Inspection on 30/09/05 for The Grange

This inspection was carried out on 30th September 2005.

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

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

Other inspections for this house

The Grange 20/07/09

The Grange 23/02/09

The Grange 29/02/08

The Grange 12/07/07

The Grange 06/12/06

The Grange 13/06/05

The Grange 21/10/04

The Grange 19/04/04

The Grange 14/01/04

The Grange 10/11/03

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

CARE HOMES FOR OLDER PEOPLE The Grange Barn Street Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ Lead Inspector Robert Pettiford/ Susan McGrath Announced Inspection 30th September 2005 09:00 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 DS0000029055.V255705.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 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 DS0000029055.V255705.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Grange Address Barn Street Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ 01634 270674 01634 270674 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) Mr Henry Alfred James Holloway Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: The Grange is located in a rural area with few local amenities. Shops and a Post Office are about 1-½ miles away at Allhallows. To the front of the property there is a circular drive and a paved area, offering ample parking. To the rear there is a large garden mostly laid to lawn, with a raised patio area with seating, providing a pleasant place for residents to sit in the warmer weather. Although it does not provide easy access for wheelchair uses. The home occupies detached premises with accommodation on two floors. There is a single person lift between the two floors. There are 8 single rooms and 1 double bedroom. 2 of the single rooms have en-suite facilities. There are call bells in bedrooms, bathrooms and toilets. The staff provide 24-hour cover working a rota, there is one waking night staff on duty at night. There are no cooks or domestic staff employed at the home these duties are undertaken by staff. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced Inspection at The Grange took place on 30th September 2005. The Inspector agreed and explained the inspection process with the Acting Manager. Documentation and records were read. A tour of premises was also undertaken. The focus of the inspection was to assess The Grange in accordance to the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. As this report was made following an announced visit and may not cover the standards in sufficient depth for the reader to make a judgment about the home, it is recommended that a copy of the last unannounced inspection report dated 13th June 2005 also be obtained. What the service does well: What has improved since the last inspection? The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 6 Urgent work was needed following the last inspection to ensure that the home complies with the standards with regard to health and safety. The home has taken steps to ensure all electrical and mechanical systems are now safe. Improvements to the environment were seen as a priority during the last inspection. Carpets and decoration were in need of attention and replacement. This work is ongoing and is scheduled to be completed by 25th December 2005. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 7 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 DS0000029055.V255705.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Prospective service users do not have all the information they need to make an informed choice about whether they wish to live at the home. Service users rights are protected by a written contract / statement of terms and conditions. Service user can be confident that their needs will be assessed prior to moving in to the home and have an opportunity for a trial period. EVIDENCE: Service users are provided with a Statement of Purpose. However it was found not to include all the information as required of Schedule 1 of the Care Home Regulations 2001. The manager was requested to update the statement of purpose. The manager agreed to do address this and include in the homes action plan. The contracts/terms conditions of residency contained all the information as required of the standards. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 9 The acting manager confirmed that she visits prospective residents either in their own home or current setting to complete an assessment of needs to ensure the home can meet those needs. The assessments seen were comprehensive and detailed. Care management assessments were also seen that provided information on prospective service users who were funded by Social Services. The home does encourage prospective service users to come to the home for the day and have a meal, they also invite for a overnight stay. All service users coming into the home do so on a trail basis, during this time the assessment continues and the service user has the opportunity to see if they are happy at the home. If at the end of this period the home feels it can meet the service users needs and the service user/family are happy then the placement can become permanent. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 10 and 11 Residents benefit from having clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Residents also benefit from being treated with respect and their dignity and independence is well promoted. Health needs are met and residents benefit from having full access to all professional health care services as required. EVIDENCE: Several care plans were read and found to be comprehensive and contain good detail. One of the care plans however needed amendment with regard to social needs. It states ‘as home permits’, this needs to reflect what the persons needs actually are and how they are to be met. This was discussed with the acting manager who realised this was incorrect and agreed to reassess this area on the plan. Other plans were did not show this error. Care plans were seen by the acting manager and staff as working documents. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 11 It was clear from the records that the service users were all registered with a local GP and their care needs were being fully met. Access to other health professional such as Chiropodist, Opticians and District Nurses were well documented. The majority of the service users were spoken with and it was very clear they all felt well cared for and were happy to live at the home. Good interaction was seen between staff and the residents and staff were seen to respect the service users dignity and privacy and used the preferred term of address for individuals. The home has recently stated to offer ‘musical movement’ on a regular basis in an attempt to provide appropriate exercises. All of the residents were offered the opportunity to see an optician if required. Care and comfort given to residents who were very ill was discussed with staff and it was evident that every care would be taken to ensure residents could remain in the home for as long as medically possible. The home had developed good relationships with the local District Nurses. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, and 15 Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents benefit from being given opportunities to participate in a wide range of activities. The residents benefit from the appetising meals and balanced diet offered by the home and those service users requiring specialist can be confident that their dietary requirements will be met. EVIDENCE: Discussion with the residents confirmed that the level of activities was sufficient and that they enjoyed a good level of stimulation through leisure and recreational activities both inside and outside the home. The home had been very fortunate in having relatives of residents who owned a taxi and regularly offered trips out. None of the residents said they got bored living at the home. Arrangements had been made for spiritual needs to be met with the local church visiting the home as required. The manager had also arranged for the KCC library to supply the home with a regular supply of reading books. Visitors to the home confirmed that they could visit the home whenever they wished and that they were always made very welcomed. Visitors made The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 13 comments like ‘the staff are very compassionate and if I had to live in a home I would choose one just like this’. The menus were viewed and appeared well balanced and nutritious. Residents confirmed that they always had a choice and that the food was nice and they had plenty to eat at all meals. Fresh fruit and vegetables were delivered twice weekly from a local supermarket but it was noted that UHT skimmed milk was used for teas and coffee and that butter was not provided. It is advised that the residents are consulted over whether they would prefer fresh milk and whether it be full cream, semi skimmed or fully skimmed. Also they should have a choice over whether they would prefer butter to margarine. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users are aware of their rights with regard to making a complaint and to whom to complain. Service users are protected from the risk of abuse by the home’s Adult Protection policy and procedures. EVIDENCE: A copy of the Home’s complaints procedures was reviewed along with the manager. The procedure was found to met with the standards and well presented. The inspector recommended that the home introduce a low - level complaints book to enable the home to monitor concerns raised by the service users. The home’s Policy for the Protection of Service Users and staff “Whistle blowing” procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training is provided in abuse. More courses are planned to ensure all staff receive the training required to protect service users from abuse. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. Inspected at the last inspection EVIDENCE: The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Service users’ care, social and emotional needs are promoted by the employment of caring and suitably trained staff. Service users are protected by the recruitment procedures within the home. EVIDENCE: From discussions with the acting manager, observations and reviewing the staff rotas sufficient staff were on duty at the time of inspection to meet the service users basic needs. The staff training records indicated planned and undertaken training. The manager evidenced that individual and group staff training needs had been identified. A wide range of training has been identified for all staff over and above core skills courses. Dementia training has been provided to support service users further. The acting Manager is to be commended on its level of training provided for staff within the home. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 17 First Aid, Food Hygiene, Health and Safety and other core courses are undertaken to maintain current qualifications and for protection of service users. The number of staff having attained or who are working towards attaining a relevant National Vocational Qualification demonstrate commitment to ensuring there is a suitably trained workforce. A copy of the induction programme was inspected. The topics reflected those set out by the National Training Organisation. Two staff currently have an NVQ level 2 in Care. Seven staff are currently on the course. The home showed that it undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of I.D and copies of qualification certificates, seeks two written references, confirms work status and also undertakes some telephone checks and retains all the information as required under schedule 2 of the Care Home Regulations 2001. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35 Service users benefit from living in a well managed home. Service users can be confident that there are safeguards in place to protect the management of their finances and their interests in general. EVIDENCE: The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 19 The acting manager is actively involved in the day-to-day management of the home and works with staff and service users. From observation and staff feedback the manager offers a clear sense of direction and leadership, which staff and service users understand. Service users, their relatives and staff are encouraged to comment on the services the home offers and to voice any concerns they may have. Documentary evidence and discussion regarding procedures and practice indicate the support provided to service users regarding their finances has been in line with this standard. For instance only small amounts of cash are handled, records are being kept and safe storage facilities have been provided. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 20 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 2 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x x 3 x x x The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 21 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 1 Regulation OP1 Requirement 4.—(1) The registered person shall compile in relationto the care home a written statement (in these Regulations referred to as “the statement of purpose”) which shall consist of—(a) a statement of the aims and objectives of the care home;(b) a statement as to the facilities and services which are to be provided by the registered person for service users; and(c) a statement as to the matters listed in Schedule1.5.—(1) The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s guide”) which shall include(a) a summary of the statement of purpose;(b) the terms and conditions in respect of accommodation to be provided for service users,including as to the amount and method of payment of fees;(c) a standard form of contract for the provision ofservices and facilities by the registered provider service users;(d) the most recent DS0000029055.V255705.R01.S.doc Timescale for action 30/12/05 The Grange Version 5.0 Page 22 2 2 OP2 inspection report;(e) a summary of the complaints procedure established under regulation 22;(f) the address and telephone number of the Commission.(2) The registered person shall supply a copy of the service user’s guide to the Commission and each service user. 5.—(1) The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s guide”) which shall include— (b) the terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees; 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations It is recommended that residents be asked about the use of milk and butter in their diets. The Grange DS0000029055.V255705.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000029055.V255705.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!