Inspection on 31/10/05 for Grange, The

This inspection was carried out on 31st October 2005.

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 12/07/07

Grange, The 07/09/06

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 Unannounced Inspection 13:30 31 October 2005 st 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.V261372.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 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.V261372.R01.S.doc Version 5.0 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.V261372.R01.S.doc Version 5.0 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)) 23rd June 2005 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. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Friday 31st October 2005 and lasted 3 hours. The inspector spoke with three staff, two visitors and seven residents. A partial tour of the premises took place and care records were inspected. The registered manager assisted the inspector and was open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: The manager must address the problem with malodour within the home. This issue has not been a problem in the past and the manager is aware of the problem and has already ordered new carpet for the rooms affected. Staff at the home must make sure that visiting professionals attend to residents in private. These two requirements and one recommendation relating to care plans have been issued as a result of this inspection. The inspector is confident that these will be addressed by the manager within the timescales given. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 6 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, The DS0000010446.V261372.R01.S.doc Version 5.0 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.V261372.R01.S.doc Version 5.0 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 the following standard(s): 3 (Standard 6 not applicable) The registered manager makes sure that all potential service users have a comprehensive assessment completed before they move into the home so that the service users know the home will be able to meet their needs. EVIDENCE: Three files were examined from the last three service users to be admitted to the home. The files examined contained detailed assessments carried out by the registered manager and relevant professionals. The assessments covered all the topics of Standard 3 of the National Minimum Standards for Older People. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Individual care plans clearly record how the staff at the home are to meet the needs of service users. Service users have good access to health care professionals. The staff at the home must ensure that all visiting health care professionals attend to service users in private. EVIDENCE: The inspector examined six care plans during the inspection. These plans identified individual issues for each service user and how staff are to provide care and support. All care plans seen included information regarding the interests of service users and how staff are to keep service users occupied during the day. All individual risk assessments seen included information on how identified risks should be minimised. It is recommended that the manager revisit the care plan format and include the elements required for initial assessments covered under standard 3.2 of the National Minimum Standards. The registered manager said that service users are registered with a GP, many with the GP who is contracted to make monthly visits to the home for consultations. All service users have access to district nurses; a dentist, optician and chiropodist visit the home to examine and treat service users. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 10 Service users are referred to the geriatrician, community psychiatric nurse, psycho-geriatrician, as necessary. One visitor commented that the medical side of things was very good. Service users were observed to be appropriately dressed and clothes are individually marked. Service users that the inspector spoke with said that staff were respectful and considerate in regard to their privacy. However during the inspection a visiting dentist was carrying out an examination of a service user in the lounge. This practice does not provide privacy or maintain the dignity of the service user. A requirement has been made that all visiting professionals must attend to service users either in their room or in a private area. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Service users can choose from a range of activities and entertainments provided by the home. Visitors to the home are welcomed and can visit at any reasonable time. The manager and staff encourage service users to exercise choice and control over their lives. Service users receive a wholesome, balanced diet in relaxed and comfortable surroundings. EVIDENCE: During the inspection a keep fit session was being run by one of the service users. All service users in the lounge area were taking part either by exercising or by singing along with the music. Staff were also taking part and the atmosphere was relaxed and fun. Service users that the inspector spoke with were very positive about the staff. Relatives that the inspector spoke with said they were always made welcome and one relative commented that the staff were “loving and caring”. Posters displayed in the home gave information about forthcoming entertainment. The inspector examined a satisfactory record of visitors to the home. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 12 The registered manager said that none of the service users were able to handle their own financial affairs; some are handled by their relatives or the local authority. Service users are encouraged to bring personal possessions with them and evidence of this was seen in the bedrooms. Breakfast is based on individual choices. The menu for lunch, drawn up by the manager in consultation with the cook, is based on service users’ known preferences with a range of alternatives. Supper consists of a range of cooked choices, sandwiches and cakes. Hot drinks and biscuits were served morning, afternoon and at a late supper. Fruit drinks are served at each meal and are available throughout the day. The inspector was able to have a general discussion with service users regarding the quality of the food. Service users stated that they liked the food and were offered a choice. A requirement relating to pureed meals, issued at the last inspection has been complied with. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home deals with complaints properly and all complaints are recorded and investigated in line with the home’s complaints policy. EVIDENCE: The home’s complaints procedure, displayed on the notice board, specifies how complaints can be made, a 28-day timescale for a response and gives the details of the CSCI. The register of complaints was examined; the complaint is logged, together with the action taken and the outcome. Service users that the inspector spoke with said they had no complaints about the home but knew who to speak to do if they did have any concerns. It was clear that the manager takes complaints seriously and is open to disscuss any matters of concern with service users or their representatives. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Service users live in a safe, well-maintained home which is decorated and furnished to a good standard. The manager must address the issue of malodour within the home. EVIDENCE: The home is accessible, with a shaft lift connecting all floors; small flights of stairs on the first and second floor have been replaced with ramps. The lounges and dining rooms are comfortably furnished and well decorated. A regular maintenance check is made by senior staff and faults rectified when reported. The laundry and sluice are situated on the second floor, thus the removal of soiled articles and clinical waste are kept separate from the kitchen and food storage areas. A requirement that the laundry floor is kept clean has been complied with and the manager informed the inspector that regular washing with lime scale remover has been successful. A requirement that a fly screen be fitted to the back door of the kitchen has also been complied with. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 15 During the inspection a strong smell of urine was present on the ground and first floor of the home. Relatives that the inspector spoke with also commented about the smell. It appears that the odour has developed within the last few weeks. The manager was aware of the problem and has been looking at various floor coverings to replace worn and soiled carpet. The inspector was informed that a number of service users have developed incontinence problems and despite liaising with the continence advisor, the problem with odour still remains. The inspector noted that a number of bedrooms have a strong odour particularly rooms 18 and 9b. The manager was advised to not only check the carpet but also the mattress, bed and bed linen. It was also suggested to the manager that changing the carpet shampoo might be effective. A requirement relating to the odour problem in the home has been issued in the relevant section of this report. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Service users benefit from a positive, caring and competent staff team. The staff team receive a good level of training and the manager makes sure that all staff receive the required mandatory training needed for working in a residential home for older people. EVIDENCE: The registered manager said there are 5 care staff (including a senior staff) on duty during the morning and 3 or 4 in the afternoon; at night there are 3 waking night staff. The staffing rota confirmed this. The staffing establishment consists of: the registered manager, 1 deputy manager, 1 assistant manager, 22 care staff (including night staff), cook, domestic staff and administrator. The home meets the guidelines set by the previous regulatory authority on staffing ratios. One service user informed the inspector that the staff at the home are “fantastic”. Another service user commented, “We get looked after here”. It was clear from observations during the inspection that the staff were aware of the communication issues faced by people with dementia and how to communicate effectively with them. The manager has carried out a training audit for all staff and has identified mandatory training needs as a result. This was a requirement from the last inspection that has now been complied with. The inspector examined staff training records and it was clear that the manager is committed to staff training. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 There are good systems in place to monitor health and safety compliance and the manager is aware of his responsibilities to promote and protect the health and safety of staff and service users. EVIDENCE: Fire procedures and records in relation to fire safety were examined. The home has risk assessments for safe working practices at the home including fire safety. The registered manager informed the inspector that the home’s fire consultant has recently reviewed these fire risk assessments. Records indicated that fire training took place in the last month, which included a fire drill. The manager informed the inspector that he carries out night-time visits to the home and during the last visit all fire doors were closed. The manager was able to describe satisfactory evacuation procedures to be implemented in the event of a fire. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 18 A satisfactory and up to date Gas safety certificate and Electrical installation certificate were seen. A requirement issued at the last inspection that a Legionnaires test is carried out at the home has now been complied with. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 19 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 x 10 2 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 x 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 3 Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 20 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 OP10 Regulation 12(4)(a) Requirement The registered manager must ensure that visiting professionals attend to service users in private. The registered manager must ensure that the problem with malodour in the home is addressed. Timescale for action 01/12/05 2. OP26 23(2)(d) 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered manager should ensure that individual care plans cover all the elements of standard 3.3 of the National Minimum Standards for Older People. Grange, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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, The DS0000010446.V261372.R01.S.doc Version 5.0 Page 22 - 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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