Inspection on 01/02/07 for St Cross Grange

This inspection was carried out on 1st February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

St Cross Grange 17/01/06

St Cross Grange 21/07/05

St Cross Grange 08/11/04

St Cross Grange 15/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE St Cross Grange 140 St Cross Road Winchester Hampshire SO23 9RJ Lead Inspector Michael Gough Unannounced Inspection 1st February 2007 10:30 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 St Cross Grange DS0000011598.V327136.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. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Cross Grange Address 140 St Cross Road Winchester Hampshire SO23 9RJ 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) 01962 854865 stcross@greensleeves.org.uk sharnbrook@greensleeves.org.uk Greensleeves Homes Trust Mrs Anne Patricia Taylor Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: St Cross Grange is one of seventeen care homes for older people, owned and operated by Greensleeves Homes Trust, a not for profit organisation. The home provides care for up to twenty-nine male and female residents over the age of sixty-five years of age. St Cross Grange is a large Victorian house, situated on outskirts of Winchester. Access to the M3 is a few minutes away and there is a local bus service nearby. There are local shops within a short distance and Winchester city centre is just over a mile away. The home comprises three floors, with accommodation provided on the ground and first floor and the top floor being used for management offices and additional storage space. Residents have access to a communal lounge, library, dining room and conservatory. The large garden is mainly laid to lawn, with car parking facilities to the front and side of the property. Fees at the home range from £375 to £490 per week and service users are responsible for paying for their own toiletries, hairdressing, chiropody and items of a personal or luxury nature. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the evaluation of the quality of the service provided at St Cross Grange and takes into account the accumulated evidence of the activity at the home since the last inspection, which was carried out in November 2006. The inspection took into account the homes pre inspection questionnaire; and comment cards received from 19 service users, 10 members of staff and 3 health care professionals. An unannounced site visit to the home took place on the 1 February 2007. During the site visit the inspector had the opportunity to tour the home, read and inspect records and also observe the interaction between staff and service users. It was also possible to gain the views of people living at the home and the inspector had the opportunity to speak with 9 service users, 4 members of staff and 1 visitor to the home. The homes deputy manager and also the registered manager assisted the inspector throughout the visit. The home is registered to provide support for 29 service users but at the time of the inspection there were 26 service users living at the home. What the service does well: What has improved since the last inspection? Since the last inspection the home has improved its recruitment procedures and ensures that all relevant checks are carried out before anyone starts work at the home. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 6 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. St Cross Grange DS0000011598.V327136.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 St Cross Grange DS0000011598.V327136.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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where they wish to live and no service users move into the home without having their needs assessed. The home does not provide intermediate care EVIDENCE: The home carries out an individual needs assessment prior to service users moving into the home and there is a clear admission process and assessments were on file at the home and were looked at for the 3 service users case tracked. Assessments were made using a needs assessment form and service users were visited before they moved into the home, service users spoken to confirmed this. Intermediate care is not provided at the home. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of service users are contained in an individual plan of care, which gives information on what care is need, however they do not always give clear information on how this care should be given. Daily recording needs to be improved, because at present recording does not always give clear information on what care has been given to individuals or if their needs are fully met and this is not in the best interests of service users. Regular reviews are undertaken but review notes do not provide clear evaluation of how the care plan is working for the service user. Service users are registered with a number of GP’s and are able to keep their own GP if possible and this benefits service users. The home ensures that all service users have access to all relevant health care professionals and the health care needs of service users are met. Service users at the home are treated with dignity and respect and their right to privacy is upheld. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 10 EVIDENCE: Care plans were inspected for 3 service users and these gave information on daily routines, dressing and undressing, washing and bathing, drinking and eating, mobility, social interaction, recreation and leisure and personal care. However care plans did not give clear information to staff on the actual support required and when this should be given. One care plan stated “needs support washing and dressing” and “can be unsteady on her feet” but there was no clear guidance for staff on how the person needed to be supported. There was information in another care plan that said that the person, on occasion could become verbally aggressive, but there was no information on what action staff should take to resolve any issues. There were some risk assessments in place but these did not always give clear information on how staff could minimise any risk. Daily recording was very patch with information as “ slept well” or “had a good night” recorded for 5 consecutive days. More information is required in reports to evidence what care has been given and that the service users needs are met. Care plans were regularly reviewed however, review notes require more information and evaluation on how the care plan has been working and should provide information on progress of lack of it as the case may be. Service users who completed questionnaires and those spoken with on the day of the visit all stated that they were well cared for and that staff were aware of their needs. Service users are registered with a number of different GP’s, district nurse visits are arranged though local surgeries and there was evidence that occupation therapists had visited. On the day of the inspection a GP called to visit a service user at the home. Arrangements are made for dental checks to be carried out in the local community and service users visit an optician in the local community. The local GP surgery provides service users with access to all relevant health care professionals and a visiting chiropodist visits every 5-6 weeks. The home has a policy for the receipt, storage, return and administration of medication and all staff at the home has undertaken training with regard to medication. The home uses a monitored dose system from a local pharmacy and the medication records sheets were inspected and found to be up to date and correct. 2 service users were noted as being responsible for some of their own medication and there were risk assessments in place for those service users who self medicate and suitable lockable storage was provided in the service users rooms. Staff were seen to behave appropriately with residents and the inspector observed staff interacting with service users and using service users preferred form of address. Staff were seen to knock on service users doors before entering and service users spoken to confirmed that staff treat them with dignity and respect. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities for service users, which meet their expectations and the religious and recreational interests of service users at the home are provided for. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives as much as possible and they are provided with a balanced diet in pleasant surroundings at time convenient to them. EVIDENCE: Activities at the home are displayed on the notice board and these include: knitting classes, film nights, visiting entertainers, games, flower arranging, concerts and a huff and puff exercise class. A mobile library visits every 4 – 6 weeks and the home has a small shop where service users can purchase toiletries, cards and stamps. Service users spoken to and those who completed questionnaires indicated that they were happy with the activities provided, however one service user did say that she would like to have more trips out, especially in the winter months when there were not many trips arranged. The manager said that she is looking to organise more trips out into the community and will be canvassing service users to see what they would like to do. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 12 The home has a clear visitors policy and there are no set times, visitors sign in at the home and the visitor’s book is kept in the hallway. Service users spoken to said that their visitors were always made welcome. The inspector had the opportunity to speak with 1 visitor to the home who confirmed that visiting times were flexible and he had never experienced any restrictions. The inspector observed staff supporting service users and they were consulted about day to day issues in the home, service users spoken to confirmed that they are able to make informed choices and are able to control their own lives as much as possible, they said that they were consulted regularly and that staff at the home respected their views and that if they wanted anything all they had to do was ask. The majority of service users had brought some of their own possessions into the home and rooms had been personalised. The home has contracted out the catering arrangements and there is a four week rolling menu and service users spoken to were very happy with the food provided by the home. They stated that the food was plentiful and good and service users are offered a choice at meal times. Service users are able to eat their meals in the dining room or elsewhere if they prefer. One service user said that she was not consulted when the home changed the evening meal time from 1800 to 1730 and felt that this was now too early. The inspector spoke to the homes manager who will speak with the service user concerned and arrange for her evening meal to be served at a time convenient to the service user. Meals at the home were unhurried and staff provide suitable support for service users if needed. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a simple, clear and accessible complaints procedure, which includes timescales for the process and any complaints are logged and responded to appropriately. The homes policies and procedures protect service users from any form of abuse. EVIDENCE: The home has a clear complaints procedure, which contains all of the required information and service users spoken to were confident about raising any concerns they may have and stated that they would address any complaint they may have to a staff member or to the homes manager. Staff members spoken to were aware of the complaints procedure and said that they would support any service user to make a complaint if they wished to do so. There have been no complaints made to the home since the last inspection. All staff have received training on adult protection, the latest training taking place 2 months ago. The home also has a whistle blowing policy and a copy of the Hampshire Adult Protection procedure. Staff spoken to were aware of their responsibilities in this area and knew what to do should they suspect any form of abuse had taken place. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 14 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, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe and well-maintained environment and have access to comfortable indoor and outdoor facilities. Service users have the specialist equipment they require to maximise their independence, however the home needs to ensure that there is an effective call system so that service users can summon assistance if required. The home was clean, pleasant and hygienic and free from offensive odours. EVIDENCE: The inspector toured the building and all areas of the home were clean and tidy and furniture was in a good state of repair. There are attractive landscaped gardens both front and rear of the property and these were tidy and safe. The home employs a maintence man who carries out routine maintenance and decoration and this is carried out on a needs led basis. The home has a stair lift and also a passenger lift and there are suitable aids and hoist available in the home. The home has a call system for service users to summon assistance and although these were available in all rooms some St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 15 were not easily accessible and they system is some years old. Some members of staff who completed questionnaires stated that the call system could be improved and the manager explained that this is an issue that has been identified. The home has a laundry, which provides a full laundry service for service users and this is equipped with 2 industrial washing machines and tumble drier. The home employs a member of staff to carry out laundry duties and she is backed up by care staff that carry out laundry duties throughout the day and night. Dirty laundry is placed in bags and is brought down to the laundry room. Any soiled laundry is placed in red sacks so that staff are aware of the contents. All areas of the home were clean and there were no offensive odours. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good) This judgement has been made using available evidence including a visit to this service. The home has a mix of staff that has a range of skills and there were sufficient numbers of staff on duty to meet the needs of service users. The homes recruitment policy and practice supports and protects service users. Staff morale was good and service users benefit from a staff team that has had sufficient training to meet the needs of service users EVIDENCE: Staff morale appeared to be good and there was a good rapport between service users and staff. The homes staff rota was examined and this showed that the home provides 1 senior staff member plus 3 carers between 0730 – 1430. Between 1430 – 2130 there is 1 senior staff member plus 2 care staff on duty and between 2130 – 0730 there is 1 senior staff member and 1 other care staff member awake throughout the night. Staffing numbers were discussed with the homes manager and the inspector felt that the staffing levels were low during the afternoon but he was told that at present the manager felt that staffing levels were sufficient. However she said that she will continue to monitor staffing levels based on service user needs. In addition to care staff there are 4 domestic staff on duty between 0800 – 1430 Monday to Friday. The home employs a total of 21 care staff, and 10 of the care staff already hold or are working to achieve NVQII or above. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 17 The home has policies and procedures in place with regard to recruitment and staff recruitment records were inspected for 3 staff members. All staff records checked contained all of the required information including 2 x references and CRB/POVA checks. Recruitment records were kept secure in the office at the home and contained all required information. Staff training records showed that staff have completed training in, fire, medication, moving and handling, first aid, adult protection, food hygiene, infection control, managing aggression and challenging behaviour, care practices and health and safety and COSHH. Staff spoken to confirmed that they receive regular training and they were confident that they could meet the needs of service users. The home has a workbook based induction procedure which is NVQ based and there is an in house induction to cover procedures within the home. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 18 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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides effective management of the home and the home is run in the best interests of service users. Service users financial interests are protected by the homes policies and procedures and staff are appropriately supervised. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The manager has been in post since May 2006 and is currently undertaking the Registered Manager Award, she is a registered nurse with over 20 years experience of working with elderly service users. She is supported by an experienced deputy who covers in the manager’s absence. The inspector discussed the way forward for the home and it appeared that at present the St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 19 manager is undertaking the majority of management task herself and she would benefit from delegating some tasks to her deputy. The home has a quality control system in place to monitor standards and the manager said that she will be sending out a service user satisfaction survey, and intends to also survey friends and relatives. The manager also said that she intends to have a service user meeting shortly and also hopes to hold a relatives meeting. The inspector spoke to service users at the home who confirmed that they were consulted about how the home is performing and comments received from service users included “ I am well cared for here”’ “I am very happy here”’. ‘Staff are always around to help out” “everyone is very friendly” “ I am much happier here than at my last home” The home keeps some money on behalf of service users and the inspector looked at this procedure and there was a clear audit trail with records of all transactions recorded and receipts kept. The inspector checked the balances for 3 service users and these were all found to be in order and correct. At present the registered manager provides regular supervision for all of the staff at the home and records are kept of the discussions, which include performance issues and training requirements. This was discussed with the manager and she agreed that the process is quite time consuming, it was recommended that some of the supervision be delegated to the home deputy manager. The home pre inspection questionnaire indicated that annual tests of fire fighting equipment and fire alarm system was carried out in December 06, boilers and gas installation in February 06, electrical wiring on 11/3/03, hoists and lifting equipment on 9/10/06 and the passenger lift was serviced on 18/1/07. The fire log was inspected and all relevant training and testing is carried out within the specified timescales. All service users and staff spoken to were happy with the health and safety arrangements in the home. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 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 3 X 3 St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15, 17 Requirement It is a requirement that the home must carry out a review of the care plans and recording procedures in the home to provide clear and up to date information to staff on what is required in all aspects of each individuals care. It is further required that the home must improve the daily and monthly recording procedures in the home to provide clear evidence of care delivery. It is a requirement that any identified risk must be appropriately assessed. Timescale for action 01/04/07 2 OP7 13 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011598.V327136.R01.S.doc Version 5.2 Page 22 St Cross Grange 1 Standard OP22 It is recommended that the home carry out a full evaluation of the homes call system to ensure that there is an effective call system throughout the home so that service users can summon assistance if required. St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 St Cross Grange DS0000011598.V327136.R01.S.doc Version 5.2 Page 24 - 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!