Inspection on 16/06/05 for The Grange

This inspection was carried out on 16th June 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Grange 17/10/06

The Grange 23/11/05

The Grange 13/01/05

The Grange 22/09/04

The Grange 26/03/04

The Grange 12/09/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Grange 15 Holmwood Drive Tuffley Gloucester Glos GL4 0PS Lead Inspector Paul Chapman Announced 16 June 2005 09:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Grange Address 15 Holmwood Drive Tuffley Gloucester Glos GL4 0PS 01452 300025 01452 314549 Homeleighcare@btconnect.com Mr Rodney Correia 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) Susan McQuire Care Home - Personal Care 9 Category(ies) of Learning Disability (9) registration, with number of places The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The registered manager must complete her NVQ 4 in management by February 2006 The registered manager must complete her NVQ 4 in Care by February 2006 Date of last inspection 13/01/05 Brief Description of the Service: The Grange is a large detached Victorian house situated in a quiet residential area approximately three miles from the centre of Gloucester. The home offers residential care for up to nine adults with Learning Disabilities who from time to time display some challenging behaviours. Residential accommodation is provided on two floors, with three ground floor bedrooms and six first floor bedrooms. The ground floor of the property provides a Lounge, dining room, kitchen, laundry, conservatory, staff office, the communal bathroom and toilets. On the first floor in addition to the bedrooms there are two bathrooms, and an office.Outside there is a fenced garden/lawn area at the rear of the building, car parking area and garage/outbuilding. At the front there is a small garden area, with trees and shrubs. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over a 7-hour period from 9 am one morning. One of the service users were spoken with and the four staff on duty at the time. The manager and her deputy were present throughout the inspection. Three service user’s records were case tracked to ensure that their assessed needs were being met. Other records required by the Care Homes Regulations 2001 (health and safety, training, staffing rotas, etc) were also examined. A tour of the home was completed that included seeing all of the service users’ bedrooms. The inspector would like to thank the staff and service users for their support during the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Recording when staff administer medication to the service users. Staff must record what service users actually eat. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 standard(s) 5 Each service user has an individual contract that specifies exactly what the service will provide. EVIDENCE: No service users have been admitted to the home since the previous inspection. Each service user has an individual contract with the home. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 standard(s) 6, 7, 8, 9 Individual needs and risks are identified and reviewed regularly enabling staff to support service users in achieving their goals. EVIDENCE: The inspector recognises the development of the home’s care planning and risk assessment practice over the past two years. This has been due to the leadership of the manager and commitment of her team. Three service users files were examined, they all showed comprehensive care plans that covered areas of personal hygiene, anxieties, mealtimes, communication, assisting in the kitchen, laundry, cleaning, behaviour, independence, living skills and other topics. Care plans examined clearly identified service users needs and the action required by staff to meet those needs. All care plans were regularly reviewed a minimum of twice in a twelvemonth period, and more often where appropriate. Where a care plan was no longer appropriate it had been updated to reflect the new need. When service users are unable to read staff read their care plans to them and the service user is given the opportunity to sign the document if they are in agreement with it. Examples of this were seen. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 10 The only shortfall identified was in relation to a service user who travels independently in the community. Although a risk assessment was available staff had not completed a care plan, this was brought to the attention of the management team who stated this would be addressed. Service users’ files gave examples of staff supporting them to make decisions where appropriate. Service users have regular meetings and minutes of those meetings showed that they are given the opportunity to speak about any issues and decide on other future activities. An example seen related to the proposed decoration of the communal areas of the home. Service users’ had been asked what colours they liked/disliked. The three service user files that were examined all contained comprehensive risk assessments that were regularly reviewed. One shortfall that was identified related to developing a missing persons protocol for the service user who travels independently. This was brought to the attention of the manager. A relative that was visiting during the day felt that the home/staff did a good job supporting their sister and communicated any issues appropriately. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 standard(s) 12, 13, 14, 15, 16, 17 The lifestyles of the service users’ are varied and fulfilling meeting their identified needs. EVIDENCE: Observations during the inspection supported the information seen in service users’ files. The home offers a flexible and individualised lifestyle for the service users, giving them every opportunity to maintain and develop social, emotional, communication and independent living skills. A range of opportunities are available, including attending the local day services and College. Service users activities are recorded in the daily notes made by staff. On the day of the inspection a service user was being supported by a member of staff to cook some cakes. In a conversation with the staff member they said this is a regular event. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 12 Service users use local shops and leisure activities are organised regularly. A service user and staff were able to give various examples of going for walks, swimming, meals in restaurants and pubs, shopping in Gloucester and picnics in the summer. Staff spoken with during the inspection stated that they felt the service users had a good lifestyle. Holidays have been arranged for later this year and two service users spoke about looking forward to going on a canal boat holiday on the Guilford canal. Service users’ files contained care plans that related to relationships and identified the support service users would need. As stated previously in this report at the time of the inspection a service users relative was visiting and stated that this was a regular activity. Speaking with the manager they gave examples of working with parents/relatives. The daily routines in the house are led by peoples needs and the service users and their records confirmed this. Observations during the inspection confirmed that staff only enter rooms with the service users permission. All of the service users have locks on their doors, and the majority of them use them. Where service users did not use the lock on their door the reason was noted in their personal file. Service users open their own mail, and staff will support them to read letters where it is required. The home employs a member of staff to cook the meals during the week. Menu’s were examined and showed that service users have a varied and balanced diet. Each service user chooses a week’s menu, if a service user does not like what is on the menu ready meals and jacket potatoes (with various fillings) are available. Each Saturday the service users have a ‘take away’ meal of their choice. A shortfall identified was staff were not recording the actual food service users were eating, this was discussed with the manager who stated that in future it will be recorded in service users’ daily notes. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 standard(s) 18, 19, 20 Assessed physical and emotional health needs are met. The manager must ensure that all of the medication administration is managed effectively to ensure service users safety is maintained. EVIDENCE: Service users personal support needs are identified in their care plans. The home make good use of other professionals where appropriate to meet service users physical and emotional needs. Examples of this were seen in service users’ files. Medication administration was examined. It showed that medication was stored correctly and recorded appropriately when it was received and disposed of. The majority of the team have now completed an external course run by a local college in the administration of medication. At the previous inspection the medication administration sheets contained some gaps where staff should have signed to confirm service users had received their medication. The medication sheets in use at the time of this inspection did not have any gaps, but examination of the sheets for the last couple of months showed some gaps. This was brought to the attention of the manager and becomes a requirement of this report that they must ensure all staff sign to confirm service users have The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 14 received their medication. An idea mentioned by the manager was to include a reminder on the staff handover sheet. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 standard(s) 22, 23 Policies and procedures are in place to protect the service users and staff would take the correct actions if they witnessed an incident. EVIDENCE: A service user stated that they felt that their views were listened to and acted upon. The home has developed a complaints procedure in a picture format to meet the needs of the service users. In discussion with a service user they were able to say what actions they would take if they wished to make a complaint. A recommendation of this report would be for the manager to go through the complaints procedure with all service users, either in a service users meeting, or individually. No complaints have been made since the previous inspection. The training planned for staff in the future includes a day about protecting service users from abuse. Staff spoken to during the inspection were clear about the steps they would take if they witnessed a service user being abused. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The home is maintained to a high standard and meets the current needs of the service users that live there. EVIDENCE: Over the past two years the fabric of the home has improved greatly and now provides the service users with a clean, homely and comfortable environment. Since the previous inspection the lounge has been decorated and a new threepiece suite has been purchased. All of the service users’ bedrooms were seen to be clean, comfortable and decorated to a good standard. The bedrooms reflected the service users personalities and hobbies with their personal possessions. The manager stated that they plan to decorate all of the service users bedrooms in the near future; evidence was available to show service users were being consulted with about their preferred colours. All of the bathrooms and toilets were seen. The upstairs bathroom is decorated to a high standard, but the bathroom downstairs now looks a bit worn and the The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 17 storage cupboard smells of damp. The inspector is aware that the proprietor plans to refurbish this bathroom in the near future and recommends that this be completed sooner, rather than later. To the rear of the house is a good-sized garden that is well maintained. Where appropriate adaptations have been made to maintain service users independence. This is mainly in the form of additional handrails. The manager stated that some changes to the accommodation are being planned. These include the staff office being moved to where the multi-sensory room is presently (as it is not used anymore) and two service users swapping bedrooms. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 Staff roles, responsibilities, training and supervision of the management team ensure that service users needs are met. EVIDENCE: All staff have job descriptions. Since the previous inspection Homeleigh Care have reorganised their training department. Certificates were available in staff files providing evidence of a large amount of training that has been completed over recent months. This included the majority of the current staff team completing first aid, fire safety, medication administration, moving and handling, food hygiene, COSHH and PRT training. The training timetable for the next three months showed that staff would be able to attend food hygiene, medication administration, abuse and protection, pressure care, record keeping, moving and handling, first aid, challenging behaviour and diabetes training. At the time of this inspection 3 staff had completed NVQ’s while another 6 were registered to start theirs, or completing theirs at that time. Talking to members of the team they commented on how they thought the team got on well. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 19 The home has a comprehensive recruitment policy that minimises the potential risk to the service users. Once staff have been recruited they all complete an induction course that consists of an “in-house” course and an external course. Evidence was seen to show that both of these elements were being completed. All staff are now receiving supervision meetings with the manager or her deputy. Dates showed that staff had received at least two meetings since January this year and that this was on going. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 40, 41, 42 Risk to the service users’ is minimised through relevant policy and procedures, assessment and monitoring. EVIDENCE: The manager is currently completing their Registered Manager’s Award. As identified previously in this report the service has developed over the past two years and with systems put in place by the manager to ensure that the home runs effectively. Service users’ needs are identified, reviewed and met by either the staff team or other professionals where required. The home has comprehensive policies and procedures to safeguard the service users. Regulation 26 visits have been completed regularly since the previous inspection. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 21 Health and safety is regularly monitored around the home by the staff team. Records included monthly checks for defects, hot water outlet monitoring, fire alarm tests, use of the food probe and daily recording of fridge and freezer temperatures. The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 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 x x x x 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Grange Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 3 x D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 23 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 6 Regulation 12(a), 15 Requirement The manager must ensure that a care plan is developed for the service user who travels independently. The manager must develop a missing person protocol for the service user who travels indepedently. The manager must ensure that staff record the actual food that is consumed by the service users. The manager must ensure that no gaps are left when staff administer medication to service users. Timescale for action 15/07/05 2. 9 12(a), 4(b, c) 17(2) schedule 4 (13) 13(2) 15/07/05 3. 17 15/07/05 4. 20 15/07/05 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 22 27 Good Practice Recommendations The manager should go through the homes complaints procedure with all the service users. The manager should make it a priority to replace the downstairs bathroom. Version 1.30 Page 24 The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 The Grange D51_D03_S16664_TheGrange_V229395_160605_Stage4.doc Version 1.30 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!