four concerns since the last inspection, which all have been resolved by the registered manager. These covered food and environment. The complaints policy includes how long a response will take. Discussion with the registered manager showed she was aware of the actions to take to safeguard adults and had attended the local authorities managers training on safeguarding adults. Staff told us they with were aware of whom to alert if an incident occurred. The home has had one safeguarding issue since the last inspection and the registered manager has sought the advice of the Adult Protection Unit. There is an adult protection policy in place, however this needs to be reviewed to make it clear that although the proprietor should always be alerted so should the adult protection unit in Bradford. The training matrix shows only eight out of twenty-four staff have received training in adult protection. To be sure staff are always aware of how to report abuse, all staff must carry out adult protection training. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 19 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): Standards 19 and 26. People who use the service experience Good quality outcomes in this area. People live in a safe and comfortable home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People said their rooms were clean, and comfortable, they liked them and they have been decorated and furnished to their personal interests and tastes. One commented relative commented in the survey. I visit many times a week and cleaning is always ongoing. There is a large communal lounge and two dining rooms. 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. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 20 The registered manager told us the home does have a maintenance team to make sure the home is well maintained and there is a programme of improvements planned. Such as the creation of a hair and treatment room and a conservatory. There are communal toilets, one relative commented: Toilets are very shabby - some upgrading is being talked about. We asked the registered manager who confirmed that the home is looking at refurbishing the toilets in 2009. To help prevent the spread of infections and to make the home a clean and comfortable place to live the annual quality assessment questionnaire told us over half of the staff have received infection control training. Anti-Bacterial soap dispensers are installed at wash-points. The staff meeting minutes also showed us that they are reminded to adhere to the infection control procedures. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30. People who use the service experience Good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support people who use the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are twenty-eight people (twenty-one females and eleven males) living at Grange Court, the staff rota shows there are generally one senior and three care staff in a morning and a senior and two care staff at night. The registered manager, a housekeeper/cleaner, activity staff, cooks and a maintenance man support these. At our previous inspection we asked for staff to 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. Also for weekend domestic cover to be reviewed to make sure that it is sufficient to ensure that the home is kept clean and hygienic at all times. During our visit staff appeared very rushed, however three people living in the home and three relatives told us there was generally enough staff working to meet peoples needs. Also the registered manager explained following the last inspection the number of staff has been increased and a cook and cleaner are now working at a weekend. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 22 In the survey when we asked are the staff available when you need them three stated always and two stated usually. Comments made were: The staff are never too busy to deal with anything I ask. Sometimes have to look for them in the evenings. Only three staff on duty much better when there are four. Five staff that returned their surveys when asked is there enough staff three stated always, and two usually. Two staff also told us generally there were but sometime they were very rushed. We looked at two staff records who had recently been recruited to make sure the home were employing suitable people for the job. We found that all the necessary information and checks had been carried out before the person started work. The registered manager explained the home runs short sessions to update staff and they also use various trainers from outside the home. There is now a training matrix in place, which allows the registered manager to identify what training staff have had. We looked at the training matrix and found there are areas where the staff need to be updated. Such as adult protection and food hygiene. Also when we observed staff we were aware that some had not been trained to care for people with dementia, this was also confirmed in the records Staff confirmed they have regular meetings and the registered manager explained these are used as an opportunity to recap policies and to make sure staff are kept up to date and able to carry out their roles properly. People told us staff do treat them well, and provide them with the support they need. The training matrix shows under half of the staff have their National Vocational Qualification level two or above in care. This qualification helps to make sure staff are properly trained to carry out the work. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35 and 38. People who use the service experience Good quality outcomes in this area. The home is now generally managed in peoples best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager has her management qualification in health and social skills. The registered manager told us the managers of the other homes and the provider supports her in her role. There is also a deputy manager or senior care on duty to take responsibility for the smooth, safe running of the shift. The four staff surveys we received and talking to staff during our visit indicated they feel supported by the management in the home. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 24 Before the inspection the registered manager completed and sent us the annual quality assessment questionnaire and although the AQAA was brief it did contains, clear, relevant information. It told us about some of the changes they have made and where they still need to make improvements. The data section of the AQAA was completed. The registered manager asks for peoples opinions annually and residents meeting are held regularly, so the home can be run the way people living in it want it. The registered manager provided us with a sample of the surveys that were all very positive. People had made comments such as: On the whole I cannot fault Grange Court its been a godsend for me, keep up the good work. Give the staff full marks from me they do a great job. The registered manager explained the home does not hold money on behalf of people who live there. When we looked at some of the records they were not kept as recommended by data protection guidelines. We discussed this with the registered manager who agreed to change the way these documents were kept. The annual quality assessment questionnaire states the maintenance and service records are in order. The fire safety procedures were in place and equipment was maintained and staff have received the appropriate training. Accidents are recorded and reviewed by the registered manager to identify and resolve any potential risks. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X 2 3 Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered manager must make sure the care plans and risk assessments are person centred and accurately demonstrate peoples health care needs and what people want now and in the future. Also what care and support staff must provide to enable people to do this. Timescale for action 01/05/09 Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP3 OP15 OP18 OP30 Good Practice Recommendations All assessments carried out by the home should contain the date the assessment was carried out and more information about the persons needs. Lunchtimes should be a occasion for people to enjoy, where people are allowed to eat their meal in a dignified manner and without being rushed All staff need to be provided with training on the protection of vulnerable adults Staff training should be regularly updated and all staff should have Dementia training. Grange Court DS0000001244.V374516.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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