Inspection on 04/03/09 for Grangefield Residential Home

This inspection was carried out on 4th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grangefield Residential Home 16/03/07

Grangefield Residential Home 25/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grangefield Residential Home 60 Northampton Road Earls Barton Northampton NN6 0HE     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: Judith Roan     Date: 0 5 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 27 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Grangefield Residential Home 60 Northampton Road Earls Barton Northampton NN6 0HE 01604812580 01604812580 grangefieldrch@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Nikul Odedra care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: No one falling within the category of OP may be admitted to the home where there are 20 persons of category OP already accommodated in the home Date of last inspection Brief description of the care home Grangefield is a privately owned care home providing personal care for up to twenty men and ladies over the age of 65 years. Nursing care is not provided in this home. Grangefield stands in its own extensive grounds and offers ample car parking to the front of the house. It is a large detached building that has been significantly extended to the rear of the building on the ground floor. The extension provides a further eight bedrooms, two bathrooms and a hairdressing/chiropody/treatment room. The home is located on the outskirts of Earls Barton set back from the main road, and is on the main bus route. 0 Over 65 20 Care Homes for Older People Page 4 of 27 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was case tracking which involved selecting two people who use the service and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The homes registered manager also completed an Annual Quality Assurance Assessment (AQAA) a questionnaire required to be completed by CSCI. The inspection Care Homes for Older People Page 5 of 27 was unannounced and was undertaken during the afternoon of 4th March and the morning of the 5th March. The homes policies, procedures and records in relation to staffing recruitment and training, concerns and complaints, medication management, and general maintenance and upkeep of the home were viewed. The current fees range from 520 to 525. Fees are inclusive of fortnightly hairdressing and bi monthly chiropody. People using the service said that I feel very safe living here The carers are always helpful and polite My room is comfortable and kept as I would like it to be There is a wide choice of meals and we can have breakfast in our room if we prefer There is always an activity going on and we have a choice to join in What the care home does well: What has improved since the last inspection? What they could do better: It is recommended that within the signed contract for the service that a paragraph is included to state that the person using the service or their relative/advocate have received a copy of the Service Users Guide and complaints procedure. The registered manager must ensure that risk assessments are completed for all areas of need that are identified. It is good practice to include within assessments that where a need is fully met by the person being assessed that a risk assessment is not required but will be kept under review. The hot food probe must be replaced to ensure that food is served at the correct temperature and safe. It is recommended that staff should receive a minimum of six supervisions a year. Records should be maintained to evidence that supervision is an ongoing process and part of a staff members development programme. Refresher courses for manual handling and fire training need to be undertaken on a Care Homes for Older People Page 7 of 27 regular basis and in accordance with work force standards Health and safety records must be maintained and up to date. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information and pre-admission assessment ensures that the personal care needs of peoples using the service can be met. Evidence: Copies of the statement of purpose and service users guide are available within the lounges at the home. New residents and their relatives must be made aware of these documents or be given copies to read prior to admission. On speaking with a relative they confirmed that they had verbally been given extensive information about the home prior to their family members admission. In discussion with a new resident at the home they said that We were shown around the home and invited to join them in a meal which gave us an opportunity to meet everyone. The person also spent time speaking with other people using the service before making the final decision to move in. During this time the staff at the home also used the opportunity to assess their needs and confirm whether they could meet them. Care Homes for Older People Page 10 of 27 Evidence: In reviewing the care files an assessment of need was undertaken prior to admission gaining information about their needs and social history. The care file also contained a signed contract. To improve the service it is recommended that within the contract an additional sentence is included to confirm that the service users guide and complaints procedure have been received. Care Homes for Older People Page 11 of 27 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. People who use the service can expect that their health and personal care needs will be met, however the absence of some risk assessments has the potential for accidents to happen. Evidence: The care plans of two people that use the service were case tracked. Plans are developed from the assessments of need undertaken on admission and or via the review process used within the service. Preferences in relation to gender of the carer to support with personal care is promoted and respected. Evidence was found on files that plans are reviewed monthly or more often as required. Care plans are generally supported by risk assessments. Additional detail needs to be included within assessments that demonstrates that where an individual is self caring a risk assessment is not required but will be kept under review as needs change. Care plans could be made person centred by writing them in the first person as if the person had written their own plan. On reviewing the care file of one person using the service they had recently had a fall Care Homes for Older People Page 12 of 27 Evidence: causing severe bruising. The file did not contain a falls risk assessment to ensure that suitable arrangements were put in place to minimise the risk in the future, like low level lighting in their bedroom at night to aid vision, the use of mobility aids and the location of furniture in the room to avoid trip hazards. The Registered Manager has already responded positively to the feedback about risk assessments and confirmed that All care plans will include a section for a Waterlow score, nutrition and fall risk assessment. This action has been reflected in the quality outcome in this area. It is evident that health care needs are met by having a positive working relationship with local health care professionals who visit people at the home at an individuals request or when a staff member has identified concerns/needs. On one file a completed medical health questionnaire had been completed that identified family health history. In observation of care practices during the inspection carers were seen to be respectful in their approach and supported people to maintain their dignity by being discreet in how they approached people when personal care was being offered. In speaking with people that use the service they all commented that the staff were professional and maintained their privacy. Staff were fully aware of the needs of people they supported and aware of good practice in relation to personal care. Medication profiles are in place and in reviewing procedures improvements had been achieved in the management of controlled drugs. Records show that medication is handled, stored and administered in accordance with the Royal pharmaceutical society guidelines. Care Homes for Older People Page 13 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have a choice of a wide range of activities that leads to an enriched lifestyle. Evidence: The range of activities open to people living at Grangefield is wide and individuals have a choice of both private and communal areas to spend their day. In talking to people throughout the inspection they said that they could choose to take part in the chair exercise or have a game using the newly purchased Wii game. Individual were seen to be reading, chatting to peers and listening to music. There is a lively atmosphere within the home that is promoted by staff attitude and approach. Both lounges have recently been fitted with large flat screen TVs so that visibility is improved from most areas of the rooms. The AQAA confirms that This TV is part of a digital surround sound system giving great acoustics. As a result we have regularly held Movie afternoons with choc ices. In addition the registered manager states We have also this summer developed a sensory garden due to a suggestion made by a next of kin. Although we have a professionally manicured garden some residents that are visually challenged cannot see the bright flowers we have. For them we have sectioned a garden with scented flowers and herbs such as rosemary and mint and Care Homes for Older People Page 14 of 27 Evidence: have put in place a water feature which produces a soothing water sound. Planned entertainment is organised by the activity organiser who works part time and with support from others members of the staff team. A forties evening was arranged for the Saturday evening at the local community hall with most people using the service attending with families. Families are always welcome into the home and often called several times a week. Some families visited daily. In discussion with one relative they said that their family member was happy at the home and there was always something to do. A relatives forum enables family members to keep in touch and to share issues with the management team that aim to develop the service. A healthy menu is available to people that use the service. Breakfast is served people using the service in the dining room or on a tray in their room. The dining room is light airy and is pleasant area to enjoy a meal. Fresh flowers were found on the tables. A member of the staff team freshly cooks meals each day, except for a Friday when fish & chips is ordered from a local supplier. There is always a choice of meals with a wide range of alternatives. There is good domestic routine in place within the kitchen to ensure that food hygiene practices are maintained. Surfaces are maintained to a high a standard of cleanliness. The malfunctioning food probe needs to be mended to ensure that food records are maintained. The inspector was informed that this had not been in operation for sometime. Other food hygiene records were in place. Care Homes for Older People Page 15 of 27 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. Practices within the service protect people who use the service and ensure that they are listened to. Evidence: People spoken with said that they felt safe living at Grangefield. They were clear about who do speak to if they had a concern or felt that they were not being treated appropriately. Carers also said that they would report any concerns and knew that there is a whistle blowing policy in operation at the home. A complaints policy and procedure is in operation at the home and the registered manager states that I believe it is of paramount importance for the Manager to be pro active and visible on a day to day basis, to maintain strong lines of communication between Management, Residents and Relatives. The provider has also acted upon a concern raised by a relative about nurse call system and that if a resident fell away from the pull call assistance could not be summoned. The AQAA confirms the action taken We looked into getting suitable panic alarms that could be given to susceptible residents which they could wear and trigger if they had a fall and werent near a buzzer. The closest device available on the market was a panic alarm that triggered a phone call but which wasnt suitable for us due to technical reasons. We therefore developed our own panic alarms using the buzzer fobs worn around the neck linked to a dedicated door bell. This works fine and Care Homes for Older People Page 16 of 27 Evidence: has been given to two residents. This device now provides further protection for our residents. The services recruitment systems ensures that staff working at the home are subject to robust employment checks, that include, employment history, references and criminal record disclosure checks. A copy of the local safeguarding protocols and procedures are held at the home. Care Homes for Older People Page 17 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment is well maintained and exceeds expectations of people using the service. Evidence: In touring the building all areas were seen to be clean, hygienic and maintained to a high standard. The housekeeper has a well planned routine and maintains supplies/records of materials in accordance with health and safety regulations. There is a choice of bathroom facilities that are maintained well. One bathroom has a bath hoist that is serviced on a regular basis. All toilet have good facilities for hand washing to minimise cross infection. Hand sanitising sprays are supplied as a further measure to rec duce any cross infections. The decor is traditional and in keeping with the Edwardian period of the house. The garden are landscaped and maintained to a very high standard, borders containing lots of spring bulbs and shrubs. The garden provides a relaxed area where individuals can sit when the weather permits. The communal areas were clean and furnished to a high standard with homely touches such as fresh flowers and reading materials throughout the house. The communal areas facilitate the company of peers or quiet areas where people can sit and enjoy the views across the open countryside or the gardens. Care Homes for Older People Page 18 of 27 Evidence: A stair lift is in place to enable people that use the service access to the upper floor if required. This is also maintained on a regular basis. The Registered Manager within the AQAA supplied information prior to the inspectiontaking place on the frequency of safety checks and the maintenance and upkeep of the home. On reviewing these at the home all were in order except for the lack of certificates for landlords gas safety and hoist servicing. The companies undertaking the servicing had not sent these. CSCI has now had confirmation that these have been received. A programme of redecoration and refurbishments is ongoing within the home and people using the service confirmed that they are always consulted about changes. Bedrooms contained personal items of furniture and electrical equipment such as TVs, video and DVD players, Radios and CD players, personal paintings and photographs. All of the bedrooms viewed had pleasant views either to the open countryside or the front and rear gardens. Residents spoke of their satisfaction with their bedrooms saying how much they liked living at the home and how lucky they were to live there. Care Homes for Older People Page 19 of 27 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. People using the service are safe as a result of the robust recruitment procedure and feel supported by the dedicated and competent staff team. Evidence: Grangefield has a thorough recruitment procedure and files seen confirmed that required employment checks, application form, two references, criminal records bureau disclosures and interviews have taken place. The staff team have a sound knowledge base about the needs of people that use the service. Through observation during the inspection they showed that they had a range of skills to support individuals and were proactive in maintaining everyday living skills. Carers are offered a range of opportunities to train. Of the staff team of nine have achieved National Vocational Qualification (NVQ) at level two or above with a further two working towards their certificate. This is above the required minimum standards of 50 of staff being qualified. Carers spoken to had a good knowledge of the needs of people using the service and were committed to providing a good service. They felt supported but did not receive formal regular supervision. This has been addressed after feedback to the Registered Manager during the inspection. Carers have access to a wide range of topics that includes Health and safety, Fire, safety, Food Hygiene, infection control, safeguarding, healthy eating, activities for residents, and dementia awareness. Staff had also completed manual handling Care Homes for Older People Page 20 of 27 Evidence: training but annual refresher training was not taking place to keep staff aware of good practice. The registered manager has confirmed that they have taken action to rectify this shortfall. Care Homes for Older People Page 21 of 27 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 service is managed in the best interests of people living at the home. Evidence: Several discussions took place during the course of the inspection at which any shortfalls were explained. Since the inspection there has been a positive response from the registered manager setting out their action plan in meeting the shortfalls identified within this report. The registered manager did demonstrate his commitment to delivering a quality service for older people who use the service. They do need to complete the NVQ (National Vocational Qualification) in care management level 4 and the Registered Managers Award that was started as a priority at the previous inspection in 2007. Records were not available to demonstrate that formal one to one staff supervision takes place on regular basis. Staff did however say that they felt supported on a dayto-day basis. They said that they could take issues to him and other senior staff at the home and be listened to. Staff could not confirm the frequency of supervisions. Care Homes for Older People Page 22 of 27 Evidence: Supervisions are not routinely recorded. There was evidence in files seen that staff receive annual appraisals to access their performance and development needs. Staff meetings are held on a frequent basis to discuss practice issues. The staff rota is developed to ensure that there is a balance between direct work with people using the service and administrative tasks. The home does not hold any monies for people using the service and individuals are encouraged to maintain their own finances. There is a good quality assurance system in place with the use of surveys and regular meetings with people that use the service. Including the views of key health care professionals and staff could further enhance the system. Regular meeting are held with people who use the service. These meeting are fully recorded and available on the notice board at the home. Relative forum meetings are also held with families to discuss developments and issues arising at the home. Care Homes for Older People Page 23 of 27 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 27 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 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 1 8 13 The registered manager 30/04/2009 must ensure that risk assessments are completed for all areas of need that are identified. To ensure the health and safety of people using the service. 2 15 13 The hot food probe must be replaced or repaired and in working order. To ensure that food is served at the correct temperature and safe. 30/04/2009 3 37 23 The registered Manager 30/04/2009 must ensure that health and safety records are maintained. This is to ensure that people using the service live are safe. Care Homes for Older People Page 25 of 27 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 1 It is recommended that within the signed contract for the service that a paragraph is included to state that the person using the service or their relative/advocate have received a copy of the Service Users Guide and complaints procedure. It is good practice to include within assessments that where a need is fully met by the person being assessed that a risk assessment is not required but will be kept under review. Refresher courses for manual handling and fire training need to be undertaken on a regular basis and in accordance with work force standards It is recommended that staff should receive a minimum of six supervisions a year. Records should be maintained to evidence that supervision is an ongoing process and part of a staff members development programme. Records must be maintained to support safe working practices 2 7 3 30 4 36 5 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 27 of 27 - 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!