Inspection on 08/09/05 for Grange Lea Residential Home

This inspection was carried out on 8th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Lea Residential Home 13/11/06

Grange Lea Residential Home 24/02/06

Grange Lea Residential Home 08/02/05

Grange Lea Residential Home 17/06/04

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

CARE HOMES FOR OLDER PEOPLE Grange Lea Residential Home Grange Road Off Wigan Road Bolton Lancashire BL3 5QE Lead Inspector Rukhsana Yates Unannounced 08 September 2005 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 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 Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Grange Lea Residential Home Address Grange Road Off Wigan Road Bolton BL3 5QE 01204 665903 01204 665903 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr A Joy Kumar Ghosh Mrs Glynis Roberts CRH Care Home 26 Category(ies) of OP Old Age : 26 Places registration, with number of places Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered for a maximum of 26 service users, to include: up to 26 service users in the category of OP (Older People). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 8 February 2005 Brief Description of the Service: Grange Lea is a privately owned care home for 26 older people of either sex. The home is in a residential area close to Bolton town centre, and is close to several local amenities including shops, a park and coffee shop. Grange Lea has 22 single bedrooms and two double rooms. 6 rooms have en-suite facilities. There are two floors with a lift to the first floor. The home has a good choice of lounge areas, a small garden area and car park. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and carried out over 6 hours. Most of the day was spent talking to seven of the residents and observing the way in which residents were supported during the day. Discussions took place with staff. The manager was away at the time of the inspection. The remaining time was spent looking around the home and some bedrooms, and reading care plans, staff files and other paperwork relating to the care and safety of residents. What the service does well: What has improved since the last inspection? What they could do better: The home needs to work on a number of areas. These include better choices and quality at mealtimes, written information for new residents and their relatives, safer recruitment procedures, and more time for the manager and deputy to sort out the care plans. The home needs to review staffing in light of Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 6 the very long shifts being worked by existing staff, and their lack of time to carry out recreational activities with residents in the absence of the hobby therapist. 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 Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Each person moving to Grange Lea has their needs assessed prior to admission, but there is a need for assessments to clearly identify needs and for written information about the home to be readily available to new residents. EVIDENCE: At the last inspection, it was noted that the home had produced a statement of purpose and a service users’ guide containing useful information for existing and prospective residents and their families. The manager was on away on holiday at the time of this inspection. There were no copies of the statement of purpose and guide available, and staff were not aware of the whereabouts of the last inspection report. Copies of the statement and guide need to be available on request, and a copy of the most recent inspection report needs to be accessible to anybody visiting the home. In respect of new admissions to the home, there was evidence in the residents’ files that a pre-admission assessment is carried out during a visit to the prospective resident. The information gathered at this stage required some improvement. For example, one person was described as having “a bit of a temper”, which does not adequately describe personality and causes of Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 9 behaviour in a positive manner. Assessments would also benefit from better information about preferences. One assessment had been carried out by telephone, and related to a person who had spent several weeks in intermediate care. A written assessment from the intermediate care facility should have been obtained prior to admission. In general, however, the home is getting better at obtaining assessment information before agreeing to the admission of residents for long and short term care. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 Each resident’s personal, health needs and risk assessments are included in their care plan. However, specific needs, and actions to be taken to address them, should be clearly identified to promote staff understanding and to enable appropriate care to be provided. EVIDENCE: Each resident has a care plan that covers a wide range of needs, and there has been a steady improvement in the quality and level of assessment information recorded. At the last inspection, the manager and deputy were keen to simplify the care plan format and to ensure that all relevant areas were reviewed monthly. However, this has not happened, and the availability of management time to do this was highlighted as a problem. In terms of healthcare needs, as at the last inspection, residents were satisfied that their healthcare needs were adequately met and staff had a good knowledge of the health needs of the residents. Although risk assessments are in place relating to falls and nutrition, ways of addressing the risks need to be clearly identified. Care plans need to address areas of high risk. As previously required, intervention and prevention measures must be clearly recorded, Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 11 implemented and monitored via monthly reviews, in respect of moving and handling, pressure areas, falls and nutrition. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Residents feel that the quality of the meals and the level and variety of activity provision need improvement. The home needs to look at ways of improving outcomes for residents, and monitor their levels of satisfaction, in these areas. EVIDENCE: Residents said that their choice of rising and retiring times were respected, and were aware of other choices available to them, at mealtimes for example. Those consulted felt that there was little to do to pass the time at the home, other than on Thursdays when the hobby therapist visited. Through observations during the day, and in talking with the hobby therapist, it was clear that residents enjoyed his input and enthusiasm. He is sensitive to the needs of older people and records the benefits of each activity on the participants. Activities on the day included a walk to the local café. There is a need for staffing arrangements to allow time for activities to be made available throughout the week. Residents also reported that there were no trips out to places of interest throughout the summer. This was confirmed by staff, with the reason of staffing pressures given for the lack of activity provision. There are issues relating to meals and organisation of the kitchen that must be addressed. All seven of the residents consulted said they were not wholly satisfied with the quality of meals. The weekly menu was not being followed as the ingredients were not available. There were gaps in the records of residents’ Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 13 choices at mealtimes. There was no information in the kitchen about residents’ preferences. This information should be available to the cook, especially in relation to new admissions to ensure that people are being served food that they like. It was also noted that mouldy bread was being regularly thrown away due to lack of rotation and the fact that bread is delivered only twice a week. The bread is of a white, economy type and does not allow for residents’ choice in respect of quality or the option to have brown bread. The home needs to ensure that food stocks and orders are clearly based on menu plans that reflect the preferences of residents, and to closely monitor the quality of meals and residents’ satisfaction with them. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and their visitors feel able to air their views, and feel the staff and manager respond to issues they raise. Staff are aware of the procedures to follow to ensure the safety of residents. EVIDENCE: Residents consulted felt that the staff and manager were approachable and would respond to concerns raised to the best of their ability. The complaints procedure is included in the service users’ guide, but the home needs to make sure that residents, and relatives of those recently admitted, have a copy of this. The manager keeps a record of complaints received. The home has adult protection ‘ whistle blowing policies and procedures in place, and it was evident in discussions with staff that they have read and understood them. Formal training has not taken place as yet. The recommendation from the last inspection is therefore carried forward, that the manager and staff attend the relevant adult protection training courses provided by the Social Services Department. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Grange Lea provides clean, safe and generally satisfactory surroundings for residents. Some redecoration and refurbishment is required to create a more pleasant environment to current standards. EVIDENCE: The home has an acceptable standard of décor and furnishings. The main lounge is comfortable, adequately decorated and furnished and leads to a patio area. The three lounges and separate dining room ensure a good choice of communal areas. As stated at the last inspection, although there is ongoing maintenance work, it was apparent that there are some areas in particular need of attention to ensure pleasant surroundings of a good standard. One example is the ground floor bathroom which requires redecoration. The registered person should forward a written renewal programme that includes priorities and timescales for action in respect of physical standards in the home. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 16 The home was clean and hygienic on the day of the inspection. Regular fire safety checks are carried out and recorded in the fire precautions register. There were no evident health and safety hazards. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The home needs to ensure that staffing and recruitment arrangements are suitable to achieve protection and a good standard of care for residents. EVIDENCE: The staffing rota indicates that, usually, there are three carers on duty with the registered manager. Three carers are on duty in the evening and two waking staff through the night. In addition to care staff the home employs a cook, domestic staff, a maintenance person, and a hobby therapist for one day a week. On the morning of the inspection, a senior was on duty with two carers, increasing to three later in the day. There are issues to address with regard to staffing. These include the fact that the manager should be supernumerary when calculating staffing levels. This has not been addressed since the last inspection. Existing staff are under pressure to cover shifts as they are considered to be “on call” on their days off. This has resulted in excessive hours being worked. The rota showed that one staff member worked 64 hours without a day off. Staff comments indicated low morale due to the pressure to cover shifts and the feeling that their commitment and efforts were not always appreciated. The registered person must review staffing levels and ensure that the manager is supernumerary to care hours to enable management tasks to be carried out. Recruitment procedures must be improved so that they are safe and robust. The files of staff new to the home revealed serious shortfalls such as the lack of a CRB / POVA check prior to employment, no checks of gaps in employment history, no dates or evidence of qualifications, and lack of suitable references. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 18 Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff would benefit from regular supervision meetings with the manager to ensure that each person’s development and support needs can be identified, met and reviewed. EVIDENCE: The manager was absent during this inspection. Therefore standards relating directly to the management of the home will be assessed at the next inspection. With respect to staff training and support arrangements, there was evidence of ongoing training for staff in moving and handling, fire safety and NVQ training. Some staff have received training in dementia care. Some supervision meetings had taken place in May, but staff are not receiving supervision regularly. There are outstanding requirements from the last inspection for the manager to provide regular, recorded supervision at the required frequency for Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 20 all staff. A training and development profile also needs to be produced for each staff member. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x x Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 22 No 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 1 Regulation 4, 5 Requirement Copies of the statement of purpose and service users guide must be available on request. A copy of the most recent inspection report must be accessible to any person visiting the home. The registered person must ensure that intervention and prevention measures are clearly recorded, implemented and monitored for identified risks in respect of moving and handling, pressure areas, falls and nutrition. (Previous timescale of 7.3.05 not met). The registered person must ensure that food stocks and orders are clearly based on good menu plans that reflect the preferences of residents, and to closely monitor the quality of meals and residents satisfaction with them. The registered person must produce a written renewal programme, including priorities and timescales for action, to improve physical standards in the home. The registered person must Timescale for action 7 November 2005 2. 8 12, 13, 14, 15 2 December 2005 3. 15 12, 16 2 December 2005 4. 19 23 2 December 2005 5. 27 18 2 Page 23 Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 6. 29 18, 19 7. 36 18 review staffing levels and ensure that the manager is supernumerary to care hours to enable management tasks to be carried out. The registered person is required to implement robust recruitment procedures, including POVA/CRB checks prior to appointment, and to ensure individual records contain all the information specified in Schedule 2 of the Care Homes Regulations. The registered person is required to ensure the provision of regular, recorded supervision, and to develop training and development profiles for all staff. (Previous timescale of 1.6.05 not met). December 2005 10 October 2005 2 December 2005 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. Refer to Standard 3 12 18 Good Practice Recommendations Initial assessments should be more detailed and contain information relating to prospective residents preferences as well as needs. Activity provision for residents should be increased throughout the week. It is recommended that the manager and staff attend relevant adult protection training courses provided by the social services department. Grange Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park Chorley New Road Horwich Bolton BL6 6HG 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 Lea Residential Home F56 F06 S9287 Grange Lea V229086 080905 Stage 4.doc Version 1.40 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!