Inspection on 30/09/07 for Norton Grange

This inspection was carried out on 30th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Norton Grange 04/01/10

Norton Grange 02/10/06

Norton Grange 29/03/06

Norton Grange 15/08/05

Norton Grange 10/02/05

Norton Grange 08/07/04

Norton Grange 16/02/04

Norton Grange 01/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Norton Grange 46 Tern Grove Kings Norton Birmingham B38 9DN Lead Inspector Monica Heaselgrave Key Unannounced Inspection 30th September 2007 12:50 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 Norton Grange DS0000033520.V348060.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. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norton Grange Address 46 Tern Grove Kings Norton Birmingham B38 9DN 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) 0121 675 6350 0121 458 1143 Not known Birmingham City Council (S) John Christopher Wilkins Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the home is registered to accommodate 20 people over 65 years who are in need of care for reasons of old age. Registration category will be 20 (OP) That minimum staffing levels are maintained at 3 care staff throughout waking of 14.5 hours. That additional to above minimum staffing levels there must be two waking night care staff. 2nd October 2006 Date of last inspection Brief Description of the Service: Norton Grange is a care home, owned and managed by Birmingham City Council. It is located in a residential area of Birmingham, set back from a main road where public transport can be accessed. Shops and community facilities are not located near to the Home. The Home was a purpose built two-storey building. Accommodation and care is provided on the ground floor. All bedrooms are for single occupancy, with toilets and bathrooms for communal use. Toilets and bathrooms are suited to those people who require assistance. Facilities meet the needs of people living at the home. There is level access for wheelchair users to the front entrance and throughout the home. Corridors are spacious and allow people to move around the home freely and safely. The home has hoisting equipment and adaptations available to support people who require assistance with mobility. An accessible well maintained garden area is available for people to enjoy. Facilities are split into two units, each with a dining room and kitchen. There are separate lounge areas where people can choose to socialise. A separate corridor has the laundry, store rooms, staff room and office accommodation. There is a separate Asian Elders Day Centre operating from the Home, this has it’s own facilities. At the front of the Home there is a ramped access and parking space for a number of vehicles. To the rear and sides are garden areas, which are utilised by the people who live at Norton Grange. Inside the home, the reception area has notice boards, which display Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 5 information about forthcoming events and other articles that may be of interest. The current charge for living at the home is £64.65 per week low rate, £136.00 higher rate for respite care. Additional charges include chiropody, hairdressing, and outings. People wishing to have a service from Norton Grange are advised about fees and what they include in the Statement Of Purpose and Contracts. Fees are subject to change, readers are advised to seek information on this from the Home. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out between 12:50 and 8:10 p.m. The inspection included talking to people who live in the home, visiting relatives, staff and the Assistant Manager. The inspector spent time observing support and interactions from staff, had a tour of the premises including peoples bedrooms, looked at care records and health care records and medication management. Health and safety records and staffing records were also assessed. All information looked at was used to determine whether peoples varied needs are being effectively met. The manager completed an AQAA (annual quality assurance assessment), which tells CSCI about how well the Home is performing and achieving outcomes for the people who live in the Home. It also provides some factual information about the Home. Information from the AQAA was used to help inform the inspection process. Questionnaires were not sent out to people living in the Home or their relatives as part of the fieldwork for this inspection. Four service users were identified for close examination this included reading their care plans, risk assessments daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for people who live at Norton Grange. Norton Grange was last inspected in October 2006. At that time the manager was required to address ten requirements to improve the care of the people living at the home. All except two of these have been addressed. No new requirement was made as a result of this inspection. What the service does well: There is comprehensive information about the service the home offers and this is presented in many ways to ensure people who live at the home have the information they need before making a decision to move in. Some people who have had a stay in hospital have moved into Norton Grange for a short period to help them recover and return to their own home. There are good plans in place to show how their needs are to be met during their stay. The staff team have also had training specific to the needs people present, ensuring their needs can be met in a competent way. One person commented, ‘I think the staff are very kind, they help me with lots of things, like bathing, making sure I have my meals or my walking stick’. Health concerns are identified quickly meaning the needs of the people who live in the home are addressed in a timely manner. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 7 There are good arrangements in place to show how the nutritional needs of a person are met. Staff relate well to the people that they care for, and showed skill in engaging those who had dementia. This ensures an inclusive approach for those people who find it difficult to initiate activities or conversations by themselves. People described staff positively, for instance ‘I like the staff they always make time for me’. People appeared well cared for with personal care needs met in a positive manner. Staff had a clear understanding of the need to protect people from potential abuse and know what to do when they have concerns. There are good systems in place to manage complaints, this gives people who live in the home confidence to use procedures. Recruitment procedures are robust ensuring that appropriate checks have been carried out before staff are employed to work in the Home, this gives greater assurances that vulnerable people will be safeguarded from risk. There are good arrangements for managing peoples’ finances ensuring these are safeguarded. Norton Grange provides a clean, friendly, welcoming, wellmaintained and comfortable environment for the people who live there. Ongoing training opportunities have ensured that staff have the skills to meet the particular needs of the people who live in the home, and provide a skilled team of carers who provide continuity of care. An experienced manager provides effective and competent leadership for the staff. The outcomes for the people who live at Norton Grange have improved through supporting them to have their say on how the home is run. Comments such as, ‘Staff do ask us about the meals, the activities and whether we have any concerns, and they do try and change things to suit, but you can’t please everyone all of the time, generally they are good and listen to us’. What has improved since the last inspection? People have a clear care plan which identifies how their needs are met, where they require support, and what things they enjoy doing. It was positive to see that their care is planned and structured to ensure they have similar opportunities as their peers. Risk assessments have been improved and now give good detail to staff as to how a person likes to be cared for and how any risks are to be minimised. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 8 The daily records for the people living in the home have good detail, which helps to identify how their general well being and needs are met. Improvements have been made to the medication procedures ensuring people who live in the Home receive their medication in a safe manner. Toilet facilities have been partitioned providing improved privacy for people who live in the Home. Monthly visits by the Homes representative are more consistent ensuring that the service provision is monitored and the views of people who live in the Home are actively sought. Staffing levels have been maintained ensuring that a competent staff team can meet the needs of people who live in the Home. Staff regularly check the temperatures in the home to detect any fault in the heating,this has ensured that people who live in the Home are kept warm and comfortable. 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. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 9 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 Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 10 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): 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessment procedures ensured the needs of the people being admitted were known and could be met by staff. People moving into the home were able to visit prior to admission if they wished and were being issued with a contract that detailed the terms and conditions of their stay. EVIDENCE: Norton Grange has been involved in providing interim care to people who are discharged from hospital. The assistant manager said that this is a facility for those people who no longer require hospital care, but need some support prior to returning to their own homes. This can be for a period of a few weeks. It is not a rehabilitation service where people may require therapy or treatment. The people who have been referred for interim care are people who need some support to get well, over a short period of time, most are already considering residential care. The inspector was informed that arrangements are in place to support Norton Grange in this aspect of the service, this includes improvements in carrying out Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 11 hospital visits to prospective clients, and ensuring that all the necessary records and assessment of needs are in place, prior to a person moving in. Thorough assessment of need ensures that the manager has the information necessary in forming a judgement as to whether they can be certain to meet the assessed needs of a person. There have been eight referrals for interim care, of these three have moved on to other residential units, four people are now long-term at Norton Grange and one person is considering sheltered housing. There are arrangements in place to review the care package on offer. Reviews take place at three and six week intervals to ensure that the needs of the person can be met effectively by Norton Grange. Norton Grange does not have dedicated staff resources or facilities for people on interim care, but support arrangements had been put in place so that the needs of the individual can be met during their short stay. This included the district nurse who in one instance organised wound care from the district nurse team. It was also evident that training was arranged for the care staff to support another person who required a colostomy bag. A third person was able to confirm that during their stay at Norton Grange opportunities are made available to develop independent living skills such as making drinks, and small meals in the kitchenette, and looking after ones’ own personal care needs. Information from the AQAA (Annual Quality Assurance Assessment) identified that Norton Grange is aware that they need to work more closely with the Local Health Authority in supporting people to return successfully to their own home. The files for three people admitted to the home on a long-term basis since the last inspection, were sampled. All the files included copies of comprehensive assessments undertaken by the manager of the home prior to the admission of the individuals. Areas looked at during the assessment were health, abilities, needs in relation to personal care and memory. The assessment also included a summary of more personal routines and preferences, which were detailed under ‘About Me’. This had a short personal profile of the individual which related to their needs and or history, such as; I have two daughters and enjoy bingo and the Pineapple club’. ‘I like to be called………. and come from a large family’. These gave a good personal profile of the person and their history. It was particularly nice to see that these had been produced in large print making it easier for the individual to read information about them. The inspector spoke with a visitor, their comments were positive, ‘Dad had a visit from the manager in hospital. The staff was friendly when we met them and gave us lots of information about what the home offers before we made Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 12 the decision. Dads’ routines and preferences were written down so that staff could look after him the way he likes. His room is nice and staff always keep us informed, we are really pleased, dad is well looked after.’ The systems in place now have all the key elements of good practice, which in turn, helps staff to support individuals right at the start of their stay. All three files sampled included signed copies of the terms and conditions of residence at the home. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 13 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good care planning has meant that the people who live in the home receive individualised care and identified risks are minimised. The management of medication is good and ensures people receive their medication in a timely and safe manner. People are treated with respect and are clearly happy in the company of staff. EVIDENCE: People who live at the home have a plan of care that identifies their needs and gives staff instructions how to meet their needs. These are called Individual Service Statements, (I.S.S.). The three files examined had a plan of care generated from the initial assessment. The I.S.S. seen covered all required areas including, personal care, medical needs, dietary requirements and social needs. It was nice to see a record of what people are able to do for themselves and what assistance they require. Individual likes, dislikes and preferences were also included. The files of those people case tracked showed that there were a variety of health care needs which included; the management of continence, weight monitoring, risk of falls, poor tissue viability, impaired vision, communication difficulties and mobility. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 14 The care records seen, included numerous risk assessments for nutritional and tissue viability, mental health and falls assessments. There are risk assessments that identify how people are moved safely. All risk assessments are reviewed and updated regularly to ensure they are in line with the persons’ changing needs. For example one file showed that a manual handling risk assessment was in place, this gave specific details as to the hoist to be used, the sling size and how many staff were required. The I.S.S. included an overview of each person’s day which gave staff details about their preferred rising and retiring times, what times and where they liked to eat, where they liked to sit and how they liked to spend their days. It was positive to see that an ‘additional information section’ is completed where there are specific concerns or things that staff need to be aware of, this is good because it highlights important information. For instance, ‘ I get anxious and this makes me breathless, I need time to be directed around the home to different areas because I get muddled’. Another said, ‘I like my tea at 3.45 this is sandwiches, cake and a cup of tea, so that I have eaten before I go out on the Ring and Ride’. This information ensures that staff has good insight into an individuals desires and that staff have the information to respect this. It was pleasing to note that the information in the I.S.S. has continued to be updated so that staff have the information they need to meet the changing needs of people and ensure the care is individualised. All the files sampled included separate health care records, these gave an overview of visiting professionals. It was very clear from these that health care needs of the people living in the home were met. There was evidence of visits from doctors, district nurses, medication reviews, and visits from the continence advisor, dentist and optician. Where necessary the advice of more specialised health care professionals was sought, for example, the Stoma care nurse. The daily records detailed any concerns with individual peoples’ health that care staff had noted and this was then followed up and monitored. The daily records were looked at, these had good detail in relation to the general well being of and the care given to the people living in the home, making it much easier to determine if needs were being met. The medication administration records (MAR) were well kept. There were no gaps in signing for medication. There was a photograph of the person to assist with identification. The storage of medication was secure making it safe for people who live in the Home. At the previous inspection visit a requirement was made for staff to follow the medication procedures. The medication round was observed and those staff that administered medication did so correctly. The inspector was also given a copy of the medication procedures which each staff member now have in their file, this ensures everyone is aware of the Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 15 procedures, and that people who live in the Home receive their medication in a safe manner. The people living in the home raised no concerns about their privacy or dignity. Staff addressed people appropriately, and personal care was offered discreetly. There was a cordless telephone available for the use of individuals so that they could make or receive calls in private. All bedroom doors were lockable with keys available. Some people told the inspector, ‘Staff are always helpful and available when you need help’. Call bells were within reach for those that were in their bedroom and this ensured that they could call for help when needed. The lounge and communal areas were staffed consistently throughout the inspection ensuring people who are vulnerable to falls, or confused had the support they needed to keep them safe and comfortable. Staff spoken with had good knowledge of the care routines of people, and observations showed that staff knew who needs assistance and in what areas. For instance one staff identified a person who likes to have a magnifying glass to read and is registered blind, she described the support needed in detail and the I.S.S was looked at and confirmed that staff follow the guidance in this. There was good support to people moving around the home, which is good to see where people get confused and need direction. Toilet areas were signposted which helped people to locate them. Staff spoke to people in a kind and friendly manner, and supported their introduction to the inspector. In summary care records set out in detail the action that needed to be taken by care staff to ensure all aspects of the health, personal and social care needs of the person are met, both during the day and the night. Social or background profiles detailed the values, preferences, and lifestyle of the person so that staff can plan their daily routines in a positive manner. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 16 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities meet the expectations, and interests of the people who live in the home. There has been a good improvement in exploring and planning for the needs and interests of people, they have the support and assistance to engage in stimulating activities that promote their individuality. The dietary needs of people are well met, they benefit from meals that are well presented, wholesome and varied. EVIDENCE: The individual Service Statement (I.S.S) was in place for the four people who were case tracked. These were seen to reflect their choices with regards to leisure and social activities. There was a range of activities being offered to people; visits to garden centres, quiz’s, board games, bingo, visiting entertainer, mobile library, movement and music sessions, and planned trips. People spoken with indicated that they enjoy what is on offer. Comments received were; ‘The staff are really nice, they play bingo with me.’ ‘I’ve been to the garden centre a few times, out for a cup of tea or a bit of shopping’. ‘I like to have my hair done and staff arrange this for me’. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 17 An activities poster was posted on the notice board to advise people of coming events. Staff spoken with said ‘We do have activities and try to do the things that people enjoy, some go out on Ring and Ride to do community based activities, and they enjoy this’. Norton Grange actively seek the views of people as to the activities they prefer, this was reflected in the minutes of the resident meetings, individual reviews with people and their families, and surveys that the home had carried out for their quality review audits. It was positive to see that the daily records show what people can do for themselves, their strengths. For instance one plan said that the person can do some tasks independently, the daily record showed that these opportunities had been offered and how the person had responded to it, for instance, ‘made a cup of tea, kept saying couldn’t do it but did and was able to make own bed’. There was good written information to guide staff in supporting people with their personal needs. People are helped to exercise choices and make decisions, especially those people who have dementia or memory loss. For example ‘I prefer a bath not a shower I need to be handed a walking aid and directed to the lounge or dining room’. ‘I have a spoken problem due to a stroke and need staff to speak clearly and be patient for my response’. Staff said that the records give them a clearer picture of the persons’ character and preferences, which helps them to plan activities or support around their needs. The home positively demonstrates that people have the support and assistance to engage in activities that promote their individuality, and social activity. People stated they are able to go to bed and get up when they chose and spend their time as they chose. Some have personalised their rooms to their choosing as seen during the tour of the home. Several people said they made their own decisions this included what they wore, what they ate, activities and attending church or other community amenities. The daily records actively demonstrate the activity of the person, such as ‘attended church service today’, and this enables the staff to measure to what extent the goals of the I.S.S are being met. This will ensure that the care planned for the individual is ‘person centred’ designed to meet their individual needs. The menus provided by the home were good and varied and comprised a fourweek rolling menu. People said, “The food is good ”. One relative also stated that the meals provided are of good quality and plentiful. Staff was observed talking directly with people to establish their meal choices. The arrangements in place for some people who require monitoring of their food or fluid intake ensures that their nutritional needs are met. This information was clear in their care plan and showed what measures are being taken to address these needs. The mealtime occasion was relaxed and sociable, staff assistance was discrete and supportive. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints procedures are available in a format suited to the needs of the people who live in the home, ensuring that people are fully informed of the complaints process. Staff are trained in procedures designed to protect the vulnerable people in their care. EVIDENCE: The Commission has not received any complaints about this service. People who were spoken with in the home were happy to speak to either the manager or other staff members if there were a problem. The notice board was viewed and there was a copy of the complaints procedures and a ‘Compliments and Complaints’ log in large print to assist peoples to access this information. Several compliments had been received. A representative of Birmingham City Council Social Services Department carries out monthly visits. A report of these visits is available in the home. Copies of the residents meetings and monthly audits, again in large print format were on display to advise people of the outcome and action taken as a result of their concerns. This is a good means of quality assurance and shows how the views of people who live in the home are considered when making improvements. Information from the AQAA completed by the manager indicated that Adult Protection Procedures are available, but there was no date to show when these Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 19 were last reviewed, to ensure they are in line with current good practice. These were not examined at this visit. Discussion with individual staff showed a good understanding of how to keep people safe. The training records showed that most staff had received training in how to recognise abusive situations and how to respond to them in order to safeguard people in their care. The service history showed that no adult protection matter had been raised this year. The financial records of four people were seen. These showed that a record is maintained of incoming money, and expenditures. Receipts are maintained and a running total kept. No discrepancies were found. Individual people sign their records to show they had received some of their money. One visitor spoken with indicated that they were generally happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. . Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Norton Grange provides a pleasant, safe place to live. There are appropriate specialist aids and equipment to meet the needs of the people who use the service. Continued improvements have been made which have improved the facilities and comfort for the people who live in the home. EVIDENCE: A partial tour of building found that the home was clean and fresh. All areas of the home are appropriately decorated and furnishings and lighting were domestic in character. The manager has been undertaking a programme of redecoration and refurbishment. In the last year a number of improvements had been made to include provision of a shower area to promote choice for people who use the service, bedrooms have been redecorated, and a new ‘snug’ area created for people to sit quietly. People who live at Norton Grange have access to safe and comfortable communal facilities. There are two units, with a choice of lounge and dining Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 21 areas. These were comfortably furnished, clean and well maintained. There are lots of plants, ornaments and personal touches throughout. There is room for indoor activities to take place. A small kitchenette is available on each of the two units in which people do make drinks or snacks, providing them with a degree of independence and autonomy. Improvements to the premises have continued since the last visit to this service, these have included partitioning of toilets providing more privacy for people. The replacement of window handles that allow for easier closure remains outstanding. The manager has been unable to secure adjustments to radiators to enable people to control the temperature. This remains outstanding. Outdoor space is accessible for those with wheelchairs. The grounds are well kept and have lawns and borders. Toilet and assisted bathing facilities are situated on each unit, and within easy access of the communal areas. These facilities meet the needs of the people who live at Norton Grange, particularly those people who require staff assistance. They were clean, odour free and spacious. Aids and adaptations were seen to include hoists, emergency call system and hand grab rails, and these enable staff to support people in a safe and suitable manner. The equipment seen was suited to meeting the needs of the people who use the service. Bedrooms were furnished with a bed, chest of drawers, bedside cabinet, wardrobe, and a chair. All rooms are lockable. Where people required space for mobility aids or the use of the hoist, staff had rearranged furniture to make it safe. The space in the rooms is below minimum standards but none of the people spoken with were concerned about this, they had personalised their rooms with their own possessions and said they were comfortable. One person said, ‘I like my room it is my own space where I can sit and watch T.V and have a little rest’. The bathing and toilet facilities meet the current needs of people who live in the home, and include assisted bathing facilities, which allow for staff to support people in a safe manner. Modernisation of the toilets has improved privacy and accessibility. Corridor areas are spacious and it was observed that staff had sufficient room to support those people moving around the home with zimmer frames. Domestic staff is responsible for the general cleaning and all areas viewed on the day of the visit were clean, and hygienic. The arrangements in place for infection control were good staff were observed using protective clothing, and lidded waste bins were in toilet areas. A contract for the collection of clinical waste was in place. Systems were in place to deal with soiled linen, lessening Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 22 the risk of cross infection. People who live in the Home commented, ‘the standards are good the Home is always clean’. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff that cares for them. Staff receives relevant training that is focussed on improving outcomes for people who live at Norton Grange. Staffing levels have improved now providing sufficient numbers of trained staff to meet the needs of the people who live in the home. Recruitment procedures are robust and provide safeguards for vulnerable people. EVIDENCE: Staffing levels were of a concern at the last inspection visit in October 2006. There were regular occasions when the service was short staffed. Where staff works in conditions where the full staff compliment is not available, this places people at risk. Rotas were looked at and showed that minimum staffing levels of three care staff throughout the working day plus a senior is now being maintained. This has had a positive impact, both people who live in the Home and the staff who care for them have commented favourably on the change this has had. ‘There is staff around when you want them and they are good to us’. ‘I like the staff they always make time for me’. ‘I think the standards are high, we know what the expectations are, there is a good attitude towards the people we care for and more importantly we have time on our shift to spend time with the people we care for; personal time and this makes all the difference’. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 24 Staff spoken with during the visit, were enthusiastic and caring. They had a good knowledge of the individual care needs of people. Information from the AQAA indicated that the use of agency staff has been minimal which ensures people receive continuity of care from staff that knows them well. Eight of the thirteen permanent care staff had National Vocational level 2 qualification (NVQ) or equivalent. A further five staff were working towards this. The majority of staff had completed training in Infection Control, Safe Food Handling, and Health and Safety. All staff followed a statutory training programme, providing them with the skills necessary to meeting people needs. There has consistently been very little staff turnover at the Home, which provides good continuity of care for the people who live there. Staff files sampled showed staff had received induction training in line with skills for care specifications, enabling them to meet the needs of people in a safe, and professional manner. Individual records looked at showed that staff had undertaken training in Fire Procedures, Tissue Viability, Challenging Behaviour, Adult Protection, and Manual Handling. A training plan for 2007 showed that training is proposed in falls management, manual handling, nutrition assessment, Dementia care, incontinence management and pressure care. This ensures that a competent and appropriately skilled staff team supports people. Since the last inspection visit the manager has introduced ‘PDP’s , these are personal development plans. Two staff files showed that the PDP was in place and identified the individual training and development for the staff member, this ensures staff needs are addressed to ensure they have the skills and training to meet the needs of the people, competently. Recruitment and selection procedures remain robust. All the required checks, including police checks, references and work history are undertaken to ensure people who live in the Home are protected from risk. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the people living there. Systems are in place to continuously monitor the service on offer, and there has been a continuous improvement in ensuring that the outcomes for the people living at the home are positive. The health and safety of the staff and the people living in the home was well managed. EVIDENCE: The manager is experienced in the conditions that affect older people. He holds the NVQ level 4 in management and care and the Registered Managers Award. He has several years of experience in caring for older persons, and managing a staff team, this ensures he has the relevant skills to manage the care home. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 26 There are lots of platforms to encourage the inclusion of people in how the home is run; regular house meetings are held, regular audits are carried out, both by the manager, team manager and cross homes audits which consists of a manager from another home calling unannounced and auditing the practice. . Surveys were sent out to staff, people who live in the home, relatives and visiting professionals and have been analysed and actions required identified. It is evident that the views of people who use the service are actively sought and used to improve outcomes for people who live at Norton Grange. A compliments book is available with many positive comments as to the efforts of the manager and his team in meeting the needs of people who live in the home. The manager is keen to improve the home and has a programme of continuous improvements. Robust arrangements are in place for managing the finances held at the home, this provides good safeguards for those who need support in this area. Planned supervision for all staff is now more consistent providing staff with a regular platform in which to review their practice. There are appropriate arrangements to ensure the health and safety of both people who live and work in the home. Appropriate maintenance and inspection certificates for all appliances were seen. Required checks on the fire system take place including staff training to ensure that they know what actions they should take in the event of a fire. Risk assessments for fire and food were also available. There are comprehensive reports of accidents and incidents, and it was positive to see that the manager undertakes ongoing audits of these to determine if any risks can be minimised. There has been a some positive achievements; new personal development plans for staff which help to identify training needs to meet the Homes aims, new individual service statements have improved the detail available to staff to guide them in providing person centred care planning, new risk assessments specify the steps staff need to take to minimise risk to people who are vulverable in some areas. The management of the home is good, and focused on positive outcomes for people who live in the home. The requirements made at the previous visit have been met within agreed timescales. The staff team have met the challenge the interim care has presented. The manager is aware of the limitations and has put procedures in place to ensure the short-term aims are clear, measurable and that peoples’ care packages are reviewed on a regular basis to ensure that the arrangements are indeed in line with the persons’ needs. Further work is planned to improve the links with the Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 27 Health Authority and this will ensure that people are supported to return home more speedily. It is evident a lot of work has taken place and the outcome for the people who live in the home is good. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 28 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 23(2)(p) Requirement Timescale for action 01/01/08 2. OP19 23(2)(p) Window openers must be appropriate for people to control the ventilation in their own rooms. This is an outstanding requirement from 08 July 2004. The Commission must be advised of proposals in this area. Temperature controls on 01/01/08 radiators must be appropriate for people to control the temperature in their own rooms. This is an outstanding requirement from 08 July 2004. The Commission must be advised of proposals in this area 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 OP18 Good Practice Recommendations The safeguarding procedures should have a date of last review to ensure they are in line with current practice for DS0000033520.V348060.R01.S.doc Version 5.2 Page 30 Norton Grange keeping people protected from harm. Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection 3rd Floor 77 Paradise Circus Queensway Birmingham B1 2DT 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 Norton Grange DS0000033520.V348060.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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