Inspection on 22/03/06 for The Grange Care Centre

This inspection was carried out on 22nd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 04/06/08

The Grange Care Centre 01/06/07

The Grange Care Centre 25/11/05

The Grange Care Centre 18/11/04

The Grange Care Centre 20/04/04

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

CARE HOMES FOR OLDER PEOPLE The Grange Nursing Home Eastington Stonehouse Glos GL10 3RT Lead Inspector Mr Adam Parker Announced Inspection 22nd March 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 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 DS0000016609.V284872.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Grange Nursing Home Address Eastington Stonehouse Glos GL10 3RT 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) 01453 791513 thegrange@eastington.freeserve.co.uk Saddlers Hotels Limited Mrs Linda Rose Barnes Care Home 50 Category(ies) of Dementia (50) registration, with number of places The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th November 2005 Brief Description of the Service: The home is registered to accommodate 50 older people whose nursing/care needs arise from frailty due to a dementia illness. The Grange is a Grade II listed Georgian Country House situated on the fringe of the Cotswolds and the outskirts of the village of Eastington, near Stonehouse. It is set in five acres of parkland with well-maintained gardens to both the front and side of the property. There are plenty of lounge and dining areas on the ground floor. A recently refurbished and extended conservatory provides additional lounge and dining space. The conservatory also provides easy access to a landscaped secure garden area. The accommodation consists of both single and double en-suite bedrooms. They are well furnished and maintained to a good standard. There are en-suite facilities in all but one room; there are assisted bathrooms/shower room and a number of toilets in the home for service users to access. Specialised equipment is provided to meet with individual needs. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on one day in March 2006 by the lead inspector. The inspection consisted of a tour of the home, inspection of the medication arrangements and discussion with the management team regarding the arrangements for protecting service users from abuse, training, staffing, management of the home. In addition the arrangements for looking after service users money and for safe working practices in the home were looked at. The registered manager was spoken to as well as the support manager, registered nurses and support workers. Two service users and one relative of a service user were spoken to, to gain their views on the home. What the service does well: What has improved since the last inspection? Written assessments of service users needs are now signed and dated when they are written. The information held in service user’s records has improved. Daily menus are now displayed in the home and kitchen staff have information about service users likes and dislikes. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 6 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 Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 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 DS0000016609.V284872.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards assessed in this section. EVIDENCE: Although the relevant standard was met at the previous inspection, a recommendation relating to the signing of service users’ assessments has been adopted. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Individual records contain all the information needed for staff to meet service users’ needs. The home has good systems in place to protect service users and ensure that their needs in respect of medication are met, however some further work is needed in relation to medication storage and administration records. EVIDENCE: A requirement was issued at the previous inspection regarding information held in records about service users has now been complied with. The arrangements for the storage, administration and associated recording of medication were looked at. Medication is stored in two sites in the home. In the nursing unit the medication was stored in a ‘conservatory type’ room. Except for the medication storage in the refrigerator there was no monitoring of the storage temperatures in this room which may become too warm in the summer months. In addition the controlled drug storage cupboard was in need of repositioning and refitting to meet with legal requirements. A member of the The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 10 nursing staff confirmed that the condition of service users on medication is monitored and the GP contacted if there are any concerns. In the residential unit there were no means to check the temperature of stored medication. There were some omissions in the administration record charts for the residential unit, these had already been picked up in a recent internal audit and they were being addressed. Some handwritten directions in both units had not been dated or signed. Training for all staff administering medication is extensive and tailored to the needs of older people, the training includes observation and assessment of the staff member carrying out medication administration. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards assessed in this section. EVIDENCE: Although the relevant standard was met at the previous inspection, two recommendations relating to meals and food in the home have been adopted. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff have excellent training in measures to prevent abuse to service users. EVIDENCE: The home takes the issue of preventing abuse to service users very seriously. Staff receive training as part of their induction in recognising and responding to abuse and neglect and this theme is continued into NVQ training. The home gives clear messages to staff on the use of mobile telephones in the work place and the use of inappropriate language. In addition the home has a clear whistle blowing policy and this is written into the job description under a section for “Equality, Diversity and Rights”. Information is available to staff to enable them to contact external agencies if they have concerns about any abuse taking place this includes copies of the “Alerter’s Guide” produced by the local adult protection agency. Staff receive training on dealing with challenging behaviour through a video and an associated discussion. Relevant external courses have also been attended by staff. The home does not permit the constraint of service users and has a policy to guide staff in this area. The inspector was told that staff would not have any involvement in service users wills, although this did not form part of any policy there was brief mention of the subject in the home’s Policy for the Protection of Vulnerable Adults. It is recommended that a statement to this effect should be drawn up to guide staff and further protect service users. The home has a clear policy statement on gifts to staff from service users or their relatives. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Service users have the benefit of living in a clean pleasant and hygienic environment. EVIDENCE: A tour of the home revealed that communal areas and service users’ own rooms were clean and pleasant with no odours except in one room where remedial cleaning was taking place. Staff receive training in infection control procedures. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 Staffing levels in the home ensure that the needs of service users are met. There are excellent arrangements for the induction and ongoing training of staff to ensure that care of a high quality is provided for service users. EVIDENCE: The home is staffed to a level that ensures service users needs are met. Nursing and care staff are supported by cleaning staff, catering staff, administration and maintenance staff. The home places a great emphasis on staff training and has achieved a ratio of over 50 of care staff trained to NVQ level 2 or higher. All care staff receive induction training using the new common induction standards. This then leads on to NVQ training. It was reported that staff receive more than 3 paid days training per year and it was evident that training is at the core of providing a high quality service. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35 & 38 The registered manager is well supported by senior staff to provide clear leadership throughout the home to achieve a high quality of care provision and safeguard the interests of service users. The home is run in such a way as to promote the health and safety of service users and staff. EVIDENCE: The registered manager has a number of years experience in management, has achieved the registered managers award and has a relevant qualification in mental health. She has recently undertaken training relevant to the protection of vulnerable adults. The manager is not a nurse but is supported by a support manager who is a registered nurse. There is a senior carer with an NVQ qualification in charge of the residential unit. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 16 The home does has secure facilities for storage of cash and valuables although these are rarely used except for items that are found in the home. The general policy is for service users’ representatives to take responsibility for these. Staff are provided with training in safe working practices in such areas as fire safety, first aid and infection control. The home has had specialist work undertaken to reduce any risks to service users and staff from Legionella. The home has recently had a new central heating boiler installed. Checks have been undertaken on electrical systems as well as lifts and moving and handling equipment in the home. Regular maintenance in the home includes checking the functioning of window restrictors. The home carries out risk assessments for safe working practices. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 4 X X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X X X 3 X X 3 The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 18 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that all medication storage temperatures and remedial action is taken if necessary to ensure these are within correct limits. The registered person must review the positioning of the controlled drugs cupboard and ensure the correct wall fittings are used. Timescale for action 31/07/06 2. OP9 13 (2) 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP18 Good Practice Recommendations Handwritten entries on medication administration records should be signed and dated by the person making the entry. The home should produce a statement precluding staff from any involvement with service users’ wills. The Grange Nursing Home DS0000016609.V284872.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 DS0000016609.V284872.R01.S.doc Version 5.1 Page 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!