Inspection on 10/10/05 for The Grange

This inspection was carried out on 10th October 2005.

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

The Grange 17/08/06

The Grange 21/04/05

The Grange 07/02/05

The Grange 25/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Grange Staverton Road Daventry Northants NN11 4EY Lead Inspector Mrs Pat Harte Unannounced Inspection 10th October 2005 10:15 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 The Grange DS0000035002.V254968.R01.S.doc Version 5.0 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. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Grange Address Staverton Road Daventry Northants NN11 4EY 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) 01327 705226 01327 312856 Northamptonshire County Council Mrs Mary Frances Craig Care Home 38 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (38) The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. No person falling within the OP category can be admitted where there are already 38 people of OP category already in the home. No person falling within the DE(E) category can be admitted where there are already 20 people of DE(E) category already in the home. No person falling within the DE category can be admitted where there are already 5 people of DE category already in the home. No person admitted with the DE category will be below the age of 60. The total number of service users within the DE(E) and the DE category must not exceed 20. Total number of service users in the home must not exceed 38. Date of last inspection 21st April 2005 Brief Description of the Service: The Grange provides residential care for up to 38 Elderly Residents of both sexes with 20 places for Residents with Dementia, five of whom may be aged 60 to 65 years. The Home offers 28 permanent places and 10 Interim care places for up to 12 weeks when arrangements are made for discharge to the community or to another care home. The Home is owned by Northamptonshire County Council and managed by Mrs. M. Craig. The Home is situated within a residential area of Daventry and has access to local facilities and amenities. The premises consist of ground floor accommodation providing single bedrooms to all Residents with shared lounge/dining rooms. There are dedicated areas for Residents with Dementia. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. Inspection planning took one hour and consisted of a review of the last Inspection report and the Home’s service history including notifications and events. The primary method of inspection used was ‘case tracking’ which involved selecting three Residents and tracking the care they receive through review of their records, talking with them and the care staff. In addition four staff and seven Residents and two visiting Relatives were spoken with to obtain their views. A partial tour of the premises took place, a selection of records was inspected and observations made on care practices. Discussions were held with the Registered Manager. The Inspection took place during the late morning and afternoon over a period of six hours and was carried out on an unannounced basis What the service does well: The Home has a committed staff group. Residents spoken to felt that their relationships with staff were very good and that staff provided them with good care and support and valued and respected them as individuals. Routines are relaxed and flexible and Residents confirmed that they are enabled to continue with their normal routines, exercise control over their lives and maintain their independence as much as possible. Residents’ health care needs are taken very seriously and a proactive approach is taken to refer any concerns to the relevant Medical Professionals. The Home adopts a sensitive approach to supporting Relatives through the bereavement of their Residents. Residents and staff are given opportunities to pay their last respects. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 6 Meals are varied, well balanced, of good quality and nicely presented. Residents stated that they are given a good choice of options in the daily menu and account is taken of their likes and dislikes and special diets. Residents are provided with a good range of activities on both a group and individual basis including the provision of meaningful activities for Residents with Dementia. 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. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 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 The Grange DS0000035002.V254968.R01.S.doc Version 5.0 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, 2, 3, 4 & 5 Prospective Residents are provided with information to enable them to make informed choice regarding their placement and the pre-admission assessment is thorough and effective in ensuring that the needs of people admitted to the home can be met. EVIDENCE: The admission process ensures that all prospective Residents are visited and assessed by staff from the Home to identify their individual needs and ensure that these can be met. Residents and their relatives have opportunities to visit the Home prior to their admission and are given written information on the services and facilities. Residents spoken with felt that staff were well briefed on their needs and the care to be provided. Staff spoken with felt that they were given good information on their Residents needs, routines and wishes. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 9 Individual records are kept for each of the Residents and inspection of a new Resident’s records showed that the assessment process has been revised to ensure a good level of detail on the individual’s needs. Life history information is gathered for all Residents. Particular emphasis is now placed on the gathering of this information relating to those Residents with Dementia. Staff confirmed that the information assists their understanding of needs and ensures effective communication and interaction. Specific and recognised assessment tools are used to identify needs and risks as part of the assessment process with the exception of Nutritional risk assessments. The Manager is now to address this area. Residents are provided with written contracts with copies maintained in their records. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 10 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, 8, 9, 10 & 11 Progress has been made in the development of Care plans to provide instructions and guidance to staff on how the physical care needs are to be met, the development of plans and strategies for the management of behaviours in relation to Resident’s with Dementia is on going. EVIDENCE: Care plan formats have been reviewed and all existing care plans have been updated to the new format. 3 Residents care plans were inspected. The records showed a more holistic approach is now being taken in relation to physical and personal care needs. The level of instruction and guidance given to staff has been increased on how the care is to be carried through. However there are still gaps in the instructions such as the timings for specific areas of personal care such as teeth cleaning and toileting programmes. There are also no references as to how interim Residents are to be supported emotionally through, what is for them, a worry time until future arrangements are determined. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 11 The care plans showed that account is taken of Residents wishes in relation to how the care is to be provided. The plans detailed tasks that Residents’ could undertake for themselves showing that they were encouraged to retain as much control over their lives and maintain their independence as much as possible. Dementia care planning is on going. Attention has been paid to ensuring information gathering on Life Histories for Residents in general with specific attention given to those Residents with Dementia. Staff commented that the information gave them a better understanding of needs and enabled them to communicate more effectively with their Residents. Some cross referencing from the Life Histories was carried over to the individual care plans but more of the information could be used to develop written guidance and instruction for staff on strategies for the management of behaviours. It was not always clear from the plans how Residents Dementia care needs were to be supported although discussions with staff showed that strategies were in place to support Residents through their frustrations and distress. Improvements have been made to detailing Health care needs. Residents commented and records showed that staff responded quickly to any changes to their Residents’ health and made referrals to the appropriate Medical Professionals. Care plans gave clear instructions on how staff were to monitor health needs such as Diabetes. Residents commented that they felt they were respected and valued as individuals by staff. They stated that staff were quick to react to any changes in their health needs and ensure that they were able to see their General Practitioners quickly. Procedures were in place for the management of Medication. Storage was appropriate. The required records for incoming, administration and disposal of medication were in good order although gaps in the administration records were noted in one instance. Observations confirmed that Medication was safely and appropriately administered following the midday meal. Observations confirmed that Staff ensure the protection of Residents privacy and dignity when carrying through personal care. Care is taken to identify and record Residents wishes in relation to the arrangements to be made after their deaths. Discussions with staff showed that this area is treated very sensitively and it is clear that Relatives are supported in their bereavement and the Home consults with them on funeral arrangements. On the day of Inspection the funeral of a Resident left from the Home giving Residents and staff an opportunity to pay their last respects. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 12 Arrangements can be made for Relatives to come back to the Home following the funeral if this is as they wish. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 13 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 Residents are enabled to maintain their independence as much as possible and exercise control and choice in the way they wish to lead their lives and are offered an extensive activity programme including meaningful activities for those Residents with Dementia. EVIDENCE: Residents felt routines were relaxed and flexible and that their preferences on rising and going to bed times were respected. They felt that they were free to decide on how and where they wished to spend their time and that they were encouraged to maintain their independence. All of the permanent Residents spoken with said how well settled they felt and how they regarded The Grange as “a Home from Home”. The Home has an open visiting policy and Residents confirmed that they were enabled to receive their visitors in private if they wished. Visiting Relatives commented that they were made welcome, extended hospitality and that staff made time to discuss their Residents needs, health and progress with them. They felt that they were kept well informed of any changes in need or of any concerns. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 14 The Home has a good approach to providing activities on either a group or individual basis. During the Inspection all lounge areas were involved in a variety of activities including those designed specifically for Residents with Dementia. Residents were clearly enjoying the activities and there was much laughter and good-hearted repartee between them and the staff. Not all residents are able or wished to participate in the group activities and staff demonstrated that 1 – 1 time was provided to ensure Residents are not isolated. Specific programmes for such Residents were not included on the care plans. A number of Residents were spoken to and everyone who commented on the food said it was good, that they had choice and their special and likes and dislikes were catered for and respected. Residents are asked to comment and offer suggestions on the menu and changes are made accordingly. The midday meal was efficiently served and nicely presented. Staff helped Residents with their meals where necessary. The Home makes provision for relatives to join with their Resident to take meals. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 15 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): Systems are in place to ensure that complaints are listened to and acted upon and that Residents are protected from abuse. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure, which is also displayed in the Home. Those spoken with felt confident and able to raise any issues or concerns with staff. A complaints record is maintained. No complaints have been received by the CSCI in the last year. Robust procedures for the Protection of Vulnerable Adults are in place. Staff demonstrated, through discussions, their full understanding of the reporting procedures. Records and notifications received by the Commission confirm that any allegations are reported. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 16 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, 20, 21, 23, 24, 25 & 26 Residents are provided with a safe, well-maintained environment. EVIDENCE: The premises were in good order, clean, warm, comfortable and well maintained. Standards of domestic and hygiene maintenance were viewed as very good throughout the areas of the premises viewed. Residents stated that cleaning routines were carefully organised to ensure no disruption to their routines. Residents are enabled to personalise their rooms as they wish and have their furnishings and belongings around them. The Home does not provide for people with Physical Disabilities but toilets and a shower room can accommodate a hoist should this be required due to deteriorating health needs. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 17 Residents have access to garden areas, two of which are safely secured for use by Residents with Dementia. Car parking space at the Home is limited as the campus is also used by other County Council facilities and at times the area is crowded with cars. However attentions has been paid to safety aspects with yellow, no parking lines being painted on the driveway to the Home. This is to prevent parking and to allow access for emergency vehicles at all times. Staff from the Home are vigilant and showed a quick response by asking people to move their cars if they were inappropriately parked. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 18 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 numbers of care staff are deployed to meet the needs of current Residents. EVIDENCE: Staff rotas showed a variance in care staffing levels from 5 to 4 on daytime shifts, however the minimum of 4 care staff has been maintained. Discussions with the Manager, staff and Residents confirmed that the numbers of care staff deployed were sufficient to meet the needs of the current Residents. Residents spoken with said that the all the staff, including ancillary staff, were very kind, committed and caring. They felt that care needs were promptly attended to. Observations showed that staff constantly monitored their Residents. In addition to the care staff, domestic and catering staff are employed together with a Handyman. The ancillary staff provision ensures that care staff are not diverted from their care duties. Staff training was discussed with the Manager, out of a total of 26 care staff 21 have attained a National Vocational Qualification at level 2 or above and 4 more staff are currently undertaking the qualification. This exceeds the minimum expected standard of 50 trained care staff. The staff-training plan The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 19 showed regular updates of core training and the provision of specialised training particularly in the area of Dementia care. Two staff files were inspected and showed robust procedures in place for staff recruitment. The necessary checks had been undertaken and two references obtained. Records showed that staff were provided with regular supervision and that yearly appraisals were undertaken. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 20 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 The Management of the Home is effective and the home is run in the best interests of the Residents. The systems for the management of Residents monies and items held for safekeeping are not safely maintained. EVIDENCE: Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues, guide them in practice and offer support and supervision. Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager consulted with them and sought their individual views and opinions. Residents felt that they had trust and confidence in both the Manager and the staff group as a whole, relationships were observed to be very good. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 21 The systems for safekeeping and management, where necessary, of Residents moneys have been reviewed however they were not appropriately maintained in all areas. Large amounts of cash are held by the Home on behalf of Residents. It is acknowledged that the Manager is addressing this area to ensure that moneys are transferred to Residents’ individual bank accounts so that they may benefit from interest accrued. Receipts were not maintained for all transactions where staff had purchased items on behalf of Residents or where services such as Hairdressing or Dentistry had been supplied. However records of all transactions were well maintained and are subject to regular audits to ensure accuracy. The transaction records showed that Residents are encouraged to sign for withdrawals where possible. Some valuables, previously held for safekeeping by the Home, were not receipted as having been returned to the Resident or their Relatives. The Manager has agreed to address these areas. The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 22 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 2 8 3 9 3 10 3 11 4 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 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 2 X The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? 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 The Grange DS0000035002.V254968.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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. 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