CARE HOME ADULTS 18-65
The Grange Galbraith Terrace Trimdon Grange TS29 6EG Lead Inspector
Bridgit Stockton Unannounced Inspection 15th November 2005 10:30 The Grange DS0000060137.V253867.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 The Grange DS0000060137.V253867.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. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Grange Address Galbraith Terrace Trimdon Grange TS29 6EG 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) 01429 882043 01429 382043 Sovereign Care North East Ltd Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (6) The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: The Grange is a care home providing personal care and accommodation for 17 adults with a mental disorder, which includes 5 adults over the age of 65.The homes owners are Sovereign Care North East and Mr Steven Hunter is the Responsible Individual. The home is located on the edge of the small village of Trimdon Grange, close to shops, pubs and other amenities. There are local bus services, which reach a number of larger towns in the area. There are thirteen single and two double bedrooms. There are no en-suite facilities but adequate bathing and toileting facilities are provided. There is a spacious lounge and a dining room both of which overlook the front garden and main street, which are easily accessible. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over a period of 4 hours on the 15th November 2005. The home did not know the inspection was going to take place. The plan for the inspection was to check whether the home had implemented the requirements and recommendations made at the previous inspection; to talk with the residents about living in the home; to meet with care staff and the home’s management team; and to look at records. What the service does well: What has improved since the last inspection? What they could do better:
The assessment of residents prior to admission needs to take place and the supporting documentation made available. Care planning, and risk assessment processes are in need of urgent review in order that care staff can decipher what care is required to ensure service users needs are met fully and safely. The supervision and training of staff also needs to improve. All of these issues were raised at the previous inspection in April 2005; as yet they have not been completed in full. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 6 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 DS0000060137.V253867.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 The Grange DS0000060137.V253867.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): 2 New service users cannot be assured that their individual aspirations and needs can be met. EVIDENCE: The home has not had a new admission for quite sometime. The manager was unaware of any assessment tool or documentation used to assess any new prospective service users. However she did explain that if a service user was to be admitted then when ever possible a trial visit would take place so the new service user could see what living at the home would be like. Robust procedures for admitting new service users (including emergency admissions to the home) are now required to be in place. This issue was identified at the previous inspection The Grange DS0000060137.V253867.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 and 9 The care plans did not reflect the care service users were receiving of. Risk assessments were poor and there was no evidence of a person centred approach to planning care. EVIDENCE: There were two systems of care plans running in the home. Neither was accurate or reflected the care needs of the service users who lived at the home. A monthly entry had been written in all the plans examined but the actual plan had not been reviewed or updated to reflect the changes in care or support people actually required. Clearly service users were receiving care and were well supported by the staff but the documentation did not show this. Some risk assessments were recorded, but these also needed updating and reviewing and are required to be more detailed. Where people are subject to Care Programme Approach (CPA) the manager should obtain a copy of this care plan and risk management plan. The manager should familiarise herself with CPA protocols locally and should not admit someone to the home who has a mental health diagnosis without a professional risk assessment and risk management plan so she can assess the appropriateness of the placement and the potential impact on other people resident.
The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 10 There was no evidence to suggest that service users had been involved in the planning of there own care. The Grange DS0000060137.V253867.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): None of these outcomes were assessed on this occasion EVIDENCE: The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 12 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): None of these outcomes were assessed on this occasion EVIDENCE: The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 13 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 Service users can be assured that any complaints or concerns will be listened to and acted upon. EVIDENCE: All of the service users had a copy of the complaints procedure. They all confirmed that they knew who to complain to and were confident that any concerns would be dealt with immediately. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 14 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): 24,25,30 The home was comfortable and clean. Service users private rooms reflected and promoted their individuality and choice. EVIDENCE: The communal areas in the home were spacious, clean and tidy. Service users bedrooms were individual and it was obvious that service users had been given the choice of décor and furnishings. One service user said they had gone with staff and chosen the wallpaper for their bedroom. Residents said they liked there own private rooms and they said they were ‘happy and very comfortable’ One bedroom smelt of urine, the carpet needs replacing as where it had been repeatedly washed it was showing signs of wear. An area of damp was also noted in one bedroom and the provider said he would look into this immediately. There was adequate toilet and bathing facilities at the home, these were exceptionally clean. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 15 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): 36 Staff have not received any formal supervision or training. Therefore service users cannot be confident that staff are properly equipped and trained to ensure their needs can be met. EVIDENCE: The manager said that staff supervision had not taken place, the procedures, and paperwork were all in place but as yet no formal supervising of staff had taken place. The manager confirmed that she had not had any training in supervising staff and it was recommended that she tried to access some training in this area. Staff had not received any training in dealing with service users with mental illness, however most of the care staff had worked at the home for many years and had of experience to draw upon. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 16 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): 42 Service users can be confident that their safety is protected and promoted EVIDENCE: The home provided evidence that such things as the central heating systems, electrical wiring and water temperatures were monitored and serviced regularly to ensure service users and staff were provided with a safe environment. The fire and rescue service had recommended in there report that the fire extinguishers need replacement. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 17 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 X 1 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X X 1 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X 3 X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 1 X X X 1 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Grange Score X X X X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000060137.V253867.R01.S.doc Version 5.0 Page 18 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 YA2 Regulation 14(1 2) Requirement Timescale for action 15/11/05 2. YA6 15(1 2) 3. YA9 13(4) (b c) The manager must ensure that new residents to the home are only admitted following a comprehensive assessment of their needs which has been carried out by the relevant health or social care professional, and that they themselves have carried out a pre-admission assessment. Previous time scale of 29/08/05 was not met. The registered manager must 31/01/06 ensure that up to date accurate care plans are in place for all residents, that residents are directly involved in the care planning and that care plans are reviewed on a regular basis. Previous time scale of 01/11/05 was not met The registered manager must 31/01/06 ensure that residents of the home have up to date risk assessments relating to their day to day care and that any risk assessments are periodically reviewed. Previous time scale of 01/11/05 was not met The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 19 4. YA36YA32 18(1)(i) (2) 5. YA42 23(4) 6 YA30 16(2)(c) The registered manager must ensure that staff members within the home receive regular supervision and a review of their training needs. Previous time scale of 29/08/05 was not met. The registered provider is required to replace the fire extinguishers in the home, as requested by the fire and rescue services in their latest inspection report of the premises. The carpet that was identified at the time of inspection that smelt of urine requires replacement. 31/01/06 31/01/06 31/01/06 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 YA6 Good Practice Recommendations It is recommended that the manager should familiarise herself with CPA protocols, in order to ensure that inappropriate admissions to the home do not take place. It is recommended that service user become involved in planning there own care and support. The Grange DS0000060137.V253867.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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