CARE HOMES FOR OLDER PEOPLE
Le Grand Preston Old Road Freckleton Preston PR4 IHD Lead Inspector
Christine Marshall Unannounced 18 August 2005 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. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Le Grand Address Preston Old Road, Freckleton, Preston, Lancashire, PR4 IHD 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) 01772 679300 01772 679669 legrandnursing@hotmail.com Dr Maganlal Khimchand Vachhani Mrs Nootalkumari M Vachhani Mrs Deborah McLean Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate one named person under 65 years of age within a maximum of 28 people. 2. To accommodate one name person under 65 years of age for 2 weeks respite care within a 12 month period. Date of last inspection 09/02/05 Brief Description of the Service: Le-Grand Care Home with Nursing is located in Freckleton and offers care and nursing to 28 service users aged 65 years and over; the home has a condition of registration for two named service users under the age of 65 years. Accommodation is provided in a purpose built, single storey environment.All bedrooms meet the National Minimum Standards size requirements and have en-suite facilities. Each room is furnished to a satisfactory standard and personal possessions are welcomed with each service user. There are three lounges and a dining room.There is adequate parking for visitors. A bus route is close by as is the village with all its facilities and services such as shops and post office. The home is owned by Dr and Mrs Maganlal Khimchand Vachhani and the registered manager is Mrs Deborah McLean. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first of two unannounced inspection visits, scheduled from 1st April 2005 to 31st March 2006. The inspection took place during the afternoon and was carried out by the home’s designated lead inspector. The inspector undertook a full tour of the home, including bedrooms, lounge and dining areas, laundry area and toilets and bathrooms. Plans of care for the people living at the home were examined, as were the policies and procedures for the management of the home. Comment cards from residents and their families were received prior to the inspection and were all very positive and indicated that the residents are satisfied with the care that they receive. Visiting professionals such as Social Workers also returned comment cards that were positive about the care at the home. The inspector spoke privately with four of the residents, and had group discussions with other people living at the home. There were four relatives available during the inspection visit. The owners, manager and staff were friendly, welcoming and co-operative with the inspector throughout the visit. What the service does well:
Le Grand provides a pleasant environment for the people who live there: There is relaxed atmosphere throughout the home. There are three lounges and a dining room; the lounges are very homely and the dining area is pleasant with nice table settings in place. The fabric and furnishings of the home are of a good standard and the home is kept clean and hygienic.
Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 6 The inspector found the carers friendly and professional in their approach to care and the residents spoken to said that the staff were all very nice. Daily routines for the people living at Le Grand are flexible and the residents told the inspector that they enjoyed their own personal routines and lifestyles, particularly those who preferred a quieter day. Meals are good and all of the residents that were spoken to during the visit said that they were very satisfied with the quality and variety of meals that are provided. One resident told the inspector “The food is good, I couldn’t grumble at all.” Their garden areas are nicely maintained. The care staff told the inspectors that they took the people who live at the home on regular outings and the residents confirmed this. One relative had written on a comment card that the staff had “done their utmost to help and care for her husband” and that she would share this opinion with anyone who asked. The staff are friendly and understand the personal needs of each resident; the inspector observed good interaction between the staff on duty and the people living at the home. Comments from the residents included: “I am very comfortable here.” “The staff are lovely.” “I feel safe and secure.” “I have no complaints at all.” Relatives told the inspector that they were very happy with the care that was given, one relative saying ”I am more than happy with the home, it is the best place for my husband to be.” What has improved since the last inspection?
New crockery has been provided for the residents. The corridors have been re-painted. The shower in bathroom 3 has been re-grouted. All complaints outcomes are now recorded fully. Care plans fully reflect risk assessments for issues of potential restraint and include the individual service users’ choices in respect of bathing times and modes of dress.
Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 7 All hazardous substances are kept locked away. The fire door to Carl’s Lounge corridor has been repaired. Commodes are free from sharp or potentially harmful back rests. 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. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 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 Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 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) 1,2,3,4 & 5 Anyone who is considering entering Le Grand is supplied with enough information to help them make that decision. The home also gathers enough information about that person to ensure that their needs can be met. This means that people can make good choices and receive the care they require. EVIDENCE: There is a Statement of Purpose and Service Users Guide in place; this is a set of written information that tells you about the care service that is offered, who the manager and staff are and what the resident can expect if he or she decides to live at the home. Residents told the inspector that they were invited to the home to meet the staff and other residents, prior to making their decisions: Care staff confirmed this. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 10 Personal assessments are done before any person is admitted to the home, so that a clear picture of the care that is needed by each individual is prepared. The inspector looked at the files of the three most recently admitted residents to the home and each had a completed re-admission assessment of care needs in place. The manager told the inspector that trial periods of stay are offered so that if the resident is not happy, then a review can be done to decide whether or not the resident is in the right home for the care that he or she needs. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 11 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 The residents’ health and social care needs are met and people are treated with dignity and respect at this home. Residents are fully supported in their daily lives. EVIDENCE: Care plans are written records of the care that is given to each person that lives at the home and the inspector looked at three; each of these plans was satisfactory and each had been reviewed to make sure that the right care was being given. Those residents who were able told the inspector that they knew about their care plans and that they were happy with these. Residents spoken to also told the inspector that they had the GP of their choice and that they had regular visits by the chiropodist, dentist, optician and also hearing aid services.
Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 12 The residents remarked that they were happy at the home and that the staff were very kind; they also said that their privacy and dignity is always looked after. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 13 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 Residents are supported in their expectations and preferences of daily living and benefit from a flexible approach to their care needs. EVIDENCE: The inspector spoke to a number of residents and each one said that they enjoyed having their relatives visit and that they were always welcomed by the staff at the home. There are activities arranged for the residents and these include card games, quizzes and outings. A comment from one resident was “I do enjoy our trips out and sitting in the garden on a nice day. The home has a key-worker system which means that each carer takes special responsibility for individual residents and attend to the personal and social side of their care. Each key-worker writes in the activities diary about the time that they have spent with their residents; examples of this are manicures, helping to choose clothes and make-up, entertainment and personal outings. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 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) 16,17 & 18 Residents are able to voice their complaints and know who to speak to if they have any concerns. Adult protection and quality checks are in place, which means that residents live in a safe environment where their satisfaction is assured. People’s legal rights are promoted at this home. EVIDENCE: There is a written complaints procedure for the residents and their relatives; this is included in the information pack that is given to every prospective resident. There have been no complaints at the home or to the Commission for Social Care Inspection. All of the residents spoken to told the inspector that they had the opportunity to vote if they wished. They also said that they could get in touch with their relatives, solicitors or anyone else that they might need for help, if they wished: There is advocacy information available for anyone who is without relatives and who might need someone to speak on their behalf. Residents told the inspector that they had no complaints at all. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 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) 19,20,21,22,23,24,25 & 26 Residents are provided with clean, homely and pleasantly furnished surroundings and bedrooms are personalised and comfortable; this means that people feel at home, with their photographs and belongings around them. EVIDENCE: Each bedroom is personalised according to the residents’ wishes, with pictures, photographs and small items of furniture. All of the bedrooms have en-suite facilities and there are adequate toilets and bathrooms throughout the home. The inspector saw that there are aids and adaptations such as grab rails in toilets and special lifting and bathing hoists for the residents who need help with their mobility. There are also assisted baths for residents that cannot get in and out of the bath without help.
Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 16 One resident was in bed when the inspector visited and was able to speak and say that they were happy with the home; their comment was “I am very comfortable here.” Laundry systems make sure that there are no problems with cross-infection and the laundry area is kept clean and tidy. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 17 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 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 & 30 The residents care needs are met through adequate levels of staff, who mainly have the appropriate qualifications and experience necessary for the delivery of a good care service. EVIDENCE: The list of staff on duty showed that there are satisfactory levels of carers and domestic staff on duty at the home. The inspector spoke to carers and the kitchen staff, who were very helpful and showed that there is a good mix of people in place. The manager puts the training information onto a graph that shows at a glance which staff have had training and in what areas, for example food hygiene or first aid: This makes sure that the staff have the training they need to be able to take care of the residents properly. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 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 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) 31,32,33,34,35,36,37 & 38 The home makes sure that the best interests of the residents are protected in that there are regular quality checks that focus on the quality of care that is provided. EVIDENCE: The manager Mrs Deborah McLean is a Registered Nurse who holds the Registered Managers Award. The care staff told the inspector that there is an open and clear leadership within the home and residents said that they were more than happy with her approach. The home has achieved the Investors in People (IIP) quality system: This is a recognised method of checking the quality of the care systems in the home.
Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 19 All records are stored in locked filing cabinets and staff look at them only when they need to find out about that particular person’s care needs. The inspector looked at the home’s financial systems and these were all satisfactory. The inspector examined the Health & Safety check records and equipment servicing certificates, and all were current. The manager told the inspector that she was aware of all of the Health & Safety regulatory requirements in respect of the home. Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 3 Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 21 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 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 Le Grand F57 F09 S6054 Le Grand V227086 180805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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