CARE HOMES FOR OLDER PEOPLE
Innage Grange Innage Lane Bridgnorth Shropshire WV16 4HN Lead Inspector
Patricia Scott Announced 26 April 2005 09:30
th 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 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. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Innage Grange Address Innage Lane Bridgnorth Shropshire WV16 4HN 01746 762112 01746 765802 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Coverage Care Shropshire Limited Mrs Julie Roberts Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Dementia (DE) Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd December 2004 Brief Description of the Service: Innage Grange is a care home registered to provide accommodation and personal care for a total of fifty two older people; twenty one of whom may have an associated mental health disorder, and eight beds being dedicated to the provision of respite care. The Home is owned by Coverage Care (Shropshire) Ltd, and managed by Mrs Julie Roberts. It is a purpose built, single storey, brick building, divided into five discrete units, each providing single-room en-suite accommodation. Two of the Units cater for residents with confusional disorders, and the remaining three are for elderly frail clients. The units are linked by an ‘internal street’ setting, incorporating a small shop leading to communal space for the whole Home, a small library and ‘craft room’ - with each Unit having its own communal, recreational and dining space. The gardens are well maintained, with sitting areas, and are accessible to individuals of all abilities. Bridgnorth Town Centre is within walking distance of the Home allowing relatively easy access to all amenities, including a variety of shops, library, pharmacy and local hospital. Innage Grange has the additional benefit of its own minibus enabling access to all local health-care community amenities, and for social outings. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on the 26th April 2005 between the hours of 09.45 and 13.30 and was announced. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s claims to be able to meet service user requirements and expectations were being fulfilled. What the service does well:
The home provides for the needs of elderly people including those with dementia through small group living and a variety of activities. Service users were seen to be treated in a respectful and dignified way and relatives spoken with confirmed this. The quality of care that service users receive in their last days is as important to staff as that which they experience prior to this. This means that their physical and emotional needs are met, pain and distress is controlled and their privacy and dignity preserved. After appropriate risk assessment, service users are not discouraged or unduly restrained from undertaking activities solely for fear that for example, they may hurt themselves. The building is used for a number of purposes as it also incorporates day care facilities. The way in which this is managed protects the privacy of service users whilst allowing the building to be used in other ways. A service user commented that in being able to use all areas he felt he can ‘go out’ without actually having to do so. The tension between ‘outside world’ and ‘home’ has been successfully addressed at Innage Grange.
Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 6 Coverage Care provides training to a level that creates a trained and experienced staff team that is well managed. Service users living in care are often vulnerable both physical and emotionally and the manager ensures that staff are recruited with the ability to carry out personal services for people sensitively and tactfully. The recruitment of good staff is critical to the running of care homes and the manager at Innage Grange undertakes this carefully. Through discussions with the manager, the principles that should govern life as stated in the statement of purpose, focus on the importance of promoting service users’ independence through enabling them to make their own decisions, fostering their individuality, sustaining family and community contacts and ensuring that they are satisfied with the quality of life and care in the home. From this recognition flows a style of management which enables service users to make decisions for themselves, choose the way in which they spend their time, build friendships with whom they wish, and find satisfaction in living in the home environment. The manager sets the tone and style of the home in terms of its efficiency, probity, concern for service users and staff and its relationships with the outside world. A good leader can have a major impact on the way care is delivered and the National Minimum Standards that are achieved or exceeded. Mrs Roberts drive and enthusiasm and evidence at this inspection have clearly demonstrated this. What has improved since the last inspection? What they could do better:
As there were no Regulatory requirements made at the last inspection in December 2004, this inspection focussed on the manager’s future plans and vision for improving the quality and type of service provided. This is included in the main body of the report under the managerial section. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 8 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 Standards Statutory Requirements Identified During the Inspection Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 9 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 standard(s) 1 and 3 The homes statement of purpose and service user guide is good providing service users and prospective users with details of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The statement of purpose and service users guide have been updated for March 2005. A copy has been provided to the CSCI. The information provides details of needs assessment to be conducted prior to admission and examination of care plans on the units confirmed that this process had been carried out. The home provides respite care and a service user who was receiving such a break in the home stated that the transitions between the home and their own home always went smoothly and they ‘looked forward’ to coming to stay. Another service user who had following some months of receiving respite care moved into Innage on a long-term basis. This way they had been able to experience the advantages and disadvantages of moving into a care home and had received great support from the staff in coming to a decision.
Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10, 11 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Personal support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life as well as at the end of life. EVIDENCE: Care plans looked at for 4 service users were consistently completed and had all the useful information in them that is necessary to enable a care worker to provide the right care for that individual in a way that meets their wishes and preferences. Ascertaining such information can be difficult when an individual has dementia or mental health problems and records provide evidence of consultation with families and other supporters. The information that was read showed that individuals receive the level of care which their own situation requires. Communication is an important aspect of care of elderly people and a relative spoken with on the day confirmed that the home does this well. This interaction was evident during the inspection in discussion with staff and
Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 11 relatives which is helpful in sharing their understanding and knowledge of the service user. Visits by other health care professionals are documented e.g. GP, Physio. Regular monitoring and review of a service user’s condition takes place to ensure that the correct treatment and care is being given. A care record was seen of consultation with an Occupational Therapist for discharge from hospital to the home including involvement of the relatives. Staff were heard talking with service users in a respectful manner and of noting their movement about the home in a discreet way, e.g. one care assistant was heard to offer a service user a cup of tea as she had missed out earlier because of going to her room to fetch something. There was evidence of empowerment of service users. This was confirmed with a service user who had locked her bedroom door to which she held her own key. Innage Grange has scored a 4 for standard 8. This is because there is health information which is positively beneficial for service users that is displayed on notice boards in large print in the ‘street’ area. Service users can read this at their leisure. They have also scored a 4 for standard 10, the evidence for which is reflected throughout other standards in this report. Wherever possible continuity of care for the service users’ declining state of health is assured. District nurses are located close to the home and are called upon to assist with clinical help and advice where necessary. A bereaved relative took time to speak to me about the care that the staff at Innage Grange had given to her relative who had died that morning. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. EVIDENCE: There is no imposition of rules or routines within the home. A service user commented that he had wanted to spend the morning in his room and that staff had been respectful of this. He stated that staff pop in from time to time and that he had never been left for long periods. His call bell was within reach. Service users with dementia can move within the home and gardens and are not confined to their unit. Individuality is maintained as service users have their own rooms, places to withdraw to from busy active communal areas, opportunities to prepare food and drink for themselves and choice over when they get up and go to bed. Service users spoke freely of their past experiences, interests ad life histories which had been mirrored in some of the activities planned e.g. a recent service user had been president of the camera club and slide shows had been arranged within the home. Other hobbies such as Women’s Institute, tea dances had been arranged with service users past memories in mind. Several service users were on the way out to a garden centre followed by lunch.
Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 13 Service users were being enabled to vote in the coming election through postal votes. Staff spoke of ascertaining their views about the various political parties. Standards 12 and 14 have been exceeded because of the managers intention to improve the provision of this area by encouraging service users to be more self-directing in the service users meetings and planning of their own social life but supported by the staff. The manager also wishes to enhance outside interest and influence in social activities within the home. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed at this inspection. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 15 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 standard(s) 19, 23, The standard of the environment within this home is excellent providing service users with an attractive and homely place to live. EVIDENCE: A general tour of the bedrooms and communal spaces demonstrated that the home is purposely designed into small group units each with its own lounge/kitchenette/dining area and courtyard gardens. These were all in an excellent state of repair and comfortably furnished. It is easy for service users, elderly frail or those with dementia to find their way around the building. The connecting ‘street’ area allows for participating in the hubbub of daily life or service users can retreat to one of the quieter lounges. There are few ‘dead ends’ and most corridors lead out into a lounge area that enable service users to mix with each other if they wish to. The garden areas are safe and accessible to all. The home achieves a score of 4 for standard 19 because of the successful way in which staff and management use the building for the benefit of service users.
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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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29,30 The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. There is a good match of well-qualified staff offering consistency of care within the home. EVIDENCE: Examples of staff induction folders were seen that meet with TOPSS requirements. The home demonstrated that its recruitment procedures are carried out through staff files examined. These were in excellent order. Relevant training has been provided and staff spoken with confirmed this. Staff are offered financial support, subject to approval, for individual professional development. Staff observed carrying out their duties were seen to be responsive and understanding of individuals wishes and needs. The staffing establishment and rota are arranged so that there are enough senior staff and are deployed to give the cover required to meet the home’s stated aims. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 38 The manager has a clear development plan and vision for the home that will enhance the facilities even further and if taken up by Coverage Care will increase the level of service available to be commissioned by the Local Authority. EVIDENCE: All standards assessed have achieved a 4. Safety checks are carried out as seen in fire records and hot water testing. The Pre-inspection questionnaire stated that all other appliance and service checks had been updated. The manager possesses all the relevant qualification required within the standards. Discussions demonstrated that she continues to strive for excellence and find innovative ways to provided the service to the ‘community’ that is involved with the home be it service users, visitors, day care, relatives, in-house staff and outside health care professionals, etc.
Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 18 Future ideas include plans for a therapy room with kitchen assessment area. The home has very close liaisons with Social Services and Health Professionals with whom the manager would like to set up a specialised intermediate care service on a formal basis. A watered down version of this currently takes place at Innage Grange with the respite care and day care facilities but Mrs Roberts would like to provide such a service in a purpose built unit and thus vary her conditions of registration. Quality assurance surveys are conducted, as well as having leaflets available in the foyer for anyone to make comments on ways in which the service could be improved. None of the service users spoken with said they would have any hesitation about talking to staff or the management about any concerns. Quality assurance was seen to take place throughout the inspection whether it was in conversations with service users, monitoring of the plans of care, leaving someone to sit in peace and then returning to ensure all was ok. Comments received prior to inspection included “the quality of care is excellent. Staff are professional, caring and very friendly”…..”I am absolutely delighted with every aspect of Innage Grange”….”very pleased all-round”. Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 N/A 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 N/A
COMPLAINTS AND PROTECTION 4 N/A N/A N/A N/A N/A N/A N/A STAFFING Standard No Score 27 3 28 N/A 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A 4 4 4 N/A N/A N/A N/A 4 Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 20 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 Regulation Requirement There were no requirements identified as a result of this inspection. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Innage Grange E56 S20726 Innage Grange V206037 AI 260405 Stage4.doc Version 1.20 Page 21 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn, Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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