Inspection on 29/06/09 for Necton Grange

This inspection was carried out on 29th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Necton Grange 16/06/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Necton Grange St Andrews Lane Necton Swaffham Norfolk PE37 8HY     The quality rating for this care home is:   one star adequate 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: Lella Hudson     Date: 2 9 0 6 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 29 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 29 Information about the care home Name of care home: Address: Necton Grange St Andrews Lane Necton Swaffham Norfolk PE37 8HY 01760724161 01760720766 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Caring Homes Healthcare Group Limited care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Necton Grange is a Care Home providing personal care and accommodation for up to 20 older people. The Home has twelve single bedrooms and four double bedrooms. The double rooms can also be used as single bedrooms. None of the bedrooms are ensuite. The Home is an older building and provides accommodation over three floors. The Home does not have a lift but does have chair lifts fitted to the staircases. There is a communal lounge and dining room. The Home has extensive gardens. The Home is situated on the outskirts of the village of Necton and close to the town of Swaffham. The Home was bought by Caring Homes Healthcare Group Ltd in 2007. Fees currently range from £362 to £500 per week. The fees are negotiated individually Care Homes for Older People Page 4 of 29 Brief description of the care home depending on the needs of the residents. Further information about fees can be obtained from the Manager of the Home. Care Homes for Older People Page 5 of 29 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: one star adequate 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: This report contains information gathered about the Home since the last Inspection (June 2008). This includes information provided by the acting manager in the Annual Quality Assurance Assessment (AQAA), information within surveys returned to us by staff and residents as well as information gathered during an unannounced visit to the Home on 29th June 2009. During our visit to the Home we spoke to residents, staff, the acting manager and the regional manager. We looked at a selection of records and spent time observing staff supporting residents. We were also shown around the accommodation. There were eleven residents living at the Home at the time of our visit. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 29 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 9 of 29 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 10 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective pre admission assessments are carried out prior to residents moving to the Home. Evidence: We looked at a sample of care records which include the pre admission assessments. These show that detailed information is gathered prior to a resident being offered a place at the Home. Staff said that they have information about the residents needs prior to them moving in. The acting manager and regional manager are aware of the restrictions that the layout of the Home places on future admissions. The Home does not have a passenger lift. There are chair lifts to the varying levels within the Home. Also the toilet nearest to the lounge is small and not easy to use for residents who have mobility difficulties. Care Homes for Older People Page 11 of 29 Care Homes for Older People Page 12 of 29 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. The residents physical and personal care needs are met in a respectful and kind manner. Medication is managed safely. Evidence: We looked at a sample of the care records and spoke to the staff about the care that is provided to these residents. The organisation has recently introduced a new care plan format which is much easier to use and for staff to find information more quickly. The requirement about care plans that was made at the last Inspection has been met. The care plans that we saw were detailed about the needs of the residents and provide clear information for staff about how to meet the residents needs. The needs of the residents are assessed in a variety of areas such as continence, falls, skin integrity, moving and handling and nutition. The results of the assessments provide the basis for the care plan. There is also evidence that risks are identified and that risk assessments are carried out as needed. Care Homes for Older People Page 13 of 29 Evidence: We saw one example of where a care plan needs to be updated. It states that one of the residents needs two staff to assist them to turn in bed. There is only one waking night staff on duty, with a sleep in member of staff, overnight and so clearly staff are assisting the resident alone. The acting manager and staff said that only one staff is needed to assist the resident. The care plan needs to be updated to reflect this. The care plans contain detailed information about residents choices and preferences with regard to the care that they need. For example, one of the care plans states that the resident chooses not to have a shave every day, another states that the resident prefers puddings to main courses. The staff who we spoke to are aware of the individuals needs and gave consistent answers about the care specific residents require. They are also aware of the importance of offering choices to residents. One of the residents told us that they like living at the Home and that it had been a more positive experience than they had expected. They said that the staff are kind and that they are always respectful. The staff and residents surveys state that there are usually enough staff but that there are times when there are no staff in the lounge for periods of time. Currently there are two care staff on duty during the day. The regional manager said that the staffing levels will increase once more residents are admitted as there are currently only 11 residents living at the Home. Staff told us that there are 5 residents who need two staff to assist them with mobility. We observed staff supporting residents to mobilise and this was done sensitively and with care. We spent some time in the lounge and there were times when there were no staff available for short periods of times as they were both supporting one of the residents. Locks have been fitted to the bathroom/toilet doors to assist with residents privacy and dignity. One of the residents had suggested that an easy to read sign was put onto the downstairs toilet door to indicate whether it was being used or not and this has been done. The layout of the building is on several different levels and there are many different steps and staircases. The organisation have purchased a new stair lift since the last Inspection so that there is now a stair lift to all floors. However, the toilet areas are quite small and can be difficult for residents to use if they also need mobility equipment. The organisation have also purchased new hoists since the last Inspection. We looked at the medication system during our visit. The acting manager has reviewed Care Homes for Older People Page 14 of 29 Evidence: the system and has made improvements as she had identified some areas that needed to be changed to ensure a safe system was in place. There are notices reminding staff of important issues displayed in the areas where medication is stored. Medication is stored safely and records are kept of medication received at the Home and that which is returned to the pharmacy. There is guidance available for the use of PRN (as required) medication but this needs to be more clear. Care Homes for Older People Page 15 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to join in with a range of activities. The residents dietary needs are met and they are offered a choice at mealtimes. Evidence: The Home does not have an activities organiser at present. The acting manager has introduced a plan of activities that take place during the afternoons. The residents told us that they are really enjoying these and that they have included baking, gardening, art work and games. We saw that the residents art work is on display around the Home. There are also plants around the Home which the residents have potted. There are photographs of the activity sessions on display in the entrance hall. The Home has large gardens but residents told us that they are unable to sit out there easily as there are only benches to sit on. We saw staff assisting residents to go for a walk in the garden during our visit. The residents care plans contain a nutritional assessment as well as information about Care Homes for Older People Page 16 of 29 Evidence: their likes and dislikes. Residents are regularly weighed and there is evidence that action is taken to address any changes in weight. Residents told us that they enjoy the meals and that they are always offered a choice. They said that they are able to have meals in the dining room, the lounge or in their rooms. One of the residents told us that they enjoy having breakfast in their room so that they do not have to rush to get dressed in the morning. The cook has a good knowledge of the residents dietary needs and also what they prefer. She said that wherever possible fresh fruit and vegetables are used. The organisation has arrangements in place for ordering and delivery of food from a large company rather than the cook using local suppliers. We observed a mealtime. The tables were nicely set and residents sat in small groups in the dining room which has lovely views into the garden. Support was provided to those residents who need assistance at mealtimes. Care Homes for Older People Page 17 of 29 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. Complaints are taken seriously and action taken to address issues. Procedures and staff training are in place to protect the residents from abuse. Evidence: The Commission have not received any complaints about the Home since the last Key Inspection. The acting manager showed us the complaints record. We also saw the minutes from the residents meetings. These show that residents are encouraged to raise any concerns/issues/suggestions that they may have. Examples could be seen of action having been taken following the meetings, such as the provision of a sign on the outside of the toilet door. We spoke to two residents who told us that they feel safe at the Home and that they would speak to staff if they wanted to make a complaint. The organisation has a complaints procedure which is on display in the Home. Staff receive training from the organisations trainer with regard to Safeguarding and this is updated on a regular basis. The regional manager said that they are considering whether staff will also attend the training provided locally to ensure that they have a good understanding of the local Safeguarding procedures. The acting manager is aware of the procedure for making a referral to the Safeguarding team. Care Homes for Older People Page 18 of 29 Evidence: The organisation are also providing training about the Mental Capacity Act and the Deprivation of Liberty Act. There is information about these and about advocacy groups available in the hallway of the Home. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides comfortable and homely accommodation for the residents. The organisation has not addressed the risks associated with the temperature of the hot water or the uncovered radiators. Evidence: We were shown around the Home. As previously mentioned the Home is on several levels and there is no passenger lift although there are stair lifts. This does limit the residents whose needs can be met at the Home. The majority of the requirements made at the last Inspection with regard to the accommodation have been met. For example, the organisation have purchased new hoists, the shower room has been completed, new bedding has been purchased, locks have been fitted to bathroom doors and the fire doors have new closures on. However, the situation regarding the hot water has not been addressed. The regional manager said that the hot water regulaters are due to be fitted shortly. It was also noted that there are radiators in bedrooms and corridors that have not been covered to prevent possible scalds. The acting manager has already highlighted this issue to the organisation. None of the bedrooms in the Home are en suite. Some of the bedrooms have been Care Homes for Older People Page 20 of 29 Evidence: attractively redecorated and refurbished. There is evidence that residents are encouraged to bring in personal items to make their rooms more homely. The Home has a large lounge and dining room that have views to the garden. These are decorated in a pleasant and homely way. There is also a small lounge at the other end of the building but this is not easy for all residents to access due to it being on a lower level. The organisation employs domestic staff during the week. The Home was clean with no unpleasant odours on the day of our visit. Care Homes for Older People Page 21 of 29 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. Staff receive appropriate training and support to carry out their roles effectively. Recruitment procedures ensure that appropriate checks are carried out prior to staff starting work at the home. Evidence: As previously mentioned in this report there are currently two care staff on duty during the day and one waking and one sleep in staff on duty over night. There were 11 residents living at the Home at the time of our visit. The acting manager and the regional manager are aware of the need to increase the staffing levels as the number of residents increase or if the needs of the current residents increase. The Home has a stable staff team and there has been little turnover of staff over the last few months. The Home employs a cook and kitchen assistant seven days a week. There are also domestic staff although there are no domestic staff currently working at weekends. It is recommended that the number of care staff on duty is increased if domestic staff are not employed at weekends to reflect the fact that care staff are having to carry out domestic and laundry duties, although only the residents personal laundry is done on the premises. The staff told us that they feel that they work in a good team and that there is good Care Homes for Older People Page 22 of 29 Evidence: morale in the Home despite the fact that there have been three different managers at the Home in the last year. Staff who spoke to us have a good understanding of the needs of the residents and gave consistent answers to questions about the care that the residents need. Staff receive training in mandatory subjects and in some additional subjects such as diabetes and pressure care. Training is provided in different ways including by the organisations own trainer, Elearning using the computer and also through external trainers. The organisations trainer provides induction training to new staff. The acting manager has audited the training records and the results were provided to us during our visit. These show that the majority of staff have attended mandatory training. The regional manager said that there were further dates booked to ensure that all staff have received updates as necessary. We looked at a selection of staff files and could see that appropriate checks are carried out prior to staff starting work at the Home. Care Homes for Older People Page 23 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been several changes of manager in the last year but a new permanent manager has been appointed. The acting manager has made some improvements in the short time that she has been at the Home. The Home has an effective quality assurance system and involves the residents in reviewing the service provided. The health and safety of the residents has been put at risk by the organisations failure to address the hot water situation. Evidence: The Home has had three managers since the last Key Inspection (2008). Currently the Home is being managed by an acting manager who usually works at another Home owned by the organisation. She has managed the Home for three months and has made several improvements in that time. The staff spoke positively about the acting managers style of management and of the support that she has provided to them. We observed the acting manager with residents and staff and she has built good Care Homes for Older People Page 24 of 29 Evidence: relationships in a short period of time. She has a good understanding of the needs of the residents. The regional manager has provided additional support to the acting manager and said that a new manager has been appointed to manage the Home and is due to start work shortly. The regional manager carries out monthly visits to the Home and provides a report following these. There is evidence that action is taken to address issues arising from these visits. Staff said that they have received a formal supervision from the acting manager as well as the fact that she is available for support whenever they need to speak to her. There is also an oncall system in place for out of hours support. Formal supervision has not always taken place as regularly as it should have due to the changes in manager and the fact that there have been short periods of time when the Home has not had a manager in place. However, staff said that they feel well supported and the regional manager will ensure that the new manager carries out supervision appropriately. We looked at a selection of health and safety records and could see that regular safety checks are carried out on the hoists and the fire safety equipment. The most recent safety certificates for the hoists were not in the file but the regional manager checked with the Head Office and confirmed that they had been sent there rather than to the Home. Regular fire drills take place. A fire risk assessment has been carried out which is due to be reviewed by the manager. The regional manager said that the recommendations in the latest Gas Safety check have been carried out. The Home has a folder of generic risk assessments which have recently been completed. At the last Inspection it was noted that the hot water was very hot and was not regulated. A requirement was made that this was addressed by the end of June 2008. This has not been addressed although the regional manager checked with Head Office whilst we were at the Home and they said that the work will be carried out shortly. Weekly checks are carried out on the hot water temperatures and these show that the hot water is still regularly coming out at higher than recommended temperatures. We also noted that there are some radiators in bedrooms and corridors that have not been covered and could therefore pose a risk to residents. Individual risk assessments have not been carried out with regard to this situation. The organisation has an effective quality assurance system in place. The manager is Care Homes for Older People Page 25 of 29 Evidence: responsible for completing monthly reports for the regional manager and regular audits of different aspects of the service are carried out. The organisation has a quality assurance assessor who has recently carried out a full audit of the Home. The Home has regular staff meetings and residents/relative meetings at which everyone is encouraged to take part in and to raise any issues. Records show that action is taken to address issues as they arise. We also saw the most recent questionnaires that have been returned to the Home and these contain positive responses and comments about the service provided at the Home. We looked at the system in place for looking after residents money and checked the records relating to one resident. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 38 13 (4) (c) A safe system must be in place with regard to the hot water to protect the residents from scalding/burns 30/06/2008 Care Homes for Older People Page 27 of 29 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 9 13 It is required that the PRN guidance is clearer to ensure that the residents receives medication at appropriate times 31/07/2009 2 38 13 It is required that the hot water is regulated To prevent scalds or burns to the residents 31/07/2009 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 2 27 38 It is recommended that the staffing levels are increased at weekends It is recommended that the radiators are covered Care Homes for Older People Page 28 of 29 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. 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