CARE HOMES FOR OLDER PEOPLE
Sussex Grange 14 Vincent Road Selsey Chichester West Sussex PO20 9DH Lead Inspector
Mrs H Church Unannounced Inspection 16th January 2006 10:00 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 Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 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. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sussex Grange Address 14 Vincent Road Selsey Chichester West Sussex PO20 9DH 01243 606262 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) Sussex Grange Dr T Jameson Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: Sussex Grange is a privately owned care home registered to accommodate up to twenty-four persons in the category of older persons. It is a detached two storey building situated in the village of Selsey, West Sussex. It is within easy reach of Selsey village and all its amenities and facilities. The sea front is within a short walking distance. There are well-maintained gardens to the front, side and rear of the property. The accommodation consists of sixteen single rooms and four double rooms currently being used for single occupancy. All rooms have ensuite facilities. A large lounge and separate dining area provides the communal space with wide doorways giving easy access for wheelchair users. A lift provides access between the ground and first floor. Sussex Grange Limited is the registered provider with Doctor Jameson being the registered manager providing day to day management of the home. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection, under the Commission for Social Care Inspection was undertaken over the morning and lunch time activities when staff were able to give the inspector good information of the care provided to residents. The inspector examined the home’s records before spending time with the residents to hear their views of their life at Sussex Grange. To prepare for this inspection, previous documents were reviewed together with the home’s Statement of Purpose and Service Users Guide. This informs interested parties of the care and service provided and informs residents how changes can be made. These documents form a contract and are regularly reviewed to ensure the information they provide is up-to-date. During the inspection, out of the twenty-four places registered, twenty residents were being cared for but occupying all the registered rooms, some of which are double rooms. Five residents were seen privately in their rooms and eleven residents in the communal rooms. Four residents’ records examined to see if they matched the way that the residents said they lived their lives there. All of the residents’ comments were very enthusiastic and included “I didn’t think I’d like a home as I am independent but I can still be independent, it is so easy going and the staff are delightful”. Another resident said, “Lovely atmosphere” and another “just like a family”. It was clear residents are encouraged to voice their opinions and a suggestion box in the hall confirmed this. Two care staff said they felt Doctor Jameson and his deputy, who assisted the inspector with her inspection, provided good leadership. The care plans were very informative and showed that staff provide the appropriate amount of support. There were no requirements or recommendations made although one health and safety issue was immediately dealt with and other advice was given over a number of items, none of which directly affected the outcomes for residents. What the service does well:
Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 6 The residents confirmed that Sussex Grange provides a very good personal care service and encourages them to own it as their own home by furnishing it with their own furniture and personal items. The food continues to be prepared and cooked to a very high standard and a good choice is available if residents are not keen on the main choice. A number of good practice issues advised at the last inspection had been carried out demonstrating the management’s commitment to meeting the National Minimum Standards. From examining records, information gained from residents and staff and through observation, care is being recorded appropriately and recognises the individuality of residents. Staff are clearly committed to providing a professional and caring service supporting residents to lead fuller and happier lives as individuals and feel free to follow those activities provided by the home or that are personal to them. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 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 Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 All residents had been assessed before moving into the home. The staff at the home are meeting the residents identified needs. Relatives were given enough information to help them decide the home would be suitable. EVIDENCE: The residents confirmed that they had received the Statement of Purpose and Service Users Guide and were well informed about the way the home operates. Four care plans were examined and it was clear residents had been assessed to ensure the home would be able to meet their needs. Relevant risk assessments were in place and had been updated. Care plans to instruct staff how to meet identified needs had been written from the assessments and it was clear from the residents comments and staff care, that staff were well informed about the care needed and were updating records accordingly. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 All residents had an individual care plan set out for staff to follow. Staff are meeting the health care needs of the residents in a respectful manner. EVIDENCE: Sussex Grange provides residents with full information regarding managing all or any part of their medication. The inspector advised that residents sign to agree the monitoring procedure. Four care plans were examined in detail and all residents had an up-to-date care plan with care that had been identified as needing to be given. Changes in care and condition are recorded on an update sheet to inform care staff of the new needs. Risk assessments were examined and gave staff good information about the risks to residents. The Accident Record should provide continuous information to show when residents have recovered without the need for further treatment or observation. The inspector recognised that this is included in the care plan but as this forms part of the accident record, good practice directs this is included in these records. The inspector observed the interaction between staff and residents and noted that residents are treated with respect and spoken to in a caring manner. Residents said staff were “delightful”, “wonderful”, “lovely” and “nowhere else would care be any better”.
Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. A number of regular activities are provided with individual activities arranged according to the requests and dependency of the residents. Visiting is positively encouraged. Residents are served meals that are nutritious and appetising. EVIDENCE: Few residents have high dependency needs and residents are encouraged to participate in the regular activities provided by outside organisations or staff. Some residents follow their own activities and residents confirmed that where needed, staff support these. The visitor’s book showed visitors are welcomed at all times and clearly over the Christmas period, many visitors were welcomed. The main meal gives a choice of two dishes for main and sweet courses with other items available if both choices are not suitable. Three fresh vegetables were provided separately from the vegetables included in the main dish. All the food is home cooked. Most residents have lunch in the dining area but again; this is from choice or provided according to the needs of the resident. The inspector observed the lunch provided and it seemed to be of a high quality. All the residents spoke highly of the food provided with comments of “very good”, “no room for improvement”, “lovely” and “always a good choice”.
Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17.18 The complaints process is on display. Staff training records confirmed they had all received some training in Adult Protection Procedures. EVIDENCE: The home has a complaints procedure displayed on the notice board in the hall. Residents spoken with said they knew who to complain to, but they have had no occasion to use it. No complaints had been recorded since the last inspection and previously, complaints have been investigated and responded to according to the procedure. The West Sussex Multi Agency guidelines were available and staff had received appropriate training and were aware of the procedure. The senior staff confirmed that arrangements are being made to update staff members in the near future. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 The indoor areas used by residents are clean, safe and homely with good access to the front, side and rear gardens. The resident’s rooms are suitable for their needs and are homely. EVIDENCE: During a tour of the home the inspector noted that the plumbing and heating system has been revamped to provide a safe environment. There is one large ground floor lounge with a separate dining room. This is furnished with tables accommodating six residents giving it a homely atmosphere. There is a passenger lift, inspected regularly, for access between the ground and first floors. All rooms have en-suite facilities with an assisted bath to meet the needs of residents. Thermostatic valves are in place to restrict water temperatures to safe levels. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 13 Radiators are guarded and the home was clean and hygienic. Resident’s rooms were visited and were homely and comfortably furnished with personal possessions around them. Training records showed that staff have received training in fire safety procedures and from questionnaires directed at residents, safety is maintained at all times. Fire risk assessments and polices and procedures relating to these are regularly reviewed. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28.29.30. Sufficient staff are on duty over the 24 hours period to meet needs and staff recruited to meet Care Homes Regulations. Training is provided to ensure staff are competent to do their jobs. EVIDENCE: The inspector examined the staffing duty rota and noted this met residents needs. The numbers and skill mix of staff was appropriate to meet their needs with 23 of care staff having achieved National Vocational Qualification level 2 and a further 29 currently in the process of achieving this. When achieved, this will give the home the required level of trained care staff. As well as this, two other care staff are waiting for funding to start level 2. Both of the members of staff spoken with said they felt well supported by the manager and the senior staff acting as his deputy. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38. The registered manager is Doctor Tom Jameson. Doctor Jameson owns the home jointly with his wife Doctor Jameson who works as a doctor in the community. Doctor Jameson has the experience to manage the home. EVIDENCE: Doctor Jameson is completing the Registered Managers Award with his deputy, a senior care worker who continued her employment when Sussex Grange changed ownership. It was clear that Doctor Jameson is well supported by his deputy manager who has already achieved National Vocational Qualifications and has a number of years of experience at working at Sussex Grange. The residents complete a yearly questionnaire to seek their views on the success of the home in meeting their needs. The inspector examined this, concluding that improvements could be made to make it more user-friendly.
Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 16 The questions restricted answers to yes or no and although comments were requested, this did restrict the resident’s answers. From the recruitment records seen, an appropriate application form and reference request is available although the inspector did note that the manager completed one of these on the applicant’s behalf. One reference was accepted from a family member and the inclusion of a standard interview questionnaire to meet equal opportunities was not obtained. Records of induction and training were in place and although a different induction and foundation training pack had been obtained, this did not seem to include the thoughts or observations of the trainee. All care staff have received Criminal Records Bureau clearance. Supervision records or the procedure used were not examined on this occasion but the inspector observed a high commitment to ongoing training for existing staff. Staff clearly feel confident and well supported in their work and feel part of a team. All staff have access to job descriptions and care plans showed that staff provide the appropriate amount of support. Overall, the inspector could confirm that the residents take priority in the home, are cared for to a good standard and that the resident’s best interests were safeguarded. Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 4 3 3 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 3 3 3 3 3 3 3 Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 18 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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations Sussex Grange DS0000045863.V276715.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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