CARE HOME ADULTS 18-65
The Grange 2 Mount Road Parkstone Poole BH14 0QW Lead Inspector
Gill Kennedy Unannounced 08 July 2005 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 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 Stationary 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 D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Grange Address 2 Mount Road, Parkstone, Poole, Dorset, BH14 0QW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 715914 01202 743557 Leonard Cheshire Mr Paul Bulgarelli Care Home only 26 Category(ies) of PD - 26 registration, with number of places The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24 January 2005 Brief Description of the Service: The Grange is a home owned by Leonard Cheshire Foundation (a national charity) and accommodates up to twenty-six adults who have a physical disability. Twenty-two of the residents were living permanently at The Grange at the time of this inspection and two of these were based in the respite care unit. There were three other beds for respite care plus another room that could be utilised in emergencies. The day care and respite unit were upstairs, with a further four units on the ground floor accommodating five residents each. Each unit has it’s own kitchen/dining room and two bathrooms, and service users have their own bedroom. The communal area comprises a seated coffee area, with a fishpond, where guests/visitors can also sit. There is a large paved courtyard for use in the summer.The Grange offers adapted living facilities to accommodate people who use wheelchairs, with there being adapted baths, beds, lifts, electric doors, manual and electric hoists. The home also has some volunteers who enhance the service offered by paid care staff in offering additional social experiences and outings.The Grange has adapted vehicles available, so transport is provided when necessary.The Grange is situated in a residential area of Parkstone, close to local shops and amenities.
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This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. Mr Bulgarelli, the registered manager, was available throughout the inspection to answer questions and provide documentation as needed and he was helpful and co-operative. Six residents agreed to take part in a group discussion to share their views about life in The Grange. Two staff also contributed to the inspection. A selection of bedrooms and the communal areas plus the laundry were seen during this inspection. The time taken on this inspection was 6 hours, and 13 standards were inspected. Monthly reports are also sent to CSCI, which are completed by the responsible individual as required under Regulation 26 of the National Minimum Standards. These reports are used to monitor the services provided in the home. The manager also made available a Service Audit Report that had been part of a Leonard Cheshire Operational Review, which was monitoring systems and seeking the views of service users. Senior staff employed by the charity compiled this report. The terms resident and service user used in this report are interchangeable. What the service does well:
There is a commitment to encouraging residents to make their own decisions about how they conduct their lives and staff will provide support and encouragement as needed. Residents are enabled to become involved in a variety of fulfilling activities and pursue special interests. An example of this was a recent canal holiday enjoyed by four residents accompanied by four care staff from the home. Residents are offered a varied and healthy diet. All of those seen during the inspection were pleased with the food provided and felt they were actively able to make choices about what and when they ate.
The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 6 Another area where residents are encouraged to have personal choice is choosing their own GP and seven practices provide services to the home. Residents feel staff are helpful in assisting them to access specialist health care services. There are well-developed policies and procedures to deal with the protection of service users and any complaints that are made. The manager had asked a colleague to investigate a recent complaint to ensure as much impartiality as possible. The home is clean and comfortable with a range of facilities to accommodate service users with a variety of disabilities. There are comprehensive systems and policies in place that promote the welfare and safety of residents. Resident’s views about the services provided are sought annually and there had recently been a separate independent audit involving head office staff. The home is also committed to residents’ involvement in policy making and the Leonard Cheshire Organisation is active in developing forums where this is able to take place. What has improved since the last inspection? What they could do better:
There are no requirements or recommendations made on this inspection. It was clear from talking with the manager, staff and residents that the home is well run by a confident manager and a committed staff team.
The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 7 The residents expressed some reluctance to complain because of the impact this could have on their relationships with staff. However, no requirement or recommendation has been made as this was highlighted in the Service Audit Report and the manager has a timed action to deal with this issue. How successful this has been can be monitored at the next inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected. EVIDENCE: There had been no new permanent admissions to the home since the last inspection. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 The Grange is committed to encouraging residents to make their own decisions, and there are well-established consultation procedures, which enable residents to have their say. EVIDENCE: The philosophy of the Leonard Cheshire organisation is all about encouraging service users to take control of and make decisions about their lives, and to be as independent as possible. This is reflected in their policies and practical commitment to service user involvement. The residents seen felt they were able to make their own decisions about their lives and one person said The Grange was ‘The next best thing to being at home’. Residents had recently been asked to take part in a four day operational review which inspected all aspects of the service. Twenty five forms were sent out to residents and ten were returned. The audit concluded that the home provided an empowering environment and residents were well supported by staff. The evidence obtained at this inspection concurs with this assessment.
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The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15,17 Residents are assisted and supported to become involved in fulfilling activities suited to their age and aptitudes. The Leonard Cheshire organisation demonstrates a commitment to enabling residents to lead fulfilling personal lives and these values are evident in the home. Residents are provided with a varied diet and mealtimes are seen as an enjoyable social occasion. EVIDENCE: Four residents had recently been on a canal holiday supported by staff from the home. One person was just returning from a holiday in Spain and another resident was planning a Spanish holiday. Staff had encouraged another service user who was now starting to work three days a week for radio bedside. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 12 Residents spoken to confirmed that they could have visitors when they wished and see them in private. They felt they would be unable to accommodate visitors’ overnight due to the lack of facilities. However, Mr Bulgarelli said residents were able to accommodate guests in their rooms if they wished and practical arrangements could be made. The Leonard Cheshire organisation has recently developed a detailed manual to guide staff in relation to the sexual and emotional needs of residents. Selected staff will be having training on these issues and will provide advice and support for residents and staff. A selection of weekly menus was supplied to CSCI from one of the units in the home. These showed that residents were offered a varied and nutritious diet. All the residents spoken to expressed satisfaction with the food provided, they felt there was lots of choice and they were involved in drawing up the menus. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 Service users healthcare needs are promoted by obtaining appropriate advice and support from health care professionals. Medicines are securely stored and if practicable service users would self medicate. EVIDENCE: The home relates to seven GP practices and residents choose who they wish to see and change their doctors from time to time. Residents reported that they were satisfied with the care they received from the primary healthcare teams, particularly the support provided by their District Nurses. They also felt they had sufficient specialist equipment, although sometimes they had to wait for occupational therapy and specialist wheelchair assessments. Residents felt that care staff helped them as much as they could but frustration at delays was due to a general shortage of occupational therapists. None of the residents spoken to administered their own medication as they felt it was not practicable for them to do so. They were aware that when service users did self-administer a risk assessment would be undertaken. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 14 All residents now have their medicines stored in their rooms in a lockable cabinet. Evidence of this was seen. The home was now obtaining a computer generated label to attach to the MAR chart, but where medicines were hand written a second competent person would be asked to sign. The majority of medicines were now delivered in the blister packs. The Senior Care Supervisor confirmed that she would be monitoring medication to ensure satisfactory practices were upheld. The Leonard Cheshire organisation has, in conjunction with a national pharmacy chain, agreed an accredited drugs training course and evidence was seen that all staff are required to attend this course. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Whilst there are complaints systems in place for residents there was some reluctance to use them unless the issue was a very serious one. Robust systems are in place to protect vulnerable residents from abuse, neglect and self-harm. EVIDENCE: The Leonard Cheshire organisation has a leaflet for service users called ‘Have Your Say’ and this is readily available. Service users spoken to expressed some reluctance about voicing minor complaints. They felt it would have to be a serious issue before they would take the formal complaints route, as this could have repercussions in the face-to-face daily contact with their carers. This had been noted as an issue on the Service Audit Report and it was recorded that action was being undertaken to reassure residents that complaints could be made without the risk of reprisals. Two complaints had been made to the home since the last inspection. One was not upheld and the other was still under investigation, although Mr Bulgarelli felt it likely there was a case to answer. Complaints are clearly recorded and those making the complaint are advised in writing of the outcome after a thorough investigation. In the case of the second complaint the manager had requested an outside investigation to aid impartiality. There is a corporate policy to ensure any allegations of abuse are dealt with in a professional manner. Since the last inspection a resident reported that a small amount of money had been stolen. The police had been involved and staff have been asked to assist residents with record keeping so they are able to keep a close check on the funds being kept in the home.
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The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 The home is comfortable, safe and tailored to meet residents’ specialist needs. Systems are in place to ensure that the home is kept clean and hygienic and provides a pleasant environment for residents. EVIDENCE: The accommodation has been specifically designed for adults to live there who have physical disabilities. All rooms have sufficient space to accommodate equipment, furniture and are fully wheelchair accessible. Observation on inspection, discussion with residents and Regulation 26 notices supplied to CSCI confirm that the home is maintained to a satisfactory standard. The home was found to be clean and hygienic with no unpleasant smells. There were policies and systems in place to control the spread of infections and there had been no outbreaks reported. Laundry facilities were sighted appropriately. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected. EVIDENCE: The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 Systems are in place to monitor residents’ views on a regular basis and test out their level of satisfaction with the services provided. The health and welfare of residents is promoted by the systems that are in place to ensure their safety is promoted. EVIDENCE: There is an annual survey of service users views that covers a wide variety of aspects of life in the home. Whilst the Leonard Cheshire Organisation is committed to a high level of service user involvement and has a system in place to ensure service users take part in policy making, residents felt their views were listened to on a local level, but they did not always feel this was the case nationally. Some residents expressed the view that decisions were taken no matter what their views were. There has been an ongoing issue about how to charge each resident fairly for the use of vehicles, and as in all changes there will be winners and losers and this had engendered a lot of feeling.
The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 19 One senior staff member who was spoken to during the inspection has special responsibility for health and safety issues, she has systems in place to ensure that regular checks and maintenance are undertaken. This is confirmed in the Regulation 26 reports that are sent monthly to CSCI from the responsible individual and the Service Audit report notes that they found ‘evidence that maintenance and equipment records are kept to a high standard’. The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x 3 x 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Grange Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 21 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. 1. 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. Refer to Standard Good Practice Recommendations The Grange D55 S4086 Grange The V233463 080705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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