Inspection on 14/05/08 for Priory Grange Care Home Limited

This inspection was carried out on 14th May 2008.

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

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

Priory Grange Care Home Limited 21/05/09

Priory Grange Care Home Limited 22/05/07

Priory Grange Care Home Limited 13/06/06

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 28/09/2008.

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 14th May 2008 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.V363193.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.V363193.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 manager (if applicable) Type of registration No. of places registered (if applicable) 01482 504222 01482 573966 Priory Grange Care Home Limited Charles Paul Leonard 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.V363193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 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 lounge. People who live at the home that smoke must go outside. The current fees are £348.50 to £390.00 there is top up charge of £25.00 per week. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The key inspection has used information from different sources to provide evidence. These sources include: • • • • Reviewing information that has been received about the home since the last inspection; Information provided by the registered person/manager on a pre inspection questionnaire; Comment cards returned from people who live at the home, their relatives and staff; A visit to the home carried out by one inspector. A site visit was carried out which lasted 6 hours. We spoke with the people who live at the home, their relatives and staff. Records relating to the people who live at the home, staff and the management activities of the home were inspected. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity within the home. As part of this visit we looked in detail at how people were protected from harm. The manager was available to assist throughout the day. What the service does well: People who live at the home told us that they liked living at there. They also told us that they liked the care staff and thought they worked hard to look after them. Staff we spoke to commented that they were keen to ensure that people receive high standards of care. They also told us that they receive plenty of training and felt confident they knew how to do their jobs. The quality of food is good and people told us that they were pleased with this. On the day of the site visit the home was found to be spacious, well maintained, clean, comfortable and homely. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Priory Grange Care Home Limited DS0000064778.V363193.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.V363193.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. 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, what they hope for and want to achieve, and the support they need. EVIDENCE: The records and files of the people who live at the home were looked at. These contained evidence of assessments being undertaken by the local authorityplacing officer prior to admission. The home then complete a comprehensive assessment of the persons needs and from this a care pan is formulated. At the last inspection it was noted that the Statement of Purpose was out of date, as was the Service User guide. We saw that this had been updated and reflected of the current position at the home so those people who are looking Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 9 for a home can make an informed choice. The home was planning to admit a man whose religion was Muslim. They had employed the services of a translator and have translated the Statement of Purpose and the Service User Guide in his language. Unfortunately the man died before he was admitted into the home. The home does not admit people for intermediate care. Priory Grange Care Home Limited DS0000064778.V363193.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. EVIDENCE: All of the people who live at the home now have a new care plan. These now contain lots of detailed information about their needs. The care plans contain sections on past life experiences; risk assessments around falls, tissue viability nutrition and diet. We saw that the care plans are updated on a regular basis and the changing needs of the person is recorded and their care plan changed accordingly. We saw that the person, or their relative, agrees the care plan and has an input in the choices made. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 11 We saw that the people who live at the home have regular access to doctors and nurses and are helped to attend hospital appointments. Some of the people regularly see specialist nurse like Community Psychiatric Nurses (CPN), or specialist consultants, if they have any problems with dementia. We saw that the CPNs have an input in to how the person should be cared for and help the home with advise on how to support people with dementia. The home was following any instruction that the nurses or doctors were giving them and we saw that this was recorded on the people’s care plans. The home makes sure that those people who may have a pressure sores are provided with the right equipment to help relive this and work closely with any visiting District Nurses. The home have the proper assessment in place for those people whose beds are fitted with bedrails. The handling of the medication was generally good. The storage and administration of the medication ensured the safety of the people who live at home. We saw that the staff had received the proper accredited training for handling medication. Controlled drugs were stored and recorded properly. The home have policies and procedures in place for those people who want to self medicate. The home has assessments in place which make sure the person is safe before they agree to support them to self medicate. No one self medicates at the present time. During the site visit we saw that the staff treat the people who live at the home with dignity and respect and any personal care is conducted in private. The staff were heard to be using the people’s preferred form of address. The interaction between the staff and those people with dementia was sensitive and caring at no time did any one use any derogative terms or any belittling language to any of the people who live at the home. All the rooms are single and have en-suite facilities this again ensure peoples dignity and privacy. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home are able to exercise choice over their lifestyles and receive appropriate support from staff to achieve this. People who live at the home have limited opportunity to participate in any meaningful activities; this is dependent on staff availability and support from relatives. People who live at the home receive a well balanced, varied diet. EVIDENCE: During the site visit we saw that lots of people who live at the home spent the majority of the day in their rooms. The manager explained that this was their choosing. We saw that during the site visit the interaction with those people who spent time in their rooms was very limited and was mainly task based for example taking drinks ensuring the people went to the toilet etc. there was no meaningful interaction or opportunity for stimulation. We saw that they were spending long periods of time sleeping or watching TV. The manager has advertised for an activities co-ordinator but has received no applicants. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 13 At the last inspection it was noted that the opportunity for people who live at the home to access the community was variable. Those people who had relatives commented on being taken out of the building to local shops and visits. There was no evidence which would indicate that those people who are dependent on staff had regular opportunities to leave the building. During the site visit it was observed that relatives were able to visit freely and were made welcome by the home. People who live at the home were able to exercise choice in the daily lives. People spoken with confirmed that they could rise when they wished and go to bed when they wanted. Some commented on having to wait for staff to attend to their needs and some felt this was more for the convenience of the staff than to meet their needs. This was also reflected in the surveys completed by the people who live at the home one wrote, “I don’t like to ask the staff as they are always busy”. People who live at the home said that they were more than happy with the quality and choice of food provided. The manager has recently relocated the downstairs dining room into the lounge conservatory area. At the last inspection it was noted that the method of getting the food to the people was inefficient and resulted in them receiving cold food from a trolley which had been stood in the corridor for at least five minutes. This has now been addressed and on the day of the site visit we saw that people got their food while it was still hot. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. If people have concerns with their care they, or people close to them, know how to complain. Their concern is usually looked into and action taken to put things right. The home does not always safeguard people from abuse, because of lack of understanding regarding the proper safe guarding policy and procedure. EVIDENCE: The home continues to have a complaints procedure which is displayed around the home and available in the Service User Guide. The home had planned to produce this in another format for a Muslim man who was to be admitted but unfortunately he died before he was admitted. The people who live at the home told us that they would know what to do if they had any complaints and were confident that the manager would take this seriously. They confirmed that the manager is approachable and will listen to their complaints and concerns. The home is current the subject of a Safe Guarding Adults investigation being undertaken by the Local Authority into an reported incident which could have Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 15 been abusive towards one of the people who live there. The manager stated that the incident had been reported to the Local Authority via another agency. He told us that he had not report the incident because he was unsure if it was reportable under the Safe Guarding Adults procedure. Following a meeting with the Local Authority he told us that he was clearer now as what is reportable. When we spoke with the staff they displayed knowledge on how to make a safeguarding adults referral. We saw evidence in the staff-training file that all staff have received POVA training. One relative had concerns about the attitude of the manager; this was brought to the attention of the registered person during the site visit. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 16 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 & 26 People who live at the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People who use wheel chairs do not have access to the garden area. EVIDENCE: The building is purpose built and all internal areas are accessible by the people who live there. All of the rooms are single and have en-suite facilities. The home provides large bathrooms and toilets so those people who have limited mobility can easily receive help from the staff. There is still no access to the rear of the building to the garden for wheelchair users. The manager stated that quotes had been obtained for work to be carried out but there had been a problem identified in that the pipes for the heating run along the floor making Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 17 it difficult to create a door which leads outside. This continues to be an outstanding requirement from previous inspections. The people who live at the home have a choice of communal areas and both the ground floor and first floor have separate lounges for people to use. We saw written evidence that a programme of routine maintenance and renewal of the décor of the building is now in place. The owners of the home have undertaken extensive refurbishment of the building since the last inspection with the majority of the building being redecorated and the corridor carpets replaced. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 18 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 & 30 People who live at the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported by staff who have been trained and are provided in enough numbers to meet their needs. People are safe because the home makes the proper check before someone is employed. EVIDENCE: Staff are provided in numbers adequate to meet the needs of the people who live at the home. We saw rotas which showed that there are 6 care staff on duty in morning, and 5 care staff on duty in an afternoon/evening. This does not include ancillary staff for example cooks, kitchen assistants and domestics. Staff have received training and more that 50 of the care staff are qualified to NVQ level 2/3. At the last inspection it was noted that not all of the staff had received all of the mandatory training required. We saw evidence on staff files that they have now undertaken this training and it was all up to date. The manager encourages the staff to undertake any other relevant training this includes training on dementia, diabetes and other topics relating older people. The staff receive induction training when they first start at the home, however one staff member said they would like this to be updated after few months as Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 19 there was a lot of information to take in and they would like to recap on some areas. The manager undertakes regular supervision with the staff and their training needs are discussed during these sessions. We looked at the staff files and these contained references and evidence of Criminal Records Bureau (CRB) checks being undertaken before staff start working at the home. When we spoke to the staff they confirmed that checks had been done before they started working at the home. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 20 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, 33, 35, & 38 People who live at the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home which is managed and run in tier best interest. The home has mechanisms in place to monitor they way it is run and change or review practice if necessary. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: The manager has a long experience of managing services of this type; he is now registered with CSCI. Staff and people who live at the home said that he was approachable and dealt with any concerns raised. One relative said they Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 21 had experienced a problem with attitude of the manager. This was passed on to the owner. The owner undertakes regular visit to the home and completes reports required by virtue of Regulation 26 of the Care Homes Regulation 2001. Copies of these were available for us to look at. The home has an effective quality assurance system in place and this seeks the views of the people who live at the home, their relatives and visiting health care professionals like GPs and District Nurses. From this information the manager develops an action plan and identifies areas for improvement with dates for completion. People spoken with said they are involved with meetings and felt their opinions were taken seriously and were acknowledged as being valid. The manager had completed the Annual Quality Assurance Assessment (AQAA), which we send prior to the site visit and had returned it within the time given. The AQAA continued information which demonstrated that the home are looking at ways of improving generally but some areas were very brief and did not give a full picture of any planned development. An example of this was when asked to identify what improvements can the home make in some areas of practice the manager had wrote what ever is suggested. This does not demonstrate a planned developmental approach based on current good practise or policy developments based on changing legislation and practise. It suggests a passive or reactionary attitude to developing the service based on requirements made the CSCI or other regulatory bodies and not a systematic approach based on a cycle of evaluation and development. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 X X X 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 X 3 X 3 X X 3 Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 23 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 OP20 Regulation 23 Requirement The garden must be made 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, 30/04/06 01/10/06 30/08/07 not met). Timescale for action 30/11/08 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 2 3 4 Refer to Standard OP18 OP12 OP12 OP31 Good Practice Recommendations The manager must ensure that he has had up to date training regarding the referral of safe guarding adults incidents. The home should make sure that those people who spend time in their rooms are given the opportunity to participate in activities appropriate to their needs. The home should make sure staff are available to met the needs of the people who live at the home. The registered person should ensure that the as part of DS0000064778.V363193.R01.S.doc Version 5.2 Page 24 Priory Grange Care Home Limited the manager’s supervision should include training and development about management style and attitude. Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Priory Grange Care Home Limited DS0000064778.V363193.R01.S.doc Version 5.2 Page 26 - 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!