Inspection on 07/02/08 for The Grange

This inspection was carried out on 7th February 2008.

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

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 04/03/09

The Grange 10/09/07

The Grange 23/01/06

The Grange 10/08/05

The Grange 15/02/05

The Grange 14/09/04

The Grange 01/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Grange Grange Road Northway Tewkesbury Glos GL20 8HQ Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 7th February 2008 08:30 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 DS0000016608.V354770.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address Grange Road Northway Tewkesbury Glos GL20 8HQ 01684 850111 01684 290221 debbie@ctch.co.uk 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) CTCH Ltd Mrs Chris Martin Care Home 69 Category(ies) of Old age, not falling within any other category registration, with number (69) of places The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate a named service user who is 63 years of age Date of last inspection 10th September 2007 Brief Description of the Service: The Grange is a purpose built care home that has been extended over the years to provide residential and nursing care for sixty-nine older people. It is owned and managed by the C.T.C.H Ltd group of homes, and is situated in the residential area of Northway, in Tewkesbury. There is a small shopping precinct nearby and a Public House. The home has car parking spaces to the front and rear of the building, with a small-enclosed garden running alongside the home and a courtyard garden. The accommodation is set out on three floors, which are accessed by stairs or a shaft lift. Bedrooms are single with en-suite facilities, but there are a few rooms that can be used as double bedrooms if couples wish to be accommodated. Assisted bathing and showering facilities are provided, and there are several lounges, dining areas and other quiet sitting areas. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report should be available in the home for anyone to read. The weekly charges for The Grange range from the basic local authority rate of £357.90, up to £520.00, plus any Registered Nurse Care Contributions payable. Optical services, Chiropody, Hairdressing, Newspapers, and Toiletries are charged at individual extra costs. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Two inspectors carried out this inspection over one full day in February 2008. Checks were made against each of the numerous statutory requirements for improvement issued at the last inspection in order to assess the home’s progress towards compliance. Care records were inspected, with the care of six residents being closely looked at in particular. The management of residents’ medications was also inspected. A number of residents were spoken to directly in order to gauge their views and experiences of the services and care provided at The Grange. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished, and a large number of responses were received; some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, and in particular the overall management of the home was considered closely. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 6 What the service does well: The home provided a welcoming atmosphere for visitors, and ensured that there is a good amount of information about the home, its services and facilities, to assist residents and their families; however it must now ensure that it provides a copy of the latest CSCI report with its Service User Guide, as the last report had not been available. The staff respected residents’ level of independence and privacy, and in many cases sensitivity was shown towards their choices. Residents and their relatives generally spoke well of the home, the staff and their care, although there were an isolated few who felt that some staff might be better than others. Care staff were certainly seen being very attentive to the residents during the course of this visit. Numerous examples of appropriate support equipment in use on the basis of individual risk assessments were seen, and there was evidence of appropriate sourcing of medical reviews and healthcare. The systems for managing residents’ medications were good, although there were some very isolated aspects of it where shortfalls were seen, and an improvement required. The Grange provided some good opportunities for residents to maintain social contacts, with a varied programme of social activity and entertainment for most residents, however access to it for a few was limited. The meals seen appeared nutritious and appetising. Residents were very appreciative of the good quality and quantity of food provided for them, and despite a usually good degree of choice, there was one resident whose preferences had not been sufficiently considered during this visit. The kitchen was operated to a good standard. There were policies and procedures in place for the protection of the vulnerable residents, which staff were familiar with through training. The home offered a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Staff had the opportunity to attend training appropriate to their work, which included a good focus on the National Vocational Qualification training. New staff had undergone structured induction training, and had received supervision during this period. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although there was generally a much improved standard of care planning undertaken for residents here, gaps remained in the risk assessment work, with the home needing to take more robust steps towards reducing levels of risk to residents in certain areas. Staff could also record residents’ daily records in more informative detail. Although staff appear respectful in most regards towards residents’ wishes and choices, there are some areas where an improvement could be made. They The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 8 need to be more mindful of individual preferences and needs for social activity, particularly those residents with a sensory impairment. The option for use of the communal spaces was limited to residents, with at least three lounges being used for storage purposes on this occasion. Although it must be reported that there were definite indications that the proprietor has commenced an improvement plan for the deteriorating condition of the environment, progress in this area is slow, with many areas remaining in a poorly maintained and decorative state. This will be an ongoing project for the proprietor, and one which may be hastened once a designated maintenance person can be appointed for the home. The standard of cleaning in many parts was not good, with some areas appearing unclean, muddled and untidy, and odorous. A number of residents and their relatives reported they experienced problems with the laundry service, with items going missing or being incorrectly returned. Following this inspection it has been recommended that training in Managing Challenging Behaviour and the recently implemented Mental Capacity Act be provided for staff. 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 DS0000016608.V354770.R01.S.doc Version 5.2 Page 9 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 DS0000016608.V354770.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home now receive an improved standard of assessment prior to their admission, and can be more assured that the home should be able to meet their needs. EVIDENCE: There was a significant improvement in the standard of pre-admission assessment documentation seen on this occasion, although signing and dating could have been more evident in at least one of them. In the care records belonging to more recently admitted residents there were fully completed assessments that identified each individual’s health and care needs prior to admission to the home. The assessor had gone out to visit the prospective resident at their location at that time, and where applicable, the prospective resident’s relative had been party to the process with them. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 11 Prospective residents had received written confirmation of their placement in the home, as was required, and each had received a copy of the home’s Service User Guide. This Guide now requires some minor updating as the details of the previous manager are still contained within it, and neither was there a copy of the home’s latest CSCI report from September 2007 contained within it, as was required. The Grange does not provide intermediate care. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some continued shortfalls in this area, people living in this home can now expect to have their health and care needs met through an improving standard of care planning and delivery that is mindful of their privacy and dignity, and through an adequately managed system for administering their medications. EVIDENCE: There has been a great deal of work carried out in relation to the planning and documentation of residents’ health and care needs, and how they are to be met, with a whole new recording system introduced. This has been a big exercise for the home, and one that has warranted a lot more attention and focus on the needs of the residents living here; it has brought about significant improvements in the way care is planned and carried out. All residents have their own clearly written personal plan of care, which is subject to regular review. Residents’ care plans were individualised, and were The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 13 reflective of their personal wishes, their dignity, choices and levels of independence as far as possible. Six care plans were selected for a case tracking exercise. Each of these care plans was devised on the basis of an assessment of the resident’s needs, incorporating health, personal and social issues, and provided some good guidance for staff. In all cases bar one, a good range of risk assessments had also been carried out, to include manual handling, pressure sore vulnerability, nutrition, falls and the use of bed rails if relevant. In the one exception the resident had not long been living in the home, and staff had not completed the necessary risk assessments; these must be recorded at the point of admission in order to ensure that the necessary protection and care can be provided straight away. This resident had bed rails in place, although protection pads were not fitted to the rails, posing a degree of risk to the resident in terms of potential entrapment; (this also applied in a second case). Also a care chart seen in this room referred to the care of a sacral sore. This particular part of their care was not featured in their individual care plan, but in a separate file; it was recommended that, to avoid confusion, this should be part of the resident’s actual care plan. In another case, the manual handling risk assessment did not take full account of the resident’s sitting balance, with the risk assessment not reflective of the actual circumstances and risk. Support and equipment was in use on the basis of assessments where applicable, however in one case a carer was unaware of the actual feeding assistance requirements that were planned and documented for that particular resident. In another case where a high risk of falling was very evident, the radiator in the bedroom did not have a low surface temperature safety guard on it, posing a risk of burning should the resident fall against it. This person did not have a drink or a call bell to hand, which would have increased the chance of them falling whilst trying to get help or a drink for themselves, which the resident said was the case, as they lost their balance when they did this. In a third case the resident was sitting in a wheelchair for the entire day, and had no pressure relief cushion; this resident said that they had suffered with pressure sores previously, before coming into the home, and that they found the wheelchair uncomfortable. They were also registered blind, and appeared quite isolated from others, and indicated that they felt disorientated since coming here. There was no specific plan of care to address this person’s sight disability, and they were at high risk of falling. Recorded evidence of multidisciplinary working was seen between the home and other health care services. Residents were receiving regular medical The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 14 reviews and consultations when needed. The manager reported that one of the local community nursing teams planned to hold a weekly clinic on the premises, in order to develop care services for the benefit of the residents receiving personal care in conjunction with the home staff. Daily records attached to each care plan were only recorded in brief by staff, and in one case an issue of concern had been reported in relation to an emerging care need; there was no other mention of this anywhere, neither was there a plan of care to address it further. Two resident surveys out of the ten that were received indicated that they felt their care could be better, whilst the others confirmed their complete satisfaction. Each of the fourteen out of the thirty visitor and relative’s surveys received confirmed that in their view their relative was receiving good care in the home, with just one saying that hygiene needs for their relative could be better attended. Residents spoken to during this visit all spoke positively about the way in which they were looked after here, with just one exception, who said that they ‘had yet to make their mind up about living here’. A relative said ‘I feel that the home gives a lot of support, love and comfort to residents’. Medications were held securely in the nursing and residential areas of the home, although in at least one case there was an external medicinal cream on a sink unit in a room, which did not appear to have been prescribed, and was undated when opened, making it difficult to know the exact circumstances of its use; this required disposal at the time in view of this uncertainty. Medication administration charts were printed clearly by the supplying pharmacy, and contained a record of drug administrations; an isolated signature gap was noted in one case however, with no coded entry to account for an omission. Two people had signed any handwritten amendments on charts, with checks made against the supplied medication for accuracy. Audits on boxed medications were carried out in both areas of the home, and were correct in each case. Staff were observed being polite and respectful towards residents, and were delivering care in the privacy of their own rooms. Residents generally said that staff were respectful towards them, with one saying that staff always knocked on her door before entering. One relative commented that ‘the quality of their relative’s life had improved greatly since coming here’, whilst another said that ‘staff were very sensitive towards their relatives’ changing needs’. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 15 The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people living in this home are mostly supported to exercise personal choice, maintain their social contacts and have a good standard of food, there are instances where shortfalls and omissions in staff practices are having an adverse impact in this area for some of them. EVIDENCE: The home does not have a designated social activities coordinator, and care staff take responsibility for organising various events and activities, which some indicated could be problematic in terms of time constraints, given other care and maintenance responsibilities that they have. In most cases residents had been consulted about their ideas and choices for activity, and where possible this was accommodated. A programme of activity was planned and produced in the form of a monthly diary, which was issued to each resident. Many of the residents spoke positively about the social opportunities available to them, saying that they enjoyed the activities on offer. One in particular said that they enjoyed the special occasions that were observed, such as Pancake Day and parties. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 17 Comments from residents’ relatives included, ‘Staff encourage and persuade my relative to remain socially active’, ‘Staff always encourage residents to join in with social activities and are helpful with all tasks’, and ‘Staff do their best to entertain, especially on special occasions’. Links within the local community had been made, and this included local churches and schools; regular religious services were held in the home, to suit each denomination. Occasional trips out are planned, but interest among residents was reported to be varied. One particular resident who was registered blind, commented on survey that their option to participate socially was limited due to their disability. So far this resident felt that their comments to this effect had ‘fallen on deaf ears’. This was further borne out during the visit, as this person said he ‘used to have taped newspapers where he used to live, but that now he just sat and moped’. The sourcing of aids for this person, and the accessibility to the social activities programme for residents with disabilities was discussed with the manager. The home does not impose any restrictions on visitors to the home, and residents can receive their visitors in accordance with their wishes. All visitors who completed survey forms confirmed that they were made to feel welcome in the home. One said that ‘they felt particularly well supported by the staff’. The new manager planned to hold a social evening for residents’ friends and families in the near future. Residents were seen spending time in various locations around the home, in accordance with their wishes. Some were rather more reliant on the staff to assist them in this regard, but staff were mindful of this, and were heard offering choice to people, and being sensitive to their wishes. As reported above, one resident was left without a call bell, which posed restrictions on his ability to pursue choices. In a small number of other instances there was a degree of doubt as to whether individual choice had been fully respected, with one person receiving a meal they disliked and had not wanted, and another with a television screen placed in close proximity to them, with the picture rolling and shaking the whole time. A number of residents confirmed that they were freely able to choose what they did, with one saying that ‘they could pretty much do as they liked, and could get up and go to bed when they chose’. Visitors to the home confirmed on surveys that residents were supported to live their lives how they choose, with levels of independence respected. One The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 18 also said that ‘staff were very encouraging towards residents’, whilst another said ‘ staff were very supportive of their relative’s chosen way of life’. Many of the residents’ bedrooms contained personal belongings, and as a consequence appeared individual and homely. However, in one particular case the person’s room was very bare and did not appear homely and comfortable at all. The manager reported that staff had removed certain things from the room due to risks inherent with the person’s behaviour; this course of action must be kept under constant review for its continued appropriateness. The service of lunch was seen, and the meals were well presented, appeared wholesome and nutritious, and contained fresh produce. The mealtime was calm and unhurried, with residents able to enjoy their meals in a relaxed way. A list of residents’ choices from the menu was routinely given to the cook, but on this day there was a roast dinner, which the cook said all residents liked so no other meals were served. As reported above, there was at least one resident for whom this had not been the case, with them having an unacceptable meal served to them, which they had to return; this was despite this person having made it clear previously that they disliked this particular meat option. Residents spoke well of the food, with several saying it was excellent, and staff were overheard offering choice and additional portions. One visitor commented that in their experience the food they had seen being served was excellent, and that their relative’s specific diabetic needs were ‘very well addressed by the home’. Staff were also assisting residents where necessary, and those requiring it were provided with protection for their clothes and eating aids. A heated trolley was provided to allow for meal service to residents in the number of dining locations throughout the home. Special diets were catered for, and the cook was very experienced and capable in catering for the needs of the resident group. Good catering records were maintained, and the kitchen was well organised, and was reported to have fared extremely well at a recent Environmental Health inspection. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although not complete, there is a growing confidence that the people living in this home can rely on staff to help resolve their concerns, and can feel more reassured regarding the policies protecting their rights and the prevention of abuse. EVIDENCE: The home’s written procedure for addressing any complaints and concerns was displayed, and had been issued to each resident within their information brochure. Changes are now needed to some of the detail contained within it, so that interested parties can have access to the correct contact details for CSCI, as these are now out of date. There was a different attitude demonstrated by the present manager towards any concerns raised within the home. This was one that demonstrated a much clearer intent to view complaints positively, listen and address them promptly and use them as a tool to drive improvements. Where possible residents confirmed that they knew how to raise any concerns, and that staff usually listened and acted appropriately; two said that this varied, as some were better at it than others. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 20 Visitors confirmed that they knew how to raise any concerns, and that they had confidence in the home to address them. One said that ‘sometimes they had to repeat their concerns, but that on the whole things got sorted eventually’. There was more confidence among the staff group to raise and discuss issues with the new manager. A record of concerns that had been received was maintained, and since the last inspection two had been fully addressed by the home. One of these had resulted in disciplinary proceedings being undertaken with implicated staff for the protection and safeguarding of the residents, and in the other, concerns raised by a visiting healthcare professional had also resulted in disciplinary proceedings further to evidence of some poor practice from certain members of the staff team. Each of these particular circumstances had already been reported to CSCI, as was required. The home had documented policies and procedures to address forms of abuse and whistle blowing procedures, which were readily available for staff to read. Staff had received Safeguarding Vulnerable Adults training, and some said that it had been ‘a really good interactive session’. New staff had received similar training during their structured induction training. Assessments carried out on residents new to the home took account of their capacity to make decisions affecting them, however other than this there was no evidence to confirm how the home intends to ensure its compliance with the recently introduced Mental Capacity Act 2005 (MCA). The previous manager received training in this area, but has now left, and it was not clear how staff awareness in this area was to be developed. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in this home are provided with a reasonably comfortable environment, but the ongoing slow progress to improve and repair it is having a continued detrimental effect on its appearance, safety and hygiene. EVIDENCE: Since the last inspection work has commenced to halt the deteriorating condition of the home environment’s décor and standard of maintenance. Improvements were seen in certain areas, but these were few at this stage, with many areas remaining in poor decorative order. The home is endeavouring to recruit its own maintenance person in order to combat this unacceptable situation, but it is proving a challenge to find a suitable person. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 22 Patches of wallpaper remained torn, and there were numerous areas of woodwork that were badly scuffed and damaged. Painted walls were marked in a number of areas also, including some residents’ rooms. 4 out of the 6 ceiling light bulbs in bathroom 2 on the first floor were not working. A towel ring was broken off in one of the resident’s en-suite bathrooms, and had been left on the floor. The coating on the toilet seat in bathroom 3 on the top floor was badly damaged, and looked unsightly. The shower drain in the floor in bathroom 1 on the top floor was broken in half, and had been precariously left in place. Storage areas for equipment were lacking, with large bulky items stored in at least three of the communal rooms, rendering the rooms unusable to residents and limiting their opportunities for choice. There were strong unpleasant odours detected in a number of areas throughout the course of the day. Rooms were not cleaned to a good standard, and carpets were seen with debris on them, including ground-in food debris in dining areas. Bathroom floor tiling was unclean, with dirt being permitted to collect around the edges and in joints and corners. Sinks had not been thoroughly cleaned. A ‘raised toilet seat’ in one resident’s en-suite toilet had been left in a dirty condition. One resident commented on the unpleasant odours that were noticeable around the home, and one visitor commented on the ongoing maintenance issues, but also said that they had noted some improvement more recently. Bath hoists and wheelchairs were in a cleaner condition on this occasion, and a new waste bin had been provided to one of the bathrooms. A new stair carpet had been fitted where particularly needed, although other carpets were showing obvious signs of wear and tear, with a hole developing on one of the stair treads outside the kitchen area. Bathrooms were very untidy still, with a variety of assorted items being openly stacked in them, including piles of towels, incontinence pads, urinals, jugs, linen, coat hangers, chairs and disposable gloves. The laundry room was in reasonable order, with new tumble driers and four washing machines working efficiently. There was a huge volume of laundry being handled here, and there were rails of unnamed clothing that staff were finding difficult to return to their rightful owner; the laundry assistant said this was an ongoing problem, and was one that was mentioned by certain residents’ families. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 23 A visitor also mentioned that they had seen poor quality bed linen in use; when looking into this it was evident that some items had seen prolonged use, old thin blankets in particular, but a new supply of items was gradually being introduced, which should remove any poor quality items from circulation. Staff were provided with a good supply of gloves and aprons, and had liquid soaps, paper towels and sanitising hand gels. Some of the liquid soap dispensers were broken, and the manager said that new ones were being ordered, despite this assurance being given at the last inspection. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although certain changes are affecting the stability of the staff team at present, people living in this home receive care from a reasonably competent workforce, and can now feel more reassured by the home’s recruitment procedures, which have observed more robust pre-employment checks. EVIDENCE: Some reorganisation had been made to the staff rota since the last inspection, and there has been a slight increase in the amount of staff hours used. The staff were divided into two teams, to provide greater continuity in each part of the home. Allocation sheets were seen, and these directed staff in the areas of work, with a significantly greater number of carers provided for those residents requiring nursing care; these totalled eleven. Two qualified nurses were on duty during the morning on five days of the week, with one at all other times. The allocation of carers to provide personal care only is minimal, with only one on each floor, plus one extra to assist on any of the three personal care floors necessary. There were several agency staff working in the home and this was said to be due to existing staff having to take leave, as many of them had outstanding allowances at this late stage in the ‘leave year’. The manager intends to The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 25 monitor this situation more closely in the future in order that this circumstance does not reoccur. The new manager had made changes to the previously long established working practices in the home, which were proving restrictive in terms of meeting the needs of the residents and best suiting the home. The way in which staff were responding to this was variable, with some welcoming and dealing with the changes better than others. The manager had given staff additional responsibilities in the areas in which they work, as she viewed this as an essential part of the home’s and staff development, and assisted in making staff more aware and accountable for their part in the team. Some staff said that things were being changed for the better, whilst others spoke negatively regarding the additional duties and responsibilities they were being given. Some said that some of the additional non-care duties were likely to detract from their care of the residents, and from their ability to provide good social contact for them. At least four of the staff who responded to CSCI surveys indicated that they felt undervalued by the nursing team, and would like to see communication and support improve under the new leadership. Several also felt there should be more of them. The new manager recognised the work there was to do in this area, and had strategies to deal with it, but clearly this would also require cooperation and a more positive view from the staff in terms of them developing and embracing positive changes within the team. An ancillary team of administrative, catering, cleaning and laundry staff supported the care and nursing team. The manager, who is not a nurse, worked in a supernumerary capacity and was supported by a deputy manager, who is a qualified nurse, and who provides the clinical lead in the home. Residents and visitors to the home spoke well of the staff team, saying they were kind and caring. One resident said that staff ‘did not always provide the support that they wanted, with some being better than others’. All of those spoken to or surveyed indicated that staff were available when they needed them. One visitor said that ‘basically staff were tolerant and friendly’, whilst another said ‘the staff were excellent’. There was a good focus on the National Vocation Qualification (NVQ) programme for care staff, with no fewer than 27 staff having achieved the award. Personnel files relating to two members of staff who had been recruited in recent months were inspected. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 26 In each instance, the prospective employee had completed an application form providing details of their employment history. Interview notes were recorded, although these were minimal and could have been much more informative. At least two written references had been provided in each case, including one from the last employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. The manager was continuing to be the designated training coordinator, and had maintained records of training and development needed or completed for all staff. These records demonstrated the range of training undertaken, with different courses and learning available according to the person’s role in the home. In addition to mandatory training in topics such as safeguarding, manual handling, fire safety and first aid, distance-learning courses had been undertaken in infection control and in equality and diversity issues, although not everyone had done the latter. Dementia awareness training had been provided through a local college, and in consideration of certain challenging behaviours possible with a very small number of the residents it was recommended that staff receive challenging behaviour training. An assessment of new staff skills had been undertaken in line with the Common Induction Standards for Care Workers, with different levels of induction training given according to previous experience. Training records demonstrated that inexperienced staff had received a structured induction training that was in line with the national standards from an external training provider, whilst others had received an in-house induction programme. Each programme included an introduction to the home and its policies, manual handling, fire safety and safeguarding vulnerable adults training. Allocation sheets demonstrated that new staff had worked under supervision for their induction period. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although at an early stage, recent changes in this home have meant that the people living here can begin to benefit from more open and respectful management, which strives to monitor quality and standards more closely. EVIDENCE: There has been a change in the management structure of this home since the last inspection, with the previous manager leaving to manage another care home within the group. The new manager had only been in post for a month at the time of this visit, but had already made very significant in-roads into the changes and improvements that were needed in this home. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 28 The manager is not registered with CSCI for her role, and she must now submit an application to the CSCI Regional Registration Team for their consideration. She is not a registered nurse, but has already achieved the Registered Manager’s Award and the NVQ Level 4 in Care. The deputy manager was providing the clinical lead for the home in view of this. The manager had a very clear vision for the home, the emphasis of which was to ensure that the focus was brought firmly back to the welfare of the residents living at The Grange. Staff confirmed that the new manager was very accessible, approachable and easy to talk to, and was implementing lots of changes in the home, some of which were viewed positively by staff. Since the last inspection the service provider, CTCH Ltd, and the new manager have been developing strategies to improve the previously failing standards at the home, and although there was still much work to do, already some positive changes and improvements were evident. There have previously been few effective quality monitoring audits, but new auditing tools have been devised and implemented, to include monitoring of the environment, equipment, care planning and medications. The new management was eager to provide a stronger leadership and focus for the home in terms of improving standards here. The manager had devised her own development plan for the home, and was receiving regular and robust support from CTCH Ltd Group Care Manager. The required copies of monthly written reports produced by CTCH Ltd on the conduct of the home were not available there, although they have been giving regular updates on progress here to CSCI directly. Resident meetings have not been held, but the manager was seen as accessible and approachable towards them, and stated that she intended to introduce resident meetings as soon as possible. There was also an intention to introduce an annual resident survey, so that residents could be provided with an opportunity to have more of a say in how their home is run, as this has been lacking on a regular basis. This survey would also take account of visiting healthcare professionals’ views and residents’ families. A meeting combined with a social occasion was being organised for residents’ families and friends in the near future. The outcome of CSCI reports had been shared with staff, who had been given a clear direction towards making the improvements needed. The home offered a safe system for looking after residents’ money and valuables if they wish, and a small number had chosen to use this. All items were held securely, and well-kept and transparent records were held in each The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 29 case, providing a clear audit trail throughout. Random checks on two such arrangements proved to be accurate and correct. The home had written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training was provided for staff. Safety checks on the fire alarms and emergency lights have not been carried out regularly, but there were now clear directives for this to be carried out on a regular basis, with a monitoring system already in place. Fire extinguishers had been maintained. The fire safety risk assessment has been completely reviewed and upgraded, to take greater account of the safety of the residents, and to include phased evacuation procedures in the event of fire. Floor plans were seen, which provided clear direction for this eventuality. Fire safety notices around the home will now need to be reviewed and amended as well. Staff have yet to receive training in the new procedures, as they have only just been completed. Hot water temperatures were regularly checked for safe levels, and the proprietor has previously provided confirmation to CSCI that hot water is stored appropriately to prevent Legionella. Necessary safety checks and maintenance of utilities and equipment had been undertaken in a timely fashion, and the associated records were kept in these areas. There was first aid equipment provided, and basic first aid training had been provided to staff. Accident records were seen as part of the case tracking exercise, with an improved level of risk assessment for those residents at risk of accidents and falls. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 30 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 5(1d) Requirement The home must provide a copy of CSCI reports to interested parties with the Service User Guide. The home must ensure that care plans are written so as to clearly show how residents’ needs in respect of all aspects of their health and welfare are to be met, including those with a sensory impairment. The home must conduct and record a risk assessment when considering the use of bed rails. This is to ensure that any risk posed to residents by the use of the rails, such as entrapment, can be minimised or removed. The home must take steps to reduce the risk of a burn injury occurring in the case of the resident identified during inspection, who is at risk of falling against the radiator. The home must date external and topical cream medications on opening, so as to ensure they are not used beyond their expiry date. DS0000016608.V354770.R01.S.doc Timescale for action 29/02/08 2 OP7 15(1) 07/03/08 3 OP8 13(4c) 07/03/08 4 OP8 13(4a) 07/03/08 5 OP9 13(2) 07/03/08 The Grange Version 5.2 Page 32 6 OP14 12(2) 16(2n) 7 OP19 23(2l) 8 OP26 16(j.k) 9 OP33 17 (2) Schedule 4(5) The home must ensure that consideration is given towards all residents’ choice and diversity, regardless of disability, in relation to the social activity programme, how they spend their time and choose their food. The home must make suitable provision for storage purposes of the home, so that the communal areas provided for residents’ use could be kept clear of large items of stored equipment. All areas of the home must be thoroughly cleaned and then maintained in a hygienic and odour free state. Copies of the written reports produced by the provider under Regulation 26 must be kept in the home. 31/03/08 30/04/08 31/03/08 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP8 OP9 OP18 OP30 Good Practice Recommendations Staff should record the daily records in fuller detail. A pressure-relieving cushion should be provided for the resident identified during the visit. Where creams and ointments are stored in bedrooms you should make sure the arrangements are safe for everyone in the home. Training should be provided for staff in relation to the Mental Capacity Act (MCA) 2005. Training should be provided for staff in relation to Managing Challenging Behaviour. The Grange DS0000016608.V354770.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000016608.V354770.R01.S.doc Version 5.2 Page 34 - 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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