CARE HOMES FOR OLDER PEOPLE
The Grange 162 Sutton Park Road Kidderminster Worcestershire DY11 6LF Lead Inspector
Yvonne South Unannounced 22 April 2005 14:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Grange Address 162 Sutton Park Road Kidderminster Worcestershire DY11 6LF 01562 756820 01562 756822 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Worcestershire County Council Mrs Lynn Watson Care Home 35 Category(ies) of DE(E) Dementia (over 65) - 17 registration, with number OP Old Age - 35 of places PD(E) Physical Disability (over 65) - 35 The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The home may provide intermediate care for a maximum of 18 service users whose needs are in categories OP and PD/E. The home may also provide this intermediate care to users over the age of 60 who have a physical disability. The home may accommodate one person with physical disabilities under the age of 60 years for intermediate care. Date of last inspection 20 January 2005 Brief Description of the Service: This home is owned and operated by Worcestershire County Council. Mrs Lynn Watson is the registered manager and is supported by Mrs Pamela Vivian the deputy manager The Grange is a purpose built home on two floors. All thirty-four bedrooms are for single occupancy but couples can be accommodated in some of the largest rooms if desired, providing the total number of service users in the home does not exceed 35. Only two rooms have en-suite facilities. There are a variety of communal lounges and dining areas, and kitchen facilities for service users to make their own drinks and snacks should they choose to do so. There is a shaft lift between the floors. The building has an accessible garden with level paths. The premises are situated in a residential area on the edge of Kidderminster, a short distance from local shops and facilities. The Grange offers an intermediate service to people of either sex over the age of sixty-five, who need assessment of their abilities and needs, respite care or rehabilitation. The provision of permanent care is being phased out. A day care service is also provided by the home but this service is not covered by this inspection.
The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over four hours and was the first inspection to be undertaken in the year 1st April 2005 to 31st March 2006. A partial tour of the premises took place. Five service users and two relatives were spoken to and five staff assisted the inspector. Records were examined for two service users and the fire log was checked. What the service does well: What has improved since the last inspection?
Since the last inspection the maintenance plan had been almost completed as the manager and staff had hoped. New furniture and furnishings had been obtained in some rooms. Plans for building improvements had been agreed and there was an air of excitement in the home as work was due to start. The work had been carefully planned to cause as little disruption as possible to the service users and their care. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 6 Changes were being considered to the duty rota worked by senior staff. It was planned that it would provide more flexibility and senior staff would be more readily available to undertake assessments of people’s needs and staff training. The home was recruiting more staff to achieve this. Places had been obtained for two staff to undertake training to enable them to assess other care staff that were doing their NVQ training. This will enable more staff to become qualified. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Some service users were moving into the home for respite care without recent comprehensive pre admission assessments being carried out. There was therefore a risk that the home would be unable to meet the needs of people who had not been assessed shortly before admission and an initial care plan could be irrelevant. The facilities and environment were suitable to meet the needs of the people receiving the service. EVIDENCE: Two people were receiving intermediate care for rehabilitation and three people were receiving intermediate care for a respite stay. Only one person could recall being visited prior to admission. Prior to admission social care assessors under took assessments on behalf of the home of people referred for rehabilitation and assessment stays. Frequently the home relied on the Community Care Assessment undertaken by social workers when referrals were made for respite care.
The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 9 The documents that were examined revealed that some such assessments had been carried out some time prior to admission and it was unclear if answers to all questions had been sought, as the answer printed was ‘not known’. Although the document could be down loaded by the home from the computer it was of little or no value if out of date. The home should not accept any referrals until they had received and checked that the information in the Community Care Assessment was complete, up to date, needs had not changed and they could be met in the home. There were plans for a member of the senior staff to undertake pre admission assessments for respite care on behalf of the home. These would then be up to date, informative and complete. The environment was well equipped and staffed and supported by relevant specialist staff. Service users and their relatives were complimentary regarding the facilities available and the standard of care that was being provided. Those people receiving rehabilitation care spoke well of the progress they had made. Further improvements to the home were planned to commence in the near future when lounges and dining areas would be extended, new office and meeting room facilities provided, a new training kitchen installed and the gardens landscaped. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-10 There were care plans that provided staff with information that enabled them to meet the needs of the people staying in the home. The health needs of service users were well met by care staff with good multi disciplinary support. Medication was well managed. Pressure care, moving and handling and nutritional assessments were not routinely carried out so information was not always available on which to base a relevant care plan. Service users were treated with respect and their privacy was upheld. EVIDENCE: Although service users did not understand the term ‘service user plans’ they considered that they had been involved in discussions relating to their care. One service user said that ‘they tell you everything’.
The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 11 One of the plans that was inspected had not been signed by the service user. Generally the plans were brief but informative and supported by specialist plans provided by the physiotherapists and occupational therapists. The registered manager said that if concerns arose regarding nutrition and pressure care the dietician and district nurses were consulted. However nutritional and pressure care assessments were only undertaken in detail if concerns were identified. There was no indication how this decision was made. Health care matters were being addressed. Service users confirmed that they had received visits from the GPs and District Nurses when necessary. Documentation was well maintained. The service users’ at that time said that their medication was managed and administered by the staff. One person had self-medicated until she had a setback in her health. Storage and documentation was acceptable. When medication was checked into the home it was done by two members of staff and Medication Administration Sheets were hand written but only one person signed the documents. Staff had received acceptable training. The people in the home confirmed that privacy and dignity was respected. The service users said that they were assisted tactfully and sensitively. Each bedroom had a safe as well as a lockable locker drawer. Keys were available although the lock in one room was said to be broken. Bedroom door keys were offered to people when they arrived in the home and the master key for emergency access was readily available. The locks did not meet the current criteria agreed with the Fire Authorities but as they met the criteria that had been in force when they were installed there is no requirement that they be changed unless broken or unsuitable for the needs of the service user. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 An acceptable range of social activities and interests were provided. Visitors were welcomed and the autonomy of service users was supported. A choice of wholesome and pleasing meals was provided. EVIDENCE: One person considered time in the home to ‘fly past’. Others mentioned that they enjoyed the company and conversation, watching television, crochet, bingo, cards and the garden. An activities organiser visited three times a week, which was popular. Visitors were always welcome and were received either privately in the person’s bedroom or in the communal lounges. A copy of the Service Users’ Guide was available in bedrooms, which contained information for people relating to visiting. Service users managed their own finances with family support where necessary. They confirmed that they were involved in decisions and made choices regarding their care. People confirmed that they were offered a pleasing choice of menu and the meals were good and plentiful.
The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 13 On admission a record was made of special needs, likes, dislikes and allergies. This was taken to the main kitchen. A kitchen was available and service users were able to work to regain their skills. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Service users were able to raise any concerns that they had. Policies and procedures to protect people were implemented. EVIDENCE: The Service Users’ Guide contained a copy of the complaints procedure. Staff confirmed that it was brought to the notice of the service user when they moved into the home. Service users said that they would either complain through their relative or directly to a member of the staff. However everyone said very clearly that they had no complaints. Only praise for the kindness and attention they received. Acceptable policies and procedures were in force to protect service users from abuse. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Fire safety was the only aspect of health and safety inspected during this inspection. Routine fire safety checks and fire safety training contributed to maintaining a safe environment. EVIDENCE: The fire log demonstrated that appropriate fire safety checks were being undertaken. Fire safety training was being undertaken. A health and safety assessment and plan will be in place before the building work is commenced. The fire risk assessment will also be kept under review. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 19 No 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 3 Regulation 14 Requirement All prospective service users must have a full and up to date assessment of their needs prior to any admission to the home. This should include a nuitritional, pressure care and moving and handling assessment. Timescale for action 31st May 2005 2. 3. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 9 Good Practice Recommendations Both members of staff who check in and record medication on the Medication Records Sheet should sign the document. The Grange E52 S37473 The Grange V220228 220405.doc Version 1.30 Page 20 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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