Inspection on 25/11/08 for Grange Nursing Home

This inspection was carried out on 25th November 2008.

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 Nursing Home 17/05/07

Grange Nursing Home 16/05/06

Grange Nursing Home 14/11/05

Grange Nursing Home 12/05/05

Grange Nursing Home 16/11/04

Grange Nursing Home 16/04/04

Grange Nursing Home 19/08/03

Grange Nursing Home 17/09/02

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grange Nursing Home Grange Drive Heswall Wirral CH60 7RU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ingerbritt Moynihan     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Grange Nursing Home Grange Drive Heswall Wirral CH60 7RU 01513426461 01513428299 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Catherine Tunley Type of registration: Number of places registered: Grange Nursing Home Course Change Limited care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is: 32 Date of last inspection Brief description of the care home Grange is a care home providing 24 hour personal and nursing care and accommodation to 32 service users. The home is situated close to Heswall town centre on the Wirral peninsular. Local amenities such as shops, pubs, and a public library are near by. There is a bus station in Heswall which gives easy access to other parts of the Wirral and Liverpool. The home is a large converted victorian property with attractive well established and private gardens. There is a small car park close to the main entrance. Bedrooms are on the ground and first floor, a lift is availble to the first floor. Care Homes for Older People Page 4 of 26 Over 65 32 0 Brief description of the care home The communal space comprises of a number of comfortable lounges and a dining room. Most bedrooms are single occupancy, some with ensuite facilities. There are a number of shared rooms. Accessible toiltes and bathrooms are on both floors near to bedrooms and living rooms. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information about the home was obtained through discussion with service users, the manager and members of the staff team. Policies, procedures and supporting documentation were also looked at along with a selection of service users case files. We also obtained information from the Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment document that is filled in once a year by all providers. It is one of the ways that we get information from providers about how they are meeting outcomes for people using the service. A part of the inspection process include sending surveys to service users, staff and health care professionals to obtain their views on the standards of the service. Comments made in these surveys are included in the report and contribute to the basis Care Homes for Older People Page 6 of 26 of any judgments made. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 26 Some improvements need to be made to the care plans. This will ensure staff have the information they need on how to provide the right level of care. Improvements need to be made to the way medication is managed to ensure service users safety and wellbeing. Some of the bathrooms and toilets would benefit from being refurbished. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care needs are assessed before they move into the home so they know they will receive the care and support they need. Evidence: An assessment of service users care needs is carried out prior to them moving into the home. Service users, their family and any relevant health care professional can contribute to the assessment to ensure the service user receives the right level of care. Staff surveys returned to us indicated they are always given up to date information about the service users they support. Before a service user moves into the home, they are given an opportunity to look around the building to see whether the facilities meet their care needs. Care Homes for Older People Page 11 of 26 Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health care needs are met. Evidence: A plan of the care given to each service user is recorded. This information has been updated and improved upon since the last inspection. More detailed information still needs to be recorded in the care plans, particularly in relation to wound care, to ensure staff have all the information they need on how to provide the right level of care. The manager agreed to address this issue immediately. Three of the service user surveys return to us indicated they always receive the care and support they need, two surveys indicated this is usually the case. All of the surveys indicated that staff listen and act on what they say. Four of the five surveys indicated they always receive the medical support they need, one indicated this is usually the case. Service users health care needs are met. Staff will seek advice from relevant health care professionals when necessary. A record of this information is kept so that staff can monitor service users health care needs over a given period of time. The health Care Homes for Older People Page 13 of 26 Evidence: care professional surveys return to us indicated the staff always seek advice and act upon it to manage and improve service users health care needs. The home employs a part time physiotherapist who supports staff with service users care needs and offers individual support as required. One healthcare professional survey noted I am often approached regarding how a patient can be helped, for example appropriate exercises and positioning in chair/bed. A staff survey returned to us noted residents care and the relationship between staff and residents is excellent. Medication administration is not being managed properly which means service users health is not being promoted as well as it should be. The manager audited the medication at the end of the visit and confirmed that all of the outstanding issues had been rectified. Because concerns about this area of care have been raised at past inspections, the CSCI pharmacist will be asked to visit the home in order to carry out a more in-depth inspection. Staff demonstrated a clear understanding of how they must ensure service users are treated with respect and their right to privacy is upheld. The service users spoken to said the staff are sensitive when carrying out personal care and they had no concerns to raise. One service user said the staff are excellent, they are all very good especially when they help me have a bath. The health care professional surveys return to us indicated that staff always respect service users privacy and dignity. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes routines are flexible and service users are helped to exercise choice and control over their lives. Evidence: A range of social activities are provided to ensure service users have opportunity to meet with the other people living in the home and to prevent them from becoming bored. A part-time activity organiser is employed at the home. She will work with service users in groups or on an individual basis. Three of the five service user surveys returned to us indicated activities are always provided which they can take part in. One survey indicated that activities are sometimes provided. Another survey indicated they would like more activities especially a sing-along and an entertainer. The service users spoken to said the homes routines are flexible and their friends and family can visit at any time. They confirmed they can wander around the home as they wish and can get up and go to bed when they want. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure service users are protected from the risk of harm and they know what to do if they want to make a complaint. Evidence: A complaints procedure is available so that service users know what to do if they are unhappy about the service they receive. Service users spoken to said they know who to speak to if they want to make a complaint, this was also indicted in the service user surveys returned to us. Staff are clear on the action they should take in the event of them receiving a complaint. We have not received any complaints about this service. One of the service users said I have no complaints to make, I am perfectly happy with everything. During discussion staff demonstrated a basic understanding of the different types of abuse that can occur and what they should do if they know or suspect abuse is taking place. Staff are provided with training in this area of care and a policy and procedure is in place to support them with the management of any allegations of abuse. The service users spoken to during the visit said the staff are always polite and they have never been spoken to or treated badly. One service user said the staff are lovely, nothing is ever any trouble to them. The manager must ensure she is clear on the procedures to follow in the event of an allegation of abuse being made. This will ensure poor practices are identified and managed correctly and in line with the Wirral adult Care Homes for Older People Page 16 of 26 Evidence: protection procedures. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is well maintained and provides a comfortable and homely environment for service users to live Evidence: Service users live in a homely, comfortable and safe environment. The premises are secure, bright and airy. There is a programme of routine maintenance and the grounds are kept safe, tidy and attractive. There are a number of lounges around the home which service users are free to use, again these are furnished in a homely and comfortable fashion with good lighting. There are sufficient toilets and washing facilities for the number of people living at the home. Some of these bathrooms would benefit from being redecorated. Some bedrooms have ensuite facilities which includes a hand washbasin and a toilet. Adaptations and specialist equipment is provided around the home to ensure service users independence and to minimise the risk of accidents. Most of the bedrooms are single occupancy although some are shared. Care Homes for Older People Page 18 of 26 Evidence: Systems are in place to prevent the spread of infection and staff have completed training in this area of care. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by trained and competent staff. Evidence: The recruitment and selection procedures ensure suitably qualified and competent staff are employed. Staff files held the necessary information to show the correct checks had been carried out before they were employed. The manager must ensure Criminal Record Bureau (CRB) checks are disposed of in accordance with the guidance issued by the CRB office. Staff spoken to seemed clear on their role and responsibilities which means the service remains focused on the service users care needs. There is an ongoing training programme which includes training to the National Vocational Qualification standards. This training covers a range of issues relating to the care of the service users and of the running of the home. Records looked at indicated staff have completed a range of training relevant to their role. The health care professional surveys return to us indicated the staff always have the right skills and experience to support service users health and social care needs. The manager has a positive atitude towards staff training. Staff surveys return to us indicated they are given training relevant to their role which helps them understand and meet the individual needs of the service users and keep them up to date with new ways of working. One staff survey noted when asked what the service does well? very good Care Homes for Older People Page 20 of 26 Evidence: training and support for staff. Another survey noted since I started working at the Grange nursing home there are regular training courses available, this means I can better myself as a care assistant and offer the very best of care to the elderly. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run for service users best interest. Evidence: The manager, Mrs Catherine Tunley, has been in post since June of this year. She is qualified, competent and experienced to run the home. Her application to be registered with the CSCI is currently being processed. While this report has highlighted some shortfalls, we feel confident these matters will be resolved as quickly as possible. The manager has an open and positive approach which provides staff with clear direction and leadership. The staff spoke highly of the manager. One member of staff said things have improved 100 since Catherine came to work at the home. The service users also spoke highly of Mrs Tunley saying she is kind and friendly. The registered provider manages service users fees and will help them with their weekly pension if asked to do so. The records were looked at for one service user; these were accurately maintained. Care Homes for Older People Page 22 of 26 Evidence: Although a formal quality assurance system is not in place, steps have been taken to ensure the efficient and effective running of the home and the ongoing improvement of the service. One health care professional survey returned to us noted to my knowledge the staff are always diligent, hard-working and caring. In all of my visits the needs of the service users are always paramount. Mr Dean (registered person) and his staff are very professional...... A staff survey returned to us noted the Grange nursing home is a very well-run home. Management do everything to meet the needs of the residents and staff. The nursing is to a very high standard and the training that is on offer is excellent. Staff are supervised informally and formal supervision is provided on an ad hoc basis. The manager acknowledged this needs to be formalised so that staff have an opportunity to discuss their work and develop in their role. All of the staff spoken to said they enjoy their work and feel well supported in their role. They confirmed the manager and senior staff are always available for support and advice. This was also confirmed in the staff surveys which indicated the manager regularly meets with them to give support and discuss how they are working. One staff survey noted we have regular staff meetings when we can discuss any issues to improve standards of working, management are always there to listen to any suggestions. The health, safety and welfare of service users and staff is promoted through the provision of policies and procedures and regular staff training. Regular health and safety checks are carried out including fire safety, water temperatures, the passenger lift and various equipment around the building. A record of any accidents that happen is in place and all accidents are audited to see if any patterns develop. The manager will take the necessary action to minimise the risk of accidents happening again. Some of the service users have bed rails fitted to ensure the safety. Maintenance checks are carried out on this equipment and most staff have received training in this area. All staff will receive an update in their training within the next few weeks and formal training will be provided in January 2009. Fire safety training is provided and three senior staff are trained Fire Marshalls. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 15 A detailed plan of the care 12/01/2009 provided to each service user must be in place. This is particularly pertinent to wound care. This will ensure service user receive the right level of care. 2 9 13 The current systems for the administration of service users medication must be improved. This will ensure service users safety and good health. 12/01/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 21 36 Some of the bathrooms and toilets would benefit from being redecorated to ensure service users comfort. A system of formal supervision should be introduced so that staff have an opportunity to discuss their work and develop in their role. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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