Inspection on 03/11/05 for The Grange

This inspection was carried out on 3rd November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 05/06/07

The Grange 06/12/06

The Grange 22/06/06

The Grange 21/04/05

The Grange 18/11/04

The Grange 30/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Grange 75 Reculver Road Herne Bay Kent CT6 6LQ Lead Inspector Tina Thomas Unannounced Inspection 3rd November 2005 12:15 The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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 DS0000023231.V263667.R01.S.doc Version 5.0 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 DS0000023231.V263667.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Grange Address 75 Reculver Road Herne Bay Kent CT6 6LQ 01227 741357 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) Lifetime Care Development Limited Mr Eddie Fisher Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mr E.Fisher to have completed NVQ4 in management and care by July 2005 21st April 2005 Date of last inspection Brief Description of the Service: The Grange is a care home, which is registered to care for four adults with learning difficulties. It is owned by Lifetime Care Development Ltd. Mr E. Fisher is the owner and Manager. The Home is situated 1/2 mile from the shops and seafront in Beltinge. It is also located within easy access of public transport. The Home is a detached bungalow. It has an attic room, which has been converted, into an office area. All bedrooms are single. The Home has a lounge/dining room for communal use. The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted at 12.15pm until 4.45pm by two inspectors, Tina Thomas and Kim Rogers. The Provider/Manager Mr Eddie Fisher assisted the inspectors. Within the last year there has been four adult protection alerts raised, following anonymous allegations, allegations from service users(which were later retracted), and one incident at the home. All of the alerts were closed due to lack of evidence. However, a number of poor practices have been identified, which the Provider/Manager will be required to address. What the service does well: What has improved since the last inspection? What they could do better: The home must improve the quality of care planning. Service users must be involved in this process and their aspirations given consideration. Care plans must be in a format that service users can understand. Staff must respect service users’ rights to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual service user plan. The registered manager must ensure that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. Staff must enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service user’s individual plan and of the homes risk assessment and risk management strategies. The environment of the home must be improved. Some furnishings must be improved. Rooms must be made damp free. The home must have sufficient numbers of staff. The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 6 The Provider /Manager must adhere to the homes recruitment process. 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 DS0000023231.V263667.R01.S.doc Version 5.0 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 DS0000023231.V263667.R01.S.doc Version 5.0 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): None of these standards were inspected at this inspection. EVIDENCE: The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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): 6,7,8,9 Care plans do not adequately describe service users needs and aspirations. Service users are not supported adequately in making decisions about their lives. Service users are not always consulted on, or participate in all aspects of life in the home. Service users are not always supported to take risks as part of an independent lifestyle. EVIDENCE: There was some evidence that the Provider/Manager has endeavoured to improve the quality of care plans. He has worked with the community learning disability nurse to improve them. The inspectors viewed care plans and found that they still contained shortfalls. Care plans are poorly maintained. In some cases they contain outdated information. For example one service users plan indicates that the service user has music and movement at a day centre, although this no longer occurs. There was very little evidence of personal planning and no evidence of any participation from service users into their daily plans. Aspirations were not identified or assessed. Communication profiles did not reflect service users needs or the way in which they communicate, For example: when service user A does this it means this in a certain way or Service user A communicates using Makaton. The home had some documentation that is pictorial but it was The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 10 not completed. Three requirements have been made regarding this. Requirements 1,2,3. Part A. In one care plan for a service user with epilepsy there was no epilepsy guidelines. Recommendation made regarding this matter. (Recommendation 1 Part A) Respect of service users rights to make their own decisions was not evidenced in care plans. Choices and decisions were mainly made by staff, for example If Service user A wants to work in the kitchen(Which is highly unlikely……….)’ Documentation displayed restricting attitudes i.e. ‘he cant’, ‘no attention span’ Requirement made regarding this matter. Requirement 4 Part A. The inspectors observed that choices and decisions were made on behalf of the service users, rather than by service users having support to make their own decisions. The inspectors observed that Staff did not ensure that service users were offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. One example would be that the menu showed that on the day of inspection service users should have had a roast dinner, staff had decided to cook curry. Another example being that the inspectors were told by the Provider/ Manager that a parent and care manager made decisions regarding the furnishings in one service users room, rather than that person given support to give their own decision/consent. Staff also choose in-house activities. Interaction was observed to be about staff giving service users instructions. Requirement made regarding these matters (Requirement 5 Part A). One Service user was able to use sign as a form of communication. He told the inspectors that staff do not sign to him. Requirement 6 Part A). The inspectors found that risk assessments were not of good quality. They need to more accurately reflect the current abilities of service users. Staff assumed that certain activities would be ‘too risky’ instead of trying to manage and support the service user or offer opportunities. Requirement made regarding this matter. (Requirement 7 Part A). The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 11 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): 11,12,16 Some service users have the opportunities for personal development. Service Users need to be further encouraged to take part in appropriate activities. Independence, and individual choice is not always promoted EVIDENCE: One service user goes to college and lives a fairly independent life. It is agreed by a multi disciplinary team that this person has developed and progressed since they have been living at the home. As previously mentioned other service users have not been assisted fully to take part in valued and fulfilling activities. (Requirements 4,5,6) The home has introduced activity charts but they are of little value indicating only, for example, ‘lay in, drive out’ ‘Ramsgate beach.’ ‘ indoor activity’ they do not indicate what the purpose of the activity was i.e. to practice social skills, or whether new skills or experiences were achieved. As previously mentioned, staff make choices for service users instead of supporting them to make their own choices. Staff interact with service users by giving instruction. Service users have little privacy; one service user entered another’s room without seeking permission. The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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): None of these standards were inspected at this inspection. EVIDENCE: The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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): None of these standards were inspected at this inspection. EVIDENCE: The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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, 26 The environment of the home has deteriorated since the last inspection. EVIDENCE: The inspectors toured the home. They found that some areas of the home had become shabby. Some furnishings had become broken and had not been fixed for example a drawer in a chest of drawers. Requirement made regarding this matter(Requirement 8 Part A) One room smells strongly of damp. Requirement made regarding this matter. (Requirement 9 Part A). The inspectors found that service users own bedrooms were poorly furnished. The inspectors discussed one room with the manager. The manager said that this decision was made by service users parents and care managers. As previously mentioned, service users must be supported in making their own decisions. One service users room did not have a mirror. One service user had labels on the drawers i.e. socks, pants. The drawers did not contain the items described and the service user cannot read. The Provider/manager explained that this was an effort to enable the service user to be more independent. Pictorial prompts would be less institutional and more fitting. The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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): 3132,33,34 Staff are not sufficiently qualified to support the needs of service users with challenging behaviours. Sometimes there are insufficient numbers of care staff to meet service users needs. Recruitment procedures are not adequately followed. EVIDENCE: Some staff have achieved NVQ Level 2 in care, others are undertaking NVQ Level 2 in care. The inspectors discussed the methods by which other staff training has been undertaken and discussed that the manager had no evidence of staff competency. Staff have not completed training specific to service users with learning disabilities. Requirement made regarding this matter. (Requirement 10 Part A) At the time of inspection there were 2 staff and the Manager on duty. One service user was at college. 2 service users were at home and 1 day service user was present. The day service user needs 1-1 care. Staff also do the cooking. It is considered that the home is sometimes understaffed. Requirement made regarding this issue. (Requirement 11 Part A) The Manager sometimes works ‘hands on’. The manager’s hours should be recorded on the staff rota. Recommendation made regarding this matter(Recommendation 2 Part A) The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 16 The inspectors observed that a new member of staff was recruited with insufficient checks, which included insufficient references and no current CRB. (Requirement made regarding this issue(Requirement 12 Part A). The Grange DS0000023231.V263667.R01.S.doc Version 5.0 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): 37,38 The Manager is qualified to run the home. The home does not create an open, positive and inclusive atmosphere. EVIDENCE: The Registered Manager has now completed NVQ Level 4 in Management. As previously mentioned service users have little input into events in the home. Staff interaction is through instruction. Staff make choices on behalf of service users rather than supporting them to make their own choices. Staff keep social distance, i.e. staff have their own table to eat on. The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score N/A N/A N/A N/A N/A Standard No 22 23 Score N/A N/A ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 1 2 2 N/A Standard No 24 25 26 27 28 29 30 STAFFING Score 2 N/A 2 N/A N/A N/A N/A LIFESTYLES Standard No Score 11 2 12 2 13 N/A 14 N/A 15 N/A 16 2 17 Standard No 31 32 33 34 35 36 Score 2 2 2 1 N/A N/A CONDUCT AND MANAGEMENT OF THE HOME N/A PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Grange Score N/A N/A N/A N/A Standard No 37 38 39 40 41 42 43 Score 3 2 N/A N/A N/A N/A N/A DS0000023231.V263667.R01.S.doc Version 5.0 Page 19 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 2 3 4 Standard YA6 YA6 YA6 YA7 Regulation 15 15 15 12 Requirement Suitable care plans must be produced Care plans must be produced with the involvement of service users Care plans must be in a format that service users can understand Staff respect service users’ rights to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual service user plan. The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. Service users have opportunities to participate (and are enabled to participate through e.g. provision of interpreters and translators, independent advocates, training documents in appropriate formats) in activities DS0000023231.V263667.R01.S.doc Timescale for action 03/02/06 03/02/06 03/02/06 03/02/06 5 YA8 24 03/02/06 6 YA8 24 03/02/06 The Grange Version 5.0 Page 20 7 YA9 13 8 9 10 11 YA24 YA24 YA32 YA33 23 23 14 18 which enable them to influence key decisions in the home, Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service user’s individual plan and of the homes risk assessment and risk management strategies. Furnishings must be of good quality. Rooms must be free of damp Staff must have knowledge of the disabilities and conditions of service users The home has an effective staff team, with sufficient numbers and complementary skills to support service users’ assessed needs at all times. The registered person operates a thorough recruitment procedure ensuring the protection of service users. 03/02/06 03/02/06 03/02/06 03/02/06 03/02/06 12 YA34 19 03/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA33 Good Practice Recommendations The Manager should develop epilepsy guidelines The manager should record his hours of work on the staff rota The Grange DS0000023231.V263667.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 DS0000023231.V263667.R01.S.doc Version 5.0 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. 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