Inspection on 29/10/08 for The Grange

This inspection was carried out on 29th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 23/11/06

The Grange 01/03/06

The Grange 12/09/05

The Grange 23/03/05

The Grange 04/11/04

The Grange 28/01/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Grange 2 Park Vale Road Macclesfield Cheshire SK11 8AR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Porter     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Grange 2 Park Vale Road Macclesfield Cheshire SK11 8AR 01625618146 01625430831 thegrange-mailbox@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Miss Kelly Brown Name of registered manager (if applicable) Miss Kelly Brown Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: No more than 1 Service User may be LD, aged under 18 years No more than 2 Service Users may be LD Date of last inspection Brief description of the care home The Grange is a small, privately owned care home that is close to Macclesfield town centre. There are a variety of shops, churches and other facilities nearby. There are no designated car parking spaces at the home. The Grange was formerly a private dwelling that has been altered and adapted to become a care home for three service users with a learning disability. The Grange is a two-storey building with a cellar. It has five bedrooms, one of which is used as an office. The proprietor and Service users have their own bedrooms. Downstairs there is a lounge, dining room, bathroom and kitchen for service users. The resident proprietor uses a separate lounge. A small, enclosed yard provides opportunities for sitting outside during the summer months. Residential charges for living in the home depend on individual needs and can be obtained from the home manager. Care Homes for Adults (18-65 years) Page 4 of 26 3 Over 65 0 care home 3 Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We carried out this unannounced visit to The Grange on 29 October 2008. The visit lasted a total of 3 hours and was carried out by one inspector. The report says we when referring to what we did, as it is written on behalf of the Commission for Social Care Inspection. The visit was just one part of the inspection. We also looked at other information we had received about the home since our last inspection there. Before the visit the manager was asked to complete a questionnaire to provide up to date information Care Homes for Adults (18-65 years) Page 6 of 26 about the service. We also made arrangements to meet with the person living in the home so they could let us know what they think about the home. Their views are included in the report. During our visit, we looked at various records and around the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The owner of the home obtains information about the needs of the person moving in so that she can ensure she can support them appropriately. Evidence: On the day of our visit only one person was living in the home. We saw a copy of the persons assessment that had been done by the local authority and this set out clearly the aims of providing support for the person at The Grange. This provided guidance for staff at the home about the support they needed to provide for the person. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are involved in decision making and planning so that they are supported in the way they prefer. Evidence: We saw a copy of a care plan for the person who was living at the home during our visit. The plan identified what support was needed and how it should be given. We saw that arrangements were also in place for the persons further education and employment. We spoke with the person who said that they enjoyed work and they worked really hard, which was exhausting. The person told us that they shopped, cooked, cleaned and did their own laundry, sometimes needed reminding to complete things and when reminded saw this as staff being bossy. Records were also available in relation to financial support given to get to and from college and work. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: A leaving care worker had been assigned to the young person and had attended a care planning meeting on 02 September and a review meeting on 17 September. Although the records showed that the wish of the young person was to move out of the home and live independently, no clear leaving care plan has been developed by the local authority. The plan should outline the support and assistance the person would receive to enable a successful transition to adulthood and independence. The manager of The Grange told us that she is intending to semi-retire early in 2009 and therefore preparations for the young person to move on are critical so that this can be successfully achieved by the time the manager retires. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home are encouraged to participate in all aspect of living there to help make sure that they can develop the necessary skills for moving on to independent living. Evidence: The person living in the home told us about college and their work placement. They told us that they didnt like getting up early in the morning to go to work as they liked to watch television until late and liked the computer they could use in the home. The young person spoke fondly about their relationship with their mother and grandmother and we saw some photographs taken at young persons graduation. The purpose of the home is to provide support so that residents can move on and become more independent. Therefore people living there are encouraged and expected to manage their own time and responsibilities in relation to shopping, cooking, and household Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: tasks including budgeting and their health care appointments. Contracts, house rules and regular meeting are in place to air views and encourage individuals to take responsibility. During our visit two former residents visited the home and were seen as taking on a befriending role and mentoring as they had moved on to greater independence in their own home. They were seen offering advice and suggesting alternative ways of behaving. The person living in the home told us that they liked the home, saying it was better than before but they really couldnt wait to move on, get a flat and proper job. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are encouraged to manage their own personal and health care needs to help them to become more independent and move on to living on their own. Evidence: The home does not offer support with personal care. People moving in are fairly independent are able to manage their own personal hygiene. During our visit the records we looked at showed that the person living there was registered with the GP, opticians and dentist. The person told us they were expected to make and keep appointments and that for as long as they could remember had always looked after their own medicines. The records we saw in the home confirmed this. The manager confirmed that none of the staff smoke in front of the person living there. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the absence of appropriate training and procedures relevant to the individual circumstances, young people placed in the home may be at risk because staff are not aware of the local procedures for safeguarding children. Evidence: The home has a formal complaints procedure, but we could see that, on the whole, most matters are resolved in discussion as and when situations arise. However more serious matters are raised at house meetings; this often happens when house rules have not been effective. Staff or the people living in the home can call a meeting and these are then recorded so there is a clear account of the agreed outcomes. The house rules are developed by the people living in the home. The young person living in the home at the time of our visit is not yet 18, so is comes within the scope of child protection. Young people aged 16 and 17 can be accommodated at the home but there must be extra procedures in place when they are living there. These involve child protection procedures, policies and procedures agreed by the local Area Child Protection Committee, agreed protocols with the local child protection co-coordinator and staff training. A policy on countering bullying and written procedures in case of absence without authority is also needed. We found that these had not been provided whilst this young person had been living at the home. Care Homes for Adults (18-65 years) Page 16 of 26 Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in the home in comfortable, homely surroundings which are maintained so that they are kept safe. Evidence: We walked around the home and saw the communal areas. We also spent time in the residents bedroom. A new bed had been delivered during our visit and the young person was in the process of assembling it. The home is a large domestic house with some private areas such as a lounge and bedroom for the owner; all other areas in the home are shared by the people who live there. The home was clean, generally tidy and maintained. Care Homes for Adults (18-65 years) Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the absence of regular refresher training, and training relating to age of the people they support, staff may not be working in line with current best practice. Evidence: No new staff have been employed in the home since our last visit there. The owner/manager is responsible for all recruitment and induction and told us that staff would not work unsupervised unless she was satisfied they were able to carry out her wishes and were able to fulfill the aims set out in the care plan. Staff files we looked at showed that criminal record bureau checks had been done for existing staff but this had not included checking information to make sure they were suitable to work with children. The manager told us she was in the process of semi retiring in February 2009 and had not undertaken any recent training. There is no training plan in place to provide refresher training for any of the staff and consequently not all staff have not achieved all mandatory training to cover health and safety, moving and handling, first aid, food hygiene, fire safety procedures and infection control. In addition when working with young people 80 of staff should have achieved a National Vocational Qualification level 3 in Caring for Children and Young People, and staff at the home had not done Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: this. Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is aware of her responsibilities but staff and the person living in the home may be vulnerable because of the lack of training relevant to supporting someone under 18 years of age. Evidence: The owner/ manager is registered with the Commission for Social Care Inspection. She has told us of her intention to semi retire although she still wishes to retain the registration for the care home. She told us that she has informed the local authority of her decision and during the visit she was heard openly discussing this with the young person living at the home. The owner manager is aware of her responsibilities in relation to safe working practice. However mandatory staff training and training in relation to providing support to a young person 16 to 17 has not been put in place due to her imminent retirement. We saw service agreements and a maintenance plan for the home to make sure that it Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: continued to be well maintained and that equipment in the home was safe. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 Agreed child protection protocols must be in place Staff must have access to guidance, policies and procedures in relation to child protection matters 28/03/2009 2 23 13 Staff must receive training in Child Protection Procedures So that young people 16 and 17 years old accommodated in the home are protected from possible harm or abuse. 28/03/2009 3 32 33 Staff qualifications, skills and experience must be suitable for the purposes of working any young people who live at the home. This is to make sure that staff receive training relevant to working with young people so that people stay safe. 28/03/2009 Care Homes for Adults (18-65 years) Page 24 of 26 4 34 19 The registered perosn must obtain criminal record bureau check for all staff in relation to working with children (POCA) Staff must undertake criminal record bureau checks for working with children so that the people they work with are safeguarded. 13/03/2009 5 35 18 Staff must receive training 28/03/2009 appropriate to the work they perform This is to make sure that staff are trained in accordance with current best practice so that people living at the home are kept safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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