Inspection on 20/03/07 for The Grange

This inspection was carried out on 20th March 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 18/01/06

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 Claire Hutton Unannounced Inspection 20th March 2007 10:25 The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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.V332476.R01.S.doc Version 5.2 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.V332476.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address 30 Vinery Road Bury St Edmunds Suffolk IP33 2JT 01284 769887 01284 701057 karenkrabbenham@btconnect.com 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), Learning disability over registration, with number 65 years of age (9) of places The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 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 current fee for this home range from £412 to £681 per week. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that focused upon the core standards relating to Adults (18 – 65). It took place on a weekday lasting five and a half hours. The process included a tour of the building and grounds, discussions with residents and staff, observations of staff and service user interaction, and the examination of a number of documents including residents care plans, medication records, the staff rota, recruitment, training records and records relating to health and safety. The report has been written using accumulated evidence gathered before and during the inspection. Throughout the afternoon the inspector met most of the residents, most of whom were able to express themselves and talk about what it was like to live at The Grange. The registered manager was present throughout the whole inspection and was very helpful and hospitable. What the service does well: What has improved since the last inspection? What they could do better: The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 6 The main objective of The Grange is to continue with the good quality of care they currently provide. However there are two areas that need to be developed over the coming months. These include a thorough review of risk assessments to determine not only are they up to date, but if they still apply. Secondly, the manger should focus on developing systems of demonstrating how management at the home monitors quality. 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 summary of this inspection report can be made available in other formats on request. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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.V332476.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is good. Residents and their representatives can expect to be have access to updated information about the home, have needs assessed and monitored and a contract in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is able to supply up to date information about The Grange and what it has to offer. A copy of a recent update was submitted to the commission. The resident group at The Grange is stable and people have been there a number of years. Evidence in residents files showed that a community care assessment is in place for residents with annual reviews by social services that shows the placement is monitored and remains appropriate for those residents currently at the home. Contracts were seen to be in place and are developed with the local authority. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. Residents, and their representatives can be confident that the plans of care maintained at the home reflect and address the individual and changing needs and aspirations of the person concerned. Individual support and choices are positively promoted by staff. Residents are supported to take risks within a risk assessment framework, but these may not be up to date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents were tracked as part of this inspection. All their information was examined and they were spoken with during the visit. Both residents appeared happy and said they were happy to live at The Grange. Care plans are in place and these are reviewed and up dated. The care plans contain both short term and long terms goals for each resident. The daily statements in place record support given and by whom and what activities the individual participated in each day. The main source of information for staff comes from ‘Guidelines to The Grange routine’. This is a document that sets out the structure for each shift that ensures each resident preference and needs are met. It ensures that residents The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 10 get to their chosen activity on the correct transport with the correct money and their chosen packed lunch. This is a valuable tool for staff. There are risk assessments in place for residents that allow more independence and choice. There was no evidence of recent review and upon discussion with the manager these may be out of date and need revision. Residents hold what they call a ‘House Council Meeting’ once a month. These are held without staff and the residents keep a record of what was spoken about. Topics include activities and outings. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Residents, and their representatives can be confident that the home enables residents to maintain appropriate lifestyle with individual opportunities and support. Residents can expect to be offered healthy meals. Decisions around personal and family relationships are respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The daily routines for the residents are very individual and quite complicated, but are based upon accessing a variety of day services in and around Bury St Edmunds. The evenings are equally interesting for residents as a series of clubs and groups can be accessed if an individual requests. The manager explained that certain residents only like to go to specific clubs and this wish is respected. On the day of the inspection day service was not taking place as it was closed for staff training. Therefore the home had offered a trip to the zoo that all residents had opted for. However this had to be cancelled at short notice due to snowfall. However there were several activities on offer instead, with residents going out, having foot spas, beauty treatments, crafts, knitting, jigsaws and some just doing their own thing in the privacy of their own room. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 12 The interaction between staff and residents was seen as warm and supportive, with residents smiling and enjoying the company of staff as well as other residents. One resident showed their photo album. There was several for the individual residents in the lounge. This was a record of celebrations, visits and events in the individuals’ life. It contained photos of relatives and friends that have changed over time. Residents are supported by staff and manager to maintain relationships with relatives both local and at a distance, through visits and post. Lunchtime was when all the residents sat together and ate their chosen sandwiches followed by fruit and yogurt. The evening meal was in a slow cooker in the main kitchen. One resident said they liked the food at the home. Residents had their own kitchen area where they could make their own breakfast, snacks and a drink at any time. There is a changing menu that is based upon English home cooking and shows a varied wholesome diet. Examples include roast turkey dinner, live and bacon casserole, meat loaf, salads and each meal has a dessert. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Residents, and their representatives can be confident that the home offers appropriate personal and health care support. Trained staff appropriately administer medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans examined showed staff quite clearly how residents preferred and needed to be support in respect to personal care. The care plans were written with a view to respect, dignity and privacy for individuals. Residents are registered with a GP and specialist services are accessed such as psychiatrists in learning disability as well as opticians and chiropodists etc. in relation to those individuals tracked their health needs in specific specialist areas were accessed and records kept by the home to inform staff and the way they cared and supported the individuals. The medication systems in operation at the home were examined. All medication is kept secure. All staff who administer medication were trained in November 2006. All records were available to examine and where able to be audited to show that medication prescribed is administered correctly. Policies and procedures on medication are available to staff. The current practice of two staff signing for each medication administered does not match the homes The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 14 policy that states one person. Therefore it was recommended that both policy and practice become the same. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. Residents, and their representatives can be confident that the home has appropriate procedures in place to deal with complaints, protect residents from abuse and neglect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Neither the Commission nor the home has received any complaints in the last year. The home has a complaints procedure and log in place. This forms part of the Service Users Guide. In relation to protection of residents both the manager and staff have received appropriate training. In the office was a copy of the joint local procedure agreed with Suffolk Social Services and Police. Staff recruitment files showed that the home take up an enhanced CRB (criminal records bureau) check on staff and a POVA (protection of vulnerable adults) check before staff start work at the home. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection a tour of the home was undertaken. The home is clean and hygienic, the toilets and bathrooms looked at had all been recently cleaned. 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 kitchen areas was bright and designed so that it is part of the main dining area. The lounge area has comfortable chairs and had a big TV and organ and many activities for the residents to choose from. The home also has another area separate from the other communal areas; here the residents can see their visitors in private. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 17 The home has been redecorated and all the windows have been replaced. The outside area is nicely set out, there is a garden for the use of the residents and has a small fishpond. The gardens looked wonderful and last year the home won several gold awards from Bury in Bloom. They are once again preparing for this event in which several of the residents will participate. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. Residents, and their representatives can be confident that the home employs suitable numbers of staff that are well recruited and adequately trained to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four weeks of the staffing rosters for the home were examined. The staffing levels for the home are two staff on duty during the day and at night one person sleeping in. The staff group is a group of long serving staff. On of whom said that they are very happy working at the home. The home does not use any agency or relief staff and offers consistency of care from within the staff group. The home employs a total of 7 care staff. All but one staff member have an NVQ. There was evidence of training in basic food hygiene training, first aid training, fire training, infection control, health and safety and manual handling. There was evidence of regular formal supervision of staff and appraisals. Recruitment records for one staff member were examined and this showed all the required checks were in place and that a through recruitment process was The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 19 followed. Residents are involved in staff recruitment and have a say in the probationary period. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. Residents, and their representatives can be confident that the home is appropriately managed but evidencing the monitoring of quality should be developed further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is suitably qualified. She has several years relevant experience in working with people who have a learning disability. She is friendly and approachable and observations of her with residents showed that she had a good understanding of individual residents and that they liked her. Staff spoken with spoke highly of the manager. 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 Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 21 In relation to self-monitoring and demonstrating that the home is underpinned by the views of the residents the home has few systems in place and this is an area the manager agreed to develop. There are currently good practices within the home that could be built upon such as the keyworker system, medication audits and resident and staff meetings. Since the last visit to the home the local Environmental Health Officer had visited and found that all systems were satisfactory. The home uses a monitoring system called Safer Food better Business. The pre-inspection questionnaire confirmed that all necessary servicing and health and safety checks are up to date. The manager confirmed that the new windows installed to the first floor were restricted and did not allow any potential for residents to fall out. All radiators were risk assessed and covered. There is a fire risk assessment in place. The hot water in one bath was slightly high at 47.7°c. This was immediately seen to and brought down to close to 43°c. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 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 3 2 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA9 Regulation 12 (1)(a) 15 (2)(a) Requirement The risk assessments in care plans have not recently been reviewed and these are believed to be out of date, therefore the registered persons must ensure these are reviewed and updated. The registered persons must establish and maintain a system for evaluating the quality of service based upon seeking the views of the residents and their representatives. Timescale for action 30/04/07 2. YA39 24 (1) 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations The current practice of two staff signing for each medication administered does not match the homes policy, which states one person. Therefore it was recommended that both policy and practice become the same. The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange DS0000024399.V332476.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!