Inspection on 12/07/07 for The Grange

This inspection was carried out on 12th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The Grange 20/07/09

The Grange 23/02/09

The Grange 29/02/08

The Grange 06/12/06

The Grange 30/09/05

The Grange 13/06/05

The Grange 21/10/04

The Grange 19/04/04

The Grange 14/01/04

The Grange 10/11/03

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

CARE HOMES FOR OLDER PEOPLE The Grange The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ Lead Inspector Robert Pettiford and Sue McGrath Key Unannounced Inspection 12th July 2007 09:00 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 The Grange DS0000029055.V343219.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. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ 01634 270674 01634 270674 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) Mr Henry Alfred James Holloway Post Vacant Care Home 10 Category(ies) of Dementia - over 65 years of age (10) registration, with number of places The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Grange is located in a rural area with few local amenities. To the front of the property there is a circular drive and a paved area, offering ample parking. To the rear there is a large garden mostly laid to lawn, with a raised patio area. The home occupies detached premises with accommodation on two floors. There is a single person lift between the two floors. There are 8 single rooms and 1 double bedroom. 2 of the single rooms have en-suite facilities. There are call bells in bedrooms, bathrooms and toilets. The staff provide 24-hour cover working a rota, there is one waking night staff on duty at night supported by a member of staff sleeping –in the adjoining bungalow to provide support in the event of an emergency or additional support being needed. Fee’s are by assessment in the range of £385.00 to £500.00 per week. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The two Inspectors present at the inspection agreed and explained the inspection process with the senior carer present during the inspection. The owner Mr Holloway was present for some of the inspection. The focus of the inspection was to assess The Grange in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older Persons. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The Inspectors used a triangulated methodology to complete this inspection, pre-inspection information such as the previous report and discussion and correspondence with the registered provider was used in the planning process to ensure hypotheses were formulated to support the inspector to explore any issues of concern and verify practice and service provision. The home had completed an annual quality assurance assessment questionnaire which was received prior the site visit to the home. This provided the Inspector with information relating to What the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. During the inspection documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. Other area’s viewed included risk assessments, pre-admission assessments, menus, rota’s, training records and recruitment records. In addition a full environmental tour took place. The Inspectors identified three Residents for case tracking, speaking with them and assessing the available information held in the home pertaining to the care provision for both. In addition the Inspectors met with the other Residents, which gave them a good opportunity to observe the quality of care within the home and activities enjoyed. A Notice of Immediate Requirement for action was issued at the time of the inspection with regard to breaches in health and safety. The home was required to take immediate action by 4:00PM Monday 16th July 2007 to advise the Commission what steps it was taking to address the issue(s) identified and to ensure the safety of all persons in the service. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The homes procedures for the safe administration of medication was assessed and found to have areas of concern. The home will be required to update its medication Policy to fully meet with the requirement of the Royal Pharmaceutical Society of Great Britain. The service provides overall a homely environment. However it does not have a rolling programme to improve the decoration, fixtures and fittings. Various areas of the home were in need of The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 7 refurbishment including the upstairs bathroom, cleaning of the carpets, toilet fittings / seats ground floor, bedroom furniture and kitchen floor covering that was not fitted properly. This judgement was made following discussions with the owner and senior carer. Repairs and maintenance are in the opinion of the inspector are reactionary rather than planned. The owner is not proactive in ensuring that repairs and decoration are carried out to a planned programme. The home does not currently have a manager and is being managed by a senior carer. Whilst it is accepted that the senior carer has been instrumental in ensuring that the care needs of the residents are meet she does not have the experience or management competencies to ensure that the home is managed properly. The senior carer is to be commended on her efforts to maintain standards of care and that it is run to the best of her ability. The manager has not been replaced by either a competent and skilled temporary appointment or active attempts made to appoint a new person in the management role. Training, development and supervision of staff is inconsistent and staff lack leadership. The senior carer does not understand strategic planning and review. Policies and procedures are not reviewed or kept up to date. Residents interests are not safeguarded as evidenced by poor or non existing record keeping with regard to health and safety. This has lead in some circumstances to putting service users at risk, for example by poor recording of medication. Quality assurance monitoring is not regarded or implemented as a core management tool. The home is drifting and lacks purpose and direction. The home does not have a health and safety policy that meets health and safety requirements and legislation. The provider is not aware of the areas where they need to make improvements. The provider has been seen to be reactive to the inspector’s comments on this and past inspections rather than being proactive in managing risk. 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. The Grange DS0000029055.V343219.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 The Grange DS0000029055.V343219.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): 1,2,3, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents continue not have all the information they need to make an informed choice about whether they wish to live at the home. Residents rights are not fully protected by a written contract / statement of terms and conditions. Service user can not be confident that their needs will be assessed prior to moving in to the home due to the home presently not having anyone qualified to carry out this role. EVIDENCE: It was identified at the last inspection that although residents are provided with a Statement of Purpose it was found not to include all the information as The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 10 required of Schedule 1 of the Care Home Regulations 2001. This was seen as a shortfall which has not been addressed at this inspection. No evidence was seen that the home has made any attempt to review the statement of purpose and comply with the standards. Issues with regard to equality and diversity has also not been addressed within the Statement of Purpose. The contracts/terms conditions of residency continue not to contain all the information as required of the standards. No evidence was seen that the home has made any attempt to review the contracts and comply with the standards. The senior care confirmed that all prospective residents are fully assessed prior to admission. This task is normally undertaken by the registered manager, however as that post is currently vacant the home does not have anyone who is suitably qualified to carry this procedure out. The last service user to be admitted was assessed by the previous manager. The assessment was seen to be thorough and give clear information regarding needs. Evidence was also seen of care management assessments. The Commission has written to the provider to ensure that no new admissions are made at the home until such time that they have a suitably trained and experienced member of staff to make such an assessment. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10,11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ health needs are well met but care plans need to be reviewed. Residents have the potential to be at risk from poor administration of medication. Residents are treated with respect at all times and enjoy a good level of personal care. EVIDENCE: The majority of the care plans were viewed and the main problem was that the home is running two types of care plans, one from the original registered manager and one from the second manager. The provider is advised to use one comprehensive care plan so that staff are given clear advise on the care to be delivered. Some areas of the plans need to improve such as nutritional The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 12 assessments, risk assessment and guidance regarding diabetes and guidance on catheter care. Training is also recommended on both diabetes and catheter care. Tissue viability information could also be improved. Residents all confirmed they are happy with the level of care and say they are very well supported by the staff. Some very positive examples of care were seen during the inspection and clearly staff are committed to the home and are dedicated to providing good levels of care. Some visitors were spoken with and they also confirmed that they had never seen anything other that good care being offered. Residents confirm that staff treat them with respect at all times and this was observed during the inspection. Health care needs are well met with outcomes recorded and acted upon. The majority of residents are regularly weighed to ensure appropriate action can be taken if necessary. The homes procedures for the safe administration of medication was assessed and found to have areas of concern. The home will be required to update its Medication Policy to fully meet with the requirement of the Royal Pharmaceutical Society of Great Britain. Further guidance can be found on the CSCI website. Staff that administer medication must be familiar with the written procedures and policies and ensure they follow them. Medication must not be transferred to plastic pots and placed on a tray, all together, and then given out. There is a risk the wrong tablets may be given to the wrong individual. The relevant contents of each blister pack must be administered on an individual basis. The procedures and policies need to reflect this. All medications must be given as prescribed by the Doctor and only to the named person. Bottles of prescribed liquids medications must not be shared. If the prescribed instructions cannot be followed, the GP must be informed and any new instruction followed accurately. New instruction should be obtained in writing where possible. All errors in the administration of medication must be notified to CSCI under Regulation 37. Staff training must be confirmed by certification and the home must be able to evidence this training has occurred. This could not confirmed on the day. One other issue of concern was the practise of two residents signing for their own night medication (second signatory). This occurs with one brand of medication that the home deals with under the control drugs system. This is due to only having one member of night staff on duty. A full risk assessment must be in place to ensure this practise is safe. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 13 Eye drops and topical creams must be stored in a dedicated medical fridge and not in the homes general fridge in the kitchen. Dates should be recorded when eye drops are opened to ensure they are only used for 28 days. The temperature of the medical room be recorded and a new thermometer purchased. The current one is in a poor condition. The home has a policy on handling illness and death, which ensures residents are offered care and comfort in the privacy of their own rooms unless there is a strong medical reason to prevent this. Facilities are available for families to stay with their relatives at such times. The home is not registered for nursing care. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 14 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. Current residents enjoy a good lifestyle, which meets with their expectations. Relatives are actively encouraged to maintain contact with their relatives and residents are encouraged to maintain choice and control over their lives. The meals could be more nutritionally balanced. EVIDENCE: The majority of the residents spoken with confirmed they were happy with the lifestyle at The Grange and found the level of activities about right. Staffs normally arrange activities in the afternoon and records are kept of who participates and what the activity is. Activities include bingo, puzzles, quizzes, ball games, skittles and hoopla. Books from the mobile library are on offer and monthly motivation sessions are enjoyed by most. Relative confirm that garden parties, Christmas parties and birthdays celebrations are also organised. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 15 Families are encouraged to visit where possible and to remain involved in their relatives affairs where possible. Residents confirmed they are given choices over meals, activities and the pattern of daily life. There confirmed they could roam the house freely and no restriction were placed upon them Evidence was seen that residents can bring in some personal items for their rooms and staff confirm this was encouraged. The general feeling amongst residents was that the food was good, however one did say she would like more meat such as ‘a juicy pork chop’. Menus were not displayed so residents are not aware of the forthcoming meals. Residents say that often staff will ask them what they want for dinner each day. The menus seen in the kitchen indicated a high level of sausage, beef burgers and chicken burgers. Staff say this is what the residents prefer but the home is advised to seek guidance on the nutritional content of the menus offered as they appeared to be high in saturated fat and salt. Information was left regarding The Royal Institutes of Public Health Guide for Healthy Eating in Care Homes. Residents confirmed the previous days menu was a mixed grill consisting of a beef burger, sausage and liver. The main meal on the day of the inspection was chicken burger sweet corn and new potatoes. It is also recommended that residents be given the choice over fresh or UHT milk at all times. It is also recommended that a larger fridge be purchased so that the practise of freezing vacuum packed food such as cheese and cold meats can be stopped. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 16 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 are aware of their rights with regard to making a complaint and to whom to complain. Residents are protected from the risk of abuse by the home’s Adult Protection policy and procedures. EVIDENCE: A copy of the Home’s complaints procedures was reviewed along with the manager. The procedure was found to met with the standards and well presented. The home’s Policy for the Protection of Residents and staff “Whistle blowing” procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has been is provided in abuse. Staff at The Grange take the risk of abuse very seriously and are aware of what to do should any incident occur. The senior carer who is overseeing the home whilst a new manager is being employed is instrumental in the running of the home and through her leadership takes all steps possible to protect residents from abuse. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is adequate. Residents cannot be fully confident that all areas of the home are well maintained and clean. EVIDENCE: The service provides overall a homely environment. However it does not have a rolling programme to improve the decoration, fixtures and fittings. Various areas of the home were in need of refurbishment including the upstairs bathroom, cleaning of the carpets, toilet fittings / seats ground floor, bedroom furniture and kitchen floor covering that was not fitted properly. This judgement was made following discussions with the owner and senior carer. Repairs and maintenance are in the opinion of the inspector are reactionary rather than planned. The owner is not proactive in ensuring that repairs and decoration are carried out to a planned programme. Following a random inspection of the home on 27th April 2007 shortfalls were evidenced with regard to the upkeep of the home, including the downstairs toilet floors and the tiles in the kitchen. These two items have been repaired / replaced. It is The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 18 the opinion of the inspector that the owner is only influenced by the comments of the inspector at each inspection and does not see maintenance and repair as a high priority and only reacts following the presence of the inspector. Residents commented that they felt the home had a homely atmosphere and that they were comfortable. Several commented that some redecoration had taken place and that they liked their rooms. Residents say they are comfortable, the home is clean, warm, well lit and there is usually sufficient hot water. The home is generally clean and tidy. However some of the carpets were in need of cleaning and their suitability in certain area’s assessed due to odour problems. The home has recently employed the service’s of a cleaner and it is hoped that this will be addressed. The home has an industrial washing machine and tumble dryer which is suitable for the needs of the residents. Hand washing facilities are prominently sited in areas where infected material are being handled. The laundry floor finishes are impermeable and these and wall finishes are readily cleanable. The home is requested to produce a written plan of refurbishment and maintenance to ensure that the environment is kept safe and maintained in a good state of repair. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 19 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 adequate This judgement has been made using available evidence including a visit to this service. Residents’ care, social and emotional needs are promoted by the employment of very caring staff who meet their needs during the day. However insufficient staff at night put residents at risk. Residents are at risk due to poor recruitment procedures within the home. Although many of the staff have received good levels of training residents can not feel fully confident that their skills have been updated and that all staff have received training to the required standards. EVIDENCE: From observations and discussions with the residents, staff take their roles very seriously and are seen as very caring and supportive of the residents needs. At present the home does not have a manager and the senior care has taken on part of this role and in the judgement of the inspector is instrumental in ensuring that the care needs of the residents are meet as best she can influence. She is open and honest and is aware of her shortfalls with regard to The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 20 management and in the interim whist a new manager is recruited is managing as best as she can. From discussions with the senior carer and staff and observations on the day of the site visit it was evident that staffing levels are not always sufficient to meet residents needs especially at night. At present two member of staff are on duty 8:00AM to 2:00PM and two 2:00PM to 8:00PM and one waking night staff 8:00PM to 8:00AM. In the view of the inspector one member of staff from 8:00PM to 8:00AM does not allow for that staff member to meet the needs of all residents at all times, bearing in mind that the home is registered for residents who have dementia which can result in their needs being much higher. One member of staff on night does not allow for cover in the event of emergencies and should any one resident need assistance at any one time. The owner was requested to review the staffing arrangements to ensure support is available at all times. At immediate requirement was made that this concern would be addressed by 5:00PM on Monday 16th July 2007. In addition to direct care, staff were additionally responsible for cooking, laundry and cleaning in the home. A requirement was made at the last key inspection that this is reviewed. To meet with this the owner has now employed a cleaner who works at the home on a part time basis. Discussion with staff and senior carer evidenced that training in the home is at a adequate level. The majority of staff having undertaken a range of core training, including medication, Health and safety and moving and handling. Fire safety, Adult Protection and First aid. However due to poor training records this could not be fully evidenced. Not all staff have received the required training including regular updates. Many of the staff have completed dementia training which was seen as a positive to met the need of the residents. However further work is needed to ensure the updates are carried out, that the home has good training records and staff have a NVQ level 2 or equivalent and a induction programme which meets with the Sector Skills Councils specifications. A sample of staff files were inspected and these evidenced that not all appropriate recruitment checks were being undertaken. It was noted that one employed staff member only had one written reference on her file, which was not on headed notepaper from her previous employer. Additionally one member of staff had been employed who had not been through any recruitment checks, application form, references or had a CRB (Criminal Records Bureau) check of had a recruitment file. The owner was requested that the home meets with the standards with regard to recruitment and ensures that all staff have a CRB check. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 21 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): 31,32,33,37,38 Quality in this outcome group is Poor Residents live in a poorly managed home Residents and or their relatives cannot be confident that the quality of the service is monitored, and that their best interest are safeguarded by appropriate policies and procedures which are up to date. Service user’s can not feel confident that their health and safety is protected and they are not at risk of harm. EVIDENCE: The home does not currently have a manager and is being managed by a senior carer. Whilst it is accepted that the senior carer has been instrumental in ensuring that the care needs of the residents are meet she does not have the experience or management competencies to ensure that the home is The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 22 managed properly. The senior carer is to be commended on her efforts to maintain standards of care and that it is run to the best of her ability. The manager has not been replaced by either a competent and skilled temporary appointment or active attempts made to appoint a new person in the management role. Training, development and supervision of staff is inconsistent and staff lack leadership. The senior carer does not understand strategic planning and review. Policies and procedures are not reviewed or kept up to date. Residents interests are not safeguarded as evidenced by poor or non existing record keeping with regard to health and safety. This has lead in some circumstances to putting service users at risk, for example by poor recording of medication. Quality assurance monitoring is not regarded or implemented as a core management tool. The home is drifting and lacks purpose and direction. The home has not produced any clear health and safety policy or training programme and there is a significant level of risk to residents through health and safety non compliance evidenced by a history of non compliance with regard to ensuring all the necessary checks are carried out to minimises the risk to residents. The home may be in financial difficulty and the provider was requested to provide details of the home’s finances. It is evident that the home is struggling to deliver a service. The registered provider is not sufficiently involved in the control and direction of the business and there is no evidence of long term or strategic planning. The service provider is unable to produce any evidence of the home being adequately managed. Health and safety and medication concerns, poor management mean that residents are not adequately protected or safe in this home. Quality assurance was discussed and the views and opinions of many of the service user’s sought. They confirmed a great deal of satisfaction in living within the home and felt confident that their views and opinions were valued by the staff and management. However no formal quality assurance system is in place that seeks to monitor the quality of care within the home. The registered provider of the home does visit the home but does not complete what is known as a Regulation 26 visit (Statutory documented visits by the provider to monitor standards within the home). This requires the owner / provider to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. Such visits need to focus on outcomes for service user’s with regard to quality of care, staffing, adult protection, audits of policies and procedures and that they are followed, staff training, Activities, Health and Safety etc. along with speaking to staff and service user’s. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 23 Staff assisting with the inspection stated that they were not aware if the home had policies and procedures for all topics set out in Appendix 2 of the National Minimum Standards. The policies and procedures viewed were found to be on the whole out of date and in need of revision. Evidence seen confirmed that old and new policies were present that were in need of some degree of updating and re-organisation. The home does not have a health and safety policy that meets health and safety requirements and legislation. The provider is not aware of the areas where they need to make improvements. The provider has been seen to be reactive to the inspector’s comments on this and past inspections rather than being proactive in managing risk. The inspector viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The inspector viewed the Fire Log book, which was up-to-date. The inspector was not able to evidence that checks and servicing of fire safety equipment / emergency lighting had been undertaken at the required frequency. Fire risk assessments were not in place. The Regulatory Reform (Fire Safety) Order (RRFSO) 2005, which came into effect on 01 October 2006 make changes to fire safety legislation. The main emphasis of the changes was to move towards ‘self regulation’ of fire safety. Under the RRFSO the responsible person for the premises is required to carry out an assessment of the risks (a fire risk assessment) of fire and take steps to reduce or remove the risk. The assessment will need to be kept under regular review. The registered provider was requested to ensure that it compiles a fire risk assessment that complies with RRFSO as a priority. Evidence was not available however that all of the required health and safety checks had been carried out. Electrical wiring and PAT (Portable Appliance Testing) testing tests were not evidenced as being carried out by a suitably trained and competent person. The home was unable to evidence that the passenger lift had been tested at the required intervals to comply with section 9 (3)(a)(1) of The Lifting Operations and Lifting Equipment Regulations 1998. Training was also not fully evidenced with regard to health and safety. Training records were seen as poor and not all staff had either received all the required health and safety training or the required updates. Evidence was available that lifting equipment had been serviced alone with testing of electrical wiring and gas. The home was requested to review its health and safety procedures to ensure that all elements of safety are inspected and maintained to ensure the safety of service user’s and that the home meets with the standards. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 24 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 2 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 x x x 1 1 The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4(1) Requirement The registered person shall compile a statement of purpose that contains all of the information listed in Schedule1 of the Care Home Regulations 2001 The registered person shall, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his/her health and welfare are to be met. Timescale for action 09/08/07 3 OP7 15(1) 09/08/07 4 OP9 13(2) The registered person shall make 09/08/07 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The registered person shall provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared. The premises to be used as the care home are of sound DS0000029055.V343219.R01.S.doc 5 OP15 16(2) 09/08/07 6 OP19 23(2) 09/08/07 The Grange Version 5.2 Page 26 construction and kept in a good state of repair externally and internally. 6 OP26 16(1) The registered person shall keep the care home free from offensive odours. The registered person shall, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users The registered person shall, ensure that the persons employed by at the care home receive training appropriate to the work they are to perform; The registered person shall not employ a person to work at the care home unless all recruitment checks have been carried out per the Care Home Regulations 2001 And obtained a CRB and Pova check The registered provider shall appoint an individual to manage the care home who has the skills, experience and qualifications to ensure that the home is managed to a good standard. The registered person shall establish and maintain a system reviewing at appropriate intervals, and improving, the quality of care provided at the care home. The registered person shall supply to the Commission a report known as a regulation 26 in respect of a monthly review DS0000029055.V343219.R01.S.doc 09/08/07 7 OP27 18(1) 09/08/07 8 OP28 18(1) 09/08/07 9 OP29 19(1) 09/08/07 11 OP31 8(1) 09/08/07 13 OP33 24(1) 09/08/07 The Grange Version 5.2 Page 27 conducted by him for the purposes of assessing the quality of care. The person carrying out the visit shall interview, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home; inspect the premises of the care home, its record of events and records of any complaints; and prepare a written report on the conduct of the care home. 15 OP38 12(4) 23(4) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated in so much that the registered person shall ensure that all safety checks are carried out and by such persons who are suitably trained and qualified. The registered person shall after consultation with the fire authority take adequate precautions against the risk of fire and prepare a fire risk assessment that meets with The Regulatory Reform (Fire Safety) Order (RRFSO) 2005 09/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Grange DS0000029055.V343219.R01.S.doc Version 5.2 Page 28 No. Refer to Standard Good Practice Recommendations The Grange DS0000029055.V343219.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. 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