Inspection on 17/07/07 for Grange Crescent

This inspection was carried out on 17th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Crescent 27/07/06

Grange Crescent 23/11/05

Grange Crescent 24/05/05

Grange Crescent 30/11/04

Grange Crescent 21/07/04

Grange Crescent 18/02/04

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

CARE HOMES FOR OLDER PEOPLE Grange Crescent 47 Grange Crescent Sheffield South Yorkshire S11 8AY Lead Inspector Andrea Leverett Key Unannounced Inspection 17th July 2007 10:00 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 Crescent DS0000002963.V344851.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 Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Crescent Address 47 Grange Crescent Sheffield South Yorkshire S11 8AY 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) 0114 255 5539 0114 250 6863 dawn.martin@sheffcare.co.uk None South Yorkshire Housing Association Mrs Dawn Tina Martin Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 2006 Brief Description of the Service: Grange Crescent is a purpose built 42-bed home for older people accommodated on four wings. Three of the wings have ten bedrooms, and the fourth has twelve. The four wings are on two floors and each has a lounge, dining area, kitchen and each bedroom has an en-suite toilet and shower. The home is in a residential area of Sheffield with good access to public services and amenities, (e.g. bus service, shops, libraries etc). South Yorkshire Housing Association is the Registered Provider; they work in partnership with Sheffcare Limited, who provides the staff at the home. A range of information including a copy of the last inspection report was available on the notice board in the entrance to the home. The current scale of charges range from £320.00 to £404.00 depending on need. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 17th of July 2007. Nine service users were spoken with as well as 2 staff members and the manager. Feedback from people who use the service and staff questionnaires has also been reflected in this report. Some judgements about quality of life and choices were taken from direct discussions with and observations of people who use the service on the day of this site visit, followed by discussion with support staff and evidencing records held at the home. The inspector concluded that on the whole people are given a good service at Grange Crescent, although feedback from people who use the service and observation on the day suggested that some parts of the Home do not have sufficient staff to meet peoples needs at key times and that this could be undermining their health and safety. Feedback from people who use the service and records seen suggested that opportunities for social and recreational activities could be improved. On the whole people who use this service benefit from a good standard of direct personal care and access to health services and the environment is maintained appropriately. What the service does well: The manager aims at a high standard of all round care and takes time to understand the needs of people who use the service. The Home works hard to promote peoples right to maintain their independence as far as possible and in keeping with their needs and wishes. People who use the service benefit from living in a purpose built home, which is decorated, furnished and maintained to a high standard. The Home has an excellent training and development programme which enables staff to undertake NVQ level 2,3 and 4,which is linked to career development and promotional opportunities. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Crescent DS0000002963.V344851.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 Crescent DS0000002963.V344851.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): 3. People who use the service experience good quality outcomes in this area. On the whole people who use the service can be confident that their needs will be assessed before they move into Grange Crescent and that these will be met. However improvements are needed to ensure that assessments include the needs and wishes of service users in terms of social and recreational activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four assessments and care plans of people who use the service have been inspected during this site visit. All included appropriate assessments in terms of personal care, health needs and risk assessments. Nutritional and Risk of falls assessments were also in place. However this information did not include enough detail of social activities that they may wish to undertake. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 9 Feedback from people who use the service showed that they were able to visit the Home before making a decision to move their and were given appropriate information about the Home before doing so. Typical comments included: “ We were given a residents information pack.” Grange Crescent DS0000002963.V344851.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): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. People who use the service benefit from care plans that detail their health and personal care needs but more needs to be done to ensure that social needs are also reflected. People who use the service can be confident that their health care needs will be met. On the whole people who use he service are treated with respect and dignity although observation on the day showed that lack of staff at key times of the day was undermining this. Service users are supported to be responsible for their own medication if this is appropriate and can be confident that they will be protected by the homes policies and procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 11 EVIDENCE: Four care plans have been inspected during the site visit. Care plans reflected people’s needs in terms of health and personal care and included risk assessments, nutritional needs and mobility. Discussions with people who use the service, staff and information taken from the daily notes and health records evidenced that care plans are acted upon. Daily notes are routinely made and provide sufficient detail to evidence personal care needs are being met. However care plans do not include sufficient information regarding peoples social and recreational needs. A requirement has been made to ensure that care plans reflect peoples social and recreational needs and that records are maintained to evidence that these are being acted upon. Records seen and discussions with people who use the service and staff showed that access to routine and specialist health services was provided. On the whole staff were observed interacting and treating people with respect and taking time to ensure their wishes were sort and acted upon. Discussion with people who use the service and feedback from questionnaires supported this observation. However during the site visit staff were observed not being able to respond to peoples needs during the lunch time period. Call bells were not responded to properly and one staff member stated that she felt frustrated because she had not had time to make people a hot drink after their meal. This issue was discussed with the manager and is explored in more detail under standard 27. Records showed that subject to a risk assessment, people who use the service would be supported to manage their own medication if that was their wish and files included medication risk assessments. An inspection of the homes medication and administration system showed that medication was being administered appropriately and only staff who are trained to do so undertake this role. However staff were observed administering eye drops and inhalers to people at the dining table. It was not clear that peoples right to privacy and dignity was being upheld in this regard and was another example of staff not having time to do things sensitively and properly at key times of the day. A recommendation has been made that medication assessments include information on how and were people would like to receive their medication. Typical comments included: “Staff are so kind, they bend over backwards for you. You can have a joke there is no sternness, it is pleasant “ “ It is ok, I am happy here, there is plenty of freedom.” Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 12 “ I have a bath twice a week and I always have my sheets changed when I have bath.” Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. More could be done to ensure that people’s experiences match their expectations and preferences in terms of social, recreational needs. People who use the service are supported to maintain contact with family and friends and are supported to exercise choice and control over their lives. People who use the service receive a wholesome and appealing diet in pleasing surroundings and at times convenient to them, although more could be done to ensure that special diets are better presented and particular foods are always available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes own assessment of the service and information seen during the site visit showed that activities are provided. However as stated previously, social and recreational needs are not fully explored as part of peoples assessments of need and feed back from people who use the service suggested that they Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 14 would like to do more things. A requirement has been made regarding this. The Home has a dedicated activities co coordinator for 2 half days a week, in addition the Home has visiting entertainers, organises trips out and has its own transport for the benefit of people who use the service. Evidence was seen to show that people’s religious and cultural needs are supported. On the whole people were observed being supported with their lunchtime meal in a sensitive and respectful manner. Service users can choose when and were to eat including in their own room if they wish. On the whole feedback from service users was positive regarding the food and Menu’s seen are varied and nutritious. However one person who has to have their food blended told the inspector that their meal is all blended together and does not always get gravy with it. Another person told the inspector that special gluten free foods were not always available when needed. Discussion took place with the manager regarding the need to improve the presentation and preparation of blended food in line with good practice. The manager informed the inspector that after consulting people who use the service the Home is going to return to preparing and cooking food on the premises and will no longer be using a centralised kitchen. She felt that individual specialist dietary needs would be better catered for this way and a requirement has been made regarding the issues identified. Visitors are welcome at any time and examples were given of the Home maintaining contact with relatives in the best interests of people who use the service. Typical comments included: “ I would like to go out more and do more things.” “ I am happy with the food, I have a hot breakfast in the morning.” “ The food here is not bad at all. I don’t do very much; I would like to go out And about if I could.” “ I have my own kettle and fridge in my room and staff always make sure I have milk to make drinks when I like.” “ I have to have food blended, but it does not look nice and I don’t always get gravy with it.” Grange Crescent DS0000002963.V344851.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): 16 and 18. People who use the service experience good quality outcomes in this area. People who use the service are aware of their rights with regard to making a complaint and can be confident that their concerns and complaints will be listened to. People who use the service are protected from the risk of abuse by the home’s Adult Protection policy and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home has a complaints procedure that includes all the information required by this standard and discussion with people who use the service evidenced that they were aware of their right to make a complaint and would be comfortable doing so. The Home has had no complaints in the last Twelve months. The home’s Policy for the Protection of Service Users and staff “Whistle blowing” procedure was not seen on this occasion although this has been inspected at previous visits. Training records seen and discussions with staff evidenced that they had received appropriate adult protection training. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 16 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 and 26. People who use the service experience Good quality outcomes in this area. Resident’s benefit from living in a Homely environment, which is well maintained and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home is purpose built and a tour of the premises was undertaken. The Home was clean, well presented and odour free. People’s bedrooms were pleasantly furnished and it was clear that they are encouraged to furnish their rooms with personal items. People who use the service said they liked the Home and that it was clean warm and homely. A tour of the Home and information taken from the homes own assessment evidenced that the homes equipment and facilities are serviced and maintained appropriately. Bedrooms are spacious and have on Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 17 suit facilities. People who use the service benefit from having fridges and kettles in their bedrooms subject to risk assessments. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. Staffing levels are not always sufficient to meet people’s needs at key times. Service users care needs are promoted by the employment of caring and suitably trained staff. Service users are protected by the recruitment procedures within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the whole feedback from people who use the service was positive about the standard and consistency of direct personal care provided. However some feedback and observation on the day of the site visit showed that at key times of the day the Home did not always have enough staff to meet people’s needs. The inspector observed staff not always responding to call bells appropriately. For example call bells were turned of without checking that people were ok during the lunch time period and one staff member expressed frustration at not having enough time to make people a cup of tea after their meal. The manager told the inspector that she had identified some of these issues herself and was in the process of re organising staffing so that more staff would be available at key times of the day. A requirement has been made that the Home Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 19 review staffing levels and ensure that sufficient staff are available in this regard. Discussions with staff and records seen evidenced that training in the Home is ongoing with staff having undertaken a range of core training, including medication, H&S, M&H, Fire safety, Adult Protection and First aid. The Home has an excellent training and development programme which enables staff to undertake NVQ level 2,3 and 4,which is linked to career development and promotional opportunities. The homes staff recruitment records are held in the organisations central office. Although individual managers can access these files electronically, records viewed electronically were not being kept up to date in regard to Criminal Record Bureau checks. A recommendation has been made regarding this. Information was seen electronically to show that application forms, 2 written references and employment history’s of staff was kept. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 20 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 and 38. People who use the service experience good quality outcomes in this area. People who use this service benefit from a management team that is committed to providing good quality services and works hard to meet people’s needs. People who use this service can be confident that their financial interests will be safe guarded. The health safety and welfare of people who use the service are promoted and protected and on the whole the Home is run in their best interests. This judgement has been made using available evidence including a visit to this service. Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 21 EVIDENCE: Feedback from people who use the service and staff showed that they felt supported by the manager and the organisation. Generally the needs of people and the management of the environment were maintained appropriately, however some improvements are needed. Assessments of people who use the service and their care plans did not include sufficient information regarding their social care needs. Feedback and observation on the day suggested that insufficient staffing levels were undermining the wellbeing and health and safety of people at key times of the day. Requirements have been made else ware in this report regarding this. People who use the service are supported to manage their finances in line with their needs and wishes. The Home ensures that people have their own interest baring accounts, which can be managed electronically for their benefit. A sample of peoples financial records were seen and these showed that appropriate record keeping is being maintained. Information taken from the homes own assessment of the service and a tour of the premises undertaken on the day of the site visit showed that the Home was maintained appropriately. The Home has a quality monitoring system in place and records were seen to evidence that routine auditing of the environment and quality of the service was being undertaken. People are encouraged to complete feedback questionnaires and the outcomes of this information are recorded and acted upon. Typical comments included: “ The manager is very particular, we have seen a big difference since she came.” “ It is ok, I am happy, the place is spotlessly clean and I like it here.” Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 22 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 X 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 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 23 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 OP3 OP7 Regulation 14 Requirement The Home must ensure that assessments and care plans reflect service users social and recreational needs and that records are maintained to evidence that these are being acted upon. The Home must ensure that they improve the quality and appearance of meals that need to be blended to a particular consistency in line with good practice and ensure that particular foods needed for special diets are always available. The Home must review staffing levels and ensure that sufficient staff is provided to support service users at all times. The Home must ensure that staff respond to call bells appropriately and in a timely manner. Timescale for action 10/10/07 2. OP15 16 10/09/07 3. OP27 18 10/09/07 4. OP27 18 20/08/07 Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that medication assessments include information on how and where people would like to receive their medication and the Home ensure that these preferences are respected. It is recommended that the electronic staff recruitment records are kept up to date. 2 OP9 Grange Crescent DS0000002963.V344851.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 - 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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