Inspection on 12/12/06 for The Grange Care Centre

This inspection was carried out on 12th December 2006.

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 Care Centre 25/11/08

The Grange Care Centre 26/01/06

The Grange Care Centre 05/07/05

The Grange Care Centre 17/02/05

The Grange Care Centre 14/07/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Grange Nursing Home Church Green Stanford In The Vale Faringdon Oxfordshire SN7 8HU Lead Inspector Sandra Grainge Unannounced Inspection 12th December 2006 10:00 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 The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Nursing Home Address Church Green Stanford In The Vale Faringdon Oxfordshire SN7 8HU 01367 718836 01367 710672 thegrange@bonneycourt.co.uk www.grangenursing.co.uk Bonneycourt Limited 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) Mr Kenneth Ian Mead Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (3) of places The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. Up to 3 of the total registered number may be admitted between the ages of 18 - 59. The total number of persons that may be accommodated at any one time must not exceed 49. 26th January 2006 Date of last inspection Brief Description of the Service: The Grange Nursing Home is a privately owned service and is registered as a care home with nursing for up to 49 older people; registered nurses are on duty 24 hours a day. The property is a mature country house set in the centre of Stanford in the Vale; it has two lounges and a separate dining room on the ground floor. Bedrooms are situated over two floors, some bedrooms have en-suite facilities; there are five bedrooms that are large enough to be shared by two people. The site has ample car parking spaces and there are pleasant landscaped gardens for use by residents and visitors. The home has strong links with the community; the village is compact and includes shops, a public house and post office. The market towns of Wantage and Faringdon can be reached by car or public transport. Scale of charges as supplied on 25.10.06: - from £610- £760 per week. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key report contains information collected during an unannounced site visit to The Grange made on 12th December by a locum inspector. Information held in the Service file pre- informed the inspection together with data provided by the Registered Manager. Prior to the site visit, Service User views were sought in a survey “Have your say about”. Seventeen forms were returned to CSCI from Service Users and their relatives; the comments were very favourable with the exception of two that were not completely satisfied with levels of staffing and one that was concerned about cleaning of wheelchairs. Follow up of these issues is reported in the appropriate sections of this report. In addition four General Practitioners completed surveys; they considered that the home is well run, staff are aware of Service Users’ needs and give good care. A tour was made of the premises and during the visit care practice was observed. Records were inspected and the Inspector spoke to Service Users and members of staff. Service Users were pleased to praise the service and the staff. Relatives who spoke to the inspector endorsed the praise for staff and are pleased with the service that is given. Requirements of the previous inspection had been met. What the service does well: What has improved since the last inspection? Service Users receive care from staff who know them and are familiar with their needs; this has improved over the last year as less agency staff have been employed and more staff come from the local area. All staff have been given better training opportunities. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 6 The requirements of the last inspection have been met and in the process the administration and storage of medication have been improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grange Nursing Home DS0000027178.V322330.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 The Grange Nursing Home DS0000027178.V322330.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): 1,2,3,4,5. Quality in this outcome area is good. Service Users receive the information that they need to make choice about entry to the home. Before admission their needs are assessed and they receive a contract from the home to specify the service that they will receive. This judgement has been made using available evidence including a visit to this service. Standard 6 is not applicable to this home. EVIDENCE: There was evidence that all prospective Service Users and their relatives are provided with a copy of the Statement of Purpose. This document is comprehensive; it is constantly revised and updated as regulation changes. The “Have your say” surveys completed by the Service Users and their relatives were all positive that they received enough information and support to make a decision about entry to The Grange. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 9 The Registered Manager and deputy Manager of the home assess the needs of prospective Service Users prior to admission. It was clear that the Registered Manager was very thorough and particular about the assessment process. Trial visits are arranged when appropriate and each person has a contract of terms and conditions with the Service. The home does not offer intermediate care. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. Service Users receive nursing care to meet their assessed individual healthcare needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each Service User has an individual plan of care that has been designed in response to a comprehensive assessment of their need. Everyone has a named nurse and carer; Service Users are encouraged to be involved in care planning. Assessments are carried out for nutritional state, risk falls and accidents, use of bed rails, continence management and risk of pressure sore development. Referrals are made for medical and clinical expertise. Plans include appropriate instruction for care staff and are updated and reviewed on a regular basis. Daily records were in order. No Service Users were able to administer their own medication. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 11 The requirements of the previous inspection had been met; every Service User has their own named supply of medication and large stocks are not held. Service Users reported that staff treat them with respect and with nice regard of their privacy. This was observed during the tour of the property as staff followed the policy and procedures for respect and privacy of Service Users. This may be more difficult to achieve in the bedrooms that are designated for shared use. See later comments concerning the environment. A new drug fridge has been provided and is situated in a more appropriate place; temperature control for drug storage is monitored. Qualified nurses administer medication and a record of their signatures is now in place. Medication records were found to be in order on the day of the site visit. A pharmacist is available to give advice when needed and the system is inspected regularly. The service is preparing to be involved in an “End of life programme “ that is part of the local PCT development. The Nurses already work closely with the Macmillan Nursing Service. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Service Users have a lifestyle that meets their expectations and that allows them to maintain existing family and personal relationships as part of the community to which they belong. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service Users are offered a flexible routine that allows them to choose how they spend their time. Meals are offered in the dining room but are served in the Service User’s own room if they are unwell or wish to be quiet. The dining room has different areas and people sit together with their friends. Social events are advertised and individuals are encouraged to continue to participate in their previous hobbies. The home is situated next to St Deny’s Church and was once the Vicarage. Service Users are welcomed to attend the services that are held next door and the Vicar is a frequent visitor to the home; she holds a service there every month. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 13 At the time of the inspection visit the staff were all participating with a visiting performer to give a pantomime. This was enjoyed very much by Service Users and some relatives who had come in for the event. Several relatives spoke to the inspector and confirmed the results of the surveys because they are very satisfied with the service and care given. One of the older residents in the home told the inspector that she has “a lovely life” and was very well cared for. She expressed a wish to go Christmas shopping in a large store and was delighted that staff were arranging to take her. All those who spoke to the Inspector liked the food and this was reported in the surveys. Nutritional assessments are carried out; staff were observed to give assistance skilfully to those who are unable to feed themselves and to prompt others who need support. Menus choice is given, the cook visits all Service Users and their wishes are recorded. Drinks and snacks are available as needed, fluid intake records are kept and weight checks are recorded. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 14 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): 16,17,18. Quality in this outcome area is good. Service Users know how to complain if they wish and are confident that any concerns will be heard and resolved. There are arrangements in place to safeguard those receiving care in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service Users informed the Inspector that they know how to make a complaint if they need to. The relatives were also aware of the procedure. The “Have your Say” surveys contained evidence that Service Users consider that the staff listen to them and act to rectify any concerns that are raised. No information on complaints had been received by CSCI. Three had been managed appropriately in the service. There is a policy and procedure in place for the protection of Service Users from abuse. No allegations had been made. Staff in the home had received training in the awareness of abuse. Staff on duty were able to inform the Inspector of action that they would take to safeguard Service Users. A recent staff issue was referred under the Protection of Vulnerable Adults (POVA) procedure but the issue was not serious enough for inclusion in the register. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. Service Users live in a pleasant environment that is well maintained and equipped to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All bedrooms in the home meet the single bedroom minimum size requirements. In addition five rooms meet the size requirement for two persons to share a room. None of these rooms was being shared at the time of this visit and the Registered Manager was able to outline a rigorous procedure that is followed to ensure that only those who choose to do so share a bedroom. Only one of the five rooms has an ensuite facility and the rooms are not fitted with screening curtains for privacy. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 16 Given that there is little room in these rooms for care to be given from either side of each Service User’s bed, the respect of privacy and dignity could be compromised when two people share these rooms. A plan for improved screening or privacy is needed if it is planned for two persons to use one of these bedrooms. The building offers individual single rooms, many with pleasant views, that are individually furnished and accommodate Service Users’ own possessions. The shaft lift does not give level access to all bedrooms; it is necessary to negotiate a small flight of stairs to reach a few bedrooms that are situated on the first floor. A special stair lift is provided and some staff are trained to use the equipment. The home is equipped with rails, ramps, assisted baths and equipment for nursing care. One of the returned surveys commented that the wheelchairs could be cleaner. During the inspection no dirty wheelchairs were seen; all had foot rests attached and these were used. There was evidence that the service has a programme of wheelchair maintenance in operation. Clever attractive use is made of a central column that is situated in the dining room that allows the room to be divided into more interesting areas that can offer privacy for staff to assist those who need to be fed. A quieter small lounge is also available and in addition to a room that can be used for Service Users’ private meetings. Service Users live in a safe comfortable environment; hot water temperatures are controlled and Service Users are protected from scalding on hot radiator surfaces. Action has been taken since the previous inspection to risk assess and make safe all first floor opening windows. The home is clean, tidy and odour free. Arrangements have been made for proper collection of sharps and clinical waste. The laundry equipment operates to infection control standards. Staff were observed to give care in accordance with infection control procedure. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Service users receive good care from a team of well-trained Nurses and care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were additional staff on duty because of the Pantomime activities; however, the rotas show that there are additional staff on duty at busy times and at weekends. Two returned surveys expressed a view that there are not always enough staff. There was no evidence of this during the inspection or in the rotas. None of the Service Users the Inspector spoke to had any concerns about the levels of staffing. They did confirm that staff always meet their needs and listen to them. Staff meetings are held regularly and in recent months there has been little or no use of agency staff. 76 of staff have achieved NVQ level 2 or above and a further 3 staff are in training. A student nurse was supernumerary in the home; she told the inspector that she had enjoyed her placement and was very pleased with the level of care that she witnessed. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 18 There is evidence in the home that a thorough recruitment procedure is followed; staff are checked and employed in accordance with good practice. Many staff are from the local area. There is an improved staff-training programme in operation. It includes induction and on-going training following appraisal. Staff confirmed that training had improved their manual handling skills. Many of the staff have worked in the home for a long time and are able to give continuity of care to Service Users. This has been assisted recently by the employment of more permanent staff from the local area and less use of agency staff. There was evidence that the correct procedures for recruitment of new staff are followed. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 19 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): 31,32,33,34,35,36,37,38. Quality in this outcome area is good. Service Users live in a home that is well managed and offers care in an environment that is operated in accordance with health and safety legislation and where their interests are protected by staff who are directed and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is an experienced qualified nurse and he holds the Registered manager’s award. He is a founder of the home and has clearly been involved with change and development in the provision of care services over the years. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 20 The senior staff team consists of registered nurses and they have knowledge of the conditions and diseases associated with old age and are able to demonstrate the application of skilled nursing care. The service has been accepted to participate in the local PCT “End of Life” development project. There are clear lines of accountability in the home and there is an open and positive management approach. This has resulted in a staff team that works together well to support Service Users and other members of the team. The pantomime that was held for Service Users and their relatives in the afternoon gave staff the opportunity to participate in dressing up and fun activities that were much appreciated. There is a quality assurance and monitoring system in place and Service User views are sought. Action had been taken to comply with the requirements of the previous inspection. Insurance for the business is in place and there is evidence of sound financial management. Service User financial affairs are protected; none is currently able to manage their own affairs which are managed by relatives or a representative. Employment policies and procedures are in place and staff receive induction, training and supervision on a regular basis. The home has up to date records that are required for protection of Service Users and for effective operation of the service. There are systems in place to promote the health, safety and welfare of both Service Users and staff. Safe working practice for manual handling, COSHH, food hygiene, safe operation of electricity, gas and water systems is in place and recorded. Accidents are recorded and staff are trained in first aid. Fire safety procedures are followed and the fire safety officer has been consulted recently. The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 4 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 3 3 3 3 3 The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 22 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 OP10 Regulation 23, 1a, 14 1a Requirement Plans must be made to improve the screens provided for the shared rooms so that Service Users who choose to share have privacy. Timescale for action 02/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange Nursing Home DS0000027178.V322330.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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