Inspection on 16/02/09 for Spencefield Grange

This inspection was carried out on 16th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Spencefield Grange 04/03/10

Spencefield Grange 23/11/09

Spencefield Grange 06/03/07

Spencefield Grange 13/12/05

Spencefield Grange 26/05/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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: Spencefield Grange Davenport Road Leicester LE5 6SD     The quality rating for this care home is:   two star good 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: Ruth Wood     Date: 1 6 0 2 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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 28 Information about the care home Name of care home: Address: Spencefield Grange Davenport Road Leicester LE5 6SD 01162418118 01162418118 Debbie@hicare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): HiCare Limited Name of registered manager (if applicable) Mrs Deborah Crawford Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 63 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Old age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home The fees for 2008 to 2009 are £282 to £460. A copy of the most recent inspection report is available in the reception area. The home provides accommodation for up to 63 people and is owned by Hicare Care Homes for Older People Page 4 of 28 63 63 0 63 Over 65 0 0 63 0 care home 63 Brief description of the care home Limited. It is located in a quiet suburb on the outskirts of the city of Leicester and has access to a regular bus service. The building is a modern purpose built service offering accommodation on ground and first floor level. Bedrooms on the first floor are accessed by a shaft lift. There is ample car parking facilities to the front and side of the home. At the rear of the home there is an extended patio terrace with garden furniture and ornate water fountain. The garden has level access for people with impaired mobility. There are suitable facilities to support people with physical disabilities such as handrails and other specialist equipment for the prevention of pressure sores is also available through the district nursing service. Care Homes for Older People Page 5 of 28 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: two star good 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: The inspection visit took place on a weekday between 09:45 and 17:30. The registered manager was on holiday so the inspection was facilitated by the Deputy Manager. We focused on the care given to four people living in the home, observing how staff delivered their care, looking at their care plans and speaking to two of the people directly and to another persons key worker. We spoke to eight other people about their experiences of living in the home and to one persons relative about the arrangements in place for visiting the home. We spoke to two staff members about their experiences of training and knowledge of procedures to protect people living in the home and examined four staffs training and recruitment records. We also looked at records relating to fire and food safety. Care Homes for Older People Page 6 of 28 We saw the majority of the homes communal and personal areas, including the bedrooms of several people living in the home. In addition to the inspection visit this report is informed by the Annual Quality Assurance Assessment (AQAA) which is completed by the provider and informs the Commission how the home has maintained and improved the quality of its service in the preceding year. The document also gives us some statistical information about the home. We also issued ten surveys to people living in the home asking them about their experiences, such as whether they felt there were always sufficient staff to meet their needs. Seven of these were returned and their responses have also informed the report. 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 –03000 616161. Care Homes for Older People Page 8 of 28 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 28 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. Good assessment procedures ensure that peoples needs can be met Evidence: All seven people who responded to the Commissions survey said that they had received enough information about the home before moving in. The Statement of Purpose and Service User Guide are displayed in the entrance area and contain up-todate information about the service. Both documents can be provided in other languages if required. La La We discussed the recent admission of one person to the home with the Deputy Manager. The manager had visited them at their existing placement and completed an assessment of their needs, which was present in their care file. Pre-admission assessments were also in place in the three other peoples files that we looked at in detail. From the assessment an initial care plan is produced and staff are informed Care Homes for Older People Page 10 of 28 Evidence: about the new persons needs during shift handover meetings. All four people whose files we examined had a copy of the Local Authoritys Individual Placement Agreement with the service, in their file. The service does not provide intermediate care, therefore this Standard was not assessed. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements are needed in aspects of care planning, to ensure that all peoples care and health needs are consistently met. Evidence: Seven people responded to the Commissions survey, all seven said that they always or usually get the care and support that they need, including the medical support. One person that we spoke with at the inspection said that they sometimes had to wait a long time for their shower. We looked at four peoples care plans, observed the care that they received, spoke with two of the people about their satisfaction with their care and spoke to one of the persons keyworkers about their understanding of that persons needs. A recommendation was made at the previous inspection for more detail in certain aspects of care plans, particularly in relation to communication. Care plans still lack detail in some key areas, such as communication, this was evident through examining the plans and speaking to staff about how they supported people. The deputy manager Care Homes for Older People Page 12 of 28 Evidence: said that plans were reviewed on a monthly basis with care staff informing seniors of any changes that had taken place in a persons care. The deputy manager said that plans are not routinely available to care staff but that they could ask to see them at any time. One of the people whose care that we looked at in detail has pressure area care needs but there was no ongoing assessment of their pressure area needs or a care plan to direct staff as to the care the person should receive to prevent pressure sores developing. This person (along with several others in the home) uses an airwave mattress. We spoke to the district nurse involved with the home following the inspection visit who felt that pressure area care had improved and that staff, following the nurses advice, informed district nurses of problems before pressure sores had developed. Staff receive training in pressure area care during their induction period. One person whose care we looked at in detail has diabetes, controlled by insulin. This is administered by staff and there is evidence in staff files that they have received appropriate training to administer this. The persons care file contains information indicating that they have a regular diabetic health check, screening for their eyes and input from the podiatry service. The deputy manager said that the persons blood glucose levels were only checked when the person was feeling ill as they did not like them taking regularly. This information should appear in the persons care plan. The care plan gave the optimum blood glucose range for the person and action that care staff should take if the persons blood glucose was too low. Information should also be added to give guidance on the response required to too high a blood glucose level. Peoples weights are recorded on a monthly basis and although routine nutritional screening is not in place, peoples nutrition and fluid needs are met. People were observed to be offered drinks throughout the day and people requiring support to eat received it. Two people administer their own medication and have suitable storage in their rooms to keep this secure. We looked at the Medication Administration Records (MAR) for four people. The records were completed fully with no gaps in recording. The controlled drugs register was completed accurately and the running total of medication was checked and found accurate. Special storage is now required for controlled medication because of Amendments to Regulations relating to the Misuse of Drugs. This should be a metal cupboard of specified gauge with a specified double locking mechanism. It should be fixed to a solid wall or a wall that has a steel plate mounted behind it with Rawl or Rag bolts. There was excessive quantities of one type of medication in the main medication cupboard and the cupboard was untidy, we were unable to examine the returns book as this had been mislaid. Care Homes for Older People Page 13 of 28 Evidence: Throughout the inspection we observed that staff spoke with people living in the home in a kind and respectful manner and their need to do this is routinely reinforced during staff meetings. Care Homes for Older People Page 14 of 28 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. Peoples social and cultural needs are met and they receive good food in pleasant surroundings. Evidence: Spencefield Grange has a newly refurbished activities room on the first floor, which contains a large screen television, Wii game, music centre and computer with internet access. These facilities can be used by people living in the home at any time, but are primarily used when the activities organiser is present on Tuesdays, Wednesdays and Fridays. The room also contains a sensory unit and we recommended to the deputy manager that she investigate if any additional information or training is available for staff, to advise on how this piece of equipment can best be used to benefit individual residents. People and their families agree that there is usually something to do in the home and seemed satisfied with the activities on offer (such as music and movement) and the outings that take place during the spring and summer, we go out on a bus, its very nice. There is also a car available to take smaller groups or individuals out to the shops. People who live in the home and their relatives are kept informed about Care Homes for Older People Page 15 of 28 Evidence: activities through a regular newsletter. The activities room can also be used by relatives to hold private celebrations for people living in the home. Relatives visiting the home said that they were always made to feel welcome, could come at any time and were always offered some refreshment. We observed lunch being served; there was a happy and relaxed atmosphere and sufficient staff on duty to ensure that people were served promptly and those requiring additional support received it. One person living in the home helps to set the tables and ensures that the menu board is up to date. People are given a choice at each meal. Special diets required for cultural or health reasons are catered for and the cook explained how different peoples needs are met. One person has Halal food, another has Caribbean food; both people confirmed that they were happy with the arrangements made for them. Special provision is also made for people requiring a soft or diabetic diet. People were very complimentary about the food, the food is exceptionally good, You get plenty to eat. People can determine their own daily routine, one person told us that they like to have a cup of tea at 7am and this was brought to their room. Other people like to stay in bed a little later, and again their wishes are observed. Care Homes for Older People Page 16 of 28 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. Peoples concerns are listened to and they are protected by the procedures in place Evidence: The Annual Quality Assurance Assessment (AQAA), states that staff members induction contains information on safeguarding vulnerable adults and on the homes whistle blowing policy (whereby staff are encouraged to report any concerns in the first instance to senior managers or to appropriate outside agencies if they are not happy with the response). The two staff members spoken with said that they had received training in safeguarding and demonstrated awareness of the whistleblowing policy. Minutes demonstrate that staff are reminded of their responsibilities under this policy during staff meetings. Although all staff have received appropriate training in this area, and demonstrate good understanding, we recommend that the registered manager and staff take advantage of the training provided by the local authority in safeguarding vulnerable adults, to ensure that the service remains up-to-date with any local changes to procedure or practice. We looked at four staff records; two written references are obtained before people start work in the home and their names are checked to ensure that they do not appear on the vulnerable adults register. Recruitment checks such as this, ensure only Care Homes for Older People Page 17 of 28 Evidence: suitable people work at Spencefield Grange. Ten complaints were received by the home in the previous year. All were responded to within the 28 days outlined in the Complaints Procedure. The relative we spoke to said that they assumed there was a formal complaints procedure but that they would tell the manager if they had any concerns. One person living in the home said that they would tell the manager or the person who owned the home if they had any concerns as they visit regularly. People who live at the home can also raise any concerns at the monthly residents meetings. Care Homes for Older People Page 18 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable environment which meets their needs. Evidence: We looked at the majority of communal and personal areas. Changes have been made to the environment since the last key inspection. These have included additional bedrooms and communal space, including the activities lounge, a ground floor lounge and a new patio area outside. Visitors and people living in the home commented on the patio area and said that the grounds were very nice to sit in and had raised flower beds. Some en-suite bathrooms are carpeted and the deputy manager said that carpet was being replaced for a more hygienic floor covering. A flight of stairs leads off directly from an upper corridor and has been recognised by the Registered Provider as presenting a potential health and safety risk. Addi tonal precautions are being taken to escort people whose bedrooms are in this area and the Provider, in consultation with his architect and building control, is putting permanent measures in place to minimise any potential risk. Some staff have received training in infection control and all seven people who responded to the Commissions survey said that the home was always or usually fresh Care Homes for Older People Page 19 of 28 Evidence: and clean. On the day of the inspection some bedrooms and an area of a downstairs corridor smelt of urine. The deputy manager asked the cleaner on duty to ensure that these areas were cleaned. One person living in the home said, My room is very clean and the laundry is done very well. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training which helps them to meet peoples needs. Evidence: Nine of the twenty four care staff have completed a National Vocational Qualification in Care at level 2 or above and three others are currently undertaking this qualification. Discussion with two staff members, examination of staff records and the training matrix demonstrated that all staff have received training in moving and handling and use of the hoist and have also undertaken a formal period of induction, which involved shadowing a more experienced member of staff. Staff have received training in dementia care. It is recommended that people receive training in working with people with mental health conditions, to ensure that they have the knowledge to meet the needs of all people for whom the home is registered. Of the seven people living in the home who responded to the Commissions survey, six people said that there were usually staff available when needed and one that there were always staff available when needed. One person during the inspection visit said that they sometimes had to wait for attention. We looked at four staff members recruitment records. All contained a completed Care Homes for Older People Page 21 of 28 Evidence: application form, two written references and evidence of identity. Evidence of Criminal Records Bureau checks and checks against the vulnerable adults register were not available on the day of the inspection but were subsequently forwarded to the Commission. Care Homes for Older People Page 22 of 28 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. The views of people living in the home, inform how the service is run. Evidence: The registered manager has completed her Registered Managers Award and holds an NVQ in care at level 4 as well as an NVQ assessors award. She has also completed a variety of training to keep her skills up to date, including recent training in the implementation of the Mental Capacity Act. She is also scheduled to attend training on the implementation of the Deprivation of Liberty Standards. Questionnaires asking people to comment on the quality of the service are sent out annually to people living in the home, their relatives and other stakeholders (such as commissioning workers)and are also available in the entrance hall for any visitor to complete. Residents meetings are held every month and concerns raised at these or ideas for change (for example in the kind of food served) are fed back to the manager to act upon. Changes have been made to the menu, based upon the feedback from Care Homes for Older People Page 23 of 28 Evidence: these meetings. Minutes confirmed that staff meetings are held regularly and those staff spoken with valued this opportunity to share information. All staff receive a copy of minutes, whether or not they attend the meeting. A representative of the organisation visits the home at least once per month and makes a formal record of this visit. A record is kept of all transactions relating to people in the home who receive support to look after their finances with all transactions being signed by two people. Records relating to staffs Criminal Records Bureau checks and checks to see if their names appear on the vulnerable adults register were not available for inspection at Spencefield Grange when requested. These records were subsequently provided but must be available, on the premises for inspection. Fire records demonstrate that tests and maintenance on equipment and systems are up to date and the last fire drill was held on 20/01/09. Staff receive training in fire prevention as part of their induction. As part of the inspection we observed lunch being served and noted that food dropped on the floor was not picked up by any of the three staff members who walked past it, despite being aware that it was there. This was pointed out to the Deputy Manager as a slipping risk to both staff and people living in the home. The Deputy Manager picked up the food. Staff should be reminded of their responsibilities in ensuring health and safety. Care Homes for Older People Page 24 of 28 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 25 of 28 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 12 The registered person must ensure that people at risk of developing pressure sores have an approrpriate assessment in place. This is to ensure that staff have the necessary information to meet the persons needs and that any additional support is sought without delay. 31/03/2009 2 7 15 The registered person must ensure that how to meet each aspect of a persons health and personal care is outlined in detail in their care plan This is to ensure that all of a persons needs are met consistently by the staff team. 31/03/2009 3 9 13 Secure storage must be put in place for controlled drugs to meet the requirements of the Misuse of Drugs and 30/04/2009 Care Homes for Older People Page 26 of 28 Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 4 37 17 The registered person must 20/02/2009 ensure that all records relating to staff members recruitment are available for inspection at the home. This so that the Commission can ensure that appropriate recruitment checks are taking place before staff begin working in the home. 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 18 The registered person should contact the Local Authority to access any specific training or guidance that they offer in safeguarding vulnerable adults. Care Homes for Older People Page 27 of 28 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 28 of 28 - 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!