CARE HOMES FOR OLDER PEOPLE
The Grange Stump Lane Chorley Lancashire PR6 0AL Lead Inspector
Pauline Randles Unannounced Inspection 14th March 2006 09:10 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 DS0000005918.V279848.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Grange Address Stump Lane Chorley Lancashire PR6 0AL 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) 01257 241133 Mrs Sharon Louise Atherfold Mrs Diane Michelle Jolly, Mr Stephen William Sams, Mr John Paul Atherfold Mrs Sharon Louise Atherfold Care Home 26 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number disorder, excluding learning disability or of places dementia (2) The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered to accommodate 24 Elderly People suffering from dementia (Category DE(E)) Two adult persons who have a mental disorder (Category MD); Date of last inspection 16th August 2005 Brief Description of the Service: The Grange is a residential care home for people who have memory loss and mental health conditions. The home offers personal care and is registered for 26 residents of which 24 are over the age of 65 years. The location is near Chorley town that offers a range of amenities within close proximity, for example, banks, shops, health centre, doctors and, library. The home accommodates male and female residents with varying needs on a long or short-term basis. The accommodation consists of a number of single rooms and two twin-bedded rooms. All rooms have wash hand basins and commode chairs. The home has two floors, which can be accessed by a passenger lift. There are a number of communal areas for residents to choose from or, if they prefer, they can spend time in their own rooms. Most of the residents have personalised their rooms with items of their own furniture, ornaments and family pictures. The home offers a variety of social activities and maintains links with the local community. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 6 hours. There were twenty- six residents living at The Grange. The focus of the visit was to assess key standards not addressed at the previous inspection and to review progress in regard to requirements and recommendations made at that time. During the course of the visit two of the proprietors, one of whom is the registered manager, five members of staff, a visitor and ten residents were spoken to. Four of the residents spoken to were case tracked. In addition documents and records were examined and relevant areas of the premises were viewed. What the service does well: What has improved since the last inspection?
Some bedrooms had been redecorated as requested and the hall and stair carpet had been replaced which had made a significant improvement to the environment. A full risk assessment of the environment had been completed and related action to minimise risk had been taken. A copy of the completed risk assessment had been sent to the Commission For Social Care Inspection (CSCI) for record purposes. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 6 Consultation systems had been put into place to find out what people thought of the service and a suitable method had been introduced that encouraged residents to look at information held on them should they so wish. Regular supervision of staff had been established with records maintained. Water temperatures had been tested frequently and new valves fitted where appropriate. A refurbishment plan open to inspection was in place. Continence management strategies had improved and the home was clean and hygienically maintained at the time of inspection. The measures introduced have further enhanced the safety and comfort of residents within the home. 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 DS0000005918.V279848.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 The Statement of Purpose and Service User Guide provided prospective residents and their representatives with full details of the home’s services and facilities enabling an informed choice to be made about possible residency. However, the process for confirming a residential place was not fully adequate and needed further development. EVIDENCE: The Statement of Purpose and Service User Guide had been kept under review and revised as appropriate to ensure current service information was provided. A copy of the terms and conditions statement was issued with the Service User Guide although this had not been personalised to each resident. The statement of terms and conditions of residency examined on the files of residents contained all relevant information about service provision and facilities, including room number and was suitable for the purpose but had not been issued to those residents who had an individual service agreement with the Local Authority. It was required that all residents be issued with a statement of terms and conditions of residency with a copy retained on the
The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 9 individual file and signed by the resident or their representative where practicable. Copies of needs assessments examined were thorough and covered all topics required in order to effectively plan for care. A pre admission assessment and a further assessment on admission had been undertaken. Where the admission was as a result of a Local Authority assessment a copy of the related assessment and care plan had been obtained. To fully comply with requirements confirmation that a residential place is to be offered must be provided. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Procedures for the planning of care and the administration of medication were thorough, relevant to presenting needs of residents and effectively promoted good health care. . EVIDENCE: Care plans examined were thorough, covered all good practice topics and had been reviewed monthly. The needs of residents spoken to were reflected in the care documentation seen that was being used to guide daily practice. Comments made by residents when asked about their care included, “ I like it here and like all the people,” and “Staff are kind.” Also a visitor said he was, “More than impressed with the care my wife gets.” Health care needs were effectively met through the support of health care professionals including for example general practitioner, district nursing and chiropody services with a record of visits maintained on individual files of residents. A visitor spoken to said, that when his wife was admitted she had, “Bedsores starting and within 24 hours specialist equipment was made available” which resulted in an improvement in the condition. Continence management strategies had been further developed and the home was odour
The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 11 free at the time of inspection. A visitor said there seems to be a routine “They are always taking residents to the toilet.” Consent forms in relation to resuscitation wishes had recently been introduced. The intended purpose being to forward this information on when residents were admitted to hospital. It was recommended, and accepted, that any agreements so far reached in this regard be rescinded and the form be withdrawn from future use to avoid any misconceptions about the purpose and remit of the care service provision. Medication policies and procedures were in keeping with requirements and supplemented by a copy of the Royal Pharmaceutical Society guidelines. Administration of medication records had been effectively completed and general storage facilities were suitable and secure. Items of medication requiring cold storage were stored in a sealed box in a refrigerator in keeping with pharmacy inspection recommendations. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 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 the following standard(s): 12, 14 and 15 Residents were supported and enabled to exercise choice, participate in social activities and partake of a balanced and nutritious diet. EVIDENCE: Discussion with residents and examination of activity records confirmed that opportunities for social interaction and recreation were facilitated. However such opportunities remained subject to staff time and availability. Attempts to appoint an activities organiser had been unsuccessful to date and therefore remains an ongoing recommendation to ensure adequate and suitable stimulation of residents is provided. Records indicated that routines of the home were flexible to meet the needs of residents for example in relation to meal and bed times. When asked about choice, one resident said, “Plenty of choice happy with anything and grateful for it,” whilst a visitor said he had “observed residents being offered additional and alternative food.” There was limited information in regard to advocacy held in the manager’s office. It was recommended that additional information about advocacy services be obtained and distributed to residents and their relatives to ensure independence is maximised. The additional information, when available, should also be referred to in the Service User Guide.
The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 13 Menus examined indicated a balanced and nutritious diet was available. More than one resident said the “food is good.” Residents were observed to be enjoying a hot lunch at the time of inspection. The special dietary needs and personal preferences of residents were recorded and adhered to by catering staff. The dining room was warm and homely and residents were being suitably supported with their dining needs. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 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 the following standard(s): 16 The complaints procedure of the home enabled residents and their relatives to feel confident that complaints were being listened to and acted upon. EVIDENCE: The complaints policy and procedures of the home met the requirements of the standard. Staff members when spoken to demonstrated an understanding of the process. One staff member said, “ If a resident was unhappy I would spend a little time to explore the problem.” Following which, if it was felt that the resident wished to make a formal complaint, she would, “ Help them with the process.” A suitable record of complaints was maintained. A recent complaint from a relative had been satisfactorily addressed with details of investigation and outcome recorded. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 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 the following standard(s): 19, 24 and 26 The premises had a homely ambience and were hygienically and safely maintained. EVIDENCE: The entrance hall, corridor and stairway had been carpeted since the previous inspection as recommended. The decorative borders in two bedrooms that were damaged had been replaced and another room had been fully redecorated as previously requested. Bedrooms were personalised and the décor reflected the personality and preferences of the individual. Some thought had been given to installing locks to bedroom drawers for personal safekeeping of valuables although a decision had not yet been made this recommendation therefore remains. A refurbishment plan for the home indicated that further redecoration was planned plus the continued renewal of furnishings and fittings in order to maintain a safe and comfortable environment. Routine maintenance tasks had been completed as evidenced from maintenance records held.
The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 16 Discussion with domestic assistants confirmed an understanding of good hygiene practices and of methods for the effective control of substances that might be hazardous to health. Control of infection policies and procedures were in place. Laundry facilities were suitably sited and clothing was washed at required temperatures. Approaches were being made to gain confirmation that the premises comply with the Water Supply (Water Fittings) regulations 1999 which in the meantime remains a recommendation. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Effective recruitment and training processes ensured that competent staff members were employed at the care home. EVIDENCE: Examination of staffing rotas and discussion with staff confirmed that the numbers and skills mix of staff met the presenting needs of residents. The home was staffed, as a minimum, in accordance with previous regulatory guidelines taking into account the changing dependency needs of residents. There was a strong commitment to training evidenced from training plans and records. Staff members spoken to were undertaking health and safety training and nineteen staff members were about to commence a Level 2 certificate in dementia care. Over 50 of care staff hold NVQ level 2 in Care. To ensure full competence and safety of ancillary staff when handling equipment and products it was recommended that moving and handling training be provided. Recruitment processes remain thorough as evidenced at the previous inspection. Criminal Records Bureau disclosures, not examined previously, that had been in place for at least six months and held full and satisfactory information were examined on this occasion. Where adverse information had been disclosed a risk assessment had been undertaken and the assessment plus judgement reached was kept on file with the disclosure. skilled and The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, and 38 Policies and procedures of the home promoted a quality service and positive health and safety practices. However formal training for catering staff was not adequate and could compromise food safety. EVIDENCE: The registered manager has had suitable experience in the management of care services for older people, had undertaken relevant professional training and holds the Registered Managers’ Award and NVQ Levels 2 and 3 in care. It was recommended that, in order to fully meet requirements, a qualification equivalent to NVQ Level 4 in care should also be obtained. Surveys of residents and other stakeholders had been undertaken as previously recommended, the findings analysed and any necessary follow up action undertaken. The home holds Investors in People, a quality award accredited by an external body. Policies and procedures had been kept under
The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 19 review and required actions from previous inspections had been progressed within timescales to ensure continuous service improvement. Written records of personal allowances held on behalf of residents were maintained. Secure facilities for safekeeping were provided and appropriate banking and receipting procedures were in place. Supervision and appraisal processes had been established as recommended from the previous inspection. These processes were thorough and supported general supervision and guidance that were provided for staff on a routine daily basis. Records were maintained in good order and stored in accordance with data protection requirements. There was an understanding of the importance of confidentiality and data protection requirements. A notice had been posted, as previously recommended, to encourage residents, or their representatives, to seek access to information should they so wish. Training in safe working practices was provided for staff members. Refresher training in these topics plus moving and handling training for ancillary staff was to be provided as recommended. Of concern on this occasion was that the Cook had not completed certificated Food Hygiene training although she had undertaken food awareness training and was closely supervised. It was required that formal training in food hygiene is completed as a priority. Kitchen cleaning schedules were in place but not signed and there were a number of omissions. It was recommended that these schedules be fully completed and entries signed to improve accountability. Accident report records and a monthly analysis of accident trends were examined. Reports of accidents were to be filed with individual records in future to enhance confidentiality. Health and safety policies and procedures were in place with safety notices posted appropriately throughout the building. A fire risk assessment and fire records were provided for inspection. Gas, central heating and electrical checks had been carried out as noted from pre inspection information. Water temperature checks had been carried out and where necessary replacement valves fitted. The measures taken had improved the safety of the environment for the benefit of residents. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 17(1)Sc3( 3,4)14(1, d) Timescale for action Each resident must be issued 01/05/06 with a statement of terms and conditions of residency with a copy retained on the individual file, signed by the resident where practicable, and the offer of a residential place confirmed. Certificated food hygiene training 01/05/06 must be provided for staff preparing meals. Requirement 2. OP38 18 (1)(c) (i) 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. Refer to Standard OP8 OP12 OP14 OP24 Good Practice Recommendations Agreements relating to resuscitation of residents should be rescinded and taken out of future use. The employment of an activities organiser is recommended. Advocacy information should be provided to meet the varied needs of residents. Residents should have a lockable space in their private room.
DS0000005918.V279848.R01.S.doc Version 5.1 Page 22 The Grange 5. 6. 7. 8. OP26 OP31 OP38 OP38 Evidence should be provided that the services and facilities on the premises comply with the Water Supply (Water Fittings) Regulations 1999. The registered manager should hold qualifications equivalent to NVQ Level 4 in management and care. Kitchen cleaning schedules should be fully completed and signed. Moving and handling training should be provided for ancillary staff. The Grange DS0000005918.V279848.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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