Inspection on 22/08/07 for Halmer Grange

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Halmer Grange 26/10/06

Halmer Grange 27/02/06

Halmer Grange 27/07/05

Halmer Grange 08/03/05

Halmer Grange 07/10/04

Halmer Grange 17/03/04

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

CARE HOMES FOR OLDER PEOPLE Halmer Grange Grange Drive Spalding Lincs PE11 2DY Lead Inspector David Bacon Unannounced Inspection 10:00 22 August 2007 nd 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 Halmer Grange DS0000041786.V344630.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. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halmer Grange Address Grange Drive Spalding Lincs PE11 2DY 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) 01775 723251 HalmerGrange@lincolnshire.gov.uk www.lincolnshire.gov.uk Lincolnshire County Council Anne Ward Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (3) of places Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: Halmer Grange is a detached three-storey property operated by the Local Authority. It is registered to provide personal care for up to nineteen older people and three people who have needs associated with physical disabilities. Accommodation for residents is provided on the ground and first floor, which is accessed by stairs or a lift. The home is a purpose built property, opened in 1963 and originally designed to care for up to 44 long-term residents. It currently provides accommodation for its two remaining permanent residents. Following a policy of not accepting any more long-term residents the home now provides care to people who need short-term or regular periods of respite care. It also provides intermediate care for up to eight people. The intermediate care bedrooms are all located on the ground floor, with the exception of a room that is used for wheelchair users. There is a separate kitchen, which is used to assist residents’ rehabilitation if needed. Residents who are at the home on a long-term basis have a separate living room but join other residents in the main dining room for meals. In addition on the first floor there is a day centre, which provides day care for up to eight people on a daily basis. Day care is not currently registered or inspected by the CSCI. The home is located in a residential area of the Fenland town of Spalding, which has a range of facilities and services. Copies of inspection reports are maintained in the entrance to the home for service users and members of the public. The range of fees is up to £431 per week. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place during August 2007 and the visit to the home was undertaken over approximately 4 hours. The care received by three service users was looked at in detail. This process is called “case tracking” and care records relating to specific service users were viewed along with general home records and discussions with service users about their experience of the care provided and life within the home. The inspector spoke with five service users, one service users representative and five staff members. Five quality satisfaction questionnaires completed by service users and their representatives were viewed during the visit. Information received about the home since the previous inspection was also viewed as part of the overall review of the service. A partial tour of the premises was conducted including areas relating to the service users who were case tracked. Staff records were also inspected along with policies/procedures and administrative systems. What the service does well: What has improved since the last inspection? Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 6 The staff members spoken with were aware of the correct action needed to be taken in the event of an issue of abuse being identified and some awareness training has been undertaken regarding this subject. What they could do better: 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. Halmer Grange DS0000041786.V344630.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 Halmer Grange DS0000041786.V344630.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, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some systems are in place for the introduction of service users to the home although some improvements are needed with these. Service users are satisfied with the admission process, they can be assured that their care needs will be appropriately met although they are not fully involved in planning the care they receive. EVIDENCE: Halmer Grange now only takes referrals for individuals needing a short stay and for those being part of the intermediate care service although two longterm places remain. Due to the nature of the services provided service users may arrive at short notice and staff spoken with confirmed that service users had occasionally arrived without any formal pre assessment information being received. This puts pressure on staff and may ultimately place service users at risk. It is acknowledged that staff work hard to secure appropriate information Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 9 as soon as possible although basic assessment information must be received prior to a service users admission where at all possible. Admission checklists are in place for each admission although those seen were not fully completed. The care records viewed evidenced where a comprehensive assessment of each service users care needs had been undertaken. The assessment information seen clearly identified individuals care needs and included potential risks and also specific likes and general preferences. Discussions held with service users confirmed that they were satisfied with the homes admission arrangements. Comments included: “Many seem to be poorly when they arrive so probably don’t remember much, all I remember is that they were very kind to me”. “Yes, they showed me information and talked me through anything I needed to know”. “I didn’t really want to come but I have absolutely nothing to complain about, they couldn’t be faulted”. “They help settle you in and you can ask them anything”. The service users spoken with were not fully aware if they had been involved in the assessment process and records did not document that they had all received information about the services provided or their rights. For example, a terms and conditions of residence. Some information regarding the services provided is located in service users bedrooms although this is not consistent. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 10 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, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users feel satisfied with how they are treated and they can be assured that their care needs are met by a well-informed and caring staff team. Procedures for the administration of medication are appropriate. EVIDENCE: A comprehensive “person centred” care plan is completed for each service user from the initial assessment. The records seen clearly documented each individual’s care needs, any goals and how these were being met in the aim of promoting and maintaining independence where possible. Any health care needs are clearly detailed, including any input from supporting agencies and records are continuously updated and reviewed as necessary. The service users spoken with confirmed that they were fully involved in this process, that their individual circumstances were taken into account and that their views were respected. Comments included: “They are very good, very gentle with you but they know what they are doing”. “There’s nothing they Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 11 could do to improve the care, they give you the help you need”. “They are very respectful and I can have a laugh with them”. Information in the homes completed satisfaction questionnaires further confirmed high levels of satisfaction regarding the care provided. The staff spoken with said they received regular awareness training and support specific to service users assessed care needs and to promote service users privacy, dignity, choice, rights and independence of which policies, procedures and records are in place. Staff also confirmed that they felt able to express their opinions to management about the care provided and that these were listened to and acted upon where appropriate. Systems are in place to enable service users to administer their own medicines where this is risk assessed as appropriate. Staff whom administer medication receive accredited awareness training regarding this. Medicines were properly stored and records clearly documented medicines as receipted into the building, as administered and where disposed. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 12 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, 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 able to choose how they spend their time and to maintain and develop community links as they prefer. Service users enjoy the meals provided and their dietary needs are met. EVIDENCE: Service users said that there were no restrictions as to how they could spend their time and that their visitors were made welcome, which was further confirmed by the representative spoken with. Information regarding the promotion of service users rights and dignity is included within the homes statement of purpose and service users guide. Service users comments included: “You are here to get better or to have a break but you can do as you please”. It’s not regimented but they do encourage you to make the most of being here to get better”. “They look after you like it’s a hotel, but help you get better”. Service users said that they enjoyed the meals provided of which a choice of food is available at each mealtime. Comments included: “Meals good, couldn’t wish for better”. “The meals could not be improved”. “I am diabetic but they Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 13 make sure I have the right food, it is very good, no complaints”. “You have a choice, they come round each day and ask what you want”. “I’ve been pleasantly surprised, the food is good overall”. Service users are initially consulted with about their dietary needs and preferences as part of the admission process and this information is forwarded to kitchen staff although records regarding this are inconsistent. The manager said that the system is currently being improved to more clearly record any individual requirements. Meal safety checks are undertaken and records of these are maintained. Service users said that they were aware of some activities being available to them but confirmed that these were insufficient overall. There was limited information regarding the activities being undertaken in the home although it is acknowledged that these are not always recorded. Recent activities have included: quizzes, reflection, sing a longs, bingo and bowls. Service users comments regarding activities included: “Some are not well enough to get involved in activities but there’s enough for me”. “I would have liked more to do, to keep my mind alert”. “There are activities but it would be better if these were spaced regularly, to have something to look forward to”. “There could be more to do, there are some things but you can get bored”. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 14 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable service users to complain about the care they receive. Staff are made aware of how to protect service users from abuse. EVIDENCE: The pre inspection information received indicated that policies and procedures are in place to protect service users from abuse and to enable them to express any views regarding the services provided, which was further confirmed during the visit. The Service users spoken with said they felt able to express any views about the care they received, even if these were negative. Comments included: “They tell you how to complain and the other things when you get here”. “I would tell the staff if I was concerned about anything”. “There is nothing to complain about, there is some information about it somewhere but there’s no need”. Records show that there has been no complaints or safeguarding adult’s referrals since the last inspection visit. The complaints procedure is displayed in the home and information regarding this is located within the service users guide kept in each bedroom. The staff members spoken with were aware of the need to safeguard service users from abuse and the correct action to be taken in the event of a concern Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 15 being identified and confirmed they had received awareness training regarding this. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 16 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, 26 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 comfortable and well-maintained environment EVIDENCE: All the areas seen were clean, tidy and well maintained and a rolling programme of maintenance and decoration is in place along with an environmental risk assessment. The service users spoken with were satisfied with the cleanliness of the home and their own rooms and the comments seen in the homes completed satisfaction questionnaires further confirmed this. Comments included: “Yes, its clean, as clean as it is now”. “My room has been kept nice, there’s no smells anywhere”. “You certainly couldn’t complain about the standard of cleanliness, just look”. Service users are supported to personalise their own rooms during their stay. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 17 Substances identified as being potentially hazardous to health are stored appropriately, and there are information sheets and risk assessments in place providing guidance for staff who confirmed they received adequate awareness training. Call bells were within easy reach of beds and seating areas. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being staffed to meet the current needs of service users. Recruitment procedures and staff training is in place although improvements should be made with these. EVIDENCE: The service users and representative spoken with said that they were fully satisfied with the standards of care provided. Comments included: “You get help whenever you need it”. “I probably wait a moment or two if the staff are busy but not a long time, they are efficient”. “There is care when you need it”. “I don’t want to be here but they could not have tried any harder to help”. “They do everything they can to get you on your feet”. “I’m only here for a short while but they have cared for me very well”. Comprehensive recruitment guidelines are in place and equal opportunity policies and monitoring is included within these. Recruitment records contain application forms, references, criminal record bureau checks, and identification. The staff records seen evidenced that appropriate recruitment checks and procedures had been undertaken overall. However, only one reference had been obtained for one newly recruited staff member. Staff attend induction training upon commencing work at the home although some records regarding this were not available for inspection. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 19 The staff members spoken with were satisfied with the recruitment process and confirmed that they received induction and regular training appropriate for their roles although staff requested further awareness training regarding dementia care. The Pre inspection information received stated that more than 50 of care staff have achieved a national vocation qualification relevant to their work, which was further confirmed during the visit. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 20 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that care is provided in an appropriate manner although action is required to maintain the safety of the premises. Service users are supported to express their views regarding the care they receive. EVIDENCE: The service users spoken with confirmed that they were satisfied with the management of the home, the care provided and that they felt able to express their views about these. Quality satisfaction questionnaires are sent to service users once each year, which are assessed and acted upon where appropriate. Service users comments included: “I don’t know much about these places but Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 21 they really are helping me get better again”. “They all seem approachable and to know what they are doing”. “It’s run well to help people”. The staff members spoken with said they received good management support and that their views were respected. Policies and procedures are in place to protect service users where the home has any involvement in their finances. Monies are kept separate and receipts and records of transactions and totals are maintained. The areas viewed during the visit were well maintained of which records are kept and a risk assessment of the premises had been undertaken, which was updated as necessary. Fire safety tests were appropriately maintained and the home staff receive regular awareness training. Safety tests regarding legionellosis could not be located during the visit and risk assessments were in place regarding this. However, the water tanks had been assessed as having a very high risk of contamination during the most recent maintenance check. This places service users at risk. Staff said that water temperatures were regularly checked although these could not be located during the visit. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 22 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14 (1) c and 13 (4) c Requirement A full needs assessment must be completed for all service users who are admitted. Care assessments must detail all items included within standard 3 (previous timescale 30/11/06 not met). Two written references must be obtained for all staff. Confirmation must be received that the homes water tanks present no risks to service users. Timescale for action 01/11/07 2. 3. OP29 OP38 Schedule 2 (5) 13 4 (c) 01/11/07 01/11/07 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 OP30 OP15 Good Practice Recommendations Staff should sign where they receive induction to the home and a record of this should be maintained. A record of the meals provided to service users should be maintained. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 24 3. OP12 Service users recreational needs should be more fully provided for. Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Halmer Grange DS0000041786.V344630.R01.S.doc Version 5.2 Page 26 - 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!