Inspection on 25/11/08 for The Grange Care Centre

This inspection was carried out on 25th November 2008.

CSCI found this care home to be providing an Excellent service.

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 12/12/06

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 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Forest Healthcare Faringdon 25 Church Green Stanford In The Vale Faringdon Oxfordshire SN7 8HU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Delia Styles     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Forest Healthcare Faringdon 25 Church Green Stanford In The Vale Faringdon Oxfordshire SN7 8HU 01367718836 01367710672 thegrange@bonneycourt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Kenneth Ian Mead Type of registration: Number of places registered: Bonneycourt Ltd care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 49. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 31 Over 65 49 0 0 49 Brief description of the care home 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. The fees range from 547 to 1000 pounds per week (November 2008). Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed on 12.12.2006. This inspection included an unannounced visit to the home that lasted 6 hours. The key standards for care homes for older people were assessed. Prior to the visit, the registered manger sent us the annual quality assurance self-assessment (AQAA) about the home and the service it provides. We left a range of our surveys (questionnaires) in the home for residents, relatives, carers and advocates, and health and social care professionals to complete and return to us with their views. There was a good response to our surveys and some of the information and comments from them are included in the report. Discussions took place with the registered manager, deputy manager and several other staff on duty during the day. The inspctor joined residents for lunch in the dining room. Care Homes for Older People Page 6 of 31 A tour of the home and examination of a sample of the records that the home is required to keep - for example, the statement of purpose and service user guide, residents care plans and medication records, staff recruitment and training records and the duty rota - were also undertaken. The homes approach to equality, diversity, privacy and dignity of the people living and working here was considered throughout the inspection process. What the care home does well: What has improved since the last inspection? The home acted upon the requirement we made at our last inspection to review and improve the way in which it protects the privacy and dignity of people in shared rooms. Government grant monies have been used to improve the bath facilities for dependent residents and the patio area, so that there is better access to the gardens. A large screen TV has helped people with poor eyesight to continue to enjoy watching TV and films. Care Homes for Older People Page 8 of 31 Since the new owner organisation, Forest Healthcare, took over, the homes management team has benefited from being able to get advice and support from the team at headquarters. Regular updates in policies and procedures and regular monitoring and audits that take place show that the organisation is constantly checking the standard of care and safety of the environment for the people living here. The information about the home and local facilities that is available to prospective and current service users and their families has been further improved by the development of the website and a monthly newsletter. The induction and ongoing training for staff continues to improve and develop so that staff have access and opportunities for regular training and development that benefits residents through staff practice. The organisation and responsibilities of the staff team has been further established so that residents benefit from having a named nurse and key care worker who know their care needs and preferences and communicate well with health care professionals, family and representatives. The home has responded to a suggestion about increasing staffing levels at handover times by altering the shift times slightly to ensure that there are staff available to residents whilst the next shift of staff have the report. The role of the lounge assistants means that more dependent residents have someone available to make sure that they have companionship, help with meals and drinks and who will call on care and nursing staff if assistance is needed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 9 of 31 240 7535. Care Homes for Older People Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides detailed and accessible information about the service it provides so that prospective residents and their representatives can make an informed choice about whether the home will meet their individual needs. The homes pre-admission assessment process is detailed and individualised so that the prospective resident and the service can be confident that the needs and preferences of the individual will be met. Evidence: The survey responses we received from residents and their relatives show that people felt they had sufficient information about the home to help them decide whether it was likely to meet their needs. One person added that they had an informative tour of the home. Prospective residents and their families are invited to visit the home and spend time Care Homes for Older People Page 12 of 31 Evidence: talking to staff, residents and other visitors to help in their decision making when considering whether this home would be suitable for them. The homes written information - the Terms of Business and Users Guide are detailed and written in an accessible form. Additional contact details and the web site addresses for the company owner of the home (Forest Healthcare), the Grange, and the village, are included to help the reader find additional information. The homes Annual Quality Assurance Assessment (AQAA) and Terms of Business set out the procedure for assessing prospective residents care needs. The registered manager, Mr Mead, or deputy manager, Mrs Mead, undertake a detailed assessment before offering a place in the home. All residents or their representative agree and sign a contract before admission for an initial trial period during which the new resident will be able to decide whether to make The Grange their permanent home. Survey responses from health and social care professionals and care managers highlighted their appreciation of the care and time taken by the manager in the assessment of peoples needs and the individualised approach that is taken to make sure that the home has all the necessary resources in place before agreeing admission - for example, arranging the delivery of any specialist equipment or training for staff to meet the complex or specialist nursing needs of an individual. One professional wrote I place clients in The Grange with confidence. I feel Mr Mead as the manager would ensure his staff have the appropriate skills. He quite rightly asks all the appropriate questions to make sure he can provide the care we request. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here receive personal and healthcare support that is based upon the rights of dignity, equality, fairness and respect for individuals. Access to healthcare, including specialist services and equipment, is effectively managed so that residents receive the care they need. The homes policies and procedures for the management and monitoring of medication protect ensure that residents are protected from risk. Evidence: Each resident has a detailed plan of care based on pre-admission and continuous assessment of their care and support needs. From a sample of 3 residents care records examined, it was evident that there is considerable detailed information to guide staff about how to provide care that meets the preferences and needs of residents. Overall, the standard of record keeping was good, although there were some instances of records not having been updated following a change in prescribed treatment. Staff complete a daily record of the care given during their shift, but comments are not specifically linked to the numbered care needs or problems listed in the care plans. This means there is a lack of specific evaluation comments - that is, Care Homes for Older People Page 14 of 31 Evidence: the records do not show whether the prescribed care continue to meets the needs of the individual resident and if not, what changes to the care instructions have been discussed and agreed with the resident. These points were discussed with the manager and a primary nurse on duty. The care plans cover the physical care needs of residents well, but lack information about the emotional, social and recreational aspects of peoples care. The manager acknowledged that this is an area that they are looking to develop and have recently had some input from specialist workers who have worked with a small number of residents who have difficulties in communicating and so may not be able to express their preferences or be involved in the social life of the home as much as they might. Further work is planned to make sure that the social and recreational interests of all residents are included in their plans of care, and how the home will meet these important aspects of life. From conversation with the managers and staff, and the written comments received in the surveys returned from residents, relatives and other health and professional care workers, we found that there is an excellent understanding and communication about residents individual medical and nursing care, and any changes that are needed if the residents condition changes. There are regular review meetings between the homes manager, primary nurses, residents and their relatives, to make sure that the care continues to match the expectations and needs of the residents. A copy of the residents current care plan is sent to their relatives or representatives (with the residents prior permission) each month. Some of the comments in returned surveys included Any change in my (relatives) condition, medication changes etc I receive such information very promptly. Excellent. The staff are responsive to clients needs and will follow treatment plans accurately. All residents have a primary (named) nurse and a key carer who have specific responsibilites for updating the care plans and making sure that the care and support planned is carried out effectively. The role of the primary nurses and key workers is explained for residents in the Users Guide and relatives are advised to arrange to meet with their nurse and key worker when they visit to discuss any queries they may have. Relatives surveys indicate that they can always find a staff member to help and advise if the named nurse and carer are not on duty. Risk assessments are carried out for residents nutritional state, falls and accidents, use of bed rails, skin damage (pressure sores) and continence management. Referrals are made for specialist medical, physiotherapy and dietetics advise. A qualified podiatrist visits every 8 weeks. The podiatrist carries out a detailed assessment of newly-admitted residents needs in relation to foot care, and provides routine Care Homes for Older People Page 15 of 31 Evidence: treatments thereafter, including foot massage, as requested. The home has a good range of equipment and aids for treatment and assistance of disabled residents. Department of Health grant monies have been used to purchase a specialised bath system for dependent residents. Examination of a sample of the medication administration record (MAR) sheets showed that these were signed and completed by the nurses, indicating that residents receive their prescribed medications correctly. The home plans to alter its medication storage system to individual blister packs for each residents prescribed tablets that will be dispensed from a local pharmacy. Additional medicine trolleys had been purchased to store the new medication cards. The home has regular visits from the Primary Care Trust pharmacist who checks that the homes medication systems for the storage, recording and disposal of unwanted medicines are safe. The home managers also undertake a monthly audit of medicines and records. Only registered nurses are authorised to give out medicines and they are required to keep up to date and follow the best practice set out in their professional codes of conduct. None of the current residents wished to, or were assessed as able to safely manage to store or manage their own medicines. Observations made during the inspection, the comments made by residents and their visitors and in the surveys we received, all showed that the homes stated aims and objectives to foster the privacy, dignity and well-being of our service users and employees are achieved in practice. We consider that this home demonstrates its ability to meet the needs of residents and staff from various cultural, spiritual and ethnic backgrounds. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a good range of opportunities for residents to engage in enjoyable activities both in and outside the home. Managers and staff communicate well with residents, their families and local organisations in order to continue to develop links with the community to improve the social life and support available to people living and working at the home. Food and mealtimes provide a relaxed and sociable experience and meet the nutritional needs of residents. Evidence: Social events and organised monthly activities are advertised in the home and on the homes website and individuals are encouraged to continue to participate in their previous hobbies. Residents are offered a flexible routine that allows them to choose how they spend their time. Since our last inspection the home has continued to look at ways it can improve the opportunities for residents to be involved in a range of activities and social events. A Saturday Club has proved a very successful venture that many residents look forward to going to on Saturday mornings. The purchase of a very large screen TV for one of the lounges has meant that those residents with visual problems can continue to enjoy Care Homes for Older People Page 17 of 31 Evidence: the TV and watching DVDs. The access to the patio and gardens has been improved. The programme of activities planned for December included no fewer than three pantomime productions and a number of musical entertainments including local school children, Brownies, and a choral society singing carols. During the afternoon of the inspection visit several residents enjoyed a game of Bingo. Residents survey responses to our question about whether there were always activities they could join in were varied. Three out of the six people said that this was always the case, two answered usually, and one sometimes. Two additional comments were Yes, but I dont participate and I am unable to take part as I am bedridden, but I do enjoy the singing. Another persons comment was that they get very lonely in their room. This may indicate that the home should consider how well the needs of those who spend a lot of time in their own rooms (through choice or frailty) are met, and might be addressed. The Grange is situated next to St Denys Church and the original part of the building was once the vicarage. Residents are welcomed to attend the services that are held next door and the vicar is a frequent visitor to the home. She holds a Holy Communion service in the home every month and there are regular Songs of Praise services for those who cannot attend services at local churches. The home has arranged an escort service with local church members for residents to get to and from St Denys church services and social events. The home employs two staff whose roles are described as lounge manager and lounge assistant. These staff members are available during the day in the ground floor lounge areas to supervise activities, talk to and assist more dependent residents with their drinks and meals. This is an excellent way of ensuring that residents do not become isolated or overlooked when spending time in the communal sitting rooms and when nursing and care staff are necessarily busy with other residents care. The lounge manager described her role in the home and is clearly a very enthusiastic and approachable advocate for residents and their relatives. Visitors are made very welcome in the home and this was confirmed in several of the survey responses received in comments such as, My home is always welcoming to my visitors as well The home ensures that residents are included in all aspects of everyday life in the home and makes families feel welcome The home looks after the relatives as well as the user All members do their best to make it a loving and happy home. The six residents who completed our survey question about whether they liked the Care Homes for Older People Page 18 of 31 Evidence: meals in the home all answered that this was usually the case. The deputy manager said that mealtimes have been slightly amended since our last inspection and that the menu choices were currently being reviewed and updated. Residents opinions and requests for particular menu items and the meal choices on offer are sought from residents on a regular basis, through discussion with the cook, lounge staff and regular residents questionnaires. The menus seen showed that a good variety of nutritious and well-balanced meals are on offer. Meals are offered in the dining room but are served in the residents own room if they are unwell or wish to be quiet. The dining room has different areas and people sit together with their friends. During this inspection visit residents who needed assistance with eating their meals were observed to be helped in a discreet and unhurried way by staff. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here feel that they are listened to and that any concerns or complaints they have are followed up and acted upon by the managers and staff. The homes policies and procedures are effective in safeguarding residents from abuse. Evidence: The home has a clear and accessible complaints procedure that is included in the statement of purpose (Terms of Business) and service user guide documents. Leaflets are available to residents and visitors in the entrance hall of the home inviting people to make suggestions, share comments, or complain. The contact details for the company owners of the home, the home managers and other helpful contact addresses for independent advocacy and advisory organisations (for example, Age Concern and The Relatives and Residents Association) are all given in the Users Guide to the home. The home managers are readily available to residents and their families and friends and encourage an open door approach that welcomes people to raise any concerns or problems with them, so that these can be dealt with promptly and do not become a source of formal complaint. All the people who completed our surveys were confident about how to make a complaint, should they need to. Care Homes for Older People Page 20 of 31 Evidence: The homes AQAA (completed in April 2008) showed that they had received no complaints in the preceding 12 month period. The Commission for Social Care has not received any information relating to complaints or concerns raised about the service. Staff records of training and lists of topics for the planned programme of training showed that staff receive information and updates about safeguarding vulnerable adults. Managers are familiar with the local safeguarding policies and procedures for Oxfordshire. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a clean, attractive, homely and wellequipped environment for the people living here. The home owner and managers consult with service users and take action to make improvements to the building and facilities that benefit residents. Evidence: The homes AQAA tells us that by employing dedicated domestic, laundry and kitchen managers they can ensure that high standards are maintained. A tour of the premises and answers to the question in our survey, Is the home fresh and clean, confirmed that the standard of cleanliness is commendably high. Residents and relatives surveys showed their appreciation that the home is always spotless. The home has good procedures and policies in place to make sure that the building and environment is well maintained, hygienic and safe for residents, staff and visitors. Residents are encouraged to personalise their rooms. Before moving in, new residents are assured that their rooms will be redecorated, re-carpeted and new furniture added. The home owners are planning to make further improvements to the building and facilities and a new phase of planned development is due to start in 2009 to extend Care Homes for Older People Page 22 of 31 Evidence: and improve the kitchen and laundry areas, reduce the number of shared rooms, and increase the number of rooms with en-suite facilities. The older part of the building, especially on the first floor, has a split level so that a short flight of steps with a stair lift are the only access to some rooms. The planned refurbishment and building work should address some of these problems so that residents can have easier access to their rooms. Our survey respondents only suggestions for improvements were about some aspects of the environment. Comments made were, Could provide more private visiting areas at times Problem with the size of lift Provide custom built areas Improve the facilities with the refurbishment and extension planned 2009 ie remove the double rooms and add en-suites to all rooms. Since our last inspection, the home has taken action to address some problems we pointed out in terms of maintaining privacy and dignity especially for residents in shared rooms for example by ceiling tracked curtain screens have been fitted and all doors to shared toilets and bathrooms have privacy signs. The home has acted on the suggestions of residents and have improved the dining room facilities. The laundry area is not ideal for the processing of laundry work as it does not have separate areas for incoming dirty laundry and the clean items. However, it is clean, tidy and well-organised. The proposed new building work will improve the laundry area. The home is well equipped with protective aprons and gloves for staff, and hand washing and alcohol gel dispensers for hand hygiene. All staff have training in infection control matters and have discreet signs and instructions for staff about the correct procedures to be followed when a resident is known to be at additional risk from, or has, an infection. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills of the staff consistently meet the assessed care and support needs of people living here. The staff team work well together to provide a good standard and continuity of care. The recruitment and induction, training and supervision procedures for staff ensure that residents are protected from harm. Evidence: Responses to the questions in our surveys about the numbers, availibility and skills of staff at the home were positive overall. Four out of the 6 residents felt that they always receive the care and support they need, whilst two answered usually. Four out of 6 answered Yes to the question Do the staff listen and act on what you say whilst 2 wrote No and not always. One person said that staff are always available when needed, 4 said this was usually the case and 1 person stated sometimes. Eight out of 10 relatives surveyed felt that the home always give the support or care that they expected or agreed, and two that this is usually so. The same numbers and responses were given to the question Do the care staff have the right skills and experience to look after people properly?. Additional comments we received in the surveys and when talking to residents and visitors on during the inspection visit were very complementary about the staff. Some Care Homes for Older People Page 24 of 31 Evidence: of the written comments we received were, Staff are keen and enthusiastic and very friendly (residents) always look clean and well cared for We are extremely pleased and grateful to the care home and all the staff. Their care and friendliness is outstanding After (number) of years at The Grange, we are more than pleased with the treatment my (relative) has received and feel that she is well looked after and as comfortable as she can be The homes AQAA information (April 2008) tells us that the home has a high proportion of care staff who have attained a National Vocational Qualification (NVQ) in Care - 75 per cent of staff had NVQ Level 2 or above and a further 5 staff are undertaking this course. This exceeds the proportion of trained care staff recommended by the commission (50 per cent) with an NVQ at Level 2 or above. The home has a strong commitment to the training and development of its staff, and since our last key inspection has done considerable work to improve the training and opportunities for staff to access relevant courses for their role. Survey responses from health care professionals showed that they were impressed by the willingness of the manager and staff to organise additional training and updating to meet the needs of a resident with complex needs. Another commented that staff were always knowledgeable about their clients care needs and available to review and discuss care when this professional visits the home. to see people on their caseload. Examination of a random sample of three staff employed at the home since our last inspection, showed that the homes procedures for checking the references and suitability of prospective staff are robust. The deputy manager, who has responsibility for training and recruitment of staff, confirmed that the induction training for new care staff matches the standard of the national training organisation, Skills for Care. Mandatory training and regular updates in topics such as safe moving and handling, health and safety, safeguarding of vulnerable adults and first aid is provided. Records showed that there are regular staff meetings and that all staff have regular individual supervision meetings with their manager or a senior member of staff. The home benefits from having a relatively low standard of staff turnover and many of the staff have worked here for a number of years. This means that there is better continuity of care for residents and the home has little need to use agency staff. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and maintained, with clear lines of responsibility within the staff team. Residents and their families and representatives opinions about the standard of care and facilities are routinely sought and acted upon. The homes policies and procedures are consistently followed by staff and managers regularly monitor and audit practice to ensure that residents health and wellbeing is protected. Evidence: The registered manager, Ian Mead, and his wife have been managing this home since 1984 when they commissioned and opened it with a business partner. They have extensive experience and abilities in their roles and both have the Registered Managers Award (the nationally recognised formal qualification required for managers of registered homes and agencies). Both are registered general nurses. Feedback from our surveys, discussion with residents and visitors, and observation on the day of the inspection showed that the home is very well managed. Residents, their Care Homes for Older People Page 26 of 31 Evidence: families, and the staff are confident that they are listened to and their opinions are valued and acted upon in relation to the running of the home and future developments. The commitment and accessibility of the managers to residents and their families appears to achieve their stated aim of a management style which creates an open, positive atmosphere. As an established care home in a village setting, with a good local reputation and support from the community, together with a staff team many of whom live locally, the Grange Care Centre (as it is now named) has been successful in selecting and recruiting staff who only have a genuine interest in caring for our service users. From conversations with staff and comments received both during the inspection visit and in writing, there is a sense of good teamwork that is focused on the wellbeing and individual care and support of the people living here. Comments made included, The Grange is a happy nursing home and I praise all the management and staff I enjoy working here and have built up many close friends through the years I have been here and have grown very fond of the residents. The management at the Grange is very good. Ian Mead always will contact me if he has concerns or requires further guidance on issues. The manager said that the home has benefited from being part of a larger organisation since the change of ownership to Forest Healthcare in December 2007. An area manager for the company regularly visits and reports on her findings as required under Regulation 26 of the Care Standards Act. The home has an established system for getting peoples views about the home and service it provides. A questionnaire is sent to all relatives regularly. Residents views are sought through regular talks with staff and managers. The lounge manager also completes monthly feedback surveys from residents - a sample of the most recent responses was looked at by the inspector. Suggestions and comments are then fed back to the managers. The homes AQAA tells us that they plan to include the outcome of surveys and what actions will be taken in response, in the monthly newsletter. The newsletter is also available on-line. There are no formal relatives meetings held at present. Most residents have family and friends who visit regularly and it is evident that the managers open door approach, and the named nurse system operate effectively so that people feel they can raise any concerns and queries at any time. There are also leaflets - Tell Us What You Think- in the entrance hall, inviting people to make suggestions, share comments, or complain Care Homes for Older People Page 27 of 31 Evidence: The management and financial systems of the home are regularly monitored and audited so that improvements can be made if necessary and so that the home can demonstrate how it has acted in response for example, to reduce the risk of falls or residents risk of malnutrition or skin damage. The policies and procedures of the home protect residents from financial abuse. The home does not manage residents finances - relatives or an independent appointed representative deal with the financial affairs on behalf of residents who no longer wish to, or able, to manage this for themselves. The home has a system for recording any small transactions made on behalf of residents, for example, buying sweets and crisps from the mini-shop run by the lounge manager. Additional costs, such as hairdressing and podiatry, are invoiced with residents fees. The roles and responsibilities of the management team and senior staff are clearly set out in the statement of purpose for the home. The home employs an office manager who oversees the maintenance and health and safety services in the home. An external safety consultant is used by the home to regularly review and advise the home about health and safety practices Examination of a sample of the homes records showed that records for routine maintenance and safety checks and staff fire safety training are well kept and up to date. The environmental health officers report of an inspection of the kitchen in July 2008 included a requirement to fit ventilation covers. The manager confirmed that this work was in hand. Staff training records and planned training programme showed that all staff are required to attend training health and safety topics such as fire safety, safe moving and handling, first aid, food hygiene, and infection control. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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