Inspection on 09/05/07 for The Grange

This inspection was carried out on 9th May 2007.

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

The inspector 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 07/10/05

The Grange 22/04/05

The Grange 20/01/05

The Grange 26/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Grange, The 162 Sutton Park Road Kidderminster Worcs DY11 6LF Lead Inspector Nic Andrews Unannounced Inspection 9 and 14 May 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grange, The DS0000037473.V335787.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. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 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 www.worcestershire.gov.uk Worcestershire County Council Mrs Gillian Pratt Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35), Old age, not falling within any other category (35), Physical disability over 65 years of age (35) Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate people over the age of 60 for the purposes of intermediate care and respite care. The home may provide intermediate care for a maximum of 19 service users. The home may also provide this intermediate care for one person under the age of 60 years. 7th October 2005 Date of last inspection Brief Description of the Service: The Grange is a large, detached purpose built establishment that is operating as a resource centre. The premises are located in a pleasant residential area of Kidderminster close to shops and other amenities. The centre is owned and operated by Worcestershire County Council and is registered to provide care and accommodation for a maximum of 35 older people. The premises including the garden and patio areas are accessible to people in wheelchairs. The accommodation is provided on two floors. A passenger lift is installed to enable service users to have easier access to the facilities on the first floor. There are thirty-four bedrooms. One of the bedrooms can be used as a double bedroom. However, the maximum number of service users accommodated at any given time does not normally exceed thirty-four. Two of the bedrooms have an en-suite facility. There are a variety of communal lounges and dining areas and kitchen facilities are provided to enable service users to make their own drinks and snacks. The centre had an assessment unit with a total of ten places including six places for assessment, two places for respite care and two places for transitional care. The centre also provided a rehabilitation service with thirteen places and a further nine places for respite care and two places for permanent care. The thirteen places for rehabilitation and six places for assessment i.e. nineteen places altogether, formed the intermediate care service. The provision of permanent care is being phased out. The fees ranged from £66.85 per week to £353. 00 per week. The centre also provides a day-care service. However, the day care service did not form part of the inspection. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The service was inspected against the key National Minimum Standards with the assistance of the registered manager, deputy manager and other members of staff including the catering supervisor and activities coordinator. Various records and several different policies and procedures that the centre is required to maintain were inspected. Parts of the premises were also inspected. Individual discussions were held with three service users and four members of staff. As part of the inspection Comment Cards were issued to the relatives of a number of service users and to visiting professionals. Two Comment Cards were completed and returned. The majority of the responses to the questions that were asked in the Comment Cards were positive. Any additional comments that were made are reflected in the body of this report. What the service does well: What has improved since the last inspection? Since the previous inspection the centre had changed its documentation to the single assessment process for all of the service users. The staff sleeping-in facilities and staff training room had been upgraded. The refurbishment of the kitchen had been completed and a number of bedrooms and lounges had been Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 6 refurbished. The clerical officer had been relocated nearer to the main entrance and the procedure for receiving visitors had improved. A full-time occupational therapist had been appointed on a one-year secondment to be responsible for the needs of the service users in the centre. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 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.V335787.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with comprehensive and relevant information about the service and they are given a contract that contains clear details about the service they will receive. Service users in receipt of the intermediate care service are helped to maximise their independence and return home. EVIDENCE: A copy of the statement of purpose was made available for inspection. The statement of purpose included all of the required information except for the physical environment standards met by the resource centre referred to in Standard 1.1 of the National Minimum Standards. Service users were also provided with an information pack that contained a comprehensive range of relevant information normally found in a service users’ guide except for the centre’s physical environment standards. The inside cover of the information pack contained an out of date reference to the National Care Standards Commission. The registered manager confirmed that all of the service users were given a statement of their terms and conditions of residence (agreement of care) at Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 9 the point of admission. The service users were asked to sign a form confirming their acceptance of the agreement of care. The contents of the agreement of care were satisfactory apart from an out of date reference to the County Inspectorate. In addition, the contracts did not include details of the fees. The fees were assessed by financial assessors who worked for the Council but who were independent of the resource centre. This often resulted in delays before the service users were informed about the charges. There was no charge for the rehabilitation or assessment service. Similarly, any ‘rapid response’ admission was free of charge. The charge for respite care was based on a sliding scale depending on the service users’ individual resources. All the service users admitted into intermediate care places (the rehabilitation and assessment units) were assessed by social care assessors or, if necessary, the registered manager, unit coordinator or a member of the senior staff team. The social care assessors were based at another resource centre. The assessments carried out by the social care assessors did not cover all of the relevant aspects of care listed in Standard 3.3 in sufficient detail to enable the care staff to prepare a comprehensive care plan. A different assessment form was completed ‘over the phone’ for service users admitted into a ‘rapid response’ placement. The information was supplemented with details from frameworki for any person in the County who has had a social work input. The registered manager said that service users who were admitted for respite care normally made a pre-admission visit and were assessed by the staff of the resource centre. However, there was no written record of the assessments. Prospective service users were given the opportunity to visit the resource centre prior to admission, wherever possible. Pre-admission visits included a day’s visit or an over-night stay. There was no trial period. The service users in receipt of rehabilitative care were admitted on the basis of their agreement to a rehabilitation programme. Although the service users were free to leave the centre at any time, in practice the majority of service users completed their rehabilitation programme successfully and returned home. The centre provided a total of 19 places for intermediate care consisting of 13 places for rehabilitation and 6 for assessment. The purpose of the rehabilitation service was to help service users by means of a therapeutic programme to regain lost skills and to enable them to return home. The purpose of the assessment service was to assess the service users’ capabilities to enable them to decide the course of their future care either at home or in a residential care home or in sheltered accommodation. The rehabilitation unit was on the first floor and was staffed by a unit coordinator and a dedicated staff team. The staff were supported in their work by a physiotherapist, occupational therapist and the intermediate care team. The rehabilitation unit included a training kitchen, a physiotherapy room containing walking bars, steps and other mobility aids, a laundry, bedrooms, bathrooms and toilets, a combined lounge and dining room and a smaller lounge. The maximum length of stay for service users in receipt of intermediate care was normally six weeks Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 10 but the period could be extended, if necessary. Visits were made to the service users by the occupational therapist, physiotherapist, district nurse and social workers. A social worker who had been based at the centre since February 2007 offered support to any service user that was admitted into a rapid response or assessment bed. The social worker’s role included offering advice and guidance to staff and to the service users’ relatives and following up the support provided to service users in the community. The homecare service and the re-ablement team provided continuing support for service users who returned home. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 11 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 and 10 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The support provided is responsive to the individual needs of the service users who are helped to be independent and to take responsibility for their personal care. The service users’ privacy and dignity is respected. However, more attention needs to be given to care planning and medication. EVIDENCE: All of the service users had a care plan that was based on an assessment of their needs. The care plans included a reference to all of the aspects of care listed in Standard 3.3 of the National Minimum Standards. The care plans in respect of four service users were inspected. The care plans for three of the service users had been signed by them. The care plan in respect of one service user recently admitted to the centre had not yet been updated from his previous admission. Another care plan had not been fully completed. Some of the information in the columns headed ‘Care Interventions’ was insufficient to ensure that the service users’ needs were fully met. For example, the phrase ‘monitor clients eating and drinking’ was used with no clear instruction about how frequently this should be done or who should do it. In addition, there was no reference to pressure relief during the night for the same service user who had pressure sores and the nutritional assessment had not been completed. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 12 Similarly, in the care plan for another service user the ‘Care Interventions’ column included the phrase, ‘to ensure all needs are met’ in a number of places. The nutritional risk assessment for another service user had not been completed. The moving and handling risk assessment for the same service user who had an arthritic knee and who had also had two falls in two weeks had not been completed. The recommendation that was made in regard to nutritional, pressure care and moving and handling assessments as a result of the previous inspection had not been implemented. The issue is referred to again in this report as a requirement. All of the service users were registered with their local GPs. If a service user was admitted from outside the area they were registered provisionally with a GP in one of three local surgeries. Two service users on the rehabilitation unit were receiving attention daily from the district nurse. The centre had four specialist beds with mattresses for use by service users at risk of developing pressure sores. Any additional equipment that was needed would be obtained via the district nurse. Support was provided by other professionals/specialists who recorded their instructions for staff to follow in a message book that was retained at the centre. There was evidence to show that the service users received support from the continence adviser. One of the service users attended the audiology clinic on a regular basis. The two permanent service users received visits from the chiropodist. Appointments were made for the service users in receipt of respite care to receive care and attention from the chiropodist, dentist and optician if necessary. The staff were aware of the service users’ special dietary needs and a record was maintained of the service users’ weight. A risk assessment had been carried out in respect of one service user who required the use of bedrails. None of the service users required the support of a psychiatrist or community psychiatric nurse but this service had been provided in the past. The Comment Card completed by one visiting professional stated that the standard of care provided was ‘good’ and described the centre as a ‘well run facility’. Most of the medication was kept in three lockable trolleys in lockable storage rooms. Surplus supplies were also kept in a secure store. Access to the medication was restricted. The centre had a controlled drug cupboard that complied with the Misuse of Drugs (Safe Custody) Regulations 1973 and a controlled drug register. A lockable facility was provided in the bedrooms to enable the service users that self-medicated to keep their medication secure. There was a dedicated fridge in which medication that required cold storage was kept. A daily record of the fridge temperatures was maintained. A list of the names and signatures of the staff involved in the administration of medication was also maintained. The list was in the process of being updated. The home had a satisfactory policy and procedure for the administration of medication. The centre’s homely remedies policy had been agreed and signed by the local GPs. There was a satisfactory procedure for recording the receipt and return of medication. The centre had a BNF guide and a copy of the guidelines for the administration of medication produced by the Royal Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 13 Pharmaceutical Society of Great Britain. A recommendation was made as a result of the previous inspection that both members of staff who check in and record medication on the medication record sheet should sign the document. It was noted that two members of staff had signed the record of medication that had been written on to the MAR charts by hand. Therefore, the recommendation had been implemented. The MAR charts had photographs of the service users to enable the staff to identify them correctly. However, it was noted with concern that the MAR charts in respect of four service users during April and May 2007 had a total of fifteen gaps in the recording of administration. The staff had received training on the use of the monitored dosage system by the Co-op. The senior staff had also undertaken or had commenced further training. However, the majority of staff involved in the administration of medication had not undertaken accredited training. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses that were given by the staff to the questions that they were asked reflected good practice. It was confirmed that visits by visiting healthcare professionals took place in private. A mobile telephone was available to enable the service users to make and receive calls in private. It was confirmed that mail was given to the service users unopened. It was also confirmed that the service users wore their own clothes. However, ‘back up’ clothes including nightdresses, dressing gowns and underwear, were also used if a service user was admitted direct from hospital. It was stated that this was a temporary measure until the service users’ relatives were able to bring in the service users’ own clothes from home. The service users and their relatives were asked to label the clothing. It was confirmed that the staff induction included instruction on how to treat service users with respect. The service users with whom discussions were held confirmed that they were treated with respect and that their right to privacy was maintained. They confirmed that the staff knocked the door before entering their bedrooms. They also said that they were always seen in private by visiting professionals. One service user said that he had been asked by the staff about the way in which he wished to be referred. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 14 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 and 15. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The resource centre promoted the service users’ quality of life by seeking their views, offering choice and encouraging them to remain as independent as possible. EVIDENCE: The centre employed a part-time activities coordinator for 16 hours per week. The activities that were provided included various art and craftwork, quizzes, reminiscence, hangman, Scrabble, Bingo and other board games. Simple exercise and relaxation sessions that had been arranged in prior consultation with the physiotherapist were provided. A hairdresser visited and an occasional ‘sale table’ was said to be very popular. Musical entertainment was provided and occasional walks and shopping trips were arranged for individual service users. The centre also received visits from the local Anglican minister. It was confirmed that the staff made a conscious effort to meet the needs of the two permanent service users. Other service users were encouraged to continue with outside activities by attending churches and visiting clubs. There were no unreasonable or unnecessary restrictions in regard to visiting. The service users with whom discussions were held stated that their visitors were always made welcome and offered a drink. Visitors were able to make themselves a drink if they so wished. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 15 The service users were encouraged to take responsibility for their own financial affairs. The staff did not normally become involved in any matters relating to the service users money. Details of the local advocacy service were included in the Information Folder that was given to each service user on admission. Information on the advocacy service was also displayed on notice boards within the centre. The registered manager stated that the majority of the service users had a social worker to assist them in regard to financial and other matters. Service users were able to bring personal possessions with them when they were admitted to the home. However, because the majority of service users were accommodated on a relatively short periods they were discouraged from bringing large items of furniture. The single assessment process was in operation within the centre. Consequently, the service users had automatic access to the records held about them by the centre. The service users with whom discussions were held stated that they were enabled to make choices regarding daily routines and the matters that affected their care e.g. where they ate their meals and when they got up and went to bed. One service user said, ‘There are no strict time limits. The service is very flexible’. The centre operated a four-week menu. The record of the food that was provided showed that the service users received a balanced diet. The meals that were observed being served during the inspection were wholesome and appealing. The catering supervisor maintained a record of the services users’ individual food preferences, allergies and dietary needs e.g. diabetic, glutenfree and vegetarian diets. The service users were asked each day about their choice of food for the day following. The centre had embarked on ‘Safer Food Better Business’ standards. The refurbishment of the kitchen was completed towards the end of October 2006. The catering supervisor confirmed that the kitchen contained all of the necessary equipment and that it was all in working order. Food was labelled appropriately. The temperature of the cooked food was checked and fridge and freezer temperatures were being maintained. The dining areas were comfortably furnished and provided a pleasing environment in which to eat. Mealtimes were evenly spaced throughout the day. The service users were consulted about the summer and winter menus and changes were made where necessary. Special occasions were celebrated. The service users with whom discussions were held spoke positively about the food. One service user described the food as ‘excellent’. Another service user said the food was ‘very good’. Another service user said, ‘The food is not far short of being excellent. We have a good breakfast and there are at least two choices at lunchtime. It’s well cooked and well presented. I commend the staff for it and the other residents agree’. The service users confirmed that drinks and snacks were available throughout the day and that they were able to eat their meals in their bedrooms if they preferred to do so. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 16 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 and 18. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The resource centre has a clear complaints procedure and other relevant policies and procedures to help ensure that service users are protected from abuse. The service users feel confident about making a complaint and also that any concerns will be dealt with quickly and appropriately. However, relevant staff training in regard to the protection of service users from abuse needs to be provided. EVIDENCE: The centre had a clear complaints procedure. The complaints procedure was included in the information pack that was given to service users when they were admitted to the centre. The centre maintained a folder that contained cards and letters of thanks from former service users and their relatives expressing their appreciation for the service that they had received. The centre also maintained a record of complaints. Since the previous inspection the centre had received two complaints dated 17/10/06 and 15/12/06 respectively. Both complaints had been responded to and dealt with appropriately. No complaints had been made direct to the CSCI about the centre since the previous inspection. The service users with whom discussions were held expressed their confidence in making a complaint and confirmed that the registered manager and staff were approachable. One service user said, ‘If I’ve asked for anything the staff have always done it straight away’. A concern expressed by one service user was subsequently referred to the deputy manager. The centre had various policies and procedures to help ensure that the service users were protected from abuse. These included a policy and procedure for Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 17 the protection of vulnerable adults from abuse and a whistle blowing policy. The deputy manager confirmed that the policy on violence and aggression towards staff was in the process of being updated. The centre also had a copy of the Department of Health guidance ‘No Secrets’. It was stated that the staff were made aware of the contents of these documents through supervision and training. In the past, concerns about neglect and possible financial abuse had been referred to and discussed with relevant social workers as and when they had arisen. The deputy manager confirmed that no incidents of alleged or suspected abuse had occurred within the resource centre or been reported or otherwise come to light since the previous inspection. It was also confirmed that there had been no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. It was stated that all the staff underwent ‘in-house’ training on abuse approximately three years ago. However, not all of the present staff had received training in the protection of vulnerable adults from abuse. There was no policy or procedure regarding the service users’ money and financial affairs that included all of the issues referred to in Standard 18.6. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 18 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 and 26. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users are accommodated in safe, well-maintained surroundings. However, some work is needed to ensure that all parts of the premises are fully utilised. EVIDENCE: The resource centre was located in a suitable position for its stated purpose in a residential area near to local amenities. The premises were accessible, safe and well maintained. Handrails were installed in the corridors and the toilets and bathrooms had suitable aids and adaptations. The centre had a hairdressing salon and there was also a designated smoking room for the service users. The staff facilities included a training room and a sleeping-in flat. A member of staff was employed full-time to maintain the premises including the garden. There was a small, enclosed garden area and other external sitting areas for use by the service users. The registered manager confirmed that the centre had a programme of routine maintenance and renewal of the fabric and decoration of the premises. There were plans to relocate the sluice on the first floor to another area on the first floor. There were no major outstanding concerns apart from a problem with the guttering that Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 19 had resulted in water leaks that still affected bedroom 41 on the first floor. The remedial work had not resolved the problem and, consequently, the bedroom had been out of use for five months. It was intended to raise the rails on the patio roof that adjoined the smaller lounge. In the meantime, the area was temporarily out of use. Consideration was being given to the provision of a disabled toilet on the ground floor in Northwood unit in order to enhance the facilities for service users. An external contractor had carried out a fire risk assessment on 12 April 2007. The Environmental Health Officer had carried out an inspection on 28 March 2007. The report of the inspection was not yet to hand. However, it was stated that there were no recommendations. The premises were clean and tidy throughout and free from unpleasant odours. The laundry was appropriately located and contained suitable equipment including two washing machines (one for use in the event of a breakdown) and three tumble dryers. The washing machines had a sluicing facility. It was confirmed that all of the equipment was in proper working order. There was a wash hand basin and liquid soap and paper towel dispensers. The laundry floor finishes were impermeable and these and the wall finishes were readily cleanable. The policy and procedures for the control of infection were satisfactory. The service users with whom discussions were held expressed their satisfaction with the standard of cleanliness of their bedrooms and with their clothes. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 20 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 and 30. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The staff are experienced, trained and employed in sufficient numbers to fulfil the aims of the centre and to meet the changing needs of the service users. EVIDENCE: Details of the staffing establishment and copies of the staff rota were made available for inspection. In addition to the registered manager and deputy manager, the staffing establishment included two full-time senior assistants, part-time and relief seniors, a catering supervisor and assistant cook, support workers, a full-time clerical assistant, domestic and kitchen staff, maintenance and other ancillary staff. The details provided showed that the number and deployment of staff during the working day were sufficient to meet the needs of the service users. At night, three members of staff were on waking duty and one senior member of staff was on sleeping-in duty and on call. However, it was felt that the provision of a second senior assistant on duty during the day would be of particular benefit. The additional cover would help to ensure more effective staff supervision, appraisals and sickness monitoring. The registered manager would be able to devote more of her time to strategic planning and quality assurance. A unit coordinator was employed to oversee the work of the rehabilitation unit supported by a rehabilitation support assistant. Three or four support workers were employed to cover the morning shift. From 3.30 pm there were two staff on duty and then a third member of staff came on duty in the evenings. A physiotherapist, occupational therapist, district nurse and the intermediate care team all provided an input to support the work of the rehabilitation unit. The centre employed a part-time activities Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 21 coordinator for 16 hours per week. The service users with whom discussions were held spoke positively about the staff. One service user said, ‘The staff couldn’t be nicer people. They are extremely attentive and appear to be well trained and know what to do. At night I receive help promptly. I’m happy with the standard of care I receive and I can’t see how the care could be any better’. Another service user said, ‘The staff are excellent and doing a very good job’. The resource centre employed a total of 48 care staff. The details of the information provided showed that 30 members of care staff had completed the NVQ level 2 training or above i.e. 62 . This was above the 50 trained members of care staff required by the National Minimum Standards. It was also pleasing to note that a further 10 members of staff were undertaking NVQ level 2 training, seven staff had completed the NVQ level 3 training and two senior staff had completed NVQ level 4 training. The files of three members of staff were inspected. The contents of the files included an application form, two written references, evidence of an enhanced CRB disclosure check, proof of identity and a copy of a staff contract. However, it was noted that none of the files contained a recent photograph. A recommendation was made as a result of the previous inspection that newly appointed staff should receive a contract of employment in a timely manner. The registered manager confirmed that the recommendation had been implemented. The resource centre had a staff induction and foundation training programme. The programme had been devised by a senior assistant and was based on the Skills for Care standards. One newly appointed member of staff was undergoing the induction programme. A senior member of staff was responsible for the oversight of the induction of new staff. There was an expectation that all new staff would undertake the induction training before going on to complete NVQ training. It was confirmed that all the staff received a minimum of three paid days training per year and had individual training and development assessments and profiles. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 22 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 and 38. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from a safe and well-managed service. However, some improvements were needed to ensure that they are assured high quality care. EVIDENCE: The registered manager had been in post since September 2006. She had a general and mental health nursing background. She also held a BSc in Nursing Studies. She had completed the NVQ level 4 and Registered Managers’ Award training in 2006. The registered manager had direct experience of managing a nursing home and had also worked as a senior manager in a large, corporate nursing group. She was competent to run the centre and meet its stated aims and objectives. She was person centred in her approach and led a strong staff team who had been recruited and trained to a high standard. The senior staff also had extensive, relevant knowledge and experience and had taken advantage of the wide range of training opportunities provided by the County Council. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 23 A health and safety audit had been carried out in November 2006. The registered manager was also a member of the Quality Assurance Development Group. However, it was stated that audit tools were still being developed and that the centre did not operate a full, quality assurance system. Questionnaires were issued to service users at the end of the periods of respite care. Service users were given a questionnaire at the end of the first week of residence and also at the end of their stay for intermediate care. The information is analysed once a year. However, the results of the questionnaires issued during 2006 had only been recently received. It was intended that, in the future, the responsibility for analysing the feedback from the questionnaires would rest with the clerical officer based at the centre. A report dated 11 January 2007 called ‘Having your say’ contained the outcomes of the service users’ views about the service they received. Questionnaires had not been used to obtain the views of stakeholders on how the centre was achieving goals for service users. The centre held money in safekeeping on behalf of five service users. The money was kept in separate envelopes and the accounts were recorded on individual cards. The money and cards were kept in a ‘little’ safe with limited access. The records and accounts were checked and these were correct. One service user kept his money in his room and a lockable facility was provided for this purpose. Service users should be encouraged to take advantage of the safekeeping facilities provided by the centre. It was confirmed that the centre did not hold any valuable personal items on behalf of any of the service users. It was stated that if any items were handed over for safekeeping, receipts would be issued. The practice of the centre was to ask relatives and social workers to assist with the service users’ finances when it was appropriate to do so. The centre asked the non-permanent service users to keep the amount of money that they brought with them to a minimum. Accidents were recorded ‘on line’ and also in hard copy. The centre held relevant information on COSHH, copies of the reports of the visits made each month in accordance with Regulation 26 and copies of the notifications made to the CSCI in accordance with Regulation 37. The fire alarm system was checked on 26 January 2007. The gas safety inspection was carried out on 15 November 2006. The electrical installation report dated 5 January 2007 was still valid. PAT testing had been carried out in June 2006. The passenger lift had been serviced on 19 April 2007. Bath hoists had been serviced on 16 March 2006. Details of the more recent service were not available for inspection. The registered manager confirmed that opening restrictors had been fitted to all of the windows. The centre maintained a record of the monthly safety checks that were carried out on the restrictors. A risk assessment on Legionella had been carried out in July 2006. Water samples had also been taken for analysis 16 March 2007 the results of which were not yet known. The procedure to be followed in the event of an accident contained out of date references to ‘Regulation 14’ and the ‘1984 Residential Homes Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 24 Regulations’. The procedure needed to be amended, signed and dated. Risk assessments had been carried out on all safe working practice topics referred to in Standards 38.2 and 38.3. A requirement was made as a result of the previous inspection that all staff must receive fire safety training at the frequency advised by the fire authority. The registered manager stated that all the staff received fire safety training every three months. Fire safety training had been carried out during 2006 and was due to be completed by all the staff within four weeks of the inspection. The requirement was regarded as having been implemented. Moving and handling training was carried out each year and was due to be completed by all the staff within three weeks of the inspection. Food hygiene training was also due to be undertaken by all the staff within three months. First aid training had been undertaken by some of the senior staff. The registered manager and one of the senior assistants were awaiting confirmation of places on the next training course. However, it was noted that a number of staff had not undertaken any recent training on infection control, person centred planning or in the care of people with dementia or mental health needs. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 25 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 3 2 2 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 2 Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5A Requirement The fee for respite care must be included in the contract of care for all service users at the point of admission. A written assessment that includes a reference to all of the aspects of care listed in Standard 3.3 must be completed in respect of all service users including those admitted for respite care in accordance with the requirements of Regulation 14. The care plans must set out in detail the action that needs to be taken by the staff to ensure that all aspects of the service users’ needs are met. Risk assessments must be carried out and recorded on nutrition, pressure care and moving and handling (falls) in respect of all service users and any necessary action taken to ensure their safety. Action must be taken to ensure that medication is administered to the service users at the correct time and that the MAR DS0000037473.V335787.R01.S.doc Timescale for action 30/06/07 2 OP3 14 30/06/07 3 OP7 15 30/06/07 4 OP7 13,15 08/06/07 5 OP9 13 08/06/07 Grange, The Version 5.2 Page 27 6 OP9 13 7 OP18 13,18 8 OP19 23 9 10 OP29 OP33 19 24 11 OP38 12,18 charts are signed at the same time that the medication is administered. All the staff that are involved in the administration of medication must undertake accredited training that includes basic knowledge of how medicines are used and how to recognise and deal with problems in use and the principles behind all aspects of the centre’s policy on medicines handling and records. The senior staff must undertake training in the protection of vulnerable adults from abuse and all the care staff must receive training in basic awareness of abuse. The leak in bedroom 41 on the first floor must be repaired and the damage made good and the bedroom brought back into use. A recent photograph must be provided in respect of each member of staff. The quality assurance system must be developed in accordance with the requirements of Regulation 24 and Standard 33. All the staff must receive training in all of the core areas including infection control, person centred planning and the care of people with a dementia illness and mental health needs. 31/07/07 31/08/07 30/06/07 30/06/07 31/07/07 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Grange, The Refer to Good Practice Recommendations DS0000037473.V335787.R01.S.doc Version 5.2 Page 28 1 2 Standard OP1 OP18 3 4 5 6 7 OP19 OP27 OP33 OP35 OP38 The statement of purpose and service users’ guide should be amended in accordance with the guidance given in this report. A policy and procedure should be introduced regarding the service users’ money and financial affairs that is appropriate to the resource centre’s purpose and function and includes all of the issues referred to in Standard 18.6 The safety rails on the first-floor patio of the rehabilitation unit should be raised so that the patio can be brought back into use for the benefit of the service users. Serious consideration should be given to increasing the level of senior staff cover during the day. The views of family and friends and of stakeholders in the community should be sought on how the resource centre is achieving goals for service users. Service users holding large amounts of money should be encouraged to use the centre’s safekeeping facilities. The procedure to be followed in the event of an accident should be amended in accordance with the guidance given in this report. Grange, The DS0000037473.V335787.R01.S.doc Version 5.2 Page 29 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: 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. 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