CARE HOMES FOR OLDER PEOPLE
Grange, The 162 Sutton Park Road Kidderminster Worcs DY11 6LF Lead Inspector
Y South Unannounced Inspection 7th October 2005 2.45pm 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 Grange, The DS0000037473.V251355.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. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grange, The Address 162 Sutton Park Road Kidderminster Worcs DY11 6LF 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) 01562 756820 01562 756822 Worcestershire County Council Mrs Pamela Ann Vivian Care Home 35 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (35), of places Physical disability over 65 years of age (35) Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may also provide this intermediate care to service users over the age of 60 who have a physical disability. The home may provide intermediate care for a maximum of 18 service users whose needs are in categories OP and PD/E. The home may accommodate one person with physical disabilities under the age of 60 years, for intermediate care. 22nd April 2005 Date of last inspection Brief Description of the Service: This home is owned and operated by Worcestershire County Council. The post for a registered manager is currently vacant. Mrs Pamela Vivian the deputy manager is acting as a temporary manager until recruitment has been successfully completed. The Grange is a purpose built home on two floors. There is a shaft lift between the floors. All thirty-four bedrooms are for single occupancy but couples can be accommodated in some of the largest rooms if desired, providing the total number of service users in the home does not exceed 35. Two rooms have en-suite facilities. There are a variety of communal lounges and dining areas, and kitchen facilities for service users to make their own drinks and snacks should they choose to do so. The building has an accessible garden with level paths and the premises are situated in a residential area on the edge of Kidderminster, a short distance from local shops and facilities. The Grange offers an intermediate rehabilitation service to eighteen people of either sex over the age of sixty. An assessment and respite service is offered to people over the age of sixty-five years. The provision of permanent care is being phased out. A day care service is also provided by the home but this service is not covered by this inspection. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The routine unannounced inspection took place over three and a half hours between 2.45pm and 6.20pm. Assistance was given by Mrs Vivian. The inspector also spoke to five relatives, eight residents and three staff. The inspection focused on the requirements arising out of the previous inspection, and the standards relating to protection, staffing and management. A service questionnaire was left at the home to be completed and returned to the Commission for Social Care Inspection. The manager was asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but will prove useful in assessing the various views that are held. What the service does well:
The service provides a warm welcome to everyone who enters the home. Currently building work is in progress to enlarge the various communal rooms and improve facilities for residents. Despite the inevitable upheaval of building work, health and safety matters are being addressed and the staff are coping well and good-humouredly with the dust and disruption. The residents who commented on the events confirmed that it was not distressing them and in fact they found all the activity interesting. Residents say that the standard of care they received is excellent, the food and choice is wonderful and the staff are very kind and helpful. They say that they know who would help them if they are worried or feel the need to complain. The staff have good access to training and receive a lot of support and guidance from the senior staff. The training provides them with the knowledge and skills to deliver the care service that is needed. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 6 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. Grange, The DS0000037473.V251355.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 Grange, The DS0000037473.V251355.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): These standards were not assessed during this inspection. EVIDENCE: A requirement arose out of the previous inspection that prospective service users must have a full and up to date assessment of their needs specifically in relation to pressure care, nutrition and moving and handling, prior to any admission to the home. The current pre-admission assessment undertaken in the Community Care Assessment lacked the detailed information necessary in order to compile an effective care plan. The assessment process has not changed and during this inspection it was acknowledged that the home would be able to undertake a more thorough assessment. Therefore it was recommended that, as part of the admission process, full nutrition, pressure care and moving and handling assessments be completed in the home on which to base appropriate care plans. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 9 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): These standards were not assessed during this inspection. EVIDENCE: A recommendation was made following the previous inspection that hand written Medical Administration Records should be signed by two members of staff when they were writing out and when medication was checked in. This recommendation was not followed in all cases and therefore will be repeated in this report. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 10 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): These standards were not assessed during this inspection. EVIDENCE: Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 11 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): These standards were not assessed during this inspection. EVIDENCE: Although these standards were not assessed the complaint record was checked. This indicated that one complaint had been received since the last inspection and this had concerned a leaking tap. Appropriate action had been taken to effect repairs. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 12 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): 19, The residents live in an environment that suits their needs. Building work to improve facilities is being undertaken with due regard for their welfare. Facilities and equipment, supported by staff training, ensures that the risks of cross infection are kept as low as possible. EVIDENCE: A tour of the building was undertaken. It was observed that efforts were constantly being made to keep the building dust under control. The cleanliness of the home was a credit to the staff’s efforts and achievements. Generally the areas of the home unaffected by the building work were well maintained. The manager confirmed that decorative improvements would be undertaken when the building work had been completed. None the less the residents’ bedrooms were seen to be clean, well decorated and furnished, and arranged to meet the needs of the individuals.
Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 13 In one bathroom it was observed that a wooden shelf had become warped and unhygienic in the damp. This will need to be removed. Personal protective equipment was available for staff to use when necessary. Liquid soap and disposable towels were place in communal toilets and bathroom facilities. Laundry and sluice facilities were acceptable. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 14 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, 29, 30 Sufficient skilled staff are employed to meet the needs of the residents. The recruitment procedure ensures that suitable people are employed to safely provide care for the residents. A strong commitment to training ensures staff have the knowledge and skill to undertake their duties. EVIDENCE: There was one staff vacancy, one person was on long-term sick leave and another was on long-term compassionate leave. This had put pressure on the staff team but the manager said that the team was very supportive and covered extra shifts when they could. Agency staff were used when necessary and people that had previously worked in the home were preferred. The staffing levels were maintained in this way and the duty roster confirmed this. The home had a strong recruitment procedure and the records indicated that it was implemented. Appropriate references, CRB and POVA checks were obtained before anyone was appointed to a post. The staff files that were inspected did not have copies of the contract (Terms and Conditions of Employment). The manager explained that there was sometimes a delay in receiving this from the department of Human Resources.
Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 15 The National Minimum Standard 29.5 states ‘All staff receive statements of terms and conditions’. Provision of these documents in a timely manner demonstrates that staff are valued by their employer. Individual training records were maintained and demonstrated that new staff underwent induction and foundation training and there was a strong commitment to NVQ and specialist training. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 16 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): 33, 35, 38 Systems are in place to monitor the quality of the service provided and identify areas in need of improvement. The management of resident’s money provides security and safeguards their interests. Health and safety in the home is addressed through sound monitoring, servicing and training. However fire safety training is not being undertaken frequently enough with all staff. Therefore the risk of an inappropriate response in an emergency is increased. EVIDENCE: The quality of the service was continuously monitored through feedback received from the residents and their relatives.
Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 17 The manager said that everyone received a questionnaire at the end of their stay, that sought their opinion of the care and service they had received. An analysis of the results was displayed on the notice boards. A person was appointed by the provider to undertake the visits required by Regulation 26 and assess the service. Reports of these visits were provided to the manager, the Commission for Social Care Inspection, and the provider as required. The people who spoke to the inspector said that they considered the service to be excellent. The food was good. The choice was good. The staff were kind, supportive and helpful. They felt respected and treated well. A key worker system was in use and this was also used as a quality-monitoring tool through supervision, which was undertaken on a regular basis. The manager said that residents could place their personal money in safe keeping if they wished. They also had lockable storage in their bedrooms. They were asked not to bring large sums of money or valuables into the home. Storage was acceptable and signed records were being maintained. Account cards were kept as records and receipts. It should be considered that some people might prefer to have receipt they can retain when lodging anything in safekeeping. It was advised that records should be kept separate from the valuables. Health and safety matters were addressed. Equipment was regularly serviced and risk assessments were undertaken. Staff received training. However the fire training record indicated there were some gaps in the quarterly fire safety refresher training. The fire log indicated that safety checks were appropriately undertaken. Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 19 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 38 Regulation 23 Requirement All staff must receive fire safety training at the frequency advised by the fire authority. Timescale for action 07/10/05 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. 2 Refer to Standard OP9 OP8 Good Practice Recommendations Both members of staff who check in and record medication on the Medication Records Sheet should sign the document. Service users must have a full and up to date assessment of their needs on which to base a care plan. This should include a nutritional, pressure care and moving and handling assessments. Newly appointed staff should receive a contract of employment in a timely manner. 3 OP29 Grange, The DS0000037473.V251355.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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