Inspection on 06/12/06 for The Grange

This inspection was carried out on 6th December 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Grange 05/06/07

The Grange 22/06/06

The Grange 03/11/05

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 Christine Lawrence Key Unannounced Inspection 6 December 2006 12:00 The Grange DS0000023231.V307506.R01.S.doc Version 5.2 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.V307506.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 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.V307506.R01.S.doc Version 5.2 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) lifetimecare@tiscali.co.uk Lifetime Care Development Limited Mr Eddie Fisher Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection Brief Description of the Service: The Grange is a small care home for four people with learning disabilities. It is within the village of Beltinge which has some local facilities, and a short distance from Herne Bay, a nearby town with more facilities. A bus route is close by and there is a mainline rail station at Herne Bay. Parking is not restricted in the roads around the home. The statement of purpose relating to the home, as well as business cards and information leaflets are made available to prospective residents and their representatives on request, as is a copy of the latest Commission for Social Care Inspection (CSCI) inspection report. In the information sent by Mr Fisher (18 October 2006), prior to the visit to the home, fees were noted as between £800.00 and £2000.00 per week. Personal toiletries, newspapers and magazines are not included in the fees. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook an unannounced site visit to the home. The proprietor, Mr Fisher, who owns Lifetime Care Development Limited, had previously sent in a pre-inspection questionnaire with information about the home, staff and residents. There are currently two residents living in the home. One resident completed a survey with support from staff and one relative completed a survey on behalf of a resident. Comment cards were sent to the care managers for the current residents and both of them responded. During the site visit the inspector spoke to residents and staff members and made observations of interactions between residents and staff. The inspector also walked around the building, including spending time with residents in their rooms. Information from the previous inspection was also used for this inspection. What the service does well: What has improved since the last inspection? 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 DS0000023231.V307506.R01.S.doc Version 5.2 Page 6 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.V307506.R01.S.doc Version 5.2 Page 7 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be confident that their needs and aspirations will be assessed. EVIDENCE: The senior member of staff said that the format for assessing prospective residents’ needs is based on the ongoing assessment format used within the home which does incorporate ‘person centred planning’. There has been no new admission since the last inspection. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Needs and goals are reflected in individual plans. Residents and/or their representatives are involved in the care planning process, ensuring that staff know how to support residents according to their own wishes. EVIDENCE: Two individual care plans were seen. There are care plans from care managers and the records also contain reviews carried out by the care manager, involving residents, relatives, staff from the home etc. A format for ‘person centred planning’ is being used. One of these was signed by the resident, with a comment from staff … “This plan written and compiled with xxxx’s help”. An example was noted of pictures being used to illustrate daily living activities. Risk assessments are included within individuals’ records. Some examples seen were out on own, employment, bowling, kitchen safety and swimming The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 9 alone. The care plan folders have been greatly improved to ensure that information is readily available and clearly presented. Examples were noted of residents being enabled to make choices and decisions about their lives, either in simple everyday things like food, spending time in own room, times for going to bed etc and also wherever possible in more complex ways such as wishing to have employment, which activities to pursue and issues about relationships. Residents’ abilities to manage their own money vary and this was reflected in the way they are supported by staff. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents take part in appropriate activities and use community facilities. Personal and family relationships are supported and an appropriate menu is provided. EVIDENCE: Residents take part in a variety of activities and viewing records and talking to, and observing residents confirmed this. This includes leisure, educational and household activities. Some things are planned and others are more spontaneous. The senior member of staff showed the inspector the improved way of recording activities. At a recent review it was agreed that the range of activities be looked at for one person and the senior member of staff confirmed that this was happening. Residents have attended local college courses in the past but no one currently goes. The home is currently supporting one person to look at opportunities for employment. There is a television in the lounge The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 11 and both residents also have their own set. Residents also enjoy playing CDs in their own rooms. Facilities within the local community are used for things such as swimming, bowling, going to local pubs, eating out and personal shopping. One resident is involved in some food shopping. Staff work evenings and weekends to enable residents to do things at these times. There are sometimes limitations due to no driver being available. One resident has been given a different key for his own room which promotes his privacy and independence. Information was noted showing that individuals are supported regarding their family contacts and the opportunities for personal relationships. The menus seen by the inspector were satisfactory and a record is kept of individual’s choices. Specialist dietary advice has been sought and the home identifies any special requirement regarding diet and monitoring of weight. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ preferences are known and their physical and emotional care needs are responded to. Residents are protected by the homes’ policies and procedures regarding medication. EVIDENCE: Where a resident is able to speak up about preferences this is responded to. If a resident is not able to fully articulate things on a day-to-day basis, more information is included within the care plan information. Residents were individual in their style of dressing. Additional support will be sought from outside professionals such as speech and language therapists. Physical needs, and wishes associated with them, are noted for each individual and it is clear that residents are supported to attend appointments. Although physical health care needs are identified the introduction of Personal Health Action Plans (as noted on the Valuing People website) would be of benefit to residents. As previously noted, 6 monthly reviews are carried out under the auspices of the placing authority’s representative (care manager). One care manager said The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 13 that communication from the home was good and another commented on the satisfaction relatives had about the home. All staff have received training regarding medication administration. The medication administration records viewed were appropriately maintained. Storage and policies and procedures are satisfactory. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ views will be listened to. Appropriate training for staff has enhanced their ability to protect residents. EVIDENCE: The home has a suitable complaints procedure. One resident’s relatives said that they knew how to make a complaint but they have never had to. One resident in both the written survey and in conversation with the inspector said they would speak to Eddie (Mr Fisher) if they were unhappy. No complaints have been received by the home since the last inspection. There are policies and procedures relating to adult protection, including whistle blowing and Mr Fisher has the up to date policies and procedure from Kent and Medway social services. Guidelines for staff are available relating to the challenging behaviour of one person but they have not been needed since the resident moved to the home. Although there are policies in place it is good practice that training should underpin staff guidance relating to protecting residents and subsequent to a previous requirement Mr Fisher has updated the training for all staff. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home which is comfortable and homely and clean and hygienic. EVIDENCE: In general the home provides a homely and comfortable environment. Furniture and fittings are domestic in style and as a home in existence prior to 1 April 2002, the personal and communal space is sufficient. The building is adequately maintained. A new carpet has been provided in the lounge and the inspector was informed that the dining area would be next. Decoration has been carried out to all rooms, including empty bedrooms in readiness for any new resident. There is access to buses locally and to a mainline railway station in nearby Herne Bay and the home also has two vehicles, which allows residents to The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 16 access local amenities. Some things are within walking distance as the home is on the edge of a village type community. The house fits in with the local community. At the time of the inspection the home was clean and free from any unwelcome odours. Conditions in the laundry have been improved. Foodstuff is more appropriately stored and the hand washing facilities have been improved. The floor is now more easily cleaned. The inspector was informed that more work is planned to continue the improvements in the laundry. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from supported and supervised staff who are adequately trained. EVIDENCE: Three members of staff have achieved National Vocational Qualifications in care at level two. One of these (a senior member of staff) has also completed level 3 and level 4. The inspector was informed that one other member of staff is currently undertaking NVQ level 2. There is some written information relating to specific disabilities on individuals’ care plans and specialist advisors have been and are involved with residents. Throughout the time of the inspection staff were observed to be responsive to residents. The records of two members of staff were viewed and showed that the recruitment process includes using an application form, asking for at least two references, undertaking criminal record bureau checks, providing written terms and conditions of employment and providing staff with copies of the general Social Care Council code. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 18 Records of the training sessions that staff have undertaken were viewed. Some of these are with outside training providers and some are in house. Where in house training is provided Mr Fisher is endeavouring to reflect how staff competency is judged and this includes using questionnaires. Induction training is provided within a pre-printed format relating to Skills for Care recommendations. At the previous inspection Mr Fisher was aware that there are now new Common Induction Standards. He was confident that the provider he uses for induction materials was in keeping with the new standards. As Skills for Care and Valuing People are working with Learning Disabilities Award Framework (LDAF) to provide appropriate induction and ongoing standards for staff working with people with learning disabilities, it was recommended that these websites be monitored to ensure that the homes’ induction and ongoing training is appropriate. It was not possible to check with Mr Fisher if these websites are being monitored therefore the recommendation from the previous inspection is included in this report. The staff records viewed indicated that supervision is being provided. The format used covers training needs, any concerns, any suggestions, where going and any personal issues. The senior member of staff who does the supervisions also records any actions taken as a result of the supervision. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Residents benefit from a home which is run by a qualified manager. Residents would benefit from an expanded quality monitoring record. Residents’ health, safety and welfare is mostly promoted and protected. EVIDENCE: Mr Fisher is the registered manager. He has more than two and a half years experience of managing within a care setting and has his National Vocational Qualifications (level 4) in care and management. Mr Fisher was not present at the time of this inspection therefore it was not possible to find out what progress he has made regarding quality monitoring. At the previous inspection it was noted that he had established a quality monitoring system but the The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 20 record of this monitoring did not yet include details of any measures considered necessary in order to improve the quality and delivery of the services provided in the home. Mr Fisher had agreed to look at this aspect of his self-monitoring and therefore this recommendation still stands. The inspector was enabled to spend time privately with residents. The senior member of staff informed the inspector that the policies and procedures have not changed since the inspection in June. All staff have received an update to infection control training as recommended at the previous inspection and food hygiene updates are planned. A spot check on maintenance and service contracts at the previous inspection showed that these are appropriate and up to date. Accident recording is compliant with the Data protection Act (1998). Fire safety records and checks were viewed and were appropriately maintained. Risk assessments are in place for various aspects within the home eg secure storage of sharp knives. Water temperatures are monitored. The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 2 X The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 22 NO 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. Standard Regulation Requirement Timescale for action 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 3 4 Refer to Standard YA12 YA19 YA30 YA35 Good Practice Recommendations The range of activities for one resident should be reviewed as identified. Health Action Plans should be introduced in keeping with the recommendations of Valuing People. The further work planned for improving the laundry should go ahead. The websites for Skills for Care, Valuing People and LDAF should be monitored to ensure induction and ongoing training is appropriate. (from the previous inspection June 2006) The quality monitoring system should be expanded (from the previous inspection June 2006) The planned food hygiene training should go ahead. 5 6 YA39 YA42 The Grange DS0000023231.V307506.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local 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 DS0000023231.V307506.R01.S.doc Version 5.2 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. 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