Inspection on 18/01/06 for The Grange

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 20/03/07

The Grange 14/10/05

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 The Grange 30 Vinery Road Bury St Edmunds Suffolk IP33 2JT Lead Inspector Helen Fontaine Unannounced Inspection 18th January 2006 10:00 The Grange DS0000024399.V278828.R01.S.doc Version 5.1 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 DS0000024399.V278828.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000024399.V278828.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The 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 The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th October 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. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of The Grange took place over three hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Five requirements and two recommendations were set at the previous inspection and the home has complied with all of the required action. No further requirements or recommendations were identified at this inspection. The manager of the home was not present when the inspector arrived and a member of staff took the inspector on a tour of the home. The manager then assisted the inspector, records were looked at and two of the residents at the home were spoken to. However as most of the residents were out at daytime activities, it was not possible to get their opinions of living at the home. The residents were much involved in the first inspection and their opinions were recorded then. What the service does well: What has improved since the last inspection? The home has put some considerable effort into getting the administration of medication absolutely right. The manager has had the local pharmacist visit the home and has written a letter to evidence that the medication meets with necessary legislation. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 6 The home has now devised a new form that enhances their already existing Care plans. This was looked at during the inspection and found to meet the National Minimum Standard. The staff files now all have personal identification, this was missing from one staff members file at the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 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 DS0000024399.V278828.R01.S.doc Version 5.1 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): 5 The residents can expect to have a written contract with terms and conditions with the home. EVIDENCE: The home has made sure that all the residents except one have had a licence to occupy. This resident has a contract with the Local Authority, the manager said that the Social Worker arranged this and did sign it with the resident. All the residents have in their rooms a lockable cupboard, where they keep paper work including this licence to occupy. This document is on the home’s headed paper and is address to the resident individually. The document then welcomes the resident to the home; the subsequent pages cover 14 points. These are furniture, rooms, shared spaces, what the home will provide for the rooms. It also covers animals, no smoking, staying in contact with friends, separate fees, termination, aims and objective of the home, holidays, homes contribution to the holiday, and records kept. The documents looked at were both signed by the resident, the key worker and the manager. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 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 The residents can be assured that their changing needs and personal goals are reflected in a plan. EVIDENCE: The files of two residents were looked at, the resident who had lived in the home the longest and the newest resident. The home has a yearly review of the residents plan; this is over and above any reviews done by either health or Social Care. The review is on the homes headed paper; it has been kept simple for both staff and residents and is signed by the resident, key worker and the manager. The review has the residents name, the date of the review and the named key workers. It documents the long-term aims covering, personal hygiene, exercise, visual aids, domestic skills, diet and kitchen skills, communication, craft and hobbies. The next heading is short-term objectives and for one of the residents it states to encourage resident to go for short walks and daily walks in the garden. At the bottom of the review it is documented that the resident was asked who they would like present at their care plan review. The two reviews looked at were very different and covered the areas of their individual needs and aspirations. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 10 The home has also developed a new document in the shape of a small A3 size booklet for the full care plan. On the front is the name of the home and the name of the resident concerned and is headed Care Planning Assessment. Inside page has the resident’s personal details and the next page has the resident’s personal profile. This covers personal and family history, significant events, relationships, personality, and personal circumstances and how can things in the resident’s life be improved. The next section is about social and leisure, then physical health, current medication and who administers medication. The next section covers mental health with a tick box and as an example the choice of box to tick was about wandering, never, occasionally, frequently inside, frequently outside and space at the bottom for additional information. This document goes on to cover all necessary areas and has it repeated so that it can be completed at each yearly review. The newest residents files looked at also had the initial assessment, done in pictorial format. There was a health action plan and a section for resident’s health records. The home also had what the manager called the daily bible, which has in it the daily routine for all the residents. This is set up for any new staff and in the case of emergencies if any agency workers have to be used. This document had the arrangements of the resident’s rooms colour coded. It had the each residents day events, where they went and what transport was needed. Then the daily routines were set out Monday – Friday, 7.30 am – 9.30 am, 3.30 pm onwards, bed times and final check. It was then documented what evening events residents went to and events over the weekends. The document also listed the resident’s key workers and ended with a short sentence on each of the resident’s individual needs. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 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): These standards were not inspected on this visit. However evidence from the last inspection was that, residents could 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: The above standards were not specifically inspected on this visit, as there were no outstanding requirements in relation to the standards about lifestyle. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 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): 20 and 21 Residents can be assured that medication procedures and protocols do safeguard residents. Residents can expect to have their final wishes respected. EVIDENCE: At the last inspection concerns were raised by the inspector around the issues of medication and the home received a number of requirements. The manager has had the local pharmacist visit and they have supplied the home with a letter that the home has now addressed all the issues raised. The documentation for medication, now records the codes used by the home. There was also a clear documented audit of the tablets that were held in the home. The home has developed a policy and procedure for homely remedies and all risk assessment were in place. The manager said that the pharmacist would be undertaking all the staff training. The home has for each resident except one, a funeral plan. One of the resident’s plans was looked at and was in the form of a leather bound booklet, which was, headed Your Personal Organiser. The document inside was completed and stated that the document will be followed. The document covered the issues over burial or cremation, personal affects, next of kin, flowers and the document looked at had the hymns chosen as “What a friend The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 13 in Jesus and There is a green hill”. The resident who’s plan had not yet been completed the manager said it is being done in pictorial format, so the resident would understand it. This whole area that is so sensitive has been done really well by the home and exceeds the National Minimum Standard. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 14 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): These standards were not tested on this visit. However evidence from the last inspection was that, residents can expect to be protected from abuse and feel that their views are listened to and acted upon. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the Standard for concerns, complaints and protection. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 15 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 and 30 Residents can expect to live in a homely, comfortable and safe environment and furthermore then can expect their bedrooms to suit their needs and promote their independence. EVIDENCE: During the inspection a tour of the home was undertaken with a member of staff, their support was very much appreciated. The home was clean and hygienic, the toilets and bathrooms looked at had all been recently redecorated. The member of staff was very careful about accessing the resident’s rooms and knew which residents liked their rooms to remain locked. The member of staff did show the inspector rooms that were open and all of those were individual and personalized. One room where the resident liked models and puzzles, purpose built shelving had been built to store them. The manager is currently having their office re-furbished and once complete will the manager said give them space to get documents organised and be accessible to staff. The kitchen areas was bright and designed so that it is part of the main dining area. Residents are then part of the activities of the home and are involved in all meals that are being prepared. The lounge area has comfortable chairs and the home has bought a new television for the residents. At the far end of the lounge is what the manager termed the quiet area and The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 16 here the residents not wishing to watch the TV can sit or do other activities. The home also has another area separate from the other communal areas; here the residents can see their visitors in private The outside area is nicely set out, there is a garden for the use of the residents and has a small fishpond. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 17 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): 31 and 34 Residents can expect to be support by reliable, competent staff. EVIDENCE: The staff group have worked together and in the home for some years, the manager has worked in the home for many years. The manager and her family are involved with the home; her mother used to work in the home and her father was present during the inspection re-furbishing the manager’s office. A staff file was looked at, as the previous inspection there was a requirement around there being identification on record. The file had full identification, the file was nicely sent out with colour photocopies of all documents and laid out in sections. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 18 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): 39 Residents can be assured that their views are used as to underpin all developments in the home. EVIDENCE: During the inspection, conversations were had with a staff and the manager and records were looked at. This indicated that the homes approach creates an open and inclusive atmosphere. There was evidence of consistent opportunities for staff and residents to contribute to matters of the home in counsel meetings, staff meetings and daily one to one interactions. The manager said that they had already had a discussion with residents and booked their holiday this year. The manager said that they do consult with the residents about all aspect of life in the home. A discussion around reviews took place; the Local Authority is now about to start new reviews. However the home does hold the residents reviews yearly that the residents understand and are used to. The residents The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 19 all have high needs with communication and routines, all of them take time to understand or relate to anything that is new. The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 X 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 4 X X 3 X X X X The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Grange DS0000024399.V278828.R01.S.doc Version 5.1 Page 22 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. 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