CARE HOME ADULTS 18-65
The Grange The Grange Redworth Road Shildon Durham DL4 2JT Lead Inspector
Mrs Tanya Newton Unannounced Inspection 24th January 2006 09:00 The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Grange Address The Grange Redworth Road Shildon Durham DL4 2JT 01388 775764 01388 771040 highleahomes.hq@btinternet.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) Highlea Homes Limited Care Home 19 Category(ies) of Learning disability (17), Learning disability over registration, with number 65 years of age (1), Physical disability (17), of places Physical disability over 65 years of age (1) The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th August 2005 Brief Description of the Service: The Grange provides care for up to 19 adults in ground floor accomodation on the outskirts of Shildon. The home was previously a school and has been adapted. The home is suitable and accessible to people with mobility problems. The home has communal lounges, a dining area, a small kitchen area for service users to make snacks and drinks, a conservatory, a library/quiet area and a leisure room. The home is owned by Highlea Homes Ltd whose offices are based on the upper floor of The Grange. Toilet and bathing facilities are available throughout the home. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out between the hours of 9am and 3pm. The manager, assistant manager, four staff and four service users were spoken with and their feedback is included throughout the report. In line with current CSCI policy on Proportionality, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion were looked at during the previous inspection, which took place in August 2005. Issues raised in the last inspection were also examined. What the service does well: What has improved since the last inspection?
Activities have improved since the last inspection and the home now has an activities co-ordinator who is based at The Grange. More activities are now provided for residents. Feedback in this area was positive. Systems to administer medication have improved since the last inspection, residents now receive medication in line with the G.P instructions and there are clear records to support this. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 6 The standard of notifications to CSCI has improved and the home is also providing CSCI with more detailed information when events occur. The manager has applied for registration with CSCI. 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 DS0000007510.V284125.R01.S.doc Version 5.1 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 DS0000007510.V284125.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Assessments are carried out to ensure that the home is able to meet all of the physical and emotional needs of the residents being admitted. EVIDENCE: Assessments were viewed during the inspection; a new assessment tool is being implemented, there was some evidence of service user involvement within the assessment process. Assessments are usually reviewed on a six monthly basis. Assessments form the basis from which the care plan will be written. Some of the assessments were not fully completed; these need to be reviewed and updated. This was a requirement in the previous inspection report, which has not yet been actioned. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Reviews on care plans must be carried out regularly to ensure that they are up to date and support service users changing needs. EVIDENCE: Each service user has an individual plan of care; some areas of the care plan need updating to ensure that any changes in need are identified. This was a requirement in the previous inspection report, which has not yet been actioned. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 15 16 & 17 Service users enjoy a range of activities, which they help to choose and plan. Service users are supported and encouraged to see relatives and maintain friendships. Menus are provided which are based on service users choice. EVIDENCE: Service users meetings are held every month, this is an opportunity for service users to discuss what activities they would like to do and where they would like to go. Menus are also discussed during these meetings. Relatives are encouraged to visit the home; they attend social functions at the home and keep in regular contact via the telephone. Service users stated that they were able to maintain friendships. The home now has an activities co-ordinator who is based at The Grange. The activities in the home have improved and comments from service users and staff were positive.
The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 11 The cook stated that menus were flexible and that service users could have what they wanted to eat. The cook said that service users are well nourished. The Company is looking at ways of improving the nutritional value of the menus whilst still giving service users a choice. Comments from service users included “the foods beautiful” and “we are consulted about the food and the cook is very flexible”. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 & 20 The personal and health care needs of the service users accommodated are being met. The systems for dispensing medication have improved and protect service users. EVIDENCE: Personal care is provided to service users in a respectful way. Service users confirmed that staff would knock on doors prior to entering a service users bedroom. Service users could have a bath or shower daily. Where possible same sex care is provided. The home gains support from other health professionals where it is required. Medication systems were looked at during the inspection; there were improvements in this area. Medication is now being given in line with G.P instructions, all medication is being signed for and stock is ordered and returned in the correct way. At present senior staff members give out the medication. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these standard/outcomes were formally assessed during this inspection. They were addressed during the last inspection of the home, which took place in August 2005. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The home was clean and free from odour during the inspection. Some of the carpets need to be replaced. EVIDENCE: The home was clean and free from odour during the inspection. Domestic staff are employed to clean the home and there is an on-going programme to decorate service users bedrooms, those bedrooms viewed were individualised and service users said that they could choose how they would like their rooms to be decorated. The conservatory has been extended; this needs a new carpet or flooring. The room, which was previously used for activities, is now being used for wheelchair storage; it is hoped that this room will be developed as a social area for service users. Many of the carpets in communal areas are stained and dirty and need replacing and some of the bedrooms also need new carpets. There are plans to redesign the kitchenette for service users and the library area is being developed as a computer room. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 & 35 Training is provided for staff and staffing numbers in the main meet the needs of the residents accommodated. Recruitment policies and practices protect service users living at The Grange. EVIDENCE: The home has the following staff on duty 4 staff between 7.30am and 11.30am, three staff between 11.30am and 10pm and two staff throughout the night, one waking and one sleeping. These hours include the manager’s hours. It is recommended that the manager’s hours become supernumerary in order that management tasks can be completed. The home also employs a cook, domestic staff and an activities co-ordinator. Staff said that the staffing numbers had improved during the week but were still not sufficient on a weekend due to the personal care needs of the service users particularly on the morning shift. Training is provided for all staff and includes manual handling, first aid, food hygiene, health and safety and NVQ’s. Additional training such as the safe handling of medicines has also been accessed for the senior staff. Out of the eighteen staff employed 5 have gained an NVQ at level 2 or above, 4 were on-going with the award and the other 9 were waiting to access this.
The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 16 The majority of staff training was either up to date or had been booked. Staff commented that training sessions were provided at staff meetings. Recent training had included the protection of vulnerable adults (POVA) and fire training. Staff said that morale was good and that they enjoyed working at The Grange. Three staff files were examined, all contained all of the required information, which helps to safeguard service users. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 & 42 The manager is in the proceeds of applying for registration with CSCI. Quality assurance systems should continue to be developed. Risk assessments must be carried out prior to bed rails being used and in all cases where there may be danger to service users and staff. EVIDENCE: The home has a manager who is in the process of applying for registration with CSCI. The home also has an assistant manager. Comments from staff and service users about the managers were positive. Quality assurance systems are in place and include Regulation 26 visits from the provider and meetings for service users. The Company holds quality action group meetings, which are attended by service users and relatives. Quality assurance systems should be further developed to include feedback from other agencies, feedback from relatives, and questionnaires.
The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 18 The central heating system had failed during the weekend prior to the inspection. To ensure service users comfort and warmth a number of electric heaters had been hired. There was no risk assessment in place to ensure service users safety whilst these heaters were in use and the home were asked to complete one immediately. Health and safety records were examined; regular checks are carried out on the equipment and premises to make sure that they are safe for service users. Fire training records were looked at; although fire training does take place it is recommended that this be provided more often (twice yearly for day staff and three times a year for night staff). One of the service users accommodated had bed rails on their bed; there was no risk assessment in place to demonstrate why these were being used. Any service users requiring the use of bed rails must have a risk assessment, which is based on the Medical Device Agency (MDA) guidance 2001. Regular maintenance checks must also be carried out. A copy of this risk assessment should be sent to CSCI on completion. The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 1 X The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 20 YES 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 YA2YA6 Regulation 14 & 15 Requirement Timescale for action 31/03/06 2 3 4 YA24 YA32 YA42 23(2) d 18 c (i) 13(4) Assessments and care plans need to be regularly reviewed and updated. This is a previously unmet requirement. Carpets, which are badly stained, 31/08/06 require replacement. The home needs to increase the 31/08/06 number of staff attaining the NVQ 2. Risk assessments must be 24/01/06 carried out to protect service users and staff. Assessments on the safe use of bedrails must be carried out prior to their use and be based on the MDA guidance 2001. Fire training should be provided more frequently for staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange DS0000007510.V284125.R01.S.doc Version 5.1 Page 22 - 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!
