Inspection on 13/06/06 for Priory Grange Care Home Limited

This inspection was carried out on 13th June 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Priory Grange Care Home Limited 21/05/09

Priory Grange Care Home Limited 14/05/08

Priory Grange Care Home Limited 22/05/07

Priory Grange Care Home Limited 20/01/06

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

CARE HOMES FOR OLDER PEOPLE Priory Grange Care Home Limited Hessle High Road Hull East Yorkshire HU4 7BA Lead Inspector George Skinn Key Unannounced Inspection 13th June 2006 09:30 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 Priory Grange Care Home Limited DS0000064778.V300032.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. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Grange Care Home Limited Address Hessle High Road Hull East Yorkshire HU4 7BA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered acting manager (if applicable) Type of registration No. of places registered (if applicable) 01482 504222 01482 573966 Priory Grange Care Home Limited Position Vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (41) of places Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2006 Brief Description of the Service: Priory Grange is owned by Priory Grange Care Home Limited, a family company that have the one home. It is registered to provide personal care and accommodation for up to 41 people of either gender, over the age of 65, some of who may suffer from dementia. Priory Grange is located in the Hessle area of Hull to the west of the city centre. The home is purpose built with a rear garden and some car parking space. It is a short drive from the centre of Hessle where there is a wide range of shops, pubs and churches. The home provides accommodation in single rooms all with en-suite on two floors. There was a passenger lift connecting the floors. Downstairs there was a large conservatory and dining room, there was also a lounge and dining room on the first floor and a smaller smoking lounge. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit which lasted for 12 hours over 2 days. This included speaking with service users and interviewing the acting manager and staff. The inspection process included sending satisfaction surveys to all service users, relatives, staff and health care professionals, including GPs, to complete. 21 satisfaction surveys were received from service users, 30 were received from relatives, 10 were received from staff, 13 were received from health care professionals, and 2 were received from GPs. The comments have been used in the report and used to form judgements for all of the standards. What the service does well: What has improved since the last inspection? What they could do better: Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 6 The home currently keeps some records about how to meet service users’ needs, however the information still needs updating. Some of the satisfaction surveys which were received said that the service user have a limited choice of activities. The access to the rear garden is restricted and needs to be made more accessible for the service users. The home needs to make to sure that all right checks are done before someone starts working at the home. The acting manager needs to look at the cleanliness of the home as some people commented on a decline in this area. 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. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are assessed prior to being admitted to the home. Some service users have agreed contracts. EVIDENCE: Service users spoken with were happy that their care needs were being met. This was also reflected in the service user comment card used as part of the inspection process. Staff spoken to were aware of service users’ personal care needs. Visiting relatives were also happy with the care being provided. Since the last inspection the assessment has much improved and contains information about service users health and personal social care needs that ensures the home can fully meet the needs of individual service users. Three Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 9 service users have been admitted since the last inspection and all were assessed prior to moving into the home. A recent example of the assessment was seen for a prospective service user. The home have improved the contract of terms and conditions which is agreed with the service users; 9 of the responses received from the service user comment card indicated that they had received a contract. Some comments were received regarding the contract/terms and conditions as part of the inspection process from service users and relatives these included: “The conditions of payment (proportion of social services/our) has changed but no new contract has been issued”. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service users are treated with dignity and respect at all times and their health needs are met; however the care plans still need updating. EVIDENCE: Service users said that staff treat them well and they were happy with their care, this was also the view of relatives and friends that were visiting. Those care records looked at during the inspection continue to lack essential information; the acting manager has a time scale to implement new documentation which should address the short fall in the existing records. All the service users have individual files with the new information set up for the staff to use. Examples seen indicated that the information is relevant and detailed. The care plans looked at during the inspection indicated that the service users’ health needs are met and their medical wellbeing is maintained. The service Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 11 user comment card asks ‘Do you receive the medical support you need?’ the results were: Always 11 Usually 5 Sometimes 3 Never 0 All of the service users are registered with a GP and records indicate that they receive regular visits; those service users spoken with during the inspection commented on receiving GP visits by request. All GP’s were sent a comment card as part of the inspection process, 2 were returned; these were positive about the services offered at the home. Records indicated that those service users who require specialist services receive these on regular basis. Routine visits from the chiropodist are undertaken to the home. Some comments were made regarding the administration of medication these included “Administration of medication there have been occasions when the wrong medication has been brought or staff are unaware of what medication is for. Regularly medication runs out not re-ordered in time”. “Have been instances of staff not knowing what medication should have been available and incorrect advise, e.g. ointment for one part of body (ears) could be used on eyes”. The site visit indicated that the arrangements for making sure service users get their medication were good. Some service users had been asked if they want to look after their own medicines, or if they are able or are happy for the home to do this for them. Consent is now obtained from all service users for staff to give them their medication. The acting manager has ensured that staff are registered to attend accredited training for the administration of medication. There was no evidence to substantiated the above comments. The staff were observed to treat the service users with respect and dignity at all times; they were mindful to ensure that doors were properly closed and that they knocked prior to entering service users rooms. Those service users who were interviewed during the inspection commented on the staff being respectful, courteous and polite. The comment card received from relatives indicated that they could visit the service user in private; this was also confirmed by visiting relatives during the inspection. The GP comment cards indicated that their patients could be seen in private. All the service users rooms are single occupancy so privacy is ensured at all times. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 12 Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service users are treated with dignity and are encouraged to keep in touch with relatives. The service users are provided with a choice of wholesome food. The service users have a limited choice of activities. EVIDENCE: Service users and visitors were happy with the visiting arrangements and it was clear that they are supported to keep in touch with friends and family. Service users said they felt able to make their own choices about how they spend their time. They can have keys to their rooms, get their own post and can have daily newspapers. Staff knock on bedroom doors before they enter and call service users by their preferred name. The home has kept its Heartbeat award for the healthy food it provides. Service users are able to use the two dining rooms or eat in their rooms. Their Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 14 weight is monitored and any concerns are referred to community health services for support. Service users spoke positively about the quality of food. As part of the new assessment/care planning process the acting manager intends to improve how dietary needs are assessed and catered for. The new documentation will include a life history and interests. Some comments were received which would indicate that the level of activity has declined over the last few months these comments included: “Regular activities have now ceased and all to often service user may be found in the lounge area staring at the TV switched on with the sound turned down and unsuitable loud music coming from the sound system for the benefit of the staff”. “However I fell the service users would benefit from organised activities to provide exercise were possible and mental stimulation. At present no activities are taking place. Also service users don’t have the benefit of fresh air. They are never taken out doors either within the grounds or beyond”. “As I prefer to stay in my room and have limited sight and hearing no activities have been offered: - frequently frustrated. Have been offered to sit upstairs and nothing else”. “There is no activities person and hasn’t been for over a year we don’t know why. We have the odd bingo session now and again”. “Could do with more activities to stimulate service users, otherwise the staff are kind and caring”. This was a requirement from the last 2 inspections and continues to be an area that must be addressed by the registered person. During the fieldwork activity, apart from the hairdresser, there was no other stimulation or activities available for the service users to choose from. All of the respondents from the service user survey indicated that they were white British; there are no service users at the home who are from an ethnic minority group. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users knew whom to complaint to and were confident that their complaint will be taken seriously. The service users are protected from abuse. EVIDENCE: The home’s statement of purpose contains details for making a complaint, and a complaint procedure, which is posted around the home; this is also available in the service user guide. Service users spoken to said they would talk to the Acting manager if they had a concern comments included “If I had any complaints I can go and see the boss or any of the nurses or carers”. “I feel any complaints that I make are dealt with by carers or acting manager they are always approachable and helpful”. A complaint record is maintained and staff are instructed on how to handle receiving complaints in their induction. Question 10 of the service users comment card asks ‘do you know how to make a complaint?’ Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 16 13 service users answered always 2 service users answered usually 0 answered sometimes 0 answered never All those staff interviewed and who responded to the staff questionnaire indicated that they understood the process for reporting any instances of abuse. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19, 20 & 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service users live a well maintained home, however they feel standards are declining. Access is restricted to the garden for service users. EVIDENCE: On the day of inspection the home was clean and smelt fresh; and there were no malodours. There were good procedures for managing clinical waste to help promote a healthy environment. Furniture is comfortable and homely. However there were some comments which would indicate that the standards of cleanliness is deteriorating comments included; Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 18 “Cleaners not always clean thoroughly and are often understaffed. Carpets occasionally smell, as bedding isn’t there is no regular changing of beddinghave had to ask a couple of times for bedding to be changed”. “Towels changed regularly but of very poor condition. Washing of laundry is very effective run with clean clothes returned quickly”. “Cleaning quality has gone from 10/10 to 4/10 not enough support with cleaning equipment or staff. My room used to always smell fresh, but not now, and the carpets are disgusting”. “The home used to be very fresh and clean but standards have dropped and my room is not cleaned as thoroughly as it used to be”. “The home has not been as pleasant smelling as it has been with other acting managers”. “Bedding not changed on a regular basis”. “Poor quality towels and toilet rolls”. Nothing seen during the site visit indicted that the home was declining in cleanliness however it should be monitored. There is an enclosed garden area at the back of the home. Not much is made of this space and access for service users is limited. This was the case at the last inspection and something the owners should have addressed by now. Comments were received about this facility from both service users and relatives these included: “There has been talk of putting doors in the conservatory to give access to the garden area. This has been spoken of for about for about 2 years and nothing has happened”. “We were told we were getting easy access to the garden, and the garden altered to wheelchair friendly, we are still waiting”. It was reported that quotes had been sought on improving access to the garden. The home is well maintained and maintenance certificates were available. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The skill mix and numbers of staff are adequate to meet the needs of the service users. Service users are not protected from the homes recruitment and selection procedure Some staff require their mandatory training updated. EVIDENCE: The number of care hours staff work on the rota added up to 774 a week, the recommended guidance says there must be at least 774. This was based on there being equal numbers of residents with high, medium and low needs levels in terms of the care they need. At the last inspection the manager was advised to obtain a copy of the guidance to confirm the needs levels and required staffing. This is necessary to ensure there is adequate staffing at all times to meet the care needs of residents. This has not been done. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 20 The acting manager reported that he had re-designed the rota to increase (since the last inspection) the number of care hours each week and to provide a good balance of skills and experience of staff on each shift. Recruitment records were looked at the necessary checks are now being made, however some existing staff have not had a CRB check this must be done for all staff. This puts residents at risk of harm from potentially unsuitable care staff. It was clear from discussion with the acting manager that he knew what a thorough recruitment process should be and he gave assurances that all CRBs would be completed. Training records had been updated but some staff still require updating in some areas of mandatory training. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Resident benefit from a well managed home. EVIDENCE: There has been no registered acting manager of the home since April 2005. An acting manager started at the beginning of January 2206, and was previously a registered manager of another home. He has a list of priorities for improving the service and it was clear from discussion with him he knew what needed to be done. A quality assurance system that aims at improving the home primarily based on the views of service users has been implemented Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 22 The home was well maintained and the majority of maintenance certificates were available for inspection. Lots of comments were received about the competency of the acting manager from staff only, however none of these were substantiated during the process of inspection. None of the service users made any comments about the competency of the acting manager and indeed commented on how well they thought he was doing and how approachable they felt he was. One comment was received from a visiting professional this was positive ‘The manager seems to be making some positive changes’. The registered person has implemented strategies for dealing with the issues which the staff have with the acting manager and is addressing these in a constructive, effective way. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 24 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 OP2 Regulation 4, 5 & 6 Requirement Timescale for action 01/10/06 1. OP7 15 The written contract/statement of terms and conditions must: clearly inform residents of the home’s charging policy, what is included in their fees, and who is responsible for paying them. This must be agreed with all service users. (Previous target of 30/04/06 not met) The registered person must 01/10/06 ensure there is a written plan of care detailing the tasks to be undertaken by staff to meet all the care needs for each service user as detailed in NMS3.3. (Previous targets of 31/08/05 and 31/12/05 not met). Service users’ interests must be recorded and they must be given opportunities for stimulation through leisure and recreational activities in and outside the home, which suit their needs. (Previous targets of 31/08/05 31/12/05 and 30/04/06 not met). The garden must be made DS0000064778.V300032.R01.S.doc 2. OP12 12 & 16 01/10/06 3. OP20 23 01/10/06 Version 5.2 Page 25 Priory Grange Care Home Limited accessible to wheelchair users, service users with other mobility problems and those who suffer from cognitive impairments. (Previous targets of 31/08/05, 31/12/05 and 30/04/06 not met). 4. OP29 19 A CRB disclosure must be obtained prior to some one starting work at the home, in exceptional circumstances a POVA first check can be made pending the CRB disclosure. Previous time scale not met 30/04/06 Staff must have their mandatory training updated. 01/10/06 5. OP30 18 01/10/06 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 OP26 Good Practice Recommendations It is recommended that the registered person undertakes a full audit of the premises and evaluates the level of cleanliness and the condition of the furnishings including towels and bedding. Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 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 Priory Grange Care Home Limited DS0000064778.V300032.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!