Inspection on 14/10/05 for The Grange

This inspection was carried out on 14th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 20/03/07

The Grange 18/01/06

The Grange 15/03/05

The Grange 15/11/04

The Grange 08/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Grange 30 Vinery Road Bury St Edmunds Suffolk IP33 2JT Lead Inspector Tina Burns Unannounced Inspection 14th October 2005 10:00 Grange DS0000024399.V258795.R01.S.doc Version 5.0 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 Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Grange Address 30 Vinery Road Bury St Edmunds Suffolk IP33 2JT 01284 769887 01284 701057 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) Grange Residential Homes Limited Mrs Karen Frances Krabbendam Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2005 Brief Description of the Service: The Grange is registered as a care home for nine adults with learning disabilities. It is situated in a residential area of Bury St. Edmunds, approximately one mile from the town centre and close to local amenities. The house itself is a large detached building and provides seven single and one double bedroom’s. The communal facilities include a large and a small lounge area and a spacious kitchen/dining area. The home has an established and well maintained garden with a summerhouse for the use of residents. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was routine, unannounced and carried out on a weekday between the hours of 10.00am and 5.00pm. The manager was present throughout the day and fully contributed to the inspection process. The inspector spoke with residents and staff, toured the building and garden and examined a variety of records and documents including two residents care plans and two staff files. What the service does well: What has improved since the last inspection? What they could do better: The home had care plans in place and these focused on individual’s goals and aspirations. The plans should be developed further to include a wider range of need with detail about the tasks to be undertaken to meet those needs. Daily records were also minimal and did not always reflect the care plans. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 6 Procedures in place for the recording, handling, safekeeping and administration of medication must also be improved to ensure the safety of residents. Staff administering medication had received some training but there was no evidence in place to demonstrate that they had been assessed as competent to undertake the task. One individuals risk assessment for self-administering medication in an emergency was not sufficiently detailed and needs to be developed further to eliminate risk. Records relating to one member of staff were not entirely complete and did not include evidence of personal identification; this is a requirement of legislation. 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. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard 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. Prospective residents can expect to have their needs assessed and be confident that the home they chose will meet their needs. EVIDENCE: The home had a Service User Guide available to residents that had been updated to incorporate resident’s views. It was written in large bold type, included pictures and symbols, and was appropriate to the needs of the service user group. There had been no admissions since the previous inspection however the resident’s records examined demonstrated that the home had appropriate admission procedures in place, and included initial and specialist assessments and summaries of need. One resident’s records also included a communication passport that was recognised as an excellent tool enabling staff to understand the resident’s needs and communicate with them effectively. Conversations with staff and examination of recruitment, induction and training records confirmed that staff had the skills and experience to deliver the services and care which the home offers to provide. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Residents can expect to make decisions about their own lives and be consulted on matters of the home. EVIDENCE: Two residents care plans were examined. They contained resident’s profiles and included each resident’s short and long term goals with evidence that the residents had been consulted in the development of the plans. Reviews of the plans had increased in frequency since the last inspection from annually to six monthly. Although the care plans reflected the resident’s personal aspirations they did not sufficiently identify their needs and the action required to meet them. The daily records also examined were not detailed enough to gage whether or not goals were being met. Risk assessments were also in place and included individual, environmental and generic assessments and evidenced that the home supported the resident’s independence whilst minimising risks and hazards. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 10 Records seen and staff and residents spoken with confirmed that residents are supported to make informed choices and decisions including decisions about the home, daily activities and routines. For example resident’s had been supported in choosing the colour schemes and fixtures and fittings in their own rooms. Resident’s also confirmed that they participated in monthly resident’s meetings with the manager. These meetings were used as a forum for consultation, discussion of matters in the home and issues arising, and planning activities and outings. They also confirmed that the resident’s were involved in key decisions, such as staff recruitment. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Residents can expect to develop their independent life skills and enjoy a wide range of social and leisure opportunities. Furthermore, they can expect to contribute in the planning and preparation of meals and be offered meals of their choice. EVIDENCE: Conversations with staff and residents and observations made on the day of inspection evidenced that the home provides good opportunities for personal development. Residents were being encouraged to participate in daily tasks and routines to maintain and develop their independent life skills and most of them had a programme of activities that included weekday attendance at day centres, colleges or sheltered work environments. Activities available at the home included gardening, horticulture and bird watching as well as more traditional pass times such as crafts, puzzles and board games. The resident’s calendar and photographic displays confirmed that residents have an active social life and enjoy a range of community activities and outings. Residents are supported to access local amenities regularly, such as pubs, restaurants, leisure centres, churches, shops and theatres. The residents Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 12 also plan days out to various places of interest at their resident ‘counsel’ meetings for example day trips to London, Banham zoo, the circus and Thetford forest. Staff also confirmed that a summer holiday was being planned. Conversation with staff and residents and records seen confirmed that the home supports residents to make and maintain relationships with friends and families. The home welcomes residents’ visitors and also supports residents to arrange stays with their parents or relatives. The home has two kitchen areas. The manager confirmed that the main kitchen is generally used to prepare and cook the main meal. The second kitchen area is a kitchen/diner that is a more domestic area used by the residents to make breakfast, snacks and light meals. Records seen demonstrated that residents are consulted about the homes menu and able to chose from a range of options. Special diets were also catered for. The manager also confirmed that residents are usually involved in the weekly shopping and have the opportunity to make choices from the shop shelves. On the day of inspection resident’s comments about the food was positive, with particular praise for “bangers and mash”, “spaghetti bolognaise” and “liver and bacon”! Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Residents can expect sensitive and flexible personal and healthcare support but medication procedures and protocols do not entirely safeguard residents. EVIDENCE: Residents spoke positively about the support they received and in particular about their key workers. One resident said “they help you if you have any problems”, another said “they take you shopping and to the dentist and hospital”. Observations were that staff interacted appropriately with residents and recognised their individuality. Residents were dressed well, in individual styles that seemed to reflect their personalities. Resident’s records confirmed that the home supports residents with their health needs. There were health assessments, action plans, risk assessments and records of consultations in place. The risk assessment belonging to one resident with a severe allergy could have been more detailed to further minimise risk. Two resident’s medication records were examined during the inspection. Two staff had signed for the medication administered on all occasions and the manager confirmed that it was the homes policy that two staff always administered medicines. The records seen did not give an explanation of codes Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 14 used on occasions or clearly audit the amount of tablets held or ‘booked’ in and out. Also medication prescribed, “as required” was not recorded with sufficient detail and there was not a protocol in place for ‘homely remedies’. Actual medication was stored and labelled appropriately and each container was signed and dated on opening. The manager confirmed that all staff were involved in the administration of medication and had received training and instruction as part of their induction process, generally training had been undertaken by the manager but there was no evidence that an assessment of competency had taken place. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents can expect to be protected from abuse and feel that their views are listened to and acted upon. EVIDENCE: The home had a complaints procedure in place that had been updated to include The Commission for Social Care Inspection’s address and telephone number. The Inspector was informed that there had been no complaints made in the previous twelve months. Staff and resident’s spoken with indicated that the home is committed to listening to and acting on the views of residents, individually or via ‘counsel’ meetings, and issues are normally resolved before they become problems or complaints. Although there was no complaints recorded the manager had a complaints and compliments book in place and three letters of compliments, from residents relatives, were seen together with a variety of thank you cards on display on the notice board. The home had a Protection of Adults policy in place that had been updated to include the process for referrals. The manager also confirmed that they were booked to attend training on the Suffolk joint inter agency policy for the protection of vulnerable adults in December. Staff records confirmed that training had taken place for staff in dealing with challenging behaviour, complaints, concerns and protection, and dealing with violence and aggression. One of the residents care plans examined also evidenced that the home had appropriate guidelines in place to positively manage and minimise challenging behaviour. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Residents can expect to live in a homely, comfortable and safe environment, furthermore they can expect their bedrooms to suit their needs and promote their independence. EVIDENCE: The Grange is approximately one mile from Bury St Edmunds town centre and close to local amenities. In style, the property is in keeping with the neighbourhood and has the appearance of a large, detached, family home. There is also a large, well-maintained garden and summerhouse, recently installed for the residents enjoyment. On the day of inspection the home was seen to be clean, hygienic, comfortable and well maintained. Furniture, fixtures and fittings were domestic in style and the communal areas were well equipped for the use of residents. The home also had appropriate fire procedures and alarm systems in place. Fire extinguishers had been serviced annually and records indicated that staff had been trained in fire safety. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 17 Accommodation included six single and one double bedrooms. Bedrooms seen during the inspection were comfortably furnished, well-maintained and reflected individual choice. Staff and residents confirmed that residents had been consulted about their colour schemes and been supported to chose furnishings and equipment for their rooms. They had also been supported to personalise their own rooms with photographs and personal effects. All bedrooms had wash hand basins and one also included a shower cubicle. The home also provided a communal bathroom on the ground and first floor. Bedrooms also had call systems in place and each resident had lockable storage for money and valuables and the facility to lock their rooms. On the day of inspection the home was clean, hygienic and odour free. The laundry room was appropriately equipped and had washing machines that could be set up to a temperature of 95 degrees centigrade. Records evidenced that staff had been trained in infection control. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Residents can expect to be supported by reliable, competent and trained staff. EVIDENCE: Examination of two staff files and training records, together with conversations with the manager and staff evidenced that the home was committed to the training and development of staff. With the exception of one care worker currently undertaking a humanity degree all care staff had obtained NVQ level two or three. Training had been undertaken externally and in-house and included Manual handling, First Aid, Food hygiene, Health and Safety, Fire Safety, Infection Control, Managing Challenging Behaviour, Medication and Adult Protection. Refresher training in First Aid and Manual handling was out of date for some staff but the manager confirmed that staff are booked on courses for these in November and December 2005. Staff spoken with on the day of inspection spoke positively about the homes values in relation to staff and residents and displayed a sense of motivation and commitment to the job. One member of staff said “Residents come first, they’ve got it right here, I enjoy coming to work”. Staff and records also confirmed that the home has team meetings fortnightly and individual supervision bi monthly. Team meetings are often used for in house training as Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 19 well as exchange of information and discussion of matters arising. Minutes are taken at all team meetings and recorded appropriately. Recruitment records examined evidenced that the home has thorough procedures in place including undertaking two references and criminal record bureau checks. All documentation required was in place with the exception of evidence of identification for one member of staff that seemed to have been misfiled. The manager and staff spoken with confirmed that new staff are subject to a three-month probation period. Residents are consulted at a ‘counsel’ meeting before a permanent contract is offered. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 42. Residents can expect to benefit from the ethos and management approach of the home. Furthermore, the home promotes the health, safety and welfare of the residents. EVIDENCE: The manager had several years experience as an assistant manager at the Grange before becoming the joint owner and manager in 2004. They hold appropriate qualifications including The Registered Managers Award, City and Guilds D32 and D33 and Advanced Certificate in Food Hygiene. Records seen and conversations with the manager, staff and residents indicated that the management approach of the home creates an open, positive and inclusive atmosphere. There was evidence of consistent opportunities for staff and residents to contribute to matters of the home, i.e. counsel meetings, staff meetings and supervisions, and observations made Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 21 during the inspection indicated that the manager was approachable and respected by staff and residents. Training records evidenced that the home was committed to promoting safe working practices, accident and incidents had been appropriately recorded and investigated and individual and generic risk assessments were in place. The home also had fire safety equipment in place, including an alarm system and extinguishers and these had been serviced at appropriate intervals. Hot water temperatures were regulated, tested and recorded daily. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Grange Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 X DS0000024399.V258795.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? None 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 YA34 Regulation 19.1.b Schedule2 13.4.c Requirement The Registered Manager must ensure that the copy of personal identification absent from one staff file is replaced. The Registered Manager must ensure that the risk assessment for a named individual is developed further to minimise risk. The Registered Manager must ensure that staff responsible for administering medication are suitably trained and competent. The Registered Manager must ensure that there are sufficiently detailed instructions for the safe administration of individuals ‘as required’ medication. The Registered Manager must ensure that there is a protocol in place for the safe administration of non-prescribed medication. Timescale for action 07/11/05 2 YA20 07/11/05 3 YA20 13.2 13.6 13.2 30/11/05 4 YA20 07/11/05 5 YA20 13.2 07/11/05 Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 24 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 Refer to Standard YA6 YA20 Good Practice Recommendations Individual care plans should be developed to include a wider range of needs and daily records should reflect the tasks undertaken as detailed in the care plan. The procedures in place for recording the handling, safekeeping and safe administration of medication should be developed to improve reference. Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. Extracts may not be used or reproduced without the express permission of CSCI Grange DS0000024399.V258795.R01.S.doc Version 5.0 Page 26 - 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. 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