Inspection on 07/09/06 for Grange, The

This inspection was carried out on 7th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 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 Stephen Boyd Key Unannounced Inspection 12:00 7 September 2006 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.V292033.R01.S.doc Version 5.1 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.V292033.R01.S.doc Version 5.1 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.V292033.R01.S.doc Version 5.1 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)) 31st October 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. here 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 £430 - £480 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.V292033.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in September 2006. The manager, Mr David Skeath, assisted the inspector throughout the inspection. Four service users were spoken with in private and others in general. Three staff members were spoken with. A tour of the premises was undertaken and various records and policies were viewed. Prior to the inspection, comment cards were received from twelve service users, two health professionals and five relatives/friends. What the service does well: What has improved since the last inspection? What they could do better: The premises need further improvement in some areas as detailed in standard nineteen of this report including making safe a rail to aid mobility of service users that leads from a dining room to the garden area. The medication system needs to be improved to ensure safety for service users as detailed in Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 6 standard nine of this report regarding ensuring labelled boxes are available for all medicines used. 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.V292033.R01.S.doc Version 5.1 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.V292033.R01.S.doc Version 5.1 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 and 6 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users have their needs assessed prior to moving into the home. They can be confident of having these needs met. EVIDENCE: The file of a service user admitted to the home since the last inspection on 31/10/05 was looked at during the inspection. This showed that the service user had a comprehensive assessment carried out by the manager and a social worker on behalf of the placing authority. Other service users files seen indicated similar assessments prior to admission had taken place. The home has an admission policy which stated the home would only admit people whose needs could be met by the home. The home does not offer an intermediate care service. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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): 7,8,9 and 10 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users have individual plans of care. Their health needs are promoted and met. The homes medication system while generally working well needs some improvement to enhance safety. Service users are treated with respect with their privacy promoted. EVIDENCE: Individual care plans were seen to be available for a number of service users sampled. The plans covered people’s needs in respect of social, emotional and physical care and in the main had been regularly reviewed on a monthly basis. Only one plan was seen which had not had a review for longer than this time frame. Plans detailed what service users liked to do on a daily basis and daily reports linked to care plan objectives for individual service users. Risk assessments were also seen to be available for service users and again these had been regularly reviewed. Records of appointments with health professionals were seen to be kept for service users in a manner that offered an “at a glance” guide to whether new appointments needed to be made with people such as dentists and opticians. Assessments for pressure sore risk were seen and weight charts were also kept to assist with overall health monitoring. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 10 The home operates a monitored dosage system of medicine administration. This was seen on the day of inspection and was found to be working generally well. Appropriate records were seen to be kept including for controlled drugs held by the home. Staff who administer medication have received appropriate training. One area where the system was not working as well as it should was in relation to some boxed medication held for service users. Some boxes had been discarded leaving only strips of medication. Medication must only be administered from pharmacist labelled boxes or bottles so that staff can be sure they are administering the appropriate medication in the correct amount and at the correct time. Medication remaining in it’s prescribed container also means an audit can be undertaken to ensure that people have been given the appropriate dosage. The manager was advised of these issues during the inspection and asked to ensure this practice is changed. A requirement has been stated in respect of this at the end of the report. Service users spoken with during the inspection felt they were treated with respect most of the time. Their privacy was maintained by staff and this was seen on the day of inspection by way of staff knocking on bedroom doors before entering. Service users comments regarding staff both on the day of inspection and in comment cards received were positive. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users are generally content with the lifestyle experienced in the home. Service users maintain appropriate contact with family, friends and others. Service users have choice and control over their lives. The meal provision and food arrangements within the home are satisfactory. EVIDENCE: Service users can choose from a range of activities at the home. An Occupational therapist is contracted to work one day a week to help facilitate activities. Activities on offer include exercise, quizzes, painting and music sessions. Outside entertainers come to the home approximately twice a month. Large print books are available. Service users also follow their own interests including reading newspapers and watching television. Service users can follow their religious beliefs and currently the home is visited by an Anglican minister and Roman Catholic priest to meet service users needs in this area. All of the current service users have contact with family, friends or other representatives as they wish. Service users said their visitors are made to feel welcome. Although no visitors were seen during the inspection, five comment cards were received from relatives or friends of service users prior to the inspection and all stated they felt welcome to visit the home and could see their particular relative or friend in private. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 12 Service users spoken with during the inspection said they could exercise control and choice within the home. For example, they said they did not have to follow rigid routines and were seen to walk freely around the home. Menus seen on the day of the inspection reflected a good variety of food on offer for service users. Alternatives are always available to the days planned main meal such as fish or salad. Service users are involved in menu planning via the regular service user meetings. Stocks of food seen during the inspection were adequate for the size of home and given that food purchasing takes place on a weekly basis. Positive comments were received about the food on the day of the inspection and in written comment cards received prior to the inspection. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. The home deals with complaints in a professional manner. Service users are protected from abuse through the homes policies and procedures. EVIDENCE: The home has a complaints procedure displayed on a notice board. Copies are also given to service users with the service users guide to the home. The procedure details how to make a complaint and gives a 28-day timescale for response. Details of the CSCI are given should a complainant wish to make a complaint directly or is unsatisfied with the homes response. One minor complaint had been recorded in the complaints log since the previous inspection and dealt with appropriately. Service users spoken with said they knew how to make a complaint should the need arise. Comment cards received from relatives and friends prior to the inspection indicated they were aware of how to make a complaint. Policies and procedures on dealing with suspected or actual abuse were seen to be available. The manager advised that no referrals had been made since the previous inspection. Staff have received training in the protection of vulnerable adults from abuse. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users generally live in a safe, well-maintained environment though some action needs to be taken to enhance this. The home is clean, pleasant and hygienic. EVIDENCE: The home has accommodation on three floors accessible by a passenger lift. Since the previous inspection a number of improvements have been made. These include the purchase of some new beds and armchairs, locks being fitted to bedroom doors and the re-carpeting of three bedrooms. There are plans to double-glaze further parts of the home that have not yet had this done. Service users were happy with their individual accommodation and the communal areas, saying these were always kept clean and tidy. Rooms seen on the day of the inspection were clean, well decorated and had evidence of personalisation such as pictures and ornaments. The home has a pleasant rear garden area. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 15 There were some areas that needed to be addressed to further enhance the environment and safety for service users. Armchairs in one of the lounges were well used and worn and in need of replacement. In the dining area a new radiator cover was required as the existing one was seen to be damaged. The ramp, which leads from the above dining room to the rear garden area, had a wooden rail which had rotted away exposing nails. This rail needed to be replaced to ensure service users safety. The home was found to be clean and hygienic at the time of inspection. Problems that existed with odour at the previous inspection had been addressed. Infection control policies were available and staff were seen to have supplies of gloves and aprons. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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): 27,28,29 and 30 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users benefit from a competent staff team, recruited in a professional manner and in sufficient numbers to meet their needs. EVIDENCE: The home has at least four carers on duty throughout the waking day. At night there are three awake carers. The home has a separate cook and domestic staff. The manager is supernumerary to the above level of staff. The staff levels remain as at the last inspection and meet the current service users needs. Service users both on the day of inspection and in comment cards received prior to the inspection made largely positive comments about the staff including “ very good staff, patient and caring” AT the time of the inspection twelve of the twenty-three care staff employed had achieved National Vocational Qualifications at level two or above. Three` additional staff were in the process of doing nvq’s. Other training that had taken place since the previous inspection included, first aid, medication and food and hygiene. The manager advised that in the coming weeks training is planned to take place on moving and handling and dementia care. An Individual training record is kept for each staff member. In discussion with staff they confirmed various training had taken place as stated. The home benefits from a relatively stable staff team, a number having been employed at the home for several years. Staff files indicated that an appropriate recruitment process had been followed including the completion of Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 17 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. In discussion with staff they stated they had received an induction to the home and that ongoing supervision sessions took place. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users live in a home, which is managed professionally, and run in service users interests. Service users financial interests are safeguarded. The health, safety and welfare of those living and working in the home is generally well promoted and protected, though some work to further improve this needs to be carried out EVIDENCE: Mr Skeath, the home’s manager has been in that position for five years. He is also a joint proprietor of the home. Mr Skeath has achieved the registered managers award in 2003. Staff spoke well of the manager’s ability in running the home. The home regularly consults service users via meetings and conducts surveys of interested parties on the operation of the home. The requirements and recommendations of the last inspection report have been met indicating a responsive attitude to ensuring the home meets standards and consequently, service users needs. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 19 Some monies are kept by the home on behalf of a number of service users. 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 service users. Whilst the manager has signed that these are held, it is suggested an up to date audit is held and signatures of service users or relatives obtained to confirm what is being retained for safekeeping. 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. The home was seen to have risk assessments in place for safe working practices. 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. A couple of safety hazards were seen during the inspection and these are outlined under standard nineteen relating to a radiator cover and a guide rail. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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 2 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 2 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 3 X 3 X X 2 Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 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 OP9 Regulation 13(2) Requirement The registered provider must ensure that strips of tablets from prescribed boxes of medication are not left loose in containers with the boxes being discarded. The registered provider must improve the premises and their safety as outlined in standard 19 of this report. Timescale for action 30/09/06 2. OP19 23(2)(b) 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP29 OP35 Good Practice Recommendations It is recommended that staff files be indexed to facilitate ease of information retrieval. It is recommended that an up to date audit is carried out for valuables held on behalf of service users and signatures obtained where possible from service users or relatives. Grange, The DS0000010446.V292033.R01.S.doc Version 5.1 Page 22 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.V292033.R01.S.doc Version 5.1 Page 23 - 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. 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