Inspection on 20/07/09 for The Grange

This inspection was carried out on 20th July 2009.

CQC found this care home to be providing an Adequate service.

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 23/02/09

The Grange 29/02/08

The Grange 12/07/07

The Grange 06/12/06

The Grange 30/09/05

The Grange 13/06/05

The Grange 21/10/04

The Grange 19/04/04

The Grange 14/01/04

The Grange 10/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ Lead Inspector Sue McGrath Key Unannounced Inspection 20th July 2009 09:30 DS0000029055.V376305.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ 01634 270674 01634 270674 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) Mr Henry Alfred James Holloway Manager post vacant Care Home 10 Category(ies) of Dementia (0) registration, with number of places The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 10. Date of last inspection 29th February 2008 Brief Description of the Service: The Grange is located in a rural area with few local amenities. To the front of the property there is a circular drive and a paved area, offering ample parking. To the rear there is a large garden mostly laid to lawn, with a raised patio area. The home occupies detached premises with accommodation on two floors. There is a single person lift between the two floors. There are 8 single rooms and 1 double bedroom. 2 of the single rooms and the double room have ensuite facilities. There are call bells in bedrooms, bathrooms and toilets. The staff provide 24-hour cover working a rota, there are two waking night staff on duty. The current fees for the service at the time of the visit range from £450 - £500 per week. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is no current e-mail address for the home. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and regulations and that the outcomes are promoting the best interests of the people living in the home. The actual site visit was carried out by 1 inspector over the course of 1 day. We (the Commission) spent time touring the building, talking to all the people living in the home and relatives. We also spoke to the manager and staff and reviewed a selection of assessments, care plans, medication records, menus, staff files and other relevant documents. The registered provider was not present throughout the inspection. Prior to our visit an Annual Quality Assurance Assessment (AQAA) had been sent to us within the required time limit. The AQAA is a self-assessment, required by law. This assessment focuses on how the service considers they are meeting the outcomes of the people using the service and where it feels it can make improvements. It also provides statistical information about the service. Information from the AQAA has been used in this report where appropriate. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Care Quality Commission (CQC) to be able to make an informed decision about each outcome area. The owner has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the commission, but will be referred to as ‘the manager’ within this report. Overall this was a positive inspection with generally good outcomes for service users. The inspector on leaving the home was satisfied that residents were both safe and well cared for and wishes to thank the manager and her staff for their assistance and hospitality. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 6 The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: Staff in the home are caring and dedicated to the welfare of the residents in the home. Health care needs are well met. Residents say they like living in the home and that the food is of good quality and that they have a choice of menus. They confirmed they are provided with food in sufficient quantities. Drinks were seen to be freely available. Families are encouraged to maintain contact with their relatives and are made welcomed when they visit. Full assessments are undertaken prior to admission to ensure assessed needs can be met by the home. Relatives gave very positive feed back during the inspection, one visitor said ‘It was not like visiting her Mum in a home but like visiting her in her own home’. Another visitor said that ‘staff go the extra mile for her relative and that she can leave them there knowing they are safe and well cared for’. What has improved since the last inspection? More care staff have improved the quality of life for the people who live there. More activities are now undertaken by the people who live there, as staff have time to organise them. More 1:1 sessions are also now undertaken by staff. A new cook and domestic staff have also been employed and this enables care staff to spend even more time with the people in the home. Staff training had also improved since the last inspection. The home was a lot cleaner and fresher at this inspection. New flooring had been fitted to the kitchen, laundry, downstairs toilets and some of the en-suite toilets. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 7 New brighter lights had been fitted to the lounge area to ensure people can safety read in the evening. All pipe work and radiators are now guarded to protect the people in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to make an informed choice about moving into the home. People who live in the home benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. EVIDENCE: We looked at the information provided to people who use the service to find out whether it was detailed and answered all their questions, and to find out how the service passed on the information. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 10 We viewed one service user file and spoke with one relative to determine how the home assesses people. The statement of purpose and service user guide have been updated and now reflect what the service has to offer. The home has not admitted any new people since the last inspection. The manager confirmed that the current admission policy is that if the client has a care manager, a care plan would be initially obtained from the relevant social services. The manager would then go out to visit the prospective client and complete the assessment form to ensure that the home could meet the client’s needs. The prospective client would be invited to visit the home for a day or an overnight stay. The manager confirmed that the home would not accept a client unless they were confident that they could meet their needs. This home caters for residents with dementia and the majority staff had received training in this subject. We spoke with one relative who confirmed the above procedure was used when her relative was admitted and that she felt involved with the process. All people were provided with a contract/ statement of terms and conditions. This home does not offer an intermediate care service. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Care plans are regularly updated to ensure changes are recorded and acted upon. Health needs are met and people benefit from having full access to all professional health care services as required. People are protected by the home’s policies and procedures for dealing with medicines. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 12 EVIDENCE: We wanted to look at peoples care plans to ensure that their health, personal and social care needs were set out in a way that would enable staff to deliver good care. We looked at three plans to evidence this. We found that all information regarding each individual was now held all in one file and that all care plans were regularly reviewed. The information seen was detailed and gave a good picture of the individuals needs. Evidence was seen that all three care plans had moving and handling assessments, falls risk assessments, nutritional assessments and skin care assessments. Further assessment regarding diabetes and epilepsy were discussed with the manager. An assessment for diabetes was in place but the manager was having difficulty in completing one for epilepsy and was waiting for further information from the GP. Any incidents of pressure areas were reported to the district nurses who would give advice, treatment, and provide necessary equipment. Advice was also sought from the district nurses for continence problems. Relatives confirmed they felt health care needs were well met with one person saying: ‘I think my parent’s health care needs are well met. Staff are very observant over his health and quickly call GP or DN if they have concerns. I cannot fault the staff’ Another relative said: ‘Mum was really poorly and I think she only survived because of the good care here by the staff. They will always call the GP and keep me informed at all times.’ We viewed the administration of medication at this inspection. At the last inspection it was noted that the medication policy was not relevant to the home. The manager has now written a new policy that reflected good practise. The administration records were viewed and no errors were found. The manager explained that she audits the medication records at least twice a week and observes staff who were administering the medication. If she had any concerns over the way it was being administered, the carer would repeat the medication training and then would be reassessed as competent when this had been demonstrated. The manager has also started preparing protocols for PRN medication as recommended at the last inspection. She was advised to keep records of any audits she undertakes. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 13 A new medication fridge had been supplied to enable safe storage of medication that was temperature sensitive. The manager confirmed the home no longer had any controlled drugs on the premises. Residents in the home were treated with dignity and their right to privacy was respected. Some good examples of interaction was seen between staff and residents. Staff and relatives confirmed the higher staffing levels had improved the amount of time that could be spent with each person and this had greatly enhanced their lives. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the flexible routines in the home. Social and recreational interest and needs are well provided for with a wide range of activities organised. People are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. People benefit from the appetising meals and balanced diet offered by the home and those service users requiring specialist diets are well catered for. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 15 EVIDENCE: We wanted to look at the type of lifestyle experienced in the home and if people were happy with the level of social interaction and level of activities. We also wanted to look at if choices were given to the people and what control they had over their lives. To do this we spoke with nearly all of the people and some relatives who were visiting. Staff were also spoken with. The home cares for people with varying degrees of dementia and lifestyles can be very challenging for some. With the levels of dementia within the home it was not always easy to ensure full choices were given at all times, however staff were seen to offer choices where possible and where not possible gave full support and consideration. The home organises a range of activities for the people to keep them stimulated and motivate. The extra staff now employed by the home had greatly improved the quality of life for the people and more activities and 1:1s were being undertaken. Relatives spoken with confirmed they had seen more staff and that this meant they were less rushed and able to spend time with their relatives. Activities ranged from painting sessions, with the artwork displayed in the hallway, bingo, bean bag games. Connect 4, quizzes, skittles, films, TV shows, church services, watching the open (Golf) and Wimbledon on TV, memory card games, manicures and looking at old photographs for reminiscence work. Monthly motivational sessions and other outside entertainers are also used. Staff confirmed the extra time spent on 1:1s has really helped some. Staff said the people in the home often just like someone to sit and listen to them. They could not do this before, as they were too busy. One relative praised two care staff in particular who took her Dad to a family wedding in their own time. This also enabled him to attend to the reception. She said ‘Staff will go that extra bit further.’ One person had their own phone; others could be contacted via the homes phone. None of the bedrooms had television aerials so portable ones had to be used and some of the picture quality was poor. The provider is advised to consider fitting digital aerials, so in the future when the networks frequencies change, the people have full access to a clear television picture. Another comment from a relative was; ‘Mum always has plenty to drink and eat and always looks clean and smart. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 16 This is not like a home, more like visiting her in her own home. I know she is very happy here. The food is beautiful and sometimes I would like to eat here. I have often seen staff ask Mum and others what they want to eat or drink. A full choice is given at all mealtimes.’ The food is ordered ‘on line’ by the provider and the manager does not currently hold a food budget. The food is only delivered once a week and often staff have to buy extra food from the petty cash. The provider is advised to give the manager a food budget, as she is more aware of the everyday needs of the home. Some of the quality of the food seen in the fridge was not of a high quality and was fairly basic. Staff confirmed that fresh fruit and vegetables were ordered every Thursday with the main shopping, as was the bread and milk. The bread was then frozen. Some of the fruit seen on the day of the inspection looked past its best. The home has now employed a cook, as was required from the last inspection. Once the necessary employment checks have been carried out she will relieve the care staff from their kitchen duties. Mealtimes were seen to be relaxed and at a comfortable pace. Staff confirmed that if any one needed help with feeding this was always given in a sensitive manner. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected by a robust complaints system and residents and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures to ensure that people are protected from abuse. EVIDENCE: We wanted to ensure that all people concerned with the home were aware of the complaints procedure and felt confident their concerns would be listened to and acted upon. We also wanted to ensure all people were protected from any form of abuse. The home had a clear complaints policy, and a copy was on display in the hallway and details were in the statement of purpose. The AQAA and the manager confirmed there had been no complaints since the last inspection. Relatives spoken with also confirmed they knew how to complain but had not needed to. They felt the manager and staff would deal with any issues raised before needing to make a formal complaint. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 18 The home had policies on Adult Abuse and Whistle Blowing. The majority of the staff had now attended training on Adult Abuse and one member of staff spoken with was able to display a good knowledge of the subject. A one day First aid course had also been undertaken by the majority of staff. All current staff including the manager had an enhanced disclosure undertaken by the Criminal Records Bureau (CRB). Good recruitment procedures undertaken by the manager has ensured the safety of the people in the home. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well maintained home that is homely, clean comfortable, pleasant and hygienic. EVIDENCE: We wanted to ensure that people lived in a well maintained environment and had safe access to comfortable indoor and outdoor communal facilities. We also wanted to ensure that bedrooms were clean and comfortable and met good environmental standards. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 20 At the last inspection in February several requirements were made regarding the cleanliness of the home and some environmental issues. These requirements have now been met. Domestic staff have now been employed and the home is much cleaner. This has also releases care staff to concentrate on their care duties. The toilets and bathroom were much cleaner and fresher. New flooring had been laid in the kitchen, laundry room, downstairs toilets and some of the en-suites. New kickboards had been fitted to the kitchen units. A new cooker hood had been installed but the rest of the kitchen was looking tired, including the hob and oven. The hot water pipes noted at the last inspection had been boxed in and damaged radiator cabinet in the bathroom had been repaired. The manager confirmed all radiators now had covers fitted. One carpet in bedroom 6 that had been badly puckered had been cleaned and stretched. All rooms now had bedside lamps. Overall the environment had improved. There was a lift to the first floor but this was old and the manager confirmed that the engineers were saying that it was now obsolete and they could not guarantee being able to source new parts should it fail in the future. The provider must start planning a strategy to deal with this issue. Future financial planning should include the cost of replacing the lift. New ceiling lights in the lounge had improved the level of light available and the manager confirmed that new wall lights were on order. People in the home said the lounge was comfortable. Some of the armchairs were beginning to look tired and the manager was advised to consult with the homes fire safety adviser to ensure they meet with fire regulations to ensure they are fire retardant. There was a large patio to the rear of the home with some garden furniture and several flower pots. The large rear garden was laid to lawn. The front garden had several flower pots and hanging baskets. One person on the lower floor liked to sit in her room with the door wedged open. Unfortunately this was a fire door and should not be wedged open. The person had difficulty opening the door from inside, as she said it was too heavy. After consultation with the fire officer the provider must ensure an appropriate fire door closure is fitted to enable to door to remain open. A recent visit by the Occupational Therapist highlighted a problem with the hoist in the home. It is too wide to access some of the bedrooms. One of the people in the home confirmed that the previous day she had fallen upstairs and that staff had physically lifted her up from the floor. This is not good practise and the provider must provide the necessary equipment. A requirement will be made that the provider follows the recommendations of the Occupational The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 21 Therapist and purchases the correct hoist to meet the needs of the people in the home and the environment. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe an appropriate support as there are enough competent, qualified staff on duty at all times. They can have confidence in the staff at the home because checks have been done to make sure they are suitable. EVIDENCE: We wanted to ensure that sufficient staff were employed, who were suitably trained and had a good understanding of the needs of older people. We wanted to ensure they had been appropriately recruited to ensure the safety of the people in the home. At the last inspection on February 09 requirements were made regarding improving staffing levels and training. A new cook and domestic staff had been employed as a result and the rota confirmed the home now has three care staff during the day and two waking night staff. These requirements are now considered met. These extra hours The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 23 must now be maintained. Both families and staff confirmed the benefit these extra hours had on the home and the people who lived there. Also at the last inspection poor training was highlighted and requirements were made. The manager has worked hard to ensure staff training has been a priority and the majority of courses have now been either undertaken or booked. It is recognised that new staff are still undertaking their mandatory training. Induction training had also improved and the manager was following an induction course that met with regulation. With regards too infection control training, 7 staff had nearly completed an in depth ASET course and the remaining staff had completed a one day course. Dementia training has also improved with 6 staff completing an in depth ASET course. The manager was hoping that, in time, all staff would complete both courses. Two new staff files were viewed and all the information required by regulation was in place. The manager’s personnel file was also viewed, as an immediate requirement was made at the last inspection. This requirement has now been met. Staff personnel files were now stored in a secure cabinet as required form the last inspection. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 24 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 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider is not managing the home in a proper manner and this has the potential to impact on the quality of the service. EVIDENCE: We wanted to look at the skills of the management team and if the service benefited from the ethos, leadership and management of the home. We also wanted to see if the home was run in the best interests of the people who lived there. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 25 We also needed to ensure their health and safety was protected and promoted. The registered provider continues not to be involved in the day to day running of the home, but continues to manage the budget. He relies heavily on the manager, who has made good progress in running the home effectively and in the best interests of the people who live there. The provider rarely visits the home and seriously needs to consider his position as registered provider. The manager is currently in the process of registering with Commission. All staff spoken with confirmed she was supportive and approachable and they felt lots of improvements had been made since her appointment. Relatives also confirmed she was honest and open with them and always kept in touch regarding health matters and care issues. A Statutory Requirement Notice had been issued following the last inspection regarding non compliance with completing formal quality assurance strategies to ensure that stakeholder’s views were sought and taken into account and that all aspects of care of the people in the home are regularly audited. This had now been met and the manager is in the process of assessing the returned questionnaires and is intending to compile a report and take any necessary action that has been identified. She did comments that mostly all the returned questionnaires gave positive feedback. Relatives confirmed they had recently completed questionnaires on the home. Evidence was also seen that regular residents meeting are held and that actions are taken following these meetings. The manager also confirmed that supervision with staff was now happening on a regular basis. Staff and records confirmed this is in place. The home has robust procedures in place for dealing with the client’s monies. Receipts were kept and all transactions were documented and double signed by staff. The manager said she completed a weekly audit of the accounts. The manager was also on the process of updating the homes policies and procedures and had identified several that need to be updated. Work had begun on updating the necessary policies. Records seen on the day and information given in the AQAA confirmed that mandatory health and safety checks are now being undertaken. A new fire risk assessment had been completed in May 2009 and the fire equipment was regularly tested. The only issue raised was the lack of fire drills for staff and a requirement will be made to ensure all staff are fully aware of the correct procedure in the case of an emergency. The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 3 3 3 2 The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP22 Regulation 23 Requirement The registered person must provide equipment that meets the needs of the service users and obtain the correct moving and handling equipment as advised by the Occupational Therapist following her recent assessment. The provider must have a strategy in place to ensure the residents remain safe should the lift breakdown and be declared obsolete. The registered person must also include replacing the lift in the financial planning for the home. After consultation with the fire authority the registered person must ensure suitable door closures are fitted to room All staff must undertaken regular fire drills and records must be maintained. Timescale for action 31/08/09 2 OP22 23 31/08/09 3 OP38 23 31/08/09 4 OP38 Schedule 4 (14) 31/08/09 The Grange DS0000029055.V376305.R01.S.doc Version 5.2 Page 28 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 DS0000029055.V376305.R01.S.doc Version 5.2 Page 29 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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