Inspection on 18/03/06 for The Grange

This inspection was carried out on 18th March 2006.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 19/10/08

The Grange 19/09/07

The Grange 23/10/06

The Grange 08/07/05

The Grange 24/01/05

The Grange 03/08/04

The Grange 24/02/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Grange (The) 2 Mount Road Parkstone Poole Dorset BH14 0QW Lead Inspector Maxine Martin Unannounced Inspection 18th March 2006 14.15p Grange (The) DS0000004086.V287073.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 Grange (The) DS0000004086.V287073.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. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Grange (The) Address 2 Mount Road Parkstone Poole Dorset BH14 0QW 01202 715914 01202 743557 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) www.leonard-cheshire.org.uk Leonard Cheshire Mr Paul Bulgarelli Care Home 26 Category(ies) of Physical disability (26) registration, with number of places Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th July 2005 Brief Description of the Service: The Grange is a home owned by Leonard Cheshire Foundation (a national charity) and accommodates up to twenty-six adults who have a physical disability. The day care and respite unit are upstairs, with a further four units on the ground floor accommodating five residents each. Each unit has its own kitchen/dining room and two bathrooms, and service users have their own bedroom. The communal area comprises a seated coffee area, with a fishpond, where guests/visitors can also sit. There is a large paved courtyard for use in the summer. The Grange offers adapted living facilities to accommodate people who use wheelchairs. There are adapted baths, beds, lifts, electric doors, manual and electric hoists. The home also has some volunteers who enhance the service offered by paid care staff in offering additional social experiences and outings. The Grange has adapted vehicles available, so transport is provided when necessary. The Grange is situated in a residential area of Parkstone, close to local shops and amenities. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Carole Payne and Mrs Maxine Martin undertook an unannounced inspection, in line with statutory requirements. It was conducted between 2.15pm and 6.45pm on Saturday afternoon, the 18th March 2006. Seven standards required inspection, however during the visit matters relating to other standards were highlighted, and are referred to in this report. Four support staff members were on duty at the time of the visit, one for each unit. The senior staff member supported the inspectors, accessing service user files and meeting residents. Further documentation was viewed at the end of the inspection, when the deputy came in for the feedback from the inspectors. Access was then available to the office area. Two staff members contributed to the inspection, service users’ plans were viewed, staff rotas, records and staff files were viewed and the general environment toured. Five service users talked with the inspectors about their views. In November/December 2005 twenty-eight feedback cards were received: • • • Fourteen from residents Nine from relatives/carers Five from health and social care staff, independent to the service. Comments included in these comment cards are referred to in the main report. Monthly reports are submitted to the Commission, which are completed in line with Regulation 26. The term resident and service user will be used throughout this report and for such purposes are interchangeable What the service does well: The Grange is an established purpose built service in a residential area with a range of specialist equipment. It has a committed staff team who support residents to be involved in all aspects of their care. The feedback cards from health and social care staff are very positive, ‘I have found both carers and senior staff very supportive and understanding of the service users’ needs. They carry out any instructions given regarding health care with competence, but are always happy to ask for help. We have an excellent working partnership’. Files viewed showed evidence of care plans to address the specialist needs of service users and to ensure their rights and choices are considered. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 6 There is a philosophy of ensuring staff are appropriately trained. This and welldeveloped care plans support good care practice. As part of a national organisation well-developed policies and procedures are in place. From the fourteen resident feedback cards received eleven gave positive responses to the provision at The Grange. On the day of the inspection residents spoke highly of the staff and generally enjoyed living at the service. Two service users felt that ‘the care at The Grange is first class’. What has improved since the last inspection? What they could do better: One key theme was identified in the feedback cards, discussion with residents, observation and review of the rotas – that is the need to ensure a consistent staffing level to meet the needs of the people living at the service. The general concern was that on occasions there were insufficient staff, which was impinging on all aspects of service provision. The manager stated that there had been an outings organiser who had not been in post for over 10 years, however feedback from carers reflected that they valued this post. An immediate requirement notice was issued to ensure adequate staffing levels. The manager has responded with a six-stage strategy to address this matter. The manager also advised following the inspection, that there had been times when the staffing levels had exceeded the roster level. Health and safety practice needs to be monitored to ensure consistent practice. An immediate requirement notice was issued. The manager has sent in an action plan to address this. A few additional health and safety actions have been identified under the requirements for the service to address. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 9 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 Records are in place, which support the identification of service users’ needs and the establishing of care plans to meet these needs. This documentation needs to be consistently completed and available with sufficient detail to ensure that all needs are met appropriately. EVIDENCE: One file was viewed from a recent admission; there was no name on the file and some un-secure pieces of paper at the front of the file. The rest of the file contained the standard organisational format for recording detailed information of care needs and plans, however under certain headings it said ‘assistance with’ but did not go on to specify what assistance was required. There was evidence on the file of service user or their representative’s involvement in the assessment and planning process. Some forms had not been signed where required. It was not clear in the records of the pre-admission process, including the assessment that the service could meet the individual’s needs. This was discussed at the feedback, since which the manager – Mr Paul Bulgarelli – has contacted the Commission to advise that in this situation the person had been attending the respite unit and that the full pre-admission document was on another system. He said that most people who move into the home have usually attended the respite service previously. He confirmed that Leonard Cheshire have a nationally agreed format for pre-admission assessment, that Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 10 often the process of introduction is undertaken whilst the person is using the respite unit. They have a service contract evidenced on other files. Although the pre-admission assessment document could not be viewed on the day of the inspection the discussion with the manager and the standard generally of the service’s documentation clarified that this process is in place. The service needs to consider how to consistently ensure specific details are recorded to support residents who have very complex health and social care needs. Terms such as ‘assistance with’ need to then specify the detail, so that all staff members can support the residents in the best way possible. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 11 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 Service users are actively involved in the care planning process and supported to take risks, which are assessed. Service users are encouraged to be involved in the decision-making processes within the home. EVIDENCE: In service users’ files there was evidence of service user involvement and consultation. One person said ‘I am very happy here, I get on well with the staff’. On some files viewed service users had signed their care plans and there were sections for them to discuss personal preferences. One resident on the day said ‘excellent care’ ‘can choose what to do’, they referred to a residents committee. The service users spoken to on the day talked about a committed staff team. A group of service users and one staff member were going out to a football match as the inspection commenced. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 12 From the feedback cards received at the end of 2005 one health professional said: ‘I have found both carers and senior staff very supportive and understanding of service users needs’. The whole philosophy of the service is to support people to live as independently as possible and be involved in the decision making process. The concern would be that these principles and practices could be affected by staffing levels. Please cross reference to standard 33 for further details. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 13 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): 13 and 16 Service users are encouraged and supported so that they can take part and be involved in their local community. Service user’s rights are recognised and they are encouraged to take responsibility where appropriate. EVIDENCE: The trip to the football game is a regular activity. The residents are supported by staff and volunteers to undertake activities like this. However, there is concern expressed that these activities have reduced see - standard 33. Two people spoken to on the day said they go to church each week, although friends from the church facilitate this. The care plans indicated that people attend a range of local activities during the week. The home is situated within a residential area and had several mini buses, which are used to support residents to take part in events. There are local shops available for residents to use, as well as reasonable driving distance to larger shopping areas. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 14 The care plans seen indicated that service users are encouraged to make choices, and, where applicable, to take responsibility for certain aspects of their daily living. i.e. individuals manage their own medication and finances. Service users sign to say these decisions have been made. One service user said ‘I am happy with whoever does my care, if I’m unhappy I will say’. The service has several vehicles, which can be used to support residents going out on activities. According to residents there is a mileage charge currently under review. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are supported with personal care in a way they choose and supports their dignity and independence. EVIDENCE: All service users spoken to about their care spoke of a committed staff team, who provide support in line with their individual, care plans. The concern relating to personal care was that as staff members are ‘so busy’ personal care is being ‘rushed’. On the files viewed specific details were evidenced on individual preferences and choices, including gender care preference forms, preferred name and a personal care plan. The building is purpose built with a range of necessary equipment to enable staff to support individuals in an appropriate manner. Evidence on records indicated the involvement of a range of multi-disciplinary staff to support the needs of the individuals. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 16 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): None of these standards were inspected. EVIDENCE: Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 17 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): None of these standards were inspected. EVIDENCE: Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Staffing levels must be consistently at a sufficient level to meet the identified needs of service users and ensure effective care practice, which supports the rights and choices of the residents. Staff are trained to the required standard and there is a positive policy of ongoing training and development. EVIDENCE: In relation to staffing levels observation and discussion with service users confirmed concerns that had been identified in the feedback cards relating to staffing levels. These initial concerns were identified in December 2005. Three service users spoken to on the day all stressed the commitment of the staff, but that levels had reduced, ‘they are very busy and we just have to wait’. This was also mentioned by six relatives in the feedback cards: quotes included ‘ outings are infrequent and mainly only shopping’, ‘would like to see more staff on – mainly at weekends so residents can have more outings – when most are in’. One individual said very low staff at weekends ’and no one to talk to.’ Concern was expressed that personal care is hurried and sometimes people just have to ‘wait for a long time’ for personal assistance including support to go to the toilet, as the staff are so busy. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 19 In one case the service user said they were distressed and concerned about their personal care because of waiting for staff to be available to help them. All parties made particular reference to weekends and to evenings in the ‘reduced opportunity to go out’. During the inspection there were four staff on duty, due to individuals with very high levels of needs, staff were stretched in trying to meet people’s needs and, on occasions, individuals requiring help had to wait some time. As there was no one in the office area any visitors would have to wait until a care staff person could come to the main door. This could also present a security risk as both the inspectors and ambulance staff, returning with a resident, had entered the building and it was a short while before a staff member was available to come to that area. An immediate requirement was issued under Regulation 18 (4) ( C ) requiring the service to submit a plan to ensure the service can effectively respond to the needs of service users, with adequate staffing levels. The manager complied and submitted a plan on 24/03/06, the report states that they are putting into place six strategies, which include the employment of additional staff and reviews of existing rotas at times of higher levels of dependency. Full details can be obtained from the service. In relation to staff training, staff confirmed that they have undertaken a range of training. Records viewed evidenced this; the service has a training matrix, which provides an overview of training for all staff members. Records on care plans also confirmed that staff had undergone relevant training. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Work needs to be undertaken to ensure the consistent application of health and safety procedures so that the environment is safe for residents. EVIDENCE: During the inspection several containers of hazardous substances were seen in accessible places. This was brought to the attention of the management during the feedback and an immediate requirement notice was issued under Regulation 13 (4) (a). The deputy manager assured us this would be addressed immediately. Since the inspection a written response has been received from the manager confirming that a range of actions have been undertaken and strategies put in place to ensure this matter is dealt with appropriately. They have advised that this matter will also be re-enforced in training for all new staff and that all team leaders have been briefed. For full details of actions please contact the service. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 21 The communal laundry was viewed and there were free standing fans, which resulted in trailing wires. This section must be risk accessed and appropriate action taken in relation to leads and ventilation of the laundry. In one person’s room the call bell was not accessible for the individual to use to ring for staff assistance. This requires action by the service to ensure consistent availability of call systems. Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 2 3 x 4 x 5 x 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 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 1 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x X 3 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x x x x x x x x 2 x Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 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 YA33 Regulation 18 (1) (a) Requirement To undertake a review and submit an action plan within the timescale as to how the service is to effectively meet service users needs. A plan has been received from the manager An immediate requirement notice was issued on 18/03/06 To ensure safe storage of all hazardous substances in line with COSHH legislation An immediate requirement was issued on 18/03/06 To undertake a risk assessment of ventilation in the laundry area and ensure environment safe from trailing leads and free standing fans. Establish consistent systems to ensure all call bells are accessible to service users. Timescale for action 25/03/06 2. YA42 13 (4) (a) 18/03/06 3. YA42 12 (1) 18/04/06 4. YA42 12 (1) 18/04/06 Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grange (The) DS0000004086.V287073.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!