Inspection on 23/10/06 for The Grange

This inspection was carried out on 23rd October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 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 18/03/06

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 Heidi Banks Key Unannounced Inspection 23rd October 2006 16:45 DS0000004086.V317711.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 DS0000004086.V317711.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. DS0000004086.V317711.R01.S.doc Version 5.2 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 DS0000004086.V317711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of seven service users in need of personal care in the category of PD(E). 18th March 2006 Date of last inspection 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 on the first floor, with a further four units on the ground floor each accommodating five residents. Each unit has a kitchen/dining room and two bathrooms, and service users have their own bedroom. A communal area in the centre of the building 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 to provide transport to service users. The Grange is situated in a residential area of Parkstone, close to local shops and amenities. A bus route is located nearby. According to information provided by the Registered Manager in the preinspection questionnaire on 9th October 2006, the current fees for residents at The Grange range from £572.57 to £784.50 per week based on assessment of individual needs. This fee excludes certain items such as hairdressing, chiropody, personal toiletries, activities, magazines, newspapers, holidays and transport. Service users also make a contribution of £5 towards a television licence. DS0000004086.V317711.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 which took place over approximately eleven hours on three weekdays; 23rd and 24th October and 9th November 2006. The purpose of the inspection was to assess the home’s progress in meeting the key National Minimum Standards and assess the provider’s progress in meeting the four requirements made at the last inspection of the service. The focus of the inspection was on how the home achieves positive outcomes for its service users. There are twenty permanent residents living at The Grange at the present time. The current age range of service users is between 26 and 87. During the course of the inspection the inspector was able to meet and talk with four residents, the relatives of one service user who were visiting the home, the home’s Care Supervisor and five other members of staff. The Registered Manager of the home was on annual leave on the first two days of the inspection but the inspector was able to meet with him on the final day of the inspection to discuss the findings of the inspection process. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. The inspector was also able to take a tour of the care home. Sixteen completed service user surveys were received in addition to two comment cards from relatives, one comment card and a telephone call from social care professionals and one comment card from a general medical practitioner who has contact with the home. A pre-inspection questionnaire completed by the Registered Manager was also supplied. Information obtained from these sources is reflected throughout the report. Twenty-two standards were assessed during this inspection. What the service does well: The inspection highlighted a number of positive practices within the home which promote service users’ independence and give them some control over aspects of their support. This includes service users having ownership of their support plans and clear evidence of their involvement in the planning and review process. Risk assessments are in place to promote service users’ independence in their home environment and community. Service users have opportunities to attend day services and participate in courses at local colleges as appropriate to meet their needs for personal development. There was also ample evidence of the service promoting service users’ contact with their families and friends so that they have circles of support outside their home. Service users are supported to take responsibility DS0000004086.V317711.R01.S.doc Version 5.2 Page 6 for their lives and aspects of their home and there was evidence to indicate that their rights to lead ordinary lives are respected by staff with flexible mealtimes and the freedom to access all communal areas of their home. The physical and emotional health care needs of service users are met through liaison between the home and outside health professionals. All service users spoken with spoke highly of the skills and competence of the staff who support them and it was clear that service users value their relationships with their key workers. This means that care workers are working in partnership with service users to ensure their needs are met. Procedures to ensure the safe administration of medicines in the home are in place and service users are supported to take some responsibility for this to promote their independence in this area. There are clear procedures in place to protect service users from abuse and ensure that staff working with them are checked during the recruitment process and are fit to work with vulnerable adults. Induction and ongoing training for staff is in place and care workers spoken with commented positively on this, reporting that they feel prepared for the work they do with service users. Service users also reported that staff know what they are doing and they feel confident when being supported by them. A quality assurance process is in place by which the home obtains feedback from service users and staff about the service although it is suggested that the report of findings includes objectives to develop the home based on the views of service users. What has improved since the last inspection? Four requirements were made following the last inspection of the service in March 2006. Progress has been made in relation to three of these requirements. On a tour of the premises there was no evidence of hazardous substances not being stored appropriately. The Care Supervisor reported that, following the last inspection of the service, staff were reminded of the need to ensure that chemical substances are stored securely to ensure the safety of service users and comply with legislation. The safe storage of substances is an area that is audited on a regular basis as part of the home’s quarterly health and safety checks. At the last inspection of the service it was noted that the laundry area of the home contained free-standing fans with trailing leads. There was evidence within health and safety documentation that this has been followed up by the organisation’s Regional Health and Safety Advisor. Ventilation of the laundry room has been reviewed with a skylight and wall-fans installed to avoid risks posed by trailing wires. DS0000004086.V317711.R01.S.doc Version 5.2 Page 7 Discussion with the Care Supervisor indicated that, since the last inspection, staff had been reminded of the need to ensure that call bells are always accessible to service users. This is emphasised during the home’s induction programme for new staff when delivering personal care is covered. There was no evidence at this inspection to indicate that service users were being left without access to their call bells. What they could do better: As a result of this inspection, six requirements and four recommendations have been made. A warning letter has also been sent to the registered provider in response to the home’s persistent breach of Regulation 18 regarding inadequate staffing levels at times in the home and the impact this has on achieving positive outcomes for service users. At the last inspection of the service in March 2006, concerns were expressed by service users about staffing levels in the home which resulted in an immediate requirement notice being issued. This was noted to impact on many areas of care provision including the delivery of personal support and access to social and community activities. This was reviewed at this inspection. Feedback from service users and their relatives through discussion, surveys and comment cards indicated that the situation had not improved. Service users reported that they cannot always do the activity of their choice on the day they wish due to staffing levels. Support with service users’ personal care is also affected by lack of staff on occasion. This means delays in staff responding to service users’ call bells and requests for personal support. Lack of quality one-to-one time with staff was highlighted by service users as a problem. According to service users, lack of staff meant that care workers were often too busy to stop and talk to them and personal care could be rushed as a result. It was clear from discussion with service users that they enjoyed their relationships with staff and wanted more opportunities to talk with them and engage in 1:1 activities. Although documentation examined during the inspection indicated that there is some recording of food eaten by service users, the home must ensure that these are kept in more detail so that individuals’ intake and choices can be clearly evidenced. The security of the home must also be reviewed as there are potential risks associated with current arrangements for entering the building which means that service users’ safety could be compromised by the presence of strangers in their home. Progress made in relation to an immediate requirement issued at the last inspection was seen to be limited with no real positive change for service users. The registered provider must ensure that they take appropriate action to meet the regulations and achieve improved outcomes for service users. DS0000004086.V317711.R01.S.doc Version 5.2 Page 8 Steps should be taken to improve communication between service users and management to ensure that service users always feel listened to by staff and have confidence that management will act on their views. Service users and their representatives / relatives should be provided with a copy of the home’s complaints procedure so that they are aware of the process by which they can raise concerns. The provider should also consider ways in which concerns raised by service users can be documented, with their outcomes, to evidence how the service responds to these issues and ensures that service users have a satisfactory outcome. Ten out of sixteen service users responding to the survey indicated that the home was not always clean. Therefore it is recommended that the home reviews its arrangements for maintaining cleanliness and good hygiene to ensure that risks of infection are minimised for service users. 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. DS0000004086.V317711.R01.S.doc Version 5.2 Page 9 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 DS0000004086.V317711.R01.S.doc Version 5.2 Page 10 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): 2 This standard was not assessed on this occasion as there have been no new admissions to the home since the last inspection of the service. EVIDENCE: According to the information supplied with the pre-inspection questionnaire, there have been no admissions to the home since the last inspection of the service in March 2006. Therefore this standard has not been assessed at this inspection. The last inspection of the service indicated that a pre-admission assessment process is in place for service users to ensure their needs can be met by the home although at this time there were some shortfalls in relation to completion of the paperwork. DS0000004086.V317711.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have ownership of their individual plans which contain a good amount of information about their needs and preferences. Although service users are involved in making choices about their daily lives the actual delivery of person-centred care may be hindered by staff availability and this needs to be addressed for this outcome area to be rated as ‘good’. Service users’ independence is promoted and risks to their well-being minimised through the completion of risk assessments. EVIDENCE: Individual support plans are kept by service users themselves in their own bedrooms. Two individual plans were seen. Both plans showed evidence of having been reviewed by the service users and their key workers on a regular basis to ensure that information remains up-to-date and relevant. Service users spoken with stated that they had been involved in writing their plan and DS0000004086.V317711.R01.S.doc Version 5.2 Page 12 this was evidenced by their signature on parts of the plan to indicate their agreement with its content. Information within the plan was seen to be sufficiently detailed to offer staff guidance on the service users’ personal care requirements and preferences. Discussion with service users indicated that they are involved in making decisions about their support and their daily lives. This includes management of their medication where appropriate, their finances, activity planning and flexibility in their daily routines, for example, arrangement and timings of meals. Out of sixteen service user surveys received, eleven service users indicated that they ‘always’ made decisions about what they did each day with five indicating that they ‘usually’ or ‘sometimes’ made decisions. Comments made in surveys indicated that while service users are involved in making choices and decisions about their lives, whether their choices were carried out often depended on staffing levels; ‘ providing we have enough staff I can do whatever I want to do’; ‘it depends on staffing levels. We need more staff and a Team Leader on every shift’. All service users spoken with indicated that they would appreciate more individual time with staff to discuss their needs and personal goals. This issue is explored in more detail in relation to Standard 33 but there is concern that service users’ ability to make choices and know that they will be followed through is limited by there being insufficient numbers of staff on duty at any one time to meet service users’ needs and preferences. There was evidence in individual plans that risk assessments had been carried out in relation to aspects of care including, for example, moving and handling needs. Service users spoken with felt that they are enabled by staff to be as independent as possible in their home and community and a number of service users now have bus passes so that they can access their local area independently. DS0000004086.V317711.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home clearly strives to promote service users’ ability to make choices, promote their independence and offer opportunities for personal development in many aspects of their lives. However, at times, inadequate staffing levels mean that service users’ needs and preferences in relation to their activities are not always fully met. Service users’ contact with their family is encouraged and there is evidence that the service is working hard to ensure that service users receive support that is individualised around meal-times and that offers them flexibility with regards to their daily routines. EVIDENCE: Information supplied by the Registered Manager with the pre-inspection questionnaire indicated that service users take part in a range of activities in their local community. This includes attendance at various day services, local DS0000004086.V317711.R01.S.doc Version 5.2 Page 14 colleges, football, the local PHAB Club, social clubs, Bible Classes and Church according to personal preferences. One service user was reported to enjoy organising ‘jewellery parties’ in the home and an advertisement on the home’s notice board indicated that a party was due to take place in early December to which other residents and their visitors were invited. At the time of the inspection, some service users were volunteering for a ‘Make a Difference Day’ undertaking a survey in their local community on the accessibility of bank cash machines for people with disabilities. One service user spoken with stated that he had been supported to obtain a bus pass and was now a regular user of public transport in the area. He reported that he was now encouraging his peers to obtain bus passes to promote their independence. The home has several adapted vehicles to enable service users to access their community although service users spoken with stated that there was not always enough staff to facilitate this. The home has recruited a team of unpaid volunteers who work between 1 and 8 hours per week. Their duties include driving, supporting service users with college courses, befriending, gardening and supporting service users with arts and crafts and other activities. Their role is supplementary to that of paid staff in the home and their focus is intended to be service user led. Service users reported that they have an activity afternoon scheduled each week which is meant to take place with their key worker. The aim of activity afternoons is to provide opportunities for all service users to have some oneto-one time with a member of staff to do an activity of their choice, whether shopping or to pursue a sport or leisure interest in their community. Service users spoken with indicated that these do not always happen as scheduled due to staff sickness / absence. Discussion with service users indicated that activity days were extremely important to them and from conversation it was clear that it was important to them that these happened as scheduled. A member of staff spoken with stated that on occasion activity days have to be changed to an alternative time or a change of staff member is required but they are rarely cancelled. Discussion with service users did not reflect this, however, and they expressed feeling frustrated when the schedule needed to be changed. Comments received in several service user questionnaires indicated that service users want more activities, particularly in the evenings and at weekends, and ‘more volunteers to do more trips’; ‘We can’t always go out at weekends due to staffing levels’; ‘I can usually do what I want as long as staff are available’; ‘It depends on staffing levels and transport, if there are drivers on shift and the care levels of service users’. Service users spoken with reported that if they wanted to do something special they could usually arrange it in advance with their key worker and plan a suitable time. However, discussion indicated that there was little opportunity for spontaneous trips out due to staffing levels; ‘if we had more staff I would go out more at weekends and in the evenings, perhaps to the pub or to get DS0000004086.V317711.R01.S.doc Version 5.2 Page 15 some Christmas presents for my family’. Since the inspection, the Registered Manager has confirmed that all service users had been given support to do their Christmas shopping as required. A member of care staff spoken with stated that they do their best to ensure activities happen but acknowledged that if staff are off sick or on leave then service users do not always get to do what they want. Service users spoken with talked of having regular contact with their family both with their relatives visiting them in the home and their own trips to their family’s home. At the time of the inspection, a service user’s relatives were visiting and it was noted that they had been encouraged to join her while she was eating her evening meal. Observation of the meal-time showed that the atmosphere in the dining area was relaxed and good-humoured with service users, the visitors and staff interacting well. Conversation with the service user’s relatives demonstrated that they were happy with the support offered by staff; ‘It’s fantastic…like an extended family’. They reported that staff liaise well with them about their relative’s welfare and they always felt welcomed in the home; ‘The staff are excellent, especially X’s key worker’. One service user at the home had been supported to do an exchange visit earlier in the year to a Leonard Cheshire home that was near to where her sister lived to promote her contact with her family which had proved successful. Service users spoke of their friendships outside of the home and cited examples of how staff had supported them in maintaining their personal relationships. The responses of two relatives via comment cards both indicated that they are able to visit their relative in private. One service user spoken with stated that he felt service users ‘are as involved as they want to be in the running of the home’. It was clear from discussion with service users that they value the care staff very highly and felt their rights were respected by staff in terms of their independence and privacy, ‘they always knock at my door’. Meal-times are flexible to ensure service users can eat when they wish and all service users have freedom to access all parts of the building and come and go as they please. One service user talked of how he had been provided with a remote control device to operate the home’s external doors so that he can go out as he chooses and had been given some responsibility for maintaining the home’s vehicles as this is an area which is of interest to him. Care assistants in the home take responsibility for preparation of meals although a service user spoken with during the inspection stated that he could be involved in food preparation if he wanted. Service users spoken with stated that the food offered to them was generally good although one stated that she would prefer to eat more healthily. Further discussion indicated that she was being supported by her key worker to achieve this by being involved in making shopping lists each week to ensure that the items she prefers are purchased. Each apartment in the home has its own kitchen including refrigerator and DS0000004086.V317711.R01.S.doc Version 5.2 Page 16 freezer facilities. Service users reported that they are able to make choices about what they want to eat and observation showed that meal-times take place when each individual prefers so that service users do not have to eat together if they do not wish to. Inspection of the fridge, freezer and store cupboards in one apartment showed a good range of branded items available to service users. A record of meals eaten is maintained in a diary in each flat. Records were seen to vary in detail and therefore this should be reviewed to ensure that they meet the regulations. DS0000004086.V317711.R01.S.doc Version 5.2 Page 17 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 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The delivery of person-centred support to service users on a daily basis may, at times, be hampered by inadequate staffing levels. However, a competent staff team and access to generic and specialist health care services ensures that service users physical and emotional health care needs are generally met. Procedures are in place to ensure service users are safe with regards to medication practices within the home and that their independence is promoted. EVIDENCE: Service users’ individual service plans were seen to contain a good level of detail about service users’ personal care requirements. Personal preferences had also been included in the plan to ensure that staff have the necessary information with which to meet service users’ needs in a way that they prefer. Half of the sixteen respondents to the service user survey indicated that staff ‘always’ treat them well with the remaining half indicating that staff ‘usually’ or ‘sometimes’ treat them well. Comments from service users received via surveys and through interviews indicated that while they speak highly of the DS0000004086.V317711.R01.S.doc Version 5.2 Page 18 competence of the majority of staff who work with them, staff do not always have ample time to deliver their support ‘There is a lack of staff which is amounting to rushed care’; ‘There is not enough support for residents’; ‘There are many different personalities in the staff team. One knows who you can ask things of and who (and when) you cannot’. Two of the three service users spoken with stated that at times they have had to wait for their personal care due to staff being ‘rushed off their feet’. One service user expressed that this causes her distress. One service user spoken with stated that she feels the time she wants to go to bed ‘has to fit around the personal care needs of other service users’ as clearly this is a peak time in the evening routine and two members of staff are required to use the hoist to support her. As a result she has to wait for two care workers to be available. Individual support plans and discussion with service users indicated that service users access generic and specialist health care services as required to ensure their physical and emotional health care needs are met. A comment card received from a general medical practitioner who has contact with service users at the home indicated that the home communicates clearly with them and that staff demonstrate a clear understanding of the care needs of service users. A comment card from a social care professional also indicated satisfaction with the overall care provided by the home and commented that the home ‘usually’ notifies them of significant events affecting service users’ well-being. Service users’ medication is stored securely in their own bedrooms. All service users spoken with stated that they felt that this system met their needs. Service users are supported to self-medicate where appropriate and there was evidence to show that this is risk assessed on an individual basis. A sample of medication administration records were inspected against medication given and were found to be correct suggesting that medication has been administered as prescribed. The Grange has a medication policy and information in the pre-inspection questionnaire indicates that this was last reviewed in 2005. All staff who are involved in supporting service users with administration of their medication were reported to undertake training to promote their competence. DS0000004086.V317711.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that formal complaints are fully investigated but improvements to communication between management and service users are needed to ensure that service users feel that their views are listened to and acted on. Then home should also take steps to publicise their complaints procedure to service users and their relatives so that they know how to make a complaint if they wish. Policies, procedures and training are in place to protect service users from abuse and ensure that they are safe with the people who work with them. EVIDENCE: The Grange has a procedure on dealing with complaints which according to the pre-inspection questionnaire was last reviewed in 2005. There is also a procedure on whistle blowing and staff files examined showed evidence that they had received a copy of this procedure at their induction. All except one service user responding to the survey indicated that they knew who to speak to if they were not happy with one service user commenting ‘I would go to my Team Leader. If I didn’t get anywhere it would be the managers’. Thirteen out of sixteen service users indicated in their survey that they know how to make a complaint. Half of the sixteen service users responding to the service user questionnaire indicated that their care workers always listened to them and acted on what they say with the remaining half indicating that this was DS0000004086.V317711.R01.S.doc Version 5.2 Page 20 ‘usually’ or ‘sometimes’ the case. Leonard Cheshire has a Service Users’ National Association and the home has appointed Residents’ Representatives who can bring issues to the management meetings and ensure service users’ views are heard. Discussion with two service users during the inspection indicated that while they feel listened to by management, they did not feel their views were always acted upon; ‘They listen but they don’t do anything about it’. At the time of the inspection no complaints had been received by the service since the last inspection. One service user spoken with described a concern she had raised with management. This was discussed with the Registered Manager and the Care Supervisor, both of whom demonstrated awareness of the issue although the concern had not been formally documented. Both relatives of service users responding to comment cards indicated that they were not aware of the home’s complaints procedure. The home’s training records show that all staff working at the home have received training in complaints and whistle blowing. The home has a policy on adult protection and the prevention of abuse which was last reviewed in 2005. The home’s training records show that training is organised for staff in abuse awareness. Recruitment processes in the home, as evidenced in staff files, are robust and appropriate checks are carried out on staff to determine their suitability to work with vulnerable adults. DS0000004086.V317711.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The security of the premises must be reviewed to ensure that service users are safe in their home. A review of cleaning within the home is also recommended to ensure that the home remains in good order, good hygiene practice is maintained and that service users are protected from infection. EVIDENCE: Service users’ living accommodation is divided into separate apartments housing up to five service users each. Four apartments are situated on the ground floor and one apartment, used mainly for people having respite stays, is situated upstairs and is accessible by a lift and stairway. Each apartment has its own bathroom and kitchen facilities and a communal dining area. The home has been adapted to meet the needs of people with disabilities with doorways that are accessible to wheelchair users and automatic door opening. Service users interviewed reported that they have been able to personalise DS0000004086.V317711.R01.S.doc Version 5.2 Page 22 their rooms as they wish and felt that their bedrooms met their needs in terms of accessibility. The Registered Manager confirmed that service users have been fully involved in making choices about the home’s decoration. It was noted that woodwork around the doors and on wall corners has become chipped where wheelchairs have made contact. Discussion with the Registered Manager indicated that funding has been allocated for the installation of protective door / wall covers and estimates are being obtained for the work to take place as soon as possible. The home employs a person responsible for maintenance of the building and discussion with service users indicated that he is approachable and often helps them with repairs in their bedrooms. Staff spoken with reported that they feel the home is suitably equipped to meet the requirements of residents in terms of adequate hoists and specialist baths. On arrival in the home it was evident that the doors open automatically allowing visitors access to the large reception area of the home. From here, all apartments can be accessed. This issue was raised as a possible security risk at the last inspection of the home. Service users spoken with during this inspection stated that the doors are locked at 1700 hrs each day but one service user, in particular, indicated that this caused her concern especially at weekends when staffing levels are reported to be lower. A social care professional has also raised this issue with the Commission, expressing concern that she waited for some time in the reception area of the home before her arrival was noted. The relative of a service user also noted in a comment card that ‘sometimes we don’t see anyone and any stranger could walk in’. At the time of inspection the home presented as clean. However, only six out of sixteen respondents to the service user survey indicated that the home is always clean with the majority indicating that it is ‘usually’ clean. Comments made about this issue indicated that service users feel that shortfalls in this area are due to staffing levels and inadequate numbers of domestic staff; ‘When we have enough cleaners in the building the place is clean and fresh.’ A member of the staff team also stated that there were not always enough domestic staff to ensure the cleanliness of the home. Information supplied in the pre-inspection questionnaire showed that two part-time domestic staff are employed at The Grange. DS0000004086.V317711.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Induction and ongoing training offered to staff at the home is good and ensures that they have the skills and knowledge to work with the service user group. However, staffing levels are cause for concern and must be reviewed to ensure that service users’ physical, emotional and social needs are fully and consistently met on a daily basis. Service users are protected by the home’s procedures on the recruitment of staff with appropriate checks being carried out prior to them commencing employment in the home. EVIDENCE: A comprehensive three-day induction programme is provided to staff on commencement of their employment at The Grange. This includes information about the organisation, terms of employment, policies and procedures, aspects of health and safety, disability, personal care, anti-discriminatory practice and learning and development. Discussion with the Care Supervisor confirmed that following induction new staff undertake a period of shadowing an experienced member of the team. This was also confirmed by a service user spoken with. DS0000004086.V317711.R01.S.doc Version 5.2 Page 24 Care workers spoken with during the inspection indicated that they have been encouraged to access a range of training courses to promote their competence in their role; ‘The training is good here’. Service users spoken with echoed this view reporting that staff know what they are doing and are confident in meeting their needs. Care workers are encouraged to study towards National Vocational Qualifications and information supplied with the pre-inspection questionnaire showed that nineteen staff have achieved a qualification to at least NVQ Level 2 standard. A further eleven care workers were identified as currently studying towards an NVQ qualification. Several comments were received from service users commending the dedication and hard-working attitude of the staff team and a number of service users remarked on the positive relationships they have with their key workers and other members of staff. One relative stated in a comment card that ‘the carers, as individuals, are on the whole good, friendly and caring’. Conversation with members of the staff team during the inspection demonstrated their commitment to the service users they support and desire to do their best to meet their needs. An immediate requirement was issued at the last inspection of the home in March 2006 requiring the service to submit a plan to ensure the service can effectively respond to the needs of service users with adequate staffing levels. An action plan was submitted by the Registered Manager on 24th March 2006 proposing six strategies for addressing this issue including the employment of additional staff and reviews of existing rotas. A review of progress made was undertaken. Three service users interviewed indicated that staffing levels continued to be cause for concern, particularly in relation to the provision of activities and individual time but also in delays in providing personal care; ‘Staff are rushed off their feet and are working long hours to cover sickness. This means that staff are often exhausted’; ‘There is not enough support for residents and staff’; ‘It worries me’; ‘If they don’t employ more staff soon there is going to be an accident’; ‘Staff are always running around and always busy’. Care workers spoken with during the inspection also indicated that they were aware of shortfalls due to lack of staff; ‘People have to wait because we don’t have enough staff. I am always having to say ‘Can you wait a minute’’. Two relatives of service users also indicated in comment cards that, in their opinion, there are not always sufficient numbers of staff on duty. Discussion with the Care Supervisor indicated that on an average weekday there should be eight staff working a morning shift, between six and eight in the afternoon, four in the evening and three night staff; this number covering the four apartments on the ground floor (a total of nineteen service users at the time of the inspection). The three night staff also provide support for service users in the apartment on the first floor. Discussion with service users and staff suggested, however, that this was not always the case and that, for example, on the evening prior to the final day of inspection a member of staff had gone sick leaving three members of staff on duty to meet the needs of DS0000004086.V317711.R01.S.doc Version 5.2 Page 25 nineteen service users in four apartments, nine of whom are identified in the pre-inspection questionnaire as having ‘high needs’. Staff spoken with indicated that having three care workers on duty on an evening shift put the members of staff under pressure with regards to meeting the personal care needs of service users but they reported that they ‘pull together as a team and get the job done’. Staff discussed that as more than half of the service users require two care workers to support them with moving and handling, they constantly have to ‘borrow’ staff from other flats and service users find themselves having to wait until a second member of staff is available. Staff and service users spoken with felt that staff sickness was largely responsible for these shortfalls. One member of the staff team commented that staff sickness had led to Team Leader meetings being cancelled which then impacted on general communication within the team. Weekend staffing levels were of particular concern to service users spoken with and it was clear from discussion that they felt that staffing levels restricted the opportunities available to them to go out, engage in activities and have some individual time with staff. Comments received in surveys reflected this; ‘I would like it if there were more staff that listen to you’; ‘There are not enough staff who can sit and listen to what the problem is’. Service users spoken with expressed feeling concerned by staff leaving. One service user commented that he was particularly sad that his key worker had left as she had been ‘excellent’. He reported that he felt she had left due to low staff morale. This issue was discussed with the Care Supervisor who reported that there has been an ongoing recruitment campaign since March 2006, with twelve care workers having been employed and nine having resigned for a variety of reasons. Both the Care Supervisor and Registered Manager confirmed that exit questionnaires are completed by staff who leave the service but there are no patterns to indicate that this is due to dissatisfaction with the terms or conditions of their employment. A member of staff spoken with discussed that it was difficult for service users when experienced members of the team who were familiar with their needs had left and were replaced with new, less experienced staff. The progress made by the service since the immediate requirement issued in March 2006 did not evidence sufficient improvement to meet the regulation. A warning letter was sent to the registered provider on 31st October 2006 to require that action must be taken as a matter of urgency to ensure that staffing levels are adequate to meet service users’ needs. The Registered Manager has submitted a plan to address this issue and this will be monitored by the Commission at subsequent visits to the home. Enforcement action may be taken if the required improvements are not made with positive outcomes for service users. The recruitment records of a member of staff recently employed by the home were examined. The records seen were well-organised showing an application DS0000004086.V317711.R01.S.doc Version 5.2 Page 26 form and full employment history, evidence of a structured interview process, evidence of an enhanced disclosure from the Criminal Records Bureau having been undertaken prior to commencement of employment, receipt of two written references, a completed medical questionnaire and proof of identity. A copy of the care worker’s contract of employment was also on file. The Care Supervisor confirmed that shadowing of a more experienced worker does not take place without a satisfactory PoVAFirst check having been received by the organisation for the new worker. DS0000004086.V317711.R01.S.doc Version 5.2 Page 27 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a staffing structure that offers clear lines of accountability and there was sufficient evidence to demonstrate that health and safety policies and procedures are implemented. The home has a quality assurance strategy based on seeking the views of service users. However, the home’s failure to make adequate progress in improving staffing levels consistently for service users means that their best interests have not been promoted in this respect. EVIDENCE: A staffing structure is in place that offers clear lines of management and accountability. The Registered Manager of the home has several years’ experience in his post and has recently completed his NVQ Level 4 / Registered DS0000004086.V317711.R01.S.doc Version 5.2 Page 28 Managers’ Award. There is a Care Supervisor who deputises for the Manager and members of staff employed with specific responsibility for training and development, the co-ordination of volunteers and domestic / maintenance duties within the home. There are a total of six Team Leaders (including a Respite Team Leader) who have responsibility for supervising their staff team. The service has failed to fully address issues raised at the last inspection of the service in relation to staffing levels. This has resulted in a warning letter being sent to the provider by the Commission requiring that urgent action is taken to meet the regulation. The home has a quality assurance process in place which is based on seeking the views of service users. A copy of the last annual survey report was seen dated December 2005. This obtained feedback from residents about the support they receive, relationships with staff, meals and quality of food, whether their independence is promoted and community access. It was not clear from this report what was being done to improve the service available to service users. For example, to the question ‘Is help available if you should need it, to go out to the shops, theatre, college, cinema etc?’, 46.6 of respondents answered ‘always’, 40 answered ‘usually’ and 6.6 (one service user) answered ‘rarely’. It was not clear from the report’s conclusions what actions would be taken to increase the availability of support to service users to access their community or indeed, evidence of further exploration of why one service user responded that such support was rarely available to them. It is therefore strongly suggested that the provider ensures that the views of service users, as obtained via the quality assurance process, form the basis of objectives to improve the service. At the time of the inspection staff surveys were due to be distributed to obtain feedback from staff about the home. A sample of health and safety records were inspected. It was evident that health and safety checks are carried out every three months, these including a review of accident reports, moving and handling risk assessments, fire safety, first aid, food safety, the internal and external environment, control of hazardous substances, infection control practices, security, water systems and temperature checks and vehicle safety. Documentation to evidence that these checks had been carried out had been signed by the Registered Manager and the Care Supervisor, who is also the nominated health and safety link person for the home. There was evidence on file that an annual health and safety review is carried out by the organisation’s Regional Health and Safety Officer from which recommendations and action points are made. At the last inspection of the service by the Commission, three requirements were made in relation to health and safety practices in the home. Discussion with the Care Supervisor, a tour of the premises and examination of health and safety records indicated that appropriate steps had been taken to review DS0000004086.V317711.R01.S.doc Version 5.2 Page 29 practices. It was evident from records that the Health and Safety Officer had followed up the issue raised regarding the potential risks posed by trailing wires from free-standing electric fans in the laundry area. The Care Supervisor reported that a new skylight had been put in the roof to improve ventilation in the laundry and wall fans installed to eliminate the risk of trailing wires from free-standing fans. Review of the home’s induction programme for new staff indicated that health and safety policies and practices are covered including food hygiene, control of substances hazardous to health, hand washing, moving and handling and the reporting of accidents. A sample of fire safety records were examined. Records showed evidence of weekly checks of the fire alarm system and appropriate checks of the automatic door release system, emergency lighting and fire extinguishers. There was evidence on record of fire training sessions and fire drills being held in the home. Given that a total of 42 staff are employed in the home, however, it was difficult to ascertain from records whether all staff had attended the required number of fire training sessions and drills to ensure their competence and therefore a recommendation has been made that staff have individual fire training records to ensure that any gaps in training / drills can be identified promptly. Discussion with the Care Supervisor indicated that a total of nine members of staff have undertaken a Fire Marshal course facilitated by the organisation’s Health and Safety Officer which enables them to deliver training to staff. One designated Fire Marshal stated that she had undertaken the Fire Marshal training course in November 2005 but there was no evidence to indicate that further training was available to designated Fire Marshals to ensure that they have the opportunity to update their knowledge and skills in this area. DS0000004086.V317711.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 3 X X 2 X DS0000004086.V317711.R01.S.doc Version 5.2 Page 31 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 YA13 Regulation 16(2) Requirement The registered provider must make arrangements to enable service users to engage in local, social and community activities. The provider must ensure that service users are able to have their activity afternoon when it is scheduled and that there are adequate numbers of staff on duty to facilitate community access at times that are preferred by residents. The registered provider must ensure that there are records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. The registered provider must ensure that the care home is conducted so as to promote and make proper provision for the care of service users. Staffing levels must be reviewed DS0000004086.V317711.R01.S.doc Version 5.2 Page 32 Timescale for action 31/03/07 2. YA17 17(2) Sch.4 31/03/07 3. YA18 12 (1) 31/03/07 4. YA24 13 (4) to ensure that there are adequate numbers of staff on duty at all times to meet service users’ personal care needs promptly, safely and effectively. The registered provider must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered provider must ensure that the security of the premises is reviewed so that the home provides a safe environment for service users. The registered provider must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This was made an immediate requirement at the last inspection of the service on 18.03.2006. Insufficient progress has been made since this time for the regulation to be met. Therefore a warning letter was issued on 31st October 2006. The registered provider was required to inform the Commission in writing, by 15th November 2006, how they intend to make the necessary changes to comply with the regulations and improve outcomes for people who use the service. An action plan in relation to this requirement was DS0000004086.V317711.R01.S.doc 31/03/07 5. YA33 18 (1) (a) 15/11/06 Version 5.2 Page 33 received from the provider on 16th November 2006. 6. YA37 10(1) The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficient care, competence and skill. The registered persons must ensure that the Care Homes Regulations are met. 31/01/07 DS0000004086.V317711.R01.S.doc Version 5.2 Page 34 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 YA7 Good Practice Recommendations The registered provider should ensure that there are adequate numbers of staff on duty to ensure that service users’ can be supported in doing the things they want to do at times which suit them. The registered provider should ensure that appropriate steps are taken to review communication within the home to ensure that service users feel heard by staff and management and their views are acted on. The registered provider should ensure that all service users and their representatives are supplied with a written copy of the home’s complaints procedure. The registered provider should ensure that there is a system in place for documenting concerns raised by service users and their outcomes in addition to formal complaints. The registered provider should ensure that service users are satisfied with the standard of cleanliness and hygiene in their home and that there are adequate domestic staff employed to maintain this. Individual fire safety training / drill records should be maintained for each member of staff so that any gaps can be easily identified. The provider should provide refresher training for Fire Marshals to update their knowledge on a regular basis and ensure their continued competence at training other staff. 2. YA22 3. YA30 4. YA42 DS0000004086.V317711.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000004086.V317711.R01.S.doc Version 5.2 Page 36 - 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. 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