Inspection on 12/07/07 for Grange, The

This inspection was carried out on 12th 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, The 07/09/06

Grange, The 31/10/05

Grange, The 23/06/05

Grange, The 16/12/04

Grange, The 22/07/04

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

CARE HOMES FOR OLDER PEOPLE Grange, The 33-34 Woodside Grange Road North Finchley London N12 8SP Lead Inspector Mr David Hastings Key Unannounced Inspection 09:30 12 and 13th July 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grange, The DS0000010446.V341763.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, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange, The Address 33-34 Woodside Grange Road North Finchley London N12 8SP 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) 020 8446 5378 020 8446 4827 Mr David Skeath Mr James Richmond Skeath, Mrs Lena Margaret Skeath Mr David Skeath Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 28 people Who fall into the category of old age (OP) and who may have dementia (DE (E)) 7th September 2006 Date of last inspection Brief Description of the Service: The Grange is a privately run residential home for 28 elderly people, some of whom may have dementia. The care home was originally two houses, which have been converted into a single home. Bedrooms are provided on three floors; there are a range of lounges and dining rooms. All the floors are accessible via a shaft lift. There is a large well-tended garden with a patio accessible through French windows. The Grange is situated close to public transport services; other amenities: shops, churches, surgery are within a reasonable distance. The aims of the home are: to provide its service users with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. Fees charged at the home range from £435 -£505 per week. A copy of this inspection report can be requested from the home or viewed via the CSCI website (web address detailed on page 2 of this report) Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 12th and 13th July 2007 and lasted eight hours. I was assisted throughout the inspection by the registered manager who was open and helpful. I spoke with six staff and nine residents of the home. I inspected the building and examined various care records as well as a number of policies and procedures. All of the residents I spoke with said they were very happy with the care and support they received. One resident told me the staff were, “Very good”. What the service does well: What has improved since the last inspection? What they could do better: One requirement has been issued that the results of any quality assurance questionnaires are published and made available to all interested parties. Four good practice recommendations have been issued. Residents should have a say in how their care plans are developed and reviewed. The manager should carry out an audit of furniture and fittings in the home and replace any defective items. Residents would benefit from the menu being reviewed and Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 6 more alternatives to the main menu provided. The manager should ensure that staff receive a refresher course in the protection of vulnerable adults in order to update their knowledge and awareness of this issue. 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, The DS0000010446.V341763.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, The DS0000010446.V341763.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 (6 not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home carries out a comprehensive assessment of individual’s needs so that they know that the home is suitable for them before they decide to move in on a trial basis. EVIDENCE: I examined three assessments of people who have recently moved into the home. These assessments were detailed and covered all the requirements of Standard 3.3 of the National Minimum Standards for Older People. In addition to the assessments from local authorities the manager or deputy managers visit the prospective resident to carry out their own assessment of the person’s needs. People I spoke with said the staff understood their needs. It was clear from discussion with the manager and deputy managers that they understood the importance of making sure the home could properly support the person before a decision to move in was made. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 9 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans clearly set out residents’ health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: Six care plans were examined. These plans were detailed and set out the plan of care for each individual for staff to follow. The plans set out the health, personal and social needs of residents. Care plans gave staff a clear understanding of how people wanted their care to be delivered and included reference to choice, privacy and dignity. Staff I interviewed had a good understanding of the use of care plans and the needs of the people in their care. Although plans were being reviewed and updated regularly residents did not appear to be involved in the review of their plans. A recommendation has been issued that residents views about the care provided to them are sought Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 10 and recorded when care plans are reviewed. This will ensure that people have a say in how their care is provided. From records and discussions with the manager it was evident that people have been supported to access health care. The manager confirmed that a general practitioner visits every week and that a dentist and an optician come to the home as and when needed. Residents told me that their health care needs were being met by the home. Satisfactory and accurate records were examined in relation to the receipt, administration and disposal of medication. Medication was being stored appropriately and the temperature of the medication storage area was being monitored and recorded. Only those staff who have completed the medication training are permitted to administer medication. A recommendation was issued at the last inspection that possible indicators of pain are recorded on people’s medication chart to assist staff to provide PRN pain medication for those people with cognitive impairment. This has now been complied with. Throughout the inspection I saw examples of staff treating people with respect and upholding residents’ privacy. For example staff were seen to be knocking on people’s doors before going in. People I spoke with confirmed that they were treated with dignity and staff upheld their need for privacy. Staff I interviewed were able to give practical examples of when they have upheld peoples’ privacy. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 11 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can choose from a range of activities at the home and are kept suitably occupied and engaged. Visitors to the home are made to feel welcome and can visit at any reasonable time. Residents are helped to exercise choice and control over their lives. The food provided is of good quality and mealtimes are relaxed and enjoyable. EVIDENCE: Residents that I spoke with said they were satisfied with the activities available to them. People said they particularly enjoyed the exercise classes and music entertainment put on regularly by the home. Residents also follow their own interests including reading newspapers and watching television. People can follow their religious beliefs and currently the home is visited by an Anglican minister and Roman Catholic priest to meet People’s spiritual needs. Staff I spoke with were aware of the need to keep people with dementia suitably occupied and engaged. I saw staff sitting and chatting with residents throughout the inspection. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 12 The record of visitors indicated that residents could have visitors at any reasonable time. A visitor I spoke with said she was always made welcome and offered tea or coffee when she visited. Residents I spoke with confirmed that visitors were welcomed and they could go out of the home for a walk with staff when they wanted. Residents confirmed that they were able to have choice and control over their lives at the home. Residents told me they could do what they liked and were not “bossed about” at all. Staff I interviewed were able to give examples of how they ensure people are able to exercise choice and control within their daily routines. The kitchen was inspected. The cook on the day of the inspection was aware of individual’s likes and dislikes as well as any special diets people may require. The kitchen was clean and there was a good selection of fresh food. Fridge and freezer temperatures were being monitored and recorded. People I spoke with were positive about the food provided by the home and confirmed that a choice of menu was always available. One resident told me that the food was “Very nice”. Lunchtime was a relaxed and enjoyable experience. I noted that the menu had not been reviewed for some time and the alternatives to the main menu where slightly limited. A recommendation has been issued that the menu at the home is reviewed and more alternative choices are made available. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 13 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 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. No complaints have been received by the home since the last inspection. All the residents I spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. Staff were able to describe to me how vulnerable people could be at risk of abuse in a residential care setting. All staff were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that I spoke to said they felt safe and well supported at the home. Records indicated that most staff have undertaken training in the protection of vulnerable people. A recommendation has been given that the manager carry out a training audit and identify those staff that need a refresher course on adult protection. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 14 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is safe and cleaned and maintained to a satisfactory standard. EVIDENCE: I toured the building with the deputy manager and visited a number of residents’ rooms. The building is well maintained and decorated to a good standard. There are a few areas that would benefit from decoration and the manager told me he is carrying out a rolling redecoration programme at the home. The hoist in the bathroom and a radiator cover have both been repaired. These were requirements from the last inspection that have now been complied with. I noticed a few items of furniture were in need of repair. A recommendation has been issued that the manager carries out an audit of furniture and fittings in the home and repair or replace any defective items. I saw that incontinent waste was being disposed of in yellow bags and within waste bins that have a lid fitted. The bedding, furniture and flooring in room 8 Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 15 have been replaced which has ensured the room is of a satisfactory level of cleanliness. These were requirements from the last inspection that have now all been complied with. Residents I spoke with said the home was always clean and there were no offensive odours detected throughout the home. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 16 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. All the staff at the home work very hard to meet the needs of residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to fully protect residents at the home. EVIDENCE: The home has at least four carers on duty throughout the day. At night there are three waking carers. The home has a separate cook and domestic staff. The manager is supernumerary to the above level of staff. The staffing levels remain as at the last inspection and meet the current residents needs. People I spoke with were positive about the staff team. One resident told me, “They know me well”. The rota was examined and matched the names of the staff working. Staff told me they were happy working at the home and staff turnover is low. This benefits residents and ensures a consistent approach to care provision. Records indicated that just over 50 of care workers have now completed NVQ level 2 or equivalent. Staff were very positive about the training offered to them and individual staff training profiles examined indicated that staff at the home receive the training required to do their jobs effectively. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 17 Staff files examined indicated that an appropriate recruitment process had been followed including the completion of application forms, interviews, taking up of references and pursuing Criminal Records Bureau checks. Staff files also included photo identity and evidence of training certificates gained. Staff files have now been indexed to facilitate ease of information retrieval. This was a recommendation from the last inspection. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 18 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager of the home knows the residents very well and understands their needs. Residents have opportunities to have a say in how the home is run. Residents’ financial interests are being safeguarded. The health and safety of residents and staff are promoted and protected. EVIDENCE: Mr Skeath, the home’s manager has been in that position for six years. He is also a joint proprietor of the home. Mr Skeath achieved the registered managers award in 2003. Both residents and staff that I spoke with were very positive about the manager’s abilities in running the home. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 19 The home regularly consults residents via meetings and conducts surveys of interested parties on the operation of the home. I saw the minutes of the last three residents’ meetings held this year. I also saw the results of the last quality review questionnaires. The results of these questionnaires should be published and made available to all interested parties. A requirement has been issued in the relevant section of this report. Some monies are kept by the home on behalf of a number of residents. A number of records were checked against cash held and found to be correct. Some valuables such as bracelets are also held on behalf of people who use the service. Where this is the case the manager and the resident concerned have both signed an inventory form. This was a recommendation from the last inspection that has now been complied with. Various current up to date certificates were seen in relation to health and safety matters at the home. These included certificates relating to gas, electrical installation, water and lift safety. Dangerous substances were locked away appropriately. A number of staff have received first aid training and regular checks of fire equipment including alarm tests were documented. Records indicated that both day and night staff undertake fire drills on a regular basis. The manager was also aware the new fire policies and procedures in relation to care homes. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 21 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 OP33 Regulation 24(2) Requirement The registered person must ensure that the results of any quality assurance surveys are published and made available to all interested parties. This includes residents and potential residents to the home. Timescale for action 01/10/07 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 OP7 OP15 Good Practice Recommendations The registered person should ensure that the views of residents are sought every time care plans are reviewed. The registered person should ensure that the menus are reviewed with the manager, cook and residents and more alternatives made available. The registered person should ensure that a training audit takes place for all staff in order to highlight the staff who need a refresher course in Adult Protection training. DS0000010446.V341763.R01.S.doc Version 5.2 Page 22 3. OP30 Grange, The 4 OP19 The registered person should ensure that an audit of furniture and fittings in the home is carried out and any defective items are repaired or replaced. Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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 Grange, The DS0000010446.V341763.R01.S.doc Version 5.2 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. 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!