Inspection on 24/07/07 for St Peters Grange

This inspection was carried out on 24th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Peters Grange 10/05/06

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE St Peters Grange 24 Upper Maze Hill St Leonards-on-sea East Sussex TN38 0LA Lead Inspector Jason Denny Key Unannounced Inspection 09:30 24th July 2007 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 Peters Grange DS0000066217.V336876.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 Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Peters Grange Address 24 Upper Maze Hill St Leonards-on-sea East Sussex TN38 0LA 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) 01424 423427 01424 434678 stpetersgrange@beeb.net Care Anytime Limited Mr Michael Patrick Crotty Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability over 65 years of age of places (15) St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is fortyfour (44) Service users must be older people aged sixty-five (65) years or over on admission Up to fifteen (15) older people with physical disabilities may be accommodated within the total number of forty-four (44) 10th May 2006 Date of last inspection Brief Description of the Service: St Peters Grange is a large Victorian building in a residential area of St Leonards-on-Sea approximately half a mile from the seafront and town centre. The home is close to local transport links. The home is located on three floors of the building with a passenger lift to all floors. The fabric of the home is bright and welcoming to visitors, substantial work has been carried out on the environment of the home over the last 5 years and continues. This work currently involves the installation of a more effective larger passenger lift. The home has secluded and well maintained gardens, which are used by residents. The garden represents a pleasant view for rear facing bedrooms. The home does not currently have its own vehicle although it loans a mini-bus for monthly summer outings. The home is registered to provide care for up to 44 people, up to 15 of which can have physical disability, and offers a limited number of respite places based on assessment. The home is currently not exceeding 34 people in number. The range of fees charged ranges from the Social services basic price of £322.40 to around £400 per week as reported in the last report of May 2006. Clarity about the current range of fees and contracts is currently being sought. The latest Inspection report is sent out to any enquirer who expresses an interest in the home. A copy of the report is kept on display in the reception area of the home with copy obtainable via the manager. In March 2006 St Peters Grange moved in to the ownership of a company called Care Anytime after a successful registration process with the Commission. Care Anytime run by Mr Amin and V. Patel successfully owns and manages two other care homes, Nursing and learning disability services respectively, within the South East. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 9.50am and 3.00pm on July 24, 2007. This inspection focused on the key major areas such as how needs are being met. Activities, lifestyles, environment, staffing of the home, along with the management of the home, and how concerns are dealt with. This inspection process covers the period since the last inspection May 10 2006. Following this visit four relatives were spoken with. In addition one [1] questionnaires were received from relatives, and three [3] from Residents following the inspection, with comments positive, especially about the care, the manager, and the staff. Seven [7] of the current 18 Residents were spoken with in detail during the inspection visit all of who confirmed a good service The visit also included discussion with some staff and observation of carepractices. The home completed and returned its annual quality assurance assessment [AQAA] shortly before the inspection. The AQAA contains good information about improvements and plans for the future of the service, and assisted the planning of the inspection and informs this report. The focus of the inspection was on the newest Residents who have moved in since the last inspection and some respite users, and to check on improvements to care planning. Some diversity and equality areas were explored in relation to lifestyles. Care records for 5 Residents along with health and medication needs were looked at. Discussions with management looked at progress since the last inspection. The inspector toured all communal areas of the home with Meal arrangements were examined. A record of complaints was inspected. Staffing was looked at in detail along with the homes management, including measures to ensure quality for Residents. Six [6] areas are Good, and one [1] area is Adequate [ok] and in need of improvement. What the service does well: The manager, his deputy and most staff have worked in the home for a number of years, which provides a continuity of care. The turnover of staff remains low. Staff and management create a warm, friendly and calm atmosphere, which benefits Residents and visitors. Routines are flexible to meet resident’s different [diverse] needs. Residents benefit from having well equipped rooms, with toilet en-suite facilities. Accommodation is spacious and there is a choice of lounges and well-maintained gardens. The home continues to have enough staff on duty who were variously described by all Residents as good with typical comments such as “they treat you well and respond quickly when you need help” relatives spoken with all praised the staff and some St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 6 indicated how respite users look forward to coming back to the home one describing the home as excellent. The home has a dedicated activities coordinator. Staff was observed to be attentive and skilled at meeting residents needs. The home is good at maintaining a clean and fresh environment. The home ensures the recruitment of suitable people. The home [with one exception] supplies prospective new residents with a good level of information before they make a decision to move in. The home ensures that before admitting any prospective new resident they first assess them. The home acts quickly when they can longer meet care needs. The home surveys residents and families when respite stays come to an end in order to assist further improvements and respond quickly to any concerns. What has improved since the last inspection? What they could do better: The following areas are identified for improvement although there was no evidence that the following shortfalls were seriously affecting outcomes although they need tightening to protect Residents’ rights and meet their needs. Whist it is acknowledged that the home has now drawn up appropriate contracts/terms and conditions for all Residents they are again awaiting signature and agreement around fees charged. This has been required for several years and needs to be urgently resolved. The home needs to clarify confusion around its admissions policy to ensure that all people who use the service even for short periods are in line with the home’s purpose and conditions of registration. Staff continue to be concerned and struggle with existing arrangements for the transport and dispensing of medication with the potential for mistakes. The home are again asked to obtain a suitable trolley. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 7 The home collects a lot of information from Residents and other stakeholders and acts upon these. The home also has other quality assurance methods such as inspections and audits in order to ensure and improve quality. However this information will benefit from being linked to an updated annual report and action plan, which can be, published in the home as the most recent survey report in the homes guide is of 2004. This will show the extent to which information collected from Residents and their advocate’s affects the development and running of the service. 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 Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 8 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 Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 9 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): 2, 3, 4, & 5 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing Residents, with a good level of information, with the exception of contracts. The way in which the home assesses prospective or existing Residents ensures, that it currently meets needs of Residents although some clarity around the admittance process for respite users is needed. EVIDENCE: Contracts for new residents and respite users over the last 4 years were again, not found to be signed or completed in relation to fees charged. The manager showed the inspector a new contract which he has developed for all current residents which takes into account the new 2006 regulations whcih require fuller information to protect Residents. Those samples looked at had individual St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 10 names of Residents and their room numbers. However the manager explained and showed that he has not yet got these signed. The manager explained that he is now awaiting clarity from Social Services as to the new fee levels, which is paid to the owners of the service, as it relates to those, funded by Social Services. Fees are said to range from £322.40 to 400 for larger rooms. The manager explained that he is not aware that any current Residents are selffunding and has copies of the original financial contract. This therefore reduces the current risk of inappropriate charging. The manager was advised to liaise with the owners around making copies of information held by the organisation to be made available in the home as the owners will know what social services are paying for each Resident, in order to speed up the signing and issuing of contracts. Residents and relatives who were spoken with raised no issues in relation to money or their contractual terms and conditions. It was evident from some of the survey cards returned that some were not aware of contracts. The manager explained that he has developed a welcome pack for new residents which provides a sample copy of a contract. Residents who moved in before 2003 and those now moving in, have gone through a normal process in relation to agreeing contracts such as fees and room to be occupied. Confirmation is just awaited in the from of signed contracts in the home The manager stated that all contracts should be agreed and signed over the next two months. The Inspector look at care information in relation to four of the newest Residents which included looking at some respite users. Records were showed to be improved and it was evident that at all respite users who stay for short periods all had care-plans. Records showed that the manager had assessed all Residents prior to admittance and indicated how needs will be met. In addition all files showed that comprehensive assessments had also been received from social services. An extended discussion took place around one recently admitted respite Resident user who is in their early 40’s in a home registered for 65 or over on admission. The person has a physical disability which the home is meeting, with the relative pleased with the home which is supporting the person to be more independent. The Resident was spoken with and indicated that they were confused “miffed” to be in a home given the difference in their age in relation to others. It was positively noted from records and talking with all relevant people that social services have identified a more appropriate home and that this stay was only intended for the short term. The manager explained that the admission was an emergency and not preferable but was based on information from Social Services who have a block contract. The manager also assessed the person before admittance. The home were therefore advised to review their admission process and get clarity as to their conditions of registration and explore a variation if their intention is to admit people based on a needs assessment who are younger than 65 years old. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 11 The inspector made contact with Social services contracts department shortly before the inspection to check if there had been an improvement with the satisfaction levels of respite users based on their own checks. At the last Inspection the inspector reported that respite user spoken with were satisfied with the service. The inspector was unable to get any feedback from Social Services prior to writing this report. Those respite users spoken with during the Inspection and along with their relatives indicated satisfaction with the service. A number of initial respite users have gone on to become permanent Residents. One relative stated how their husband looks forward to going back to the home for short respite stays. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 12 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. Care-planning and record keeping has improved with the manager and staff meeting Residents needs including quick responses to any changes. Residents could be at risk due to the home’s current medication arrangements Residents can feel confident that they will be treated with dignity and respect and that their wishes will respected. EVIDENCE: The Inspector sampled 5 Care-plans, 2 of which were current respite users. It is positively noted that all respite users now have care-plans and that the home more regularly updates these after each stay to reflect changes over several years. Those Residents who were available to speak with the Inspector indicated that there needs were being met and it was evident that there needs and wishes were recorded in the care-plan such as mobility, health and St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 13 preferred routines, such as wake up times. Staff who spoke with the inspector including key workers for some of these Residents case-tracked indicated a good working knowledge. The plans contained guidance about how to actually meet identified need and what support is required. All plans indicated whether Residents need assistance with a bath and were clearer about what residents could do for themselves. The plans contained some information on choices such as room key and how the resident wants to store valuables. The plans are more regularly reviewed and showed where needs changed such as one Resident who following some eyesight issues now need full support with personal care. There was also good information to show how changes in Residents behaviours are supported by the home seeking external professional help such as psychiatrist nurses. The management of the home was seen to be involving staff more in the careplanning process and accessing relevant training so that plans reflect the full range of different [diverse] needs. Along with the detailed care-plans staff now have a basic care-plan sheet for each individual Resident in their staff room to give them quick information on how to support needs and preferred routines. Care-plans looked at are signed by Residents. Comment cards and questionnaires maintained in the home filled in by relatives all indicated satisfaction with the care being provided to residents. All residents spoken with commented on the prompt attention they receive from staff. The inspector looked at medication stocks and record keeping. Staff were observed to have returned to transporting medication on a tray rather than trolley. Staff were observed to carry several peoples medication on the tray along with records. Staff and management indicated that they have requested for the owners of the home for a proper medication trolley as they had previously used an open tray carrying trolley, which does not provide the necessary security. Staff also indicated and were seen to have difficulty working in the cramped environment of the medication room where chairs impede accessibility around the medication cabinet and ability to separate medication. The manager indicated that the owners [Proprietors] have a nursing home and should be able to provide a trolley. In the absence of a trolley the staff will need to carry Residents medication separately to avoid the risk of confusion. Care-plans and the shorter front line plan have the section on medication stated as “see MARS sheet” the manager was advised to transfer relevant medication information into the plans so staff know before they are medication trained what medication each Residents has and for what reason. Some residents have their preference to self-medicate respected subject to an agreed risk assessment. A resident’s previous concern about being able to St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 14 self-catheterize has been resolved as seen in records and discussions following a number of GP visits and consultations. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 15 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. Whilst the home provides a good range of activities based on resident preferences and which are advertised and regularly reviewed with Residents, some Residents are awaiting some organised outings. Residents benefit from experiencing routines that are flexible and they can be confident they will be treated as individuals. Residents enjoy food, which is under constant review, is good and tasty, varied, healthy, in good portions, with a good range of choice provided. EVIDENCE: The home provides a range of appropriate activities, which continues to improve in the opinion of residents and based on records and schedules examined. Over the last year the manager has appointed a dedicated activity co-ordinator and introduced Saturday film mornings on a 42-inch plasma TV. A resident who has lived in the home for a number of years stated that in the summer of 2005 she had more outings [3] than she had ever had. The St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 16 manager stated in his Annual Quality Assurance Assessment that a recent survey of Residents views indicated that they wanted more summer outings in coach or min-bus. The manager explained that this summer there have been reliability issues with the vehicle supplier but was hopeful of a solution. Only a small number for Residents have requested this and they may be able to join with another home to make trips financially viable The introduction of sherry mornings on Tuesdays, exercise classes on Mondays and quizzes on Thursdays along with Bingo twice a week is popular with residents spoken with. Those who do not attend for health reasons or personal choice are aware of their existence. The bingo session on the day of the inspection was found to be well attended. Resident’s views are collected twice a year through questionnaires and at weekly sherry mornings, which are well attended. The manager indicated in the Annual Quality Assurance Assessment and discussions, that gardening facilities for Residents along with the library are planned to be improved. Visitors to the home have previously confirmed the flexibility afforded to them in relation to their visits. Relatives confirmed satisfaction with these arrangements and explained how they are afforded a warm welcome and that staff respond quickly to any requests. The home was found to have a clear written visitors policy. Decisions such as the choice of a bedroom key are carefully recorded in careplans along with activities, dietary preferences, and financial management. Menus contain a main scheduled meal with alternatives offered depending on the diverse needs of residents with individualised diets for some residents based on their choices and needs such as those who are vegetarians. There is also a choice of deserts and suppers, which are both hot and cold. All residents spoken with including new residents some of whom prefer meals in their rooms stated that food was good and is served at the right temperature, with an alternative always offered. The cooks regularly consults with Resident’s as to their views, which are well recorded in care-plans and identified on admission and in the homes pre-assessments. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 17 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. Residents benefit from living in a home that operates in an open manner and which has not had a formal complaint since the last inspection. Residents can be confident that all complaints and concerns will be well handled. The home maintains a clear record of complaints made and advertises a clear procedure which Residents and visitors are aware of. Staff continue to demonstrate a sound understanding on how to prevent and report abuse in accordance with the home’s updated policy. EVIDENCE: The complaints procedure is clearly displayed in the home’s reception area. The home now holds a full record of complaints and concerns made within one file. Since the home has insisted that all respite users are assessed before moving into the home, there has been a reduction in reported concerns. All respite users and their relatives spoken with described the home as good. Complaints management Training for the manager and his deputy along with senior staff has now taken place as evidenced in certificates examined which meets a requirement dating back to two inspections following the outcome of a St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 18 complaint investigation carried out by an independent human resource specialist on behalf of the home’s owner No formal complaints have been raised over the last year or since the last inspection, which builds on the progress over the last 2 inspections. A concern about any outstanding monies left [potentially a small amount] from the personal allowances relating to a deceased Resident. This has been raised with the service by a relative although this related to the records maintained by a previous owner with the current owners resolving this issue according to the manager with the Commission not aware of any further outcomes. The other concern related to one Resident disappearing from the home having accessed the front door when the double security electrical dial pad was disabled to assist morning staff access the home from outside. This Resident was identified on arrival at hospital due to a nearby ambulance taking her due to confusion. Since this incident all visitors including staff have to ring the bell to gain access and no one can walk out of the home unless they have the capacity to use the dial pad system. All residents and Relatives spoken with or who completed survey cards indicated that they know how to raise concerns and all indicated satisfaction with their rooms along with the cleanliness of the home. The home has reviewed its adult protection policy over the last year. This has resulted in an improved step-by-step policy, which highlights the key points and necessary information. This policy is now signed by all staff that also receive their own copy of the policy and procedure. Staff who spoke with the Inspector again showed a full understanding of how to both identify and report alleged abuse. New staff receive this policy during induction as seen in records. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 19 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): 24, & 26. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a fresh, clean, warm, and homely environment, which is spacious and well maintained. Residents benefit from occupying bedrooms which are attractive, popular and well maintained. EVIDENCE: The inspector found a clean home with full schedules in place including daily cleaning staff. All communal toilets had soap dispensers and no bars of soap. The only bedrooms looked were of those residents who met with the Inspector. All of these bedrooms were found to be in order and benefit from en-suite toilets with many very spacious. All residents spoken with indicated satisfaction with the facilities. Relatives indicated how impressed they are with many of the bedrooms and are pleased with the cleanliness of the home as confirmed in questionnaires completed by relatives and visitors, which the home maintains. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 20 One relative and the manager confirmed that one current respite user has a smaller room which is not big enough for their possessions however it is noted that this user is due to move to a more suitable permanent home where their will be enough room for their books. Another Resident was unsure as to the safety of their bed and whether they could catch their leg. An examination of the bed showed some additional safety features such as additionally padded legs. The home’s management confirmed through records and discussions how a range of additional support has been afforded to the Resident. The Resident indicated to the inspector that their main concern is linked to a range of additional medical tests, which they have requested. The home was found to have dealt well with issues around the reliability and limitations of the previous lift and the introduction of a new bigger passenger lift which had been delayed though no fault of the home. The larger lounge is being used as a temporary dining room along with other Residents requesting meals in their room. The full introduction of the new lift will lead to further benefits and allow a greater number for Residents to access the home quicker. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 21 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. Residents benefit from sufficient numbers of experienced staff on duty who are well supervised and who benefit from improved training. Residents are protected by the home’s tight recruitment procedures with all new staff having good inductions into the job The care of residents is enhanced because staff are on course to meet all training targets in the near future. EVIDENCE: The home maintains an accurate rota and has sufficient numbers on duty to meet needs. The home also indicates the capacity and role of each person marked on the rota. The rota shows that 5 care staff work the morning shift, which gradually reduces throughout the day based on Residents needs with 3 staff on the evening shift followed by waking night carers. These levels are supported by cleaning and cooking staff along with the manager and their deputy. Staffing levels were observed to be sufficient for Residents needs and numbers, which are currently 18. Residents confirmed to the inspector how staff respond quickly to their requests. Visitors indicated that when they arrive staff are always available to assist them. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 22 The homes Annual Quality Assurance Assessment and discussions during the Inspection showed an significant improvement in staff training The manager provided written evidence of 6 of the 20 care-staff having at least a NVQ 2 qualification with 5 others currently on the course with others planned to start. This clearly shows that the home is on course to meet the target of 50 as soon as possible. In addition other staff that have declined National Vocational Qualification in Care level 2 opportunities have at least completed the Foundational care qualification. Training provision has been greatly assisted by the company, which oversee the home appointing a training manager who visits once a week and who delivers allot of the training. Staff indicated in discussions and through records how the range of training has improved and has included other courses this year such as First aid, infection control, risks assessing, care-planning, food hygiene, health and safety. Staff showed how additional training was improving their ability to meet Residents needs. The extra support of the training manager allows for staff to be supported in a more timely way to achieve targets and frees up the homes management to focus on careplanning and other administration areas. The home was also found to have introduced the new wider ranging Skills for Care 12 week induction effective from September 2006. This induction has been issued to all new staff however experienced. In a staffing file examined a trained nurse was found to have completed this workbook over a 3-month period based on the dates entered with supervisory support from the homes management. The staffing files relating to the two of the newest staff were looked at and confirmed that all necessary checks such as references and referrals to the Protection of Vulnerable Persons Register has been carried out with Police CRBS applied for and received back within a short period. No staff start work unless a POVA first has been obtained and work under supervision until the CRB comes back. The manager confirmed that POVA checks are sometimes confirmed over the phone rather than by letter or email and was therefore advised to write up such verbal communications on the staffing record. The home and Residents benefit from a low turnover of staff with just 4[3 full time] leaving over the last year. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 23 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. Whilst residents benefit from living in a home that is well managed and which has introduced an improved range of Quality assurance measures, this information could be better organised in to an updated overall report and plan to show Residents’ involvement in the running of the home. Residents benefit from living in a safe home. . EVIDENCE: The manager is experienced, has the necessary qualification and has since the last inspection identified and accessed further training to update his knowledge and practice. The deputy manager has developed the care-plans and is St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 24 supporting staff to take more responsibility in the running of the home such as in care planning. The administration of the home has improved with additional training support to staff, which has assisted their development and freed up more of the mangers time to the overall running of the home. Records and discussions with staff showed that they are receiving more regular written supervision and are better planned by the homes management. Quality monitoring tools are in place and much data is collected. The Inspector saw completed questionnaires from both long-term service users and respite users, all of which were positive from the most recent ones sampled. The questions cover a full range of areas such as cleanliness, food, activities, and suggested improvements. Respite users and their representatives are given questionnaires on departing from the home after each stay with a prepaid envelope. Interviews are also arranged where necessary. The manager confirmed in he Annual Quality Assurance Assessment and to the inspector that a survey of Residents views took place in December2006/Janaury 29007 with any suggestions acted upon or being considered. These findings are yet to be written up into a report and action plan to show how Residents affect the plans for the home. The most recent published report of Residents view in the homes service guide is of 2004. The home is therefore advised to collect all information gathered and produce published plan. The Annual Quality Assurance Assessment recently completed at the request of the Commission identified clear plans for the home, which will benefit from being published in the home as part of an annual development plan. A requirement was not made in this area as it was not affecting outcomes or risks, and just needed minor work to bring together. An internal company audit carried out on the home on June 8th as evidenced in a report showed how the home is inspected with improvements recommended such as in relation to infection control, and kitchen safety in respect of food. The area confirmed that all recommendations were promptly addressed. The manager also stated that he intends reintroducing a systematic quality assurance-measuring tool, which is divided in to each month of the year to focus on 12 separate areas. The new owners produce monthly reports of their visits to show the quality of care. The two owners have been doing weekly visits since last summer of 2005 and have sent to the Commission the necessary reports on request to show how the home is running. These reports show interviews with staff and Residents along with action plans. A small number of residents have their personal allowances managed on their behalf by the management subject to their signed agreement. A sample of monies examined along with written records was all found to be in order. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 25 These 5 Residents have book, which records when their personal allowance is paid out to them, weekly by the home for them to manage. On the day of their inspection no monies was found to be held by the home. The manager explained that all benefits are paid directly to the company unless any Residents have direct payments or relatives are appointees. The Company office is based outside the home and send a cheque to the home in respect of personal allowances initially paid to them. The other 13 Residents have their financial affairs overseen by either their families or the company owners. The manager was advised that if there are any records of the company handling any monies that such information should also be held in the home in case of any queries. No issues were found on this inspection in respect of Residents monies. The home invoices relatives for any additional expenses such as personal items purchased by the home for Residents. All staff have received all necessary health and safety training such as Moving and Handling, First Ad, and Food Hygiene. All safety records are well maintained, as is all equipment. All Mains Electricity and portable appliances continue to be tested regularly as confirmed in the homes Annual Quality Assurance Assessment. The home has made improvements to front door security to avoid a repeat of an incident earlier this year when a Resident went missing after walking out of the home unnoticed and who is at risk if not supervised. The key code is now on at all times. St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 3 St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5[1][b] and as amended Sept 30 2006 Requirement That the Registered Person must ensure that copies of all service user [Resident] signed contracts are kept in the home available for inspection, and are in accordance to the required items listed in the standard and regulations. That Service users [resident] or their representative have a copy of their terms and conditions. Requirement made at the last 6 inspections. Requirement first made in 2004. That the provider confirms to the Commission once this requirement has been met by the timescale stated. 2. OP3 4 [1][c] Schedule 1. 8 That the Registered person must review the homes admissions criteria to ensure that admissions are in line with the homes conditions of registration and that emergency admissions are avoided where possible. That the home takes advice on applying to vary their conditions DS0000066217.V336876.R01.S.doc Timescale for action 24/10/07 24/10/07 St Peters Grange Version 5.2 Page 28 of registration in light of any review of the admissions criteria. That a copy of a reviewed admissions criteria is sent to the Commission by the date shown 3. OP9 13[2] That the registered Person must 24/10/07 ensure that medicines are appropriately handled and administered to Service users [Residents] with the provision of a suitable trolley to assist the secure handling, transport of medicines, and the signing of the Mars sheet in a timely manner. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. Refer to Standard OP7 OP28 OP33 Good Practice Recommendations That care-plans make specific reference to medication needs That the home reaches the 50 target in respect of care staff achieving at least National Vocational Qualification in Care level 2 , as soon as possible. That the home produce a report of a recent survey of residents views along with an action plan which is published in the home. That this plan shows evidence of informing the homes business and overall annual development plan. That copies of all relevant information relating to Residents such as contractual information and financial records administered by the organisation are available at the home 4 OP37 St Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Peters Grange DS0000066217.V336876.R01.S.doc Version 5.2 Page 30 - 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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