Inspection on 17/01/06 for Grange House

This inspection was carried out on 17th January 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grange House 11/05/07

Grange House 17/08/06

Grange House 12/07/05

Grange House 06/12/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Grange House 9 Grange Road Hayes Middlesex UB3 2RP Lead Inspector Robert Bond Unannounced Inspection 17th January 2006 10:00 Grange House DS0000048879.V273879.R01.S.doc Version 5.0 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 House DS0000048879.V273879.R01.S.doc Version 5.0 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 Adults 18-65. 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 House DS0000048879.V273879.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Grange House Address 9 Grange Road Hayes Middlesex UB3 2RP 0208 813 5264 0208 813 5264 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) londonroad@tiscali.co.uk Milbury Care Services Limited Mr Nicolas Debourg Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: Grange House is operated by Milbury who are a nationwide Limited Company who provide residential care to people with learning disabilities. Grange House is registered to provide care to five service users, and the home’s speciality is to provide for people with autism. Grange House is a detached property on a quiet residential street in Hayes. The home is a short drive from the local amenities of Hayes town centre and its public transport links. The property has five single en-suite bedrooms, one of which is on the ground floor. The communal rooms are spacious and include a through lounge, kitchen/diner, conservatory, and a large secure garden with a large activities room at the end. The home has its own vehicle to enable staff to take service users on outings. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second of the inspection year but it followed an additional visit that had taken place on 14th October 2005 that had been carried out in order to check the home’s progress in achieving compliance with the substantial number of requirements that had been made in the inspection report dated 12th July 2005. It was found at the time of the additional visit that the Manager Designate and the Operations Manager had taken steps to address the situation the Inspector had found and that of the 30 requirements made in July 2005, 18 had been met by the October 2005 visit. Further improvements have taken place since then, and the Inspector found during the current inspection that only 6 of these original requirements remained unmet. The Inspector made 2 additional requirement and 2 recommendations. The Inspector assessed the home against 29 of the standards and their outcomes that are part of the government’s National Minimum Standards (NMS), and he found that 20 were fully met, 8 were only partly met, and 1 was not met. As part of this inspection, the Inspector talked in depth with the Manager Designate, briefly met three staff members and two service users, toured the premises, and examines various files, policies and records. The home has the full complement of five service users, but there is not a full permanent staff team in post. Recruitment is under way. What the service does well: The home continues to provide a good standard of care for the service users. Care Plans and activities are much improved. The home is an attractive and homely place to live. The Manager Designate reported that there is a committed staff group, with a good team spirit, who understand their roles’. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 6 of the requirements from the last full inspection remain unmet. These relate to; relatives signing their agreement to service users’ terms and conditions; relatives signing their agreement to service users’ care plans; all staff being trained in the Protection of Vulnerable Adults; 50 of care staff obtaining an NVQ level 2 or 3 in care; a recent photograph of all members of staff being kept on file in the home; and a training and development profile being undertaken on each member of staff. In addition, the Manager Designate reported that he wants to involve parents more in the operation of the home and wants to create the right forum for this to happen in, such as a quarterly meeting. In addition he hopes that parents will become more involved in care planning, and reviews of the service users. The home is not fully staffed with permanent staff. In particular the deputy manager is on long term sick, and no one is acting as deputy. This affects the ability of the Manager Designate to undertake everything that is expected of him in the time available to him. Thus for example not all staff receive formal supervision as frequently as the NMS require as no other senior member of staff in the home has been trained to provide that supervision. The Manager Designate is also expected to manage Ross Cottage supported living scheme, whereas he should be able to concentrate on managing and meeting the NMS at Grange House. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 7 The Manager Designate has been in post for 12 months and yet has not yet been put forward by Milbury to be registered by the CSCI as the manager of the home. This must now become a priority. 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. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Service users’ aspirations and needs are assessed and met in a satisfactory manner. The terms and conditions that should be made available to service users are not in a suitable format for that purpose and do not show who has agreed to them. EVIDENCE: NMS2: The Inspector examined in detail the care file and records for a service user chosen at random. The Inspector noted that there was a detailed service user plan based on an assessment of need, and that files were well structured and maintained. NMS5: The Manager Designate reported that each service user’s file contained a copy of the contract that their placing authority had issued. The Inspector responded that NMS 5 required each service user to have terms and conditions issued to them by Milbury, and that they or their representative or relative should sign their acceptance of those terms and conditions. The terms and conditions should if possible be in a format that the service user can understand. Relatives or representatives are not signing their agreement to terms and conditions. Requirement 1 Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Individual care plans are not yet in a satisfactory format. EVIDENCE: NMS 6: The Manager Designate reported that staff have been trained in Person Centred Planning and that PCP care plans are now being set up in the home, with substantial use of photographs of food for example to assist service users in menu choice. This is commended. The Manager Designate however disclosed that not all care plans have been signed and approved by relatives or representatives. Requirement 2. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 AND 17 Service users are offered a satisfactory range of activities both within the home and in the wider community. Service users are consulted about their food preferences and are provided with a satisfactory food menu. EVIDENCE: NMS13 and 14: The Inspector examined the latest service users’ printed activity programme that was displayed in the hallway of the home. It was dated August 2005 but had been updated in pen. Recommendation 1. The Inspector noted that four out of the five service users now regularly attend day centres and colleges. This is commended. The Manager Designate reported that swimming sessions in a local pool are planned but do not take place at present because of ‘staffing issues’. Recommendation 2. The home has a well equipped activity room. The Manager reported that in house sessions are provided by a reflexologist, an art therapist, and a music workshop leader. NMS17: The Inspector examined the home’s record of meals taken. The Manager Designate reported that the Person Centred Planning being Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 12 undertaken is focussing at present on providing service users with photographs of food in order to assist them in their menu choice. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Service users’ physical health is being monitored in a satisfactory way. The home’s procedures for storing, administering and recording medication are satisfactory. EVIDENCE: NMS19: The Inspector examined two weight charts for service users and found that their weight is now being regularly recorded, and if the service user declines to be weighed, then that also is now being recorded. NMS20: The Inspector checked the medication storage cupboard and the record of administration. No errors were detected. Medication awaiting return to the pharmacist is now satisfactorily stored and properly recorded. No service user is able to administer their own medication. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The homes complaint procedure and its application are satisfactory. Services users are not adequately protected as not all staff have been trained in POVA. EVIDENCE: NMS22: The Inspector examined the home’s complaints record. It contained one complaint that had been recorded since the previous inspection. The complaint, its investigation and outcome were recorded in a satisfactory manner. NMS23: The Inspector examined the home’s record of staff training and discovered that four members of staff had not yet received training in the Protection of Vulnerable Adults. Requirement 3. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30 All the environmental outcomes and standards are fully met. Services users live in a safe, attractive and clean home that is designed, furnished and equipped to met their needs. EVIDENCE: The Inspector toured the home, including one service user’s bedroom at her invitation. The home was seen to be adequately furnished and decorated, clean and hygienic. No safety issues were identified. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 There is sufficient clarity of staff roles and responsibilities. Service users are not sufficiently supported by a competent and qualified staff team as they are not sufficiently well qualified in terms of NVQ’s in Care. Although sufficient staff are employed, there are insufficient management staff in the home. Recruitment checks on new staff are adequate except they do not always include providing a photograph. Recording of individual staff training and development needs is inadequate. Staff are not receiving formal supervision sufficiently often. EVIDENCE: NMS31: The Inspector examined a job description and a contract issued to a support worker. NMS32: The Manager Designate reported that of the 15 care staff employed at the home, only 1 has an NVQ in care, although 3 are working towards gaining the qualification. Requirement 4. The Manager Designate reported that Milbury lack sufficient NVQ assessors and that the home should have a LDAF mentor. NMS33: Sufficient staff were on duty on the day of the inspection but the Manager Designate reported that the deputy manager was on long term sick and that although there was a senior support worker on the staff, there was no acting deputy. It is recommended that a suitable deputy is put in place. See NMS 36 and Requirement 8. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 17 NMS34: The Inspector examined the recruitment file of a member of staff who had recently joined the home. All appropriate checks had been undertaken. The Manager Designate however reported that he had not yet obtained a photograph of every member of staff for their recruitment file. Requirement 5. NMS35: The home’s training and development programme was examined by the Inspector and found to be not completely up to date. The Manager Designate reported that members of staff did not yet have an individual training and development assessment and profile. Requirement 6. NMS36: The Manager Designate reported that he was not up to date in the formal supervision of staff as the deputy manager was on sick leave and the senior support worker had not been trained in how to provide professional supervision. This is evidence that the role of deputy manager is crucial and should be filled in some way. See NMS 33 and Requirement 8. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 40, 41 and 42 It is not satisfactory that the Manager Designate has been in post for a year without having been put forward to be assessed by the CSCI as ‘a fit person’. It is also not satisfactory that the Manager Designate also manages a supported living scheme. The Manager Designate does manage the home in the best interests of service users. Service users’ personal allowances are appropriately spent, and adequate records are kept. Service users’ interests are safeguarded by the homes policies and procedures. Service users’ health and safety is promoted. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 19 EVIDENCE: NMS37: The current Manager Designate has been in post for a year. He reports, and this is confirmed by the Operations Manager, that there has been a mix up over the fees to be paid to the CSCI in order to have the manager assessed to see if he is ‘a fit person’ to become the Registered Manager. It must become a high priority for this application to be made. Requirement 7. It is unsatisfactory that the manager of Grange House also has to manage the supported living scheme known as Ross Cottage. NMS38: The Manager Designate has achieved many of the requirements of the previous inspection. He has also instigated frequent staff meetings in the absence of sufficient one to one supervision sessions. NMS40: The Inspector examined the personal allowance records of two service users. NMS41: The Inspector examined the home’s ‘Physical Intervention’ and ‘Nonviolent crisis intervention’ policies together with ‘crucial incident report’ forms. The Inspector was satisfied that the company’s procedures had been followed. NMS42: The Inspector toured the home and examined records of fire prevention issues, hot water temperatures, and fridge and freezer temperatures. No issues were found. COSSH chemicals were safely locked away. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x x x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 x 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 2 2 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Grange House Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 1 3 x 3 3 3 x DS0000048879.V273879.R01.S.doc Version 5.0 Page 21 yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 5 Requirement Timescale for action 01/04/06 2 OP6 15 3 OP23 18 (1) © 4 OP32 18 (1) (a) Service user terms and conditions must be issued to all service users, with a copy placed on file that has been signed by Milbury and service users representatives. RESTATED FROM THE PREVIOUS INSPECTION AS THE TIMESCALE HAS NOT BEEN MET. Evidence is required to be placed 01/04/06 on service users files to show that all service users and/or their representatives have been consulted on the contents of the service user plans. RESTATED FROM THE PREVIOUS INSPECTION AS THE TIMESCALE HAS NOT BEEN MET. All staff must be trained in 01/04/06 Protection of Vulnerable Adults procedures. RESTATED FROM THE PREVIOUS INSPECTION AS THE TIMESCALE HAS NOT BEEN MET. 50 of care staff are required to 01/12/06 have an NVQ level 2 or 3 in Care by the end of 2005. RESTATED FROM THE PREVIOUS INSPECTION AS THE TIMESCALE HAS NOT BEEN MET. DS0000048879.V273879.R01.S.doc Version 5.0 Grange House Page 22 5 OP34 19 and Sch2 6 OP35 18 7 OP37 8 (2) 8 OP36OP33 18 (1) (a) A recent photograph is required for all staff members. RESTATED FROM THE PREVIOUS INSPECTION AS THE TIMESCALE HAS NOT BEEN MET. A training and development assessment and profile must be formulated for each member of staff. RESTATED FROM THE PREVIOUS INSPECTION AS THE TIMESCALE HAS NOT BEEN MET. The registered provider must give notice to the Commission of name of the manager they are putting forward to become registered. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers appropriate for the health and welfare of service users. 01/03/06 01/04/06 01/02/06 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP14 OP14 Good Practice Recommendations The home’s printed activity programme should be updated Ways should be found to introduce the planned swimming trips as the needs and wishes of service users must be paramount. Grange House DS0000048879.V273879.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 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 House DS0000048879.V273879.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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