Inspection on 29/08/08 for The Grange

This inspection was carried out on 29th August 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Grange 13/03/08

The Grange 21/12/06

The Grange 06/02/06

The Grange 23/08/05

The Grange 10/11/04

The Grange 18/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Grange Grange Close, Manor Road Goring On Thames Oxfordshire RG8 9DY Lead Inspector Marie Carvell Unannounced Inspection 11:00 29 August & 2 September 2008 th nd X10015.doc Version 1.40 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 DS0000013090.V371417.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 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 DS0000013090.V371417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address Grange Close, Manor Road Goring On Thames Oxfordshire RG8 9DY 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) 01491 872853 01491 873397 thegrangegoringltd@tiscali.co.uk The Grange Limited Mrs Susan Lewis Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition 1 The four rooms for double occupancy must be identified to CSCI by number and used for the purpose of accommodating married couples as stated in the application dated 20 September 2004. 13/03/ 2008 Date of last inspection Brief Description of the Service: The Grange is a residential home registered for 42 older persons who require personal care and accommodation. The home is not registered to admit service users who require full time nursing care. The home is owned by The Grange Limited and is situated in a quiet residential area in the village of Goring. The accommodation is a large Victorian house that has been altered and adapted for its purpose but also retains many of the features of a family home built over 100 years ago. The home provides people who live there with the opportunity of using the large extensive grounds that lead down to the river and also the convenience of the village close by. The village offers shops, pubs and cafes with transport links to Reading and Oxford. Individual accommodation is provided over 3 floors with 2 lifts available should people wish to use them. Fees range from £650. 00 per week to £750.00 per week. Items not covered within the fees include hairdressing, podiatry, newspapers and magazines, toiletries and contributions to some outings and activities. Continence aids are provided free of charge from the District Nursing Team, following an assessment of need. More information about charges can be obtained by telephoning the home. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’ carried out over two days. We arrived at the service at 11:00 and was in the service until 19:00 on the first day and from 13:00 until 14:40 on the second day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager Susan Lewis, in the form of the Annual Quality Assurance Assessment (AQAA) this is a self-assessment and summary of services questionaire that all registered services must submit to the Commission each year and any information that CSCI has received about the service since the last inspection. The AQAA was received by the Commission on the 9th November 2007. We asked the views of the people who use the service and other people seen during the inspection. Three service users, four members of staff and a healthcare professional responded to surveys sent out by the Commission. We looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. Time was spent with service users, staff on duty, a relative and Susan Lewis. A tour of the premises was carried out and a sample of records required to be kept in the home were examined, including case tracking of service user’s files and staff personnel records. In addition we spent time observing how care was being delivered to service users. At the last inspection carried out in March 2008, ten requirements and eight good practice recommendations were made. The requirements related to care plans, recreational activities, recording of complaints, prevention of the spread of infection, replacement of aids and equipment in bathrooms and toilets, hand washing facilities for staff, provision of liquid soap and paper towels to reduce the risk of cross infection, authenticating references for staff including those recruited from abroad, requesting necessary recruitment information and the provision of regular infection control training for all members of staff. The good practice recommendations related to using a nationally evidenced based nutritional assessment for service users, medication policies and procedures, service user’s personal history and interests are recorded, make the home’s complaints procedure available in the home, develop a system to monitor the state of cleanliness in the bathrooms, develop a system to show what training is needed by staff members, so that training needs of the staff team are identified, records of money transactions on behalf of service users The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 6 be updated as soon as possible and that assessments are carried out to minimise the risks to people living in the home from infection and fire posed by storing bed coverings in the laundry room. Requirements and good practice recommendations made are referred to in the body of the report. Feedback was given to Susan Lewis throughout the two days and at the end of the inspection on the second day. What the service does well: What has improved since the last inspection? Requirements made at the last inspection regarding replacement of bathroom aids and equipment, cleanliness of the home, measures to reduce the risk of cross infection have been addressed. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. Service users are assessed prior to admission to ensure that their needs can be effectively met by the home. All service users are able to move into the home for a trial period, before making a decision to stay permanently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Susan Lewis undertakes a pre- admission assessment to ensure that the home is able to meet the prospective service user’s needs. This includes information regarding the service users social history and hobbies and interests. All prospective service users and their representatives are encouraged to visit the The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 10 home, stay for a while to meet the staff team and other service users, before making a decision to move in on a trial period. All service users are admitted for a trial period of four to six weeks. Surveys completed by three service users confirmed that they had received enough information about the home before they moved in to be able to decide if it was the right place for them and had received a contract/ terms and conditions. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Standard 7 was subject to requirement at the last inspection. Standards 8 and 9 were subject to good practice recommendations at the last inspection. Quality in this outcome area is adequate. Care plans need to be further developed to include emotional and social care needs. Medication storage, administration and recording were seen to be well maintained. Service users feel that they are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 12 At the last inspection a requirement was made that care plans give staff information and instruction about how the care is to be provided to service users. Files of five service users were case tracked and although it was evident that some improvements had been made to the assessment and care planning process, care plans were still not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided. No information is recorded in the care plan about how the emotional and social care needs of the service user or how these will be met. Information about social activities and hobbies are recorded in a book by the activity organiser or staff on duty, however this needs to be incorporated into the care plan and daily records. At the last inspection a good practice recommendation was made that the home should consider using a nationally evidenced based nutritional assessment, to make sure that service users nutritional needs are being properly assessed. This has been addressed. The healthcare needs of the service users are met by a local GP practice and a range of healthcare professionals are available as necessary. The manager expressed her satisfaction of the service provided and said that she had a good working relationship with the visiting GPs and healthcare professionals. Comments made by one healthcare professional included that the home ‘ usually’ seek advice and act upon it to manage and improve individuals’ health care needs, that individuals’ health care needs are ‘usually’ met by the home, the home ‘usually’ respect the individuals’ need for privacy. The healthcare professional commented that one area that the home does well is ‘personal care and help with organising appointments’. The healthcare professional commented that the home could improve by ‘ staff to accompany (if allowed) service users to appointments, who know what the problems/concerns are. At the last inspection a good practice recommendation was made that the home should check that the home’s medication policies and procedures adhere to the Royal Pharmaceutical Society publications. This has been addressed. Medication such as eye drops, that have a short life span are dated when opened. All medication was seen to be appropriately stored. Medication administration records are well maintained and no obvious gaps in recordings were observed. All staff who administer medication have received training from a pharmacist, this is evidenced and updated on a regular basis. Some service users take responsibility for the storage administration of their own medication, this should be supported by a risk assessment being completed and action to minimise risks identified. Susan Lewis agreed to address this. Staff were observed to interact with service users in a respectful and professional manner. Staff were observed addressing service users by their preferred term of address and in discussion with members of staff, they were clear about the need to respect service users privacy and dignity. During the inspection it was noted that all service users were appropriately dressed and well groomed. Attention had been given to ensuring that service users had The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 13 dentures, spectacles and hearing aids in place. We gained the impression that there was a good rapport between service users and the staff team. From discussion with Susan Lewis and observation, the inspector considers that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. We spent time with one relative, who expressed her satisfaction of the care provided to her husband and the kindness, thoughtfulness and support given to her by the staff team. Comments made by service users who completed surveys included, two service users who confirmed that they ‘always’ received the care and support needed and one service user who confirmed that they ‘usually’ received the care and support needed and added that this is dependent on enough staff being on duty and more staff needing to be on duty at night. All three service users confirmed that they receive the medical support they need. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Standard 12 was subject to a requirement and good practice recommendation at the last inspection. Quality in this outcome area is good. Service user records do not record that routines of daily living are flexible and varied to suit the expectations, diverse needs or preferences. Service users are provided with a varied, wholesome and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made that the home consults with service users about their social interests and make arrangements to enable them to engage in recreational activities to relieve their boredom. Susan Lewis has introduced some activities on a daily basis, however it is not recorded if the activities provided suit the requests, preferences and capabilities of the service users. A weekly activity schedule was displayed on the notice board and a record is kept of each days activities and the names of service users who The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 15 take part. Regular entertainment is provided, activities include Tai Chi, weekly manicures, daily quizzes, painting, bingo, board games, group crossword puzzles, musical entertainment (monthly). Several service users expressed their satisfaction of the beautiful grounds and the flower beds. Because care plans make no reference to service users preferred daily routine or their social interests or hobbies, it was not evidenced how individual needs are met for those service users, who prefer not to be part of a large group or are more suited to one to one attention. We were advised that the home has an activity organiser, who works for twenty hours per week. However, this was unclear as this role is undertaken by a part time team leader, who is contracted to work 25 hours per week. Susan Lewis was advised to record on the duty roster the hours undertaken by the member of staff when working as an activity organiser and it is recommended that the hours available be increased. At the last inspection a good practice recommendation was made that the service users personal history and interests are recorded in greater detail, to support staff to be able to provided activities and service users to continue with their interests. This has been addressed. Comments made by service users about activities arranged by the home included one service user who confirmed that activities were ‘ always’ arranged that he/she could take part in. One service user stated that ‘I don’t want activities’ and another stated ‘ I used to – I am too old now’ Many service users have friends or family who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. Religious ministers visit the home on a regular basis and arrangements can be made for service users to attend a local place of worship, if requested. Service user meetings take place on a regular basis. Some service users confirmed that routines in the home are flexible, such as being able to choose when to get up, when to go to bed and how they spend their day. Service users are encouraged to exercise choice and control over their daily lives. One service user who smokes in his/her bedroom has an appropriate risk assessment in place that identifies and minimises the risks. The completed risk assessment has been agreed and signed by the service user. Service users able to express an opinion were complimentary about the food provided. A choice is always offered and service users described the cook as ‘a very good cook’. From discussion it was clear that the cook is familiar with the food preferences of all service users. None of the current service users require a special diet. Menus seen demonstrated that a varied, wholesome and nutritious diet is provided to service users. Comments made on surveys completed by service users included one service user who ‘usually’ liked the meals served and one service users who ‘ sometimes’ liked the meals served. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 16 The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18. Standard 16 was subject to a requirement and good practice recommendation at the last inspection. Quality in this outcome area is adequate. The home has a comprehensive complaints procedure in place and service users feel that their concerns are taken seriously and addressed. Policies and procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made that a record of all complaints received by the home be kept, and the action taken in respect of any complaint, so that people know that the home takes complaints seriously. The good practice recommendation was that the home takes action to make the complaints procedure, available in the home. The home’s complaints procedure is displayed and a copy is given to all service users and their representatives. The home has received seven complaints since the last inspection. However, the complaints book is kept in the entrance hall, information recorded is not able to be confidential and Susan Lewis was asked to remove the book and her attention draw to the working in the book ‘ This book is a confidential document and should be stored properly’. This was actioned during the The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 18 inspection. Not all complaints recorded what action had been taken or the outcome. Susan Lewis agreed to address this as a matter of urgency. Service users spoken to said that if they had a concern or complaint, they would speak to Susan the manager, a member of staff or a family member. All three service users’ who completed a survey confirmed that they knew how to make a complaint. Since the last inspection, the Commission has not received any information regarding complaints about this service. Susan Lewis confirmed that the home has policies and procedures in relation to safeguarding adults and making a referral to the Safeguarding Adults team. Members of staff receive training in safeguarding adults from abuse and the home’s whistle blowing policy. In discussion with members of staff, it was confirmed that training had been undertaken and members of staff were clear about their responsibilities. No safeguarding adult referrals or safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,22 and 26. Standards 22 and 26 were subject to four requirements and standard 26 to a good practice recommendation. Quality in this outcome area is adequate. The home is maintained to a reasonable standard and is kept clean, hygienic and pleasant to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is generally well maintained and Susan Lewis said that there was an ongoing programme of redecoration and refurbishment. This was not made available to us. Service users are encouraged to bring in items of furniture to personalise their rooms, it was not evident that a record of furniture brought in by the service user was kept. The laundry is very shabby and would benefit from refurbishment, including improving the ventilation and natural light, as The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 20 this room has no windows. Some areas of the home are beginning to look tired and would benefit from being decorated. The maintenance person maintains the gardens to a high standard and service users expressed their satisfaction and pleasure of this facility. At the last inspection four requirements were made that the aids and equipment for bathrooms and toilets are replaced where necessary, that all bathrooms are cleaned and kept clean, that members of staff have access to hand cleaning facilities in staff toilets and in the laundry to reduce the risk of infection and that the home provides people who live in the home and staff with suitable provisions such as liquid soap and paper towels to reduce the risk of cross infection. The good practice recommendation was that the home should develop a system to monitor the state of cleanliness in the bathrooms. All requirements and the good practice recommendation have been addressed. Since the last inspection, aids and equipment in toilets and bathrooms have been replaced where necessary and washbasins installed in communal areas as necessary. Staff now have access to hand washing facilities and all communal toilets and bathrooms have liquid soap and paper towels. We toured the premises with Susan Lewis and spent time talking to the housekeeper and cleaner, who were praised for the high standard of cleanliness in the home and the absence of malodours. Communal areas of the home have been made comfortable and the home has a welcoming and homely feel. There is an ongoing programme of redecoration and refurbishment in progress; this was not made available to us. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Standard 29 was subject to two requirements and standard 30 was subject to requirement and a good practice recommendation. Quality in this outcome area is poor. Staffing levels appear to be adequate to meet the needs of the service users. Recruitment procedures need to be more robust. Training is promoted and staff are competent to do their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with Susan Lewis, staff on duty and examination of duty rosters, staffing levels are the very minimum needed to meet the needs of the current 35 service users. The home currently has vacancies for night and day care staff. Staffing levels are generally four care staff including a team leader on duty from 7.30am until 2pm and three members of staff from 2pm until 8pm. Two waking night staff are on duty from 7.45pm until 7.30am the following morning. Catering and housekeeping staff are also employed. Susan Lewis, frequently provides hands on care to service users. No agency staff are used as permanent staff will cover shifts when necessary. Susan Lewis said that she will be recruiting additional care staff as more service users are admitted to the home and consideration is being given to the recruitment of a The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 22 third member of staff for night duty. No administrative support is provided to the manager and the home would benefit from employing a laundry person. Susan Lewis agreed to consider employing of a part time laundry person. It is recommended that the duty roster demonstrates a handover for all care staff at the start of their shift. Information was not available about the names, designation and contracted hours of staff, although this was requested. Information recorded on the AQAA, stated that 22 care staff are in post. This was not reflected on the twoweek duty roster given to us during the inspection. The AQAA stated that of the ‘ 15 permanent care staff, 9 had completed National Vocational Qualification training (NVQ) level II or above and 5 were working towards NVQ training. At the last inspection two requirements were made, that all the necessary information, including authenticated references, be acquired for people working in the home, including those recruited from abroad, to help protect vulnerable people living in the home and that the home requests the necessary recruitment information about the individual already working in the home, so that all information is available. These requirements have not been complied with and Susan Lewis has continued to employ members of staff, without appropriate recruitment checks being in place. We looked at personnel files for six members of staff, who have been recruited to the home since the last inspection. Only one personnel file evidenced that written references, Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks had been obtained prior to employment. Application forms were either blank, except for name and address or did not contain information about previous employment history. References were either not obtained until after the member of staff was in post, were ‘ To whom it may concern’ or not requested. A member of staff from abroad, recruited via a recruitment agency did not have authenticated references, two photocopies of ‘to whom it may concern’, both related to employment in 2001/02. This member of staff is working on a student visa, although he/she has been issued with a contract for 40 hours per week. Susan Lewis said that this member of staff had been recruited from abroad to undertake NVQ at level II and that documentation was available to support this and therefore 20 hours were provided for NVQ training, no documentation was made available to us. Another personnel file contained an application form blank except for name, address and hobbies. No evidence of an interview or references being taken up and as the individual is aged sixteen; there is no requirement for CRB or POVA checks to be requested. Most personnel files evidenced that an interview had taken place, prior to appointment. None of the personnel files recorded evidence of the member of staff being physically and mentally fit for the purpose of the work being undertaken or made reference to the working time directive. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 23 All newly appointed care staff complete an induction programme, which meets Skills for Care guidance. This was well documented and records the date of the induction and an additional date when the member of staff has been able to demonstrate competence. At the last inspection a requirement was made that action be taken to make sure all staff members have regular infection control training, to better protect people living in the home. This has been complied with. A good practice recommendation was made that the home should develop a system to show what training is needed by all the staff members, so that the training needs of the staff team can be identified. Susan Lewis confirmed that this is being addressed. Evidence was seen that some mandatory training had been provided to staff. Staff spoken to were positive about training offered and felt that this gave them confidence in carrying out their duties and assisted with career advancement within the organisation. Susan Lewis is a NVQ assessor. Staff meetings are held regularly in the home, these are minuted. Comments made by staff who completed surveys included: ‘ I have been very happy with the level of support/ appraisal given since I started at the Grange. Mrs Lewis has always been professional and helpful and very positive about all aspects of my work. It is wonderful to feel appreciated and valued as an employee’ ‘ We try very hard to accommodate and provide our service users with the best care and choices’ ‘The home is very well run at the present time’ ‘ I have always had the support and encouragement when needed by my manager and team leaders, we all work together in a nice and friendly environment and our work mates are there to be supportive too, we try to help each other out when needed. I love my job and have no intention of leaving’ ‘ I am training in an NVQ level II- Health and Social Care and have recently completed a course in Infection Control. I have been offered a course in Dementia Care’ ‘ The Grange provides a warm, caring environment, which is safe and secure. It certainly has a homely atmosphere and encourages service users to live and thrive with respect, dignity, choice and self fulfilment’ The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38. Standards 35 and 38 were subject to good practice recommendations at the last inspection. Quality in this outcome area is poor. The home is not being effectively run. Systems for measuring the quality of the service need to be improved. The home’s management has not developed a more robust system of recruiting staff, therefore putting service users at possible risk of harm. Some areas identified during this inspection, potentially put service users at risk of injury. Risks identified have not been addressed. Not all documents requested were available in the home. This judgement has been made using available evidence including a visit to this service. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 25 EVIDENCE: Susan Lewis is an experienced and qualified manager, having completed NVQ IV and the Registered Managers Award. She has been the manager at The Grange for the last four years. Requirements made at the last inspection remain outstanding; this includes a requirement about recruitment that was issued during the last inspection. The Responsible Individual for the company that owns the Grange, Mr Collin Northey was present in the home during the two days of the inspection, but declined to take part in the inspection. Susan Lewis is frequently expected to provide direct care to service users and therefore neglects her management responsibilities. It is a recommendation that the she records her hours worked on the duty roster. The AQAA submitted to us by Susan Lewis in November 2007, was incomplete. Some information was provided during this inspection. Susan Lewis said that a quality assurance survey was carried out at the end of last year and that the comments received had been collated. A copy of this was requested, but was not made available. No evidence was avail able to evidence that quality audits take place on a regular basis and include medication, health and safety, accidents/falls and care planning. An annual development plan has not been produced. The home’s business and financial plan was not available for examination. At the last inspection a good practice recommendation was made that the records of petty cash transactions be updated as soon as possible, to make sure the records are accurate. This has not been addressed. The home manages money on behalf of one service user. Records are maintained and expenditure is receipted, but it was noted that goods purchased on behalf of the service user, were not recorded for several weeks. No evidence was available to demonstrate that the home is being run in the best interests of the service users. A company, The Grange Limited, owns the home. This requires the responsible individual (one of the two directors) to visit the home at least once a month, unannounced and to write a report on the conduct of the home. The report must be available in the home for examination by inspectors. The AQAA stated that during the last twelve months, six service users have passed away either in the home or in hospital. The manager is required by regulation to notify the Commission of all deaths. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 26 The handy person carries out weekly checks on the fire alarms, fire extinguishers and door guards. The manager confirmed that water temperatures are not checked as valves are in place, but has agreed to undertake regular hot water checks. Service records requested were not available. It was noted and discussed with Susan Lewis, that the majority of bedrooms have en-suite baths. No safe bathing risk assessments are undertaken to identify and minimise any potential risks to service users. It was also noted and discussed with Susan Lewis that none of the windows on the first and second floors of the home had window restrictors in place, as with safe bathing, no risk assessments were in place to identify and minimise any potential risks to service users. In the grounds there is a large, deep pond. An external health and safety consultant identified the need to undertake a risk assessment and suggested that a life buoy and notice be displayed warning of the dangers of the pond. No risk assessment could be provided to us to and at the pond there was no life buoy or warning sign. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 1 The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement That the care plans give staff information and instruction about how the care is to be provided to individuals. This requirement from our inspection of December 2006 and March 2008 has not been complied with. Timescale for action 10/10/08 2. OP27 18 3. OP29 19 That a review of staffing in the 10/10/08 home is undertaken to ensure that the needs of the service users are met at all times, this includes management, care staff, catering and domestic staff. That all the necessary 10/10/08 information, including authenticated references, be acquired for people working in the home, including those recruited from abroad, to help protect vulnerable people living in the home. Full and satisfactory checks including, CRB/POVA 1st and satisfactory references must be available on file for each member of staff before they start work in the home. The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 29 That the home requests the necessary recruitment information about the individual already working in the home, so that all the information is available. This requirement from our inspection of December 2006 and March 2008 has not been complied with. 4 OP33 24 A method of continual monitoring, reviewing and improving the service must be implemented to ensure that the care provided to service users and the home is monitored effectively. Effective quality assurance systems must be put in to place based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and statement of purpose. A copy of the home’s business and financial plan must be sent to the Commission, to demonstrate the effective and efficient management of the business. 10/10/08 5 OP37 37 The Commission is to be notified retrospectively, in writing of the service users who have died since the inspection in December 2006. A copy of the written report prepared by the responsible individual on the conduct of the DS0000013090.V371417.R01.S.doc 10/10/08 6 OP32 26 10/10/08 The Grange Version 5.2 Page 30 home completed following an unannounced visit to the home must be sent to the Commission, each month until January 2009 7 OP38 13 Risk assessments must be carried out to identify and minimise potential risks to service users in relation to safe bathing, falling from windows on the first and second floors of the home and risk of falling in to the garden pond. 22/09/08 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 DS0000013090.V371417.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange DS0000013090.V371417.R01.S.doc Version 5.2 Page 32 - 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. 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