Inspection on 14/07/09 for The Grange

This inspection was carried out on 14th July 2009.

CQC found this care home to be providing an Good service.

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 18/07/07

The Grange 25/07/06

The Grange 31/01/06

The Grange 30/08/05

The Grange 07/03/05

The Grange 07/09/04

The Grange 15/03/04

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Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Grange Kerry Lane Bishops Castle Shropshire SY9 5AU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pat Scott     Date: 1 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: The Grange Kerry Lane Bishops Castle Shropshire SY9 5AU 01588638708 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: mayfair4care@yahoo.co.uk Mayfair Care Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 24, Old age, not falling within any other category (OP) 24 Date of last inspection Brief description of the care home The Grange is a privately owned Care Home situated in Bishops Castle. The Proprietors are Mr Geoffrey Tilling and Miss Taylor. Miss Taylor is responsible for the care management at the home and has many years experience in a care setting. The home stands in its own grounds, in close proximity to the centre of the small rural market town of Bishops Castle. The main building, formerly The Old Police Station, has been adapted and extended to its present form and additional accommodation is available across the courtyard in two separate self-contained bungalows. These are The Grange Lodge and The Vine, accommodating two and three service users respectively. The Care Homes for Older People Page 4 of 23 24 0 Over 65 0 24 Brief description of the care home home makes their services known to prospective service users in: The Statement of Purpose, Service User Guide and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in the entrance hall. Fees are reviewed annually and are in the service users guide. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the commission, looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. Care Homes for Older People Page 6 of 23 What other people have told us about the service. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. People have a preadmission assessment so that their needs are identified and planned for when they move to the home. Evidence: The service has a statement of purpose which provides good information about the home. The guide is in a large print format and the content is clear. Evidence shows that people have a needs assessment carried out before they are admitted to the home. The files of two people were viewed. The manager consults the assessment information to see if the home can meet the persons needs before they make the decision to accept the application for admission and offer a placement. The manager has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the service users. Staff training to ensure that they have the necessary skills and ability to care for Care Homes for Older People Page 10 of 23 Evidence: residents who are admitted is on-going. Care Homes for Older People Page 11 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that all residents can be sure that their health and personal care needs will be fully met to ensure their well being. The manager understands the need to comply with safe medication systems and staff are trained so that service users health matters are safely addressed. Evidence: Two care plans were examined. The staff involve residents in the development and review of the plan and sign them where able. The plans include the basic information necessary to plan the individuals care. There is recorded evidence of updating information and changing actions in the care plans. People have access to health care services that meet their assessed needs both within the home and in the local community. People have access to dentists, opticians and other community services. Peoples health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and is able to provide the aids and equipment recommended. There is written evidence in the daily notes of health Care Homes for Older People Page 12 of 23 Evidence: care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. Staff were seen to be aware of the need to treat residents with respect and to consider dignity when delivering personal care. The service provides stand alone screens for privacy in shared rooms. Residents seen and spoken with all appeared well groomed with their hair, nails and clothes looking clean. This indicates that people have the support they need so ensuring they feel good about themselves. The trolley for peoples medication is kept in the managers office. At the front of each care plan there is a photo of the person so that any unfamiliar staff would know who to give the medication to. Medication charts sampled had been signed when medication had been given. Receipt, and disposal are also accounted for. Staff spoken with are alert to changes in mood, behaviour and general wellbeing. People are cared for in the least restrictive regime practicable. Care Homes for Older People Page 13 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and community mean the people have opportunities to participate in leisure pursuits. The provision of meals, although lacking in specific choice, ensures service users have a wholesome meal. Evidence: The care records looked at indicate that peoples food and drink intake is monitored daily and regular meals and drinks are offered. People can have an alternative to the main menu but it is not clearly displayed as an option. Results of resident questionnaires showed that people are satisfied with the meal provision. Through service surveys people and their relatives can indicate their preferences for activities and comment on what is provided. Informal discussion takes place for people to decide on group events such as outings and pastimes. People were seen sitting in the lounges or in their room watching TV, listening to music or writing. There are activities but no dedicated activity co-ordinator in charge of this at the moment. Residents look happy and relaxed. Families are at ease when they visit. Staff have a good interaction with the people they look after. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a complaints procedure which is accessible to relatives so that people who visit the service have information of how to make complaints about the home. Adult protection training is provided for staff so that service users are protected from abuse and have their legal rights protected. Evidence: The home has a complaints policy and procedure displayed in the hall and within the service user guide. The service has not received any complaints recently. All staff working at The Grange have the relevant criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks including references. Staff files show that adult protection is discussed during induction and supervision and updates are provided. Good interaction is observed between staff and residents. They are relaxed in their company and showed no signs of distress. The proprietor/manager stated that minimal money is held for safekeeping on behalf of any people living at the home. This is kept in a safe and records kept. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The fittings of the home should improve so that people live in a better-maintained, private and comfortable environment. Evidence: Some aspects of the premises have improved such as a new walk in shower room and cleanliness is good. The glass panel in the door to the shower room can be seen through. A bath is in need of refurbishment as the enamel is chipped and the shower attachment leaking. Some of the vacant bedrooms are in need of redecoration. A carpeted bathroom is stated to be used by staff only but there is no indication of this. A fire escape route passes through a vacant bedroom. This room is lockable and if occupied may not allow speed of escape in the event of a fire. Many bedrooms have a glass panel in the door which although obscured does not provide total privacy for people within their own space. Laundry hours are vacant and are being filled by care staff. Staff follow procedures for dealing with foul linen but this system could improve. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. Evidence: The residents know the staff very well and observation showed that they provide a personal but professional service. The staff file seen of two new recruits showed that all employment checks had been carried out prior to them starting their role. Induction processes are thorough and mandatory training updates provided. Staff also stated that other training topics have been discussed which they have enjoyed, particularly those on mental capacity and deprivation of liberty. The service has care staff trained at national vocational qualification (NVQ) level 2 and 3. The manager has achieved NVQ level 4 plus the registered manager award. Care staff currently deal with the laundry. Care Homes for Older People Page 17 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home will start to implement quality assurance systems and audits so that people are more assured that the service is closely monitoring its own practice and that the overall conduct of the home is being well managed. Evidence: The service has a care manager who has experience and is confident to manage the service. She understands the need to have a plan for the business and to monitor the quality of care provision. A quality assurance system has been purchased and is to be implemented during the year ahead. She finds out what people like by talking to them, involving them in their care and holding resident meetings so that any issues can be discussed. The AQAA contains information that is supported by evidence but did not inform us of changes needed to make any improvements to the service. The organisation considers the views of people through surveys to relatives and residents. People are supported to manage their own money and records are kept. Care Homes for Older People Page 18 of 23 Evidence: People who use the service say that they trust the staff and feel safe in the home. Comments from people include: I am shown kindness and wonderful attention, the manager finds time to listen, Willing to discuss problems. The manager has introduced the concept of person centred thinking and including residents to shape the delivery of the service. Care Homes for Older People Page 19 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 15 19 19 People should be enabled to choose an option from the daily menu. The bathroom reported to be used by staff only should have adequate signage so that residents do not use it. The provider should consult with the fire authority regarding the escape route through bedroom 14. People should have privacy in their accomodation and care. All doors with glass panels to bedrooms and bathing facilities should be removed. Vacant rooms should be kept in good decorative order and people should have a choice of room decoration before they are admitted. People should use assisted bathrooms which are maintained in good order. The chipped green bath and shower attachment should be replaced within the agreed three months timeframe. Staff should use the red alginate bag system for foul linen so that it is handled once at source. Page 21 of 23 4 19 5 19 6 19 7 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 9 27 35 Recruit laundry staff as care staff should not carry our ancillary duties. The monitoring of the quality of the service provision including audits shoud be implemented. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!