Inspection on 14/06/05 for The Grange

This inspection was carried out on 14th June 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 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 10/09/07

The Grange 23/10/06

The Grange 19/12/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Grange 69 Southend Road Wickford Essex SS11 8DX Lead Inspector Vicky Dutton Unannounced 14th June 2005 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 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 I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Grange Address 69 Southend Road Wickford Essex SS11 8DX 01268 766466 01268 767130 grange@runwoodhomes.co.uk Runwood Homes plc Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager post vacant Care home 43 Category(ies) of Old age OP (43) registration, with number Dementia DE(E) - over 65 (22) of places The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Personal care to be provided to up to 43 older people. 2. Personal care to be provided to up to 22 older people with dementia. 3. Maximum number to be cared for shall not exceed 43. Date of last inspection 27/09/04 Brief Description of the Service: The Grange is registered to provide care and accommodation for forty three older people of whom up to twenty one may suffer with dementia.There are 42 single rooms each with en-suite facilities. The home currently has two beds that are allocated for respite care. There is a choice of five sitting and dining areas, one of which is designated for smokers. There are five bathrooms and one shower room. There is a small seating area at the rear of the house, a steep path leads to a sloping grassed area and there is a paved patio area at the back of the garden. Vehicular access to the front of the building is restricted to emergency vehicles only and a barrier is in place. Staff and visitor parking is at the rear of the building.The Grange situated on a busy road near Wickford town centre with its shops and amenities It is on a regular bus route and there is a regular train from Wickford Station. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of six and a half hours. The inspection mainly focused on the progress the home had made since the last inspection. The registered manager at the home has recently left to take on another role within the organisation of Runwood Homes. A new acting manager has been appointed and had been in post for two weeks at the time of inspection. The new acting manager was not available at this inspection. Another senior member of staff at the home very competently managed the inspection process. A partial tour of the premises took place and care and staffing records were selected at random and inspected. A number of residents and staff were spoken with. Three visitors and a visiting hairdresser were also briefly spoken with. A notice was displayed in the main entrance area throughout the day advising all visitors to the home that an inspection was taking place with an open invitation to speak with an inspector. The member of staff in charge was given feedback throughout the inspection, with a summary given at the end of the inspection. What the service does well: The Grange provides a bright and cheerful environment. The lobby area provides a range of information for residents and visitors. Staff were friendly and helpful. Residents, staff and visitors were very positive about life at The Grange. One resident said ‘It’s lovely here, I think of it as my home, the staff are marvellous.’ A visitor said, ‘I can’t believe how nice it is here, and how well my friend is cared for’. Residents at The Grange have the opportunity to take part in a range of different activities. Activities are planned with the individual needs of residents in mind. Outings and entertainments are also provided. Residents were mostly positive about the food provided by the home. The home does not have many staffing vacancies at the moment, and so are not using many agency staff. This provides residents with care that is provided consistently by staff that they know. Staff at the home are well trained to do their jobs. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 6 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 I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 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 standard(s) 3, 4 Prospective residents have their needs assessed before moving into the home. Staff at the home have received ongoing training to help them to meet residents assessed needs. EVIDENCE: Although not inspected at this visit, The Grange has a comprehensive statement of purpose and service users guide in place. These were on display in the homes lobby area. A ‘Welcome to The Grange’ pack was seen in a respite room. The senior member of staff present at the inspection confirmed that residents are always visited and have their needs assessed before moving into the home. Records of recently admitted residents showed that pre admission assessments had been well completed. Staff records and staff spoken with identified that appropriate training is undertaken. This includes training in dementia care. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 9 Intermediate care is not provided at The Grange. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 Resident’s health and care needs are well identified and planed for. Medication practices at the home are well managed and ensure that residents are kept safe. EVIDENCE: Several care files were viewed at this inspection. Apart from one they were comprehensively completed and provided a good basis for care. There was evidence of regular reviews and resident involvement in the process. Staff spoken with and observed demonstrated a good awareness of residents needs. One care plan looked at had not yet been fully completed following a resident’s admission six weeks earlier. The senior member of staff undertook to rectify this. Residents spoken with felt that staff cared for them well. One said that she was able to see her doctor at any time. Records showed that residents access other professional services such as chiropody, optician and dentist. The home is supported by district nursing services and a district nurse was visiting the home during the inspection. Unfortunately there was not time for them to The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 11 speak with the inspector. However there was clearly a good rapport and working relationship between the home and nursing service. To monitor residents’ wellbeing their weight is regularly monitored and a nutrition record maintained. Medication at the home is well managed. To enhance this and ensure the safest possible service to residents, the home was advised to review how it manages medication that is prescribed to be taken on an occasional basis (PRN). Protocols should be in place and readily accessible for all such medication. Throughout the day staff were noted to treat residents with courtesy and respect. Doors were kept shut when personal care was taking place. A member of staff was observed to deal sensitively with a resident who had ‘had an accident’. Interactions between staff and residents were observed to be used as an opportunity to provide positive stimulation and conversation. A pay phone is available and many residents have their own telephones in their bedrooms. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14, 15 Residents live in a stimulating environment where a range of different activities are on offer. Residents are free to exercise choice in their daily lives. EVIDENCE: The Grange has an enthusiastic activities co-ordinator in post. There is also a ‘Friends of The Grange’ group who are very active and supportive to the home. A wide range of entertainment activities and outings are provided on a regular basis. Up and coming events and activities are well advertised and each resident is given their own weekly timetable of the activities on offer. On the day of the inspection visit an outing took place in the afternoon. One resident said ‘I always love going on the outings.’ Fund raising activities take place with the proceeds being used to enhance the life of residents at the home. Residents are encouraged to follow their own interests. One resident has sky TV, another enjoyed telling the inspector that they had recently taken swimming by staff, as this had been a previous interest. Visiting at the home is unrestricted to suit residents and visitors needs and routines. Visitors spoken with said that they were always made very welcome at the home. There is a lounge/visitors area where hot drinks can be made. This was not available during the inspection as it doubles as a hairdressing area. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 13 Residents can bring in their own possessions to personalise their rooms. The home uses a four weekly rotating menu. The teatime menus were noted to be mostly sandwiches or a very light hot snack. Although no residents complained specifically about this, it was advised that residents be consulted about the menus and the sorts of things they would like for tea. There is a choice of menu at each meal. Individual choices and requests outside of the menus are catered for and recorded. Each service user has a nutritional assessment and is weighed monthly. A record of fluid and nutritional intake is recorded for all new service users for the first month so that an accurate picture of their needs can be obtained. Residents spoken with mostly spoke favourably of the food provided by the home. The home has several different dining areas. Residents can choose which area they wish to sit in at any given meal. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16, 18 The home has an established complaints procedure ensuring that residents and their families feel free to, and know how to raise concerns. Staff awareness and procedures protect residents from abuse. EVIDENCE: Residents spoken with said that they would feel confident in raising concerns or issues with any of the staff. Staff spoken with confirmed that they had received training in adult protection and demonstrated a good understanding of the types of abuse. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26. The overall standard of the furnishings, décor and fitments within the home was good, and provided residents with a pleasant, homely and safe place to live. EVIDENCE: All residents spoken with found the environment of the home pleasant. The outdoor space at the home is somewhat limited for service users to enjoy independently as it is not a level area. Access to the bulk of the garden is via a fairly steep and winding path. There are plans in hand to improve the look of the garden for the enjoyment of residents, but access difficulties will remain and need to be considered by the provider. The home was generally well maintained. A handyman and a maintenance person are employed so that small jobs can be quickly actioned. The person in charge identified that regular premises and room audits take place. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 16 There are several lounges, dining and seating areas around the home. Residents can choose where they wish to sit. During the day of inspection the hairdresser was visiting. There is no set area for this so residents were having their hair washed in an ordinary bathroom then taken round to the visitors room/smoking lounge. This is not ideal and apart from the logistical and supervisory/safety aspects, (residents left under driers in one room while the hairdresser washes another residents hair in the bathroom,) one resident, who smokes, was also inconvenienced by this situation. Toilets and bathrooms, containing assisted baths, are accessible to service users and clearly marked with pictures and words. All rooms have en-suite facilities. In some areas the tap tops indicating hot and cold were missing. This needs addressing so that residents can easily tell which tap is which. The lids were missing from some bins, presenting a potential hygiene issue. Boxes of disposable gloves and pad bags were noted to be sited in some toilet/bathroom areas. As the home is registered to provide dementia care these must be stored safely. Appropriate moving and handling and pressure relieving equipment was noted around the home. Equipment was stored tidily and did not present hazard. However it is clear that storage is an issue at the home, and some areas looked cluttered. Some frames and a chair were noted to have been placed outside the laundry area of the home. The home has recently had grab rails fitted in the corridors for the benefit of residents. These require painting to finish them off. Residents said that they liked their bedrooms. Most were personalised with some of the residents’ own belongings. Residents can control the heat in their own rooms. One resident who is a wheelchair user was accommodated in a room that, due to their preferred layout, was quite small. The room was not measured but the person in charge was advised, for future reference, that residents who use wheelchairs should not be accommodated in rooms that are less that 12 square meters in size. All areas of the home were bright warm and airy. To ensure that residents are safe from scalding water temperatures were tested at random and were satisfactory. All the homes contained a thermometer and instructions to staff on testing the bath water temperatures. The home was clean and odour free. The homes laundry area was tidy and kept locked when no staff were in attendance. Both the kitchen and laundry areas of the home are secured with a keypad lock. The inspection found a sluice door left unlocked. This could compromise resident safety. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 Staff records showed that the homes recruitment processes were generally sufficient to safeguard and protect residents. Staffing levels appeared adequate to meet the needs of residents. EVIDENCE: The homes rota showed that the homes minimum staffing levels are maintained. These levels are: 1 senior and 6 care staff from 07.00 to 22.00. (There is a decrease of one care staff from 14.45 to 16.00 in the afternoon.) 1 senior and 2 care staff at night. The person in charge felt that dependency levels at the home were currently such that these levels were sufficient. The home is using low levels of agency staff at the moment. Domestic and ancillary staff are employed. No domestic staff at the home work after 13.00 or 15.00. This must be kept under review to ensure that this practice does not affect the service received by residents. Residents said that staff at the home are excellent. An NVQ assessor was visiting the home on the day of the inspection. A number of staff at the home are undertaking NVQ training at level two and three. The person in charge said that three staff already held NVQ level 2. Staff files showed that in general good recruitment practices are followed, and that residents are protected by staff’s suitability being fully checked before The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 18 they begin working at the home. The file of one recently appointed member of staff however showed that although a Criminal Records Bureau check had been applied for a covering POVA first check was not in place. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37, 38. Since the previous inspection management arrangements at the home have changed. The consistency of service for residents has been maintained by the previous registered manager, Sue Smith, providing continued support and encouragement via her new role as operations manager for the home. EVIDENCE: The new acting manager had only been in post for two weeks and was on leave at the time of inspection. The acting manager had been promoted from her previous role as deputy manager at The Grange. She is therefore known to both residents and staff at the home. Morale at the home was good. Staff spoke positively about their roles. Residents spoke positively about their life at the home. Regular relatives meetings are held and minutes circulated. A visiting hairdresser, who also visits other homes, spoke very positively about The Grange saying that ‘the staff are so well organised’. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 20 Although not examined in detail records showed that staff receive regular support and supervision. The operation managers regular support visits to the home are also recorded. The home is well organised and records are kept securely. Staff confirmed that they receive training in core areas such as moving and handling and first aid to support their care for residents. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 3 3 The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 22 YES 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. 1. Standard 20 Regulation 23 Requirement Timescale for action 01/11/05 2. 29 18, 19 The Registered Person must provide external grounds which are accessible to all service users and suitable for the needs of service users. Previous requirement date of08/10/04 mot met. Robust recruitment procedures 01/08/05 must be maintained at tall times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 23 Refer to Standard 7 9 15 20 38 Good Practice Recommendations Care plans must be fully completed in a timely manner following a residents admission. The process of managing PRN medication should be reviewed and protocols be available in each case. Tea time menus should be reviewed in consultation with residents. Consideration should be given to the provision of a proper hairdressing facility. Appropriate storage should be provided for disposable gloves and other items that might pose a hazzard to residents. The Grange I56-I06 S64578 The Grange V233057 140605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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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