Inspection on 16/08/05 for The Grange

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14/03/06

The Grange 10/11/04

The Grange 03/06/04

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Thornton Lodge

Alfred House Residential Care Home

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Creative Support

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

CARE HOMES FOR OLDER PEOPLE The Grange Stump Lane Chorley Lancashire PR6 0AL Lead Inspector Pauline Randles Unannounced 16 August 2005 09.15 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 F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Grange Address Stump Lane Chorley Lancashire PR6 0AL 01257 241133 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) 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 DE(E) - Dementia - over 65 (24) registration, with number MD - Mental Disorder (2) of places The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate 24 Elderly People suffering from dementia (Category DE(E)). 2. Two adult persons who have a mental disorder (Category MD). Date of last inspection 10 November 2004 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 service users of which 24 are over the age of 65 years. The location is near Chorley town which offers a range of amenities within close proximity, for example, banks, shops, health centre, doctors and, library. The home accommodates male and female service users 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 service users to choose from or, if they prefer, they can spend time in their own rooms. Most of the service users 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 F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 7 hours. The focus of the visit was a review of progress in relation to the requirements and recommendations made at the previous unannounced inspection that took place in November 2004. The bedrooms and communal areas were viewed during the visit. Four service users, a district nurse, two visitors, the registered manager, and two staff members were spoken to and records were examined. What the service does well: What has improved since the last inspection? What they could do better: Bedrooms of service users are in need of redecoration and a stair carpet that is worn and beginning to tear needs replacing as a priority. Service users should have the means to be able to store money and valuables in a locked drawer in their room. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 6 A full risk assessment of the environment must now be completed without further delay. Consultation systems should be put into place to find out what people think of the service and a suitable method should be introduced that encourages people to look at information held on them. Supervision of staff should happen at least six times a year. Records of water temperatures should be available at the home and be open for inspection. These measures will further enhance the safety and comfort of service users within the home. 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 F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 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 F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 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) 1 Progress has been made in improving service user information. From this information prospective service users and their representatives are enabled to make an informed choice about the potential suitability of the home. EVIDENCE: The service user guide has been revised to include the telephone number of the Commission for Social Care Inspection and a summary of the statement of purpose as previously requested. Staff members were observed to be providing personal care only during the inspection. The visiting district nurse confirmed that she attends to nursing needs of residents as they arise. Service users talked about “care plans” and visitors commented that their relative was “always clean and dressed nice.” The expectations of service users and their representatives, prior to entering the home are being met. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 9 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) 8, 9 and 10 Medication is being stored securely and administered appropriately to service users as prescribed. Service users are treated courteously and their right to privacy is respected. EVIDENCE: Improved safeguards have been put into place to ensure lotions to be used for named individuals are only used in the care and treatment of that person. Medication records were examined for accuracy and service users spoken to say they are consulted about their medication. One service user said he is given his tablets “morning and night never miss.” Two care staff members interviewed confirmed that they had undertaken the safe handling of medicines training and training records further evidenced this. The Statement of Purpose of the home states that service users are entitled to be treated with respect and have a right to privacy. Discussion with four service users confirmed that they feel their right to privacy is respected. One comment was “staff don’t go in my room unless I let them in.” Two bedrooms smelt strongly of urine resulting in an unpleasant environment for those people using the rooms. Methods for managing continence are continuing to be reviewed and specialist advice is being sought. Staff members were observed The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 10 to be polite and courteous to service users and showed respect for privacy by knocking on the door before entering a bedroom. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 11 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) and 13 service use12 Social activities are well organised and meet the individual and group needs of service users. Visitors are made welcome and service users are enabled to choose whom they see. EVIDENCE: There has been an increase in the provision of social activities since the previous inspection as stimulation for the service users. A record is now maintained of all activities provided and of the people who have participated. The record describes group and individual activities that are planned and take place. Staff rotas indicate that four staff are employed each afternoon. The manager said that the additional staffing ensures social activities are provided. One service user said she liked the music and “singing with all the young ones”, as was observed at the time of inspection. Another service user said he “liked to be quiet” and this was respected. Staff members interviewed, said that, on occasions there wasn’t enough time when service users were ill or required assistance with going to the toilet or with bathing so activities were not a priority on these occasions. The appointment of an activities organiser, as recommended previously, would avoid any potential pressure on staff time. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 12 Two visitors spoken to said they were always “made very welcome” which encouraged them to visit frequently. Service user comments included there are ”plenty of visitors” they are always “made welcome.” Staff members were observed to check identification and ask visitors to sign in before entering the premises ensuring increased security. Staff interviewed demonstrated an understanding of the home’s policy of service users choosing whom to see or not see. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 13 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) 18 Staff members have access to, and an understanding of, adult protection procedures that protect service users from abuse and ensure their safety within the environment. EVIDENCE: The adult protection policy has been extended as previously required. The policy defines types of abuse and makes reference to Department of Health guidance. In addition it now includes a procedure to follow should abuse be disclosed or suspected. Both staff members spoken with were aware of the policy and had undertaken relevant training relating to the identification of signs and symptoms of abuse. Service users spoke about feeling “safe” and “secure” living at The Grange and the district nurse said she felt confident that she could raise any issues of concern with senior staff and said that she had seen no “evidence of misconduct.” The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 14 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) 19,23,24,26, Some improvements to the environment have been made. Further implementation of the refurbishment plan is required to ensure that service users have a totally pleasant and risk free environment in which to live. EVIDENCE: The lounge and conservatory have been recently refurbished to provide a pleasant and comfortable seating area that was in full use throughout the inspection visit. A risk assessment has been completed for a bedroom that, for safety reasons, does not have furnishing in line with the standard. To avoid the clothing of an individual becoming mixed with another service users individual laundry baskets with names on have been introduced. Service users commented that bedrooms are “nicely decorated” and “lovely and comfortable.” It was apparent from viewing bedrooms, however, that most are in need of redecoration. The registered manager confirmed that a The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 15 refurbishment plan for the home is in place, a copy of which will be sent to the Commission. The stair carpet that is showing extreme signs of wear and tear needs replacing for appearance and safety reasons. All service users should have access to a lockable facility in their room so they have the means to securely store personal money and valuables themselves, should they wish to do so. Confirmation that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999 should be sought as an element of assessing safety within the environment. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 16 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) 29 and 30 Since the previous inspection the standards of recruitment processes and induction training have improved thereby ensuring new staff are thoroughly vetted and appropriately trained to provide a good standard of care for service users. EVIDENCE: Examination of two new staff files showed that written references are being verified by telephone and that, as previously required, new staff shadow an identified worker during the initial induction period. Staff members spoken to described satisfactorily their induction experience. One staff member confirmed that she had provided peer support for new staff during the induction. The programme of induction training that has been introduced meets the specification of the Training Organisation of Personal Social Services as required following the previous inspection. Service users talked about staff being “very good.” The district nurse said she considered staff to be competent. Records indicate that staff members have been appointed following a thorough recruitment process and that induction training meets requirements thereby ensuring a consistent approach to engaging a competent workforce. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 17 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) 33,36,37,38 Staff members receive good general supervision and support that enables them to provide a caring service to best meet the rights and needs of service users. Plans are in place to improve health and safety within the environment. EVIDENCE: Service users spoken to were very positive about living at The Gables. One service user said she felt “safe and secure” whilst another said he felt “safe and cared for”. Relatives of a service user and a visiting district nurse also confirmed their satisfaction with the running of the home. Staff members were clear about the parameters of their role. All the staff members spoken to gave examples of when advice from a more senior person would be sought. Records and observation confirmed that daily maintenance tasks are effectively attended to. There remains an outstanding requirement to undertake an environmental risk assessment of the premises to ensure any potential hazards are identified, attended to, and risk minimised for the safety of all people using the premises. There was no evidence available to confirm that water The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 18 temperatures are checked and recorded to ensure that the delivery of water is maintained at a safe and suitable temperature for service users. Service users spoken to were not aware of how to access information held on them and what this might consist of. As a means of improving openness and accountability the rights of service users and, where appropriate, their authorised representative to access records and information held should be positively promoted. Staff members receive general supervision and support from managers. Formal supervision systems need to be reinstated to make sure that staff receive time and guidance from their managers on an individual basis in order to maintain competence levels in the delivery of care to service users. To measure the success of the home in meeting its aims it is recommended that the views of family, friends and other stakeholders are sought and published. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 19 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 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x 3 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 x x 2 2 2 The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 20 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 OP19 Regulation 23(2)(d) Requirement Timescale for action 01.10.05 2. OP38 13(4)(a) (c) The registered person must ensure that all parts of the home are kept reasonably decorated and carpeted. A refurbishment plan indicating the priorities for refurbishment to be forwarded to the Commission for Social Care Inspection by the date indicated. The registered person must 31.01.06 ensure that an environmental risk assessment is undertaken of the home and the working practices within the home. (Previous timescales of 30.09.04 and 31.01.05 not met) 3. 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. Refer to Standard OP8 OP9 OP12 Good Practice Recommendations The registered person should seek to continuously improve continence management strategies within the home. The purchase of a drugs refrigerator is recommended. The employment of an activities organiser is recommended. F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 21 The Grange 4. 5. 6. 7. 8. 9. 10. OP24 OP26 OP33 OP36 OP37 OP38 All service users should have a lockable space in their private room. Evidence should be provided that the services and facilities on the premises comply with the Water Supply (Water Fittings) Regulations 1999. The views of service users, their family, friends and other stakeholders should be sought to assess whether the home is achieving service user goals successfully. Care staff should receive formal supervision at least six times a year. Service users and their authorised representatives should be informed of their right to see information held by the home in accordance with the Data Protection Act 1998. Water temperature records should be kept on the premises and be available for inspection. The Grange F57 F08 S5918 The Grange V238079 160805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Levens House Ackhurst Business Park Foxhole Road, Chorley Lancashire, PR7 1NW 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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