Inspection on 20/01/09 for Shalden Grange

This inspection was carried out on 20th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shalden Grange 10/12/07

Shalden Grange 30/05/06

Shalden Grange 16/02/06

Shalden Grange 04/10/05

Shalden Grange 24/11/04

Shalden Grange 23/06/04

Shalden Grange 22/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shalden Grange 1-3 Watkin Road Boscombe Bournemouth Dorset BH5 1HP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Martin Bayne     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Shalden Grange 1-3 Watkin Road Boscombe Bournemouth Dorset BH5 1HP 01202301918 01202300663 shaldengrange@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Kuldeep Kaur Benepal,Mr Amrik Singh Benepal Name of registered manager (if applicable) Miss Georgina Louise Smee Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Shalden Grange is registered to provide accommodation and personal care for 35 older people with frailty of old age. The home is situated in a residential area of Boscombe within half a mile of the shops and also the seafront. The home is made up of two large older properties with a single floor extension between the two. The ground floor connecting extension provides the communal areas with a reception conservatory, main lounge, dining room, kitchen and second conservatory. There are also three resident?s bedrooms with all other bedrooms provided in the older properties at either end of the home. One of the properties has a shaft lift for accessing the floors above ground level. The other property now has a stair lift so residents accommodated here can access the upper floors safely. Care Homes for Older People Page 4 of 26 care home 35 Over 65 35 0 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out a key inspection of Shalden Grange Residential Home between 9:30am and 3:00pm on 20th January 2009 and 2:00pm and 4:00pm on the 21st January 2009. The inspection was carried out by one inspector with assistance from a contract monitoring officer from Bournemouth Social Services. Throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on two requirements and three recommendations made at the last key inspection of 10th December 2007. Since the last key inspection, a new manager has been registered with the Commission and they assisted us throughout the inspection. Care Homes for Older People Page 6 of 26 During the inspection we spoke with two relatives who were visiting the home, and also to about 12 twelve residents living at the home, some within their bedrooms and some who were sitting in the communal living areas. We also spoke with two members of staff. We looked at the records that the home is required to keep up to date under the Care Homes Regulations 2001. We carried out the tour of the premises. Additional information that helped form to the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document completed by the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to move to the home benefit from having their needs assessed prior to being offered a placement, thus ensuring that Shalden Grange can meet their needs. Evidence: We discussed how referrals were managed by the home. We were told that the manager or the deputy always carried out a pre-admission assessment of need for a person referred to the home. This is recorded on a template that covers all of the topics detailed within the National Minimum Standards for older people. We looked out the pre-admission assessments of need for four residents who have been admitted to the home since the last key inspection. We saw that pre-admission assessments were recorded and filed within the persons personal records. We saw that a copy of the homes Service User Guide is kept at the front reception Care Homes for Older People Page 10 of 26 Evidence: area and we were told that there was a copy within each persons bedroom. The home also provides a newly admitted resident was a welcome pack, that informs of the name of their key worker, mealtimes and other important information about the home. Once it has been determined that the home can meet the persons needs through the preadmission assessment of need, they are informed in writing to confirm a place is offered at the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their healthcare needs being met through the care planning system, although some improvements could still be made. Better attention to stock control of medication would ensure that residents do not run out of medication. Evidence: We looked at care plans that had been developed from the assessments for the four residents we tracked through the inspection. We found that a care plan had been developed for each person, with these being kept in the lounge so that they are readily available to the staff. We saw that residents had signed their care plan, indicating that they had been involved in developing their individual care plan. At the last inspection a requirement was made that care plans be reviewed each month, to ensure that they are kept up to date. We saw evidence at this inspection that the care plans were now being reviewed each month. We found that the care plans reflected the needs of the residents we tracked through the inspection. We also saw that the care plans linked to risk assessments that looked at how risk of harm to residents be minimised. We also saw evidence that where a higher levels of monitoring were required, such as putting Care Homes for Older People Page 12 of 26 Evidence: in place of turning charts and fluid charts, this had been actioned. There were elements of the care planning system however that could be improved upon. We saw that the home had developed information about residents life histories, to assist in meeting their social and recreational needs. We recommend however that these be developed further. We saw that a photograph of the person had been put at the front of care plans, to assist staff in identifying residents. In the case of one persons care plan a photograph was not attached, but this was addressed during the inspection. We recommend that such photographs are put on the front of each persons care plan. Risk assessments are kept together with the care plans. We recommend that the care plans reference risk assessments that have been carried out so that staff are aware of how to reduce the risk of harm when following care plans. We found that bed rails had been put in place for one resident to reduce the risk of their falling from their bed. We recommend that the home maintain better evidence of the people consulted in the decision to put bed rails in place, as these can be deemed a means of restriction. We found that residents weights were being recorded, however staff were recording in differing measurement units. We recommend that one unitary measurement system be adopted. Residents told us that their health needs were met at the home. Within the care planning we saw that each resident is registered with a GP and that other health care needs with respect to chiropody, dentistry and eye sight were assessed and actioned appropriately. We also saw an example of where community psychiatric nursing assistance was sought to meet the needs of one resident. Generally there was positive feedback by residents about the way they were treated within the home. We were told that staff were respectful and treated residents with dignity. We observed the interaction between staff and residents, and there appeared to be good relationships between the two. All of the residents looked well groomed with attention paid to their personal appearance. One of person remarked, It is wonderful, I dont know what I would do if I didnt live here. We looked at how medication was managed within the home. Residents are assessed as to their ability to manage their own medication. At the time of the inspection two residents were managing their own medication and we saw that risk assessments had Care Homes for Older People Page 13 of 26 Evidence: been undertaken to ensure that they could manage this safely. All of the staff who administer medication have been trained through the local pharmacist. After their training, staff observe senior staff administering medication and they then are observed by senior staff administering medication and finally by the manager or deputy before being deemed competent to manage medication administration. We saw that there was a list maintained of staff trained to administer medication, with a sample of their signature recorded. We looked at the medication administration records for all the residents. Records were completed in full with no gaps within the records. We also saw good practice of photographs being attached to theri medication administration records. At the last inspection it was recommended that where hand entries be made to the medication administration records, a second member of staff checks and signs that the record is accurate. It was also recommended that any known allergies be recorded or None known be recorded at the top of their recording sheet. We saw that both these practices had been adopted at this inspection. We saw that the home had suitable lockable facilities for storing medication with keys being held by the senior member of staff delegated to administer medications that day. One requirement was made concerning a resident who had been without As required pain medication for four days. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a programme of individual and communal activities being arranged within the home, from being able to receive visits from friends and relatives when they choose and through being provided with a good standard of food. Evidence: In order to provide meaningful activities for people who live at the home, a short life history of each resident is recorded, although these could be developed further. We were also told the residents meetings are regularly convened at which time residents can bring forward suggestions concerning any activities they would like to partake in. We saw on the residents noticeboard a programme of weekly communal activities arranged within the home. We were told that the regular bingo sessions and music and exercise afternoons were popular with residents. Other activities are a regular arts and crafts group. We also saw evidence that some activities are arranged outside of the home, such as residents joining with a group of residents from another home to attend a pantomime. We were told that although no activities coordinator is employed, two delegated carers have responsibility for organising activities within the home, supervised by the manager. Activities programmes are regularly reviewed. Care Homes for Older People Page 15 of 26 Evidence: During the inspection one relative told us that they were always made very welcome at the home and that there were no restrictions on the times that they could visit. Concerning peoples spiritual needs, we saw that these are assessed at the point of a person being admitted. We were told that a member of the clergy visits the home to to see residents and that some residents attend church services in the church a short distance from the home. We were also told that a catholic priest visits the home to conduct Mass. In general the feedback from people living at the home was positive concerning the standard of food provided in the home. We saw within the care planning system that each resident had had a nutritional assessment and that three people had fluid monitoring charts in place to ensure that they were sufficiently hydrated. Residents likes and dislikes were recorded as part of their initial assessment. On the day of inspection we saw that the main meal of the day looked appetising, adequate and portion and nutritious. We looked at the records of food provided and this reflected a balanced and varied diet. We also saw that a record was maintained of what each resident had eaten. We spoke with one resident told us that they received a suitable vegetarian diet to meet their needs. Another resident told us that they had seen a dietician and a diabetic nurse, ensuring that their dietary needs were met. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of the home benefit from a well publicised complaints procedure and through the staff being trained in the protection of vulnerable adults. Evidence: Residents at the home are made aware of the complaints procedure as this is detailed within the Service User Guide for the home and within the terms and conditions of residence. The complaints procedure is also displayed on the residents noticeboard. We saw that the home maintains a complaints log, which records details of all complaints, how these were investigated and responded to. Since the last key inspection there have been two complaints made to the management of the home and we saw that these had been investigated appropriately. During the inspection we discussed with the manager issues raised in two letters of concern that were forwarded to the Commission. All of the staff receive training in adult protection as part of their induction training and we also saw a more in depth courses were offered to staff at a later date to an external provider. The home has copies of all relevant policies and procedures relating to adult protection. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home provides a safe and well maintained environment, however some areas of the home would benefit from redecoration when the proposed extension takes place. Evidence: As part of the inspection we carried out a tour of the premises. On the day of our visit we found the home to the warm, clean and with no adverse odours. As reported at the last key inspection the home has submitted plans and is still negotiating with the Council for an extension to the home that will provide additional bed spaces. We were told that this process was still ongoing. Some areas of the home are in need of redecoration and will be attended to as part of the work carried out with the extension. During the inspection we had the opportunity to view some residents bedrooms and it was evident that residents were able to personalise their rooms with their own possessions. We found that radiators and hot surfaces had been covered to protect residents from getting burnt and that thermostatic mixer valves have been fitted to hot water outlets to protect residents from scalding water. Care Homes for Older People Page 18 of 26 Evidence: The home now has stairlift at either end of the building to assist residents in accessing the upper floors of the home. The home has a small enclosed garden to the rear of the home that was well maintained. We saw that staff are protected with gloves and protective clothing in the interests of infection control and that alcohol gel dispensers were strategically placed around the home. The home has a laundry area that is set away from food preparation areas and is equipped with commercial machines capable of meeting the laundry needs of the home. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from there being sufficient staff to meet their needs, from the staff being recruited in line with Regulations and from the staff being offered good levels of training. Evidence: We were told that between 8 a.m. and 2 p.m. there were seven care staff on duty, between 2 p.m. and 4 p.m. four or five care staff on duty, depending on what activities had been arranged that day. Between 4 p.m. and 10 p.m. four carers, assisted by one kitchen assistant. During the night-time period there are two awake members of staff on duty. We saw duty rosters that reflected the above staffing levels. During the inspection we spoke with residents who told us that the staffing levels met their needs and that call bells were answered within a reasonable time period. During the inspection we spoke with three members of staff who told us that they thought that the staffing levels were suitable to meet needs of residents. The home also employs ancillary staff of a maintenance person, 30 hours of domestic support a week and cooks and kitchen assistants. The home has also employed two laundry assistants to manage the laundry thus freeing up more time for carers to attned to residents. Care Homes for Older People Page 20 of 26 Evidence: We looked at the staff recruitment records for four members of staff who had been recruited to the staff team since the last key inspection in December 2007. We found that all of the checks and records required under Schedule 2 of the Care Homes Regulations 2001 had been complied with. We recommend that the staff application form be changed to seek information required under changes to the care homes regulations; such as requesting a reference from the persons last place of work or when working with vulnerable adults with children from not less than three months. We looked at the training provided to staff at the home. All newly appointed staff receive induction training compliant with standards set by Skills for Care. Mandatory training is provided to all staff in fire safety, basic food hygiene, infection control, adult abuse, manual handling and first aid. The home employs a trainer who provides the majority of training within the home. We recommend that senior members of staff who have been provided with the mandatory training, more in-depth specialist training be provided in such areas as skincare, nutrition and diabetes. We found that all staff have been trained concerning the requirements of the Mental Capacity Act 2005. The home has achieved a level above 50 of staff are trained to NVQ level 2 or above. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home being well managed and run in their interests. Evidence: Generally we found evidence that the home was well managed. Since the last key inspection in December 2007 the then manager has ceased working in the home and a new manager, Mrs Smee has been appointed and registered with the Commission as manager of the home. We were told that visits on behalf of the providers are regularly made to the home unannounced and that the manager receives support and supervision from the Registered Providers of the home. Comments from both staff and residents and relatives indicated that the home was run in the interests of the residents. Some of the residents are assisted in managing small sums of money that the home safe keeps on their behalf. We looked at the records of transactions for three residents Care Homes for Older People Page 22 of 26 Evidence: who deposit money with the home. We found that the balance of money held tallied with the records that provided details of all transactions of money deposited or withdrawn. We recommend that the home invites residents to sign for any transactions as well as the staff. The returned AQAA, annual quality assurance assessment document provided by the home informed the servicing and equipment of equipment in the home was taking place is required. We looked at the fire logbook and saw the tests and inspections of the fire safety system were taking place to the required timescales. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 You are required to ensure that adequate stocks of medication are maintained to ensure that residents receive medication that is prescribed to them. This is to ensure that health needs of residents are met. 18/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 We recommend that residents life histories are further developed and recorded. We recommend that there is a full record of people consulted when a decision is made to fit bed rails. We recommend that residents weights are recorded using one unitary management system. 2 35 We recommend that where residents deposit sums of money for safekeeping at the home, they are invited to to sign the record as well as the staff. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 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. 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