Inspection on 05/07/05 for The Grange Care Centre

This inspection was carried out on 5th July 2005.

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 25/11/08

The Grange Care Centre 12/12/06

The Grange Care Centre 26/01/06

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 SN7 8HU Lead Inspector Annette Miller Announced 5 July 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Grange Nursing Home Address Church Green Stanford in the Vale Faringdon SN7 8HU 01367 718836 01367 710672 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bonneycourt Ltd Kenneth Mead Care Home (CRH) 49 Category(ies) of Care Home with Nursing (N) registration, with number of places Old age not falling within any other category (OP) 49 Physical Disability (PD) 3 The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1: On admission persons should be aged 60 years and over. 2: Up to 3 of the total registered number may be admitted between the ages of 18 and 59. 3: The total number of persons to be accommodated at any one time must not exceed 49. Date of last inspection 17th February 2005 Brief Description of the Service: The Grange Care Home is registered as a nursing home for up to 49 male and female residents aged 60 years and over. Registered nurses are on duty 24 hours a day. Two lounges and a separate dining room are located on the ground floor. Bedroom accommodation is situated on the ground and first floors, with some rooms having the benefit of en-suite facilities of washbasin and toilet. There are five double rooms. Social and recreational activities are provided and staff are employed specifically to deal with this aspect of life in the home. There are pleasant gardens that are accessible to residents and visitors. Community links in the village include a small shop, public house and post office. The market towns of Wantage and Faringdon can be reached by car or public transport. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by two inspectors over a period of seven hours. The inspection focused on talking to residents and staff to find out their opinions of the home. The availability of training was also discussed with staff and a tour of the building and inspection of documents took place. As part of the inspection process, comment cards were distributed to a range of people involved with the home and 38 were returned directly to the Commission for Social Care Inspection (CSCI). Many positive comments were received such as: “We are delighted at the way my mother has settled in the Grange. She says everyone is lovely”, “The manager of this home has a very caring and professional attitude and always seems well informed about his residents”, “We are very happy with the level of care, both for my mother and ourselves.” One respondent said he would like to have more sessions involving conversation for residents in small groups, including one-to-one groups, and the manager was informed of this comment. What the service does well: What has improved since the last inspection? Mr. and Mrs. Mead attended a nutritional screening study day in January 2005 and since then have developed nutritional screening for all residents based on the recommendations made during the study day and with reference to: ‘A Guide to the Malnutrition Universal Screening Tool for Adults’. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 standard(s) 3 Detailed assessments of needs are undertaken prior to admission into the home. EVIDENCE: The registered manager undertakes detailed assessments of prospective residents gathering a profile of the individual and information as required by standard 3. Records relating to one sampled resident evidenced that the registered manager undertook a pre-admission assessment on 12-5-05, this was recorded in a typed format on 13-5-05 and the resident was admitted on 19-5-05. The assessment included views from other professionals and significant others and was summarised. A conversation was held with an NHS nurse who was present in the home to assess residents to determine what level of funding the NHS must provide for their nursing care. She reported the quality of assessment carried out by staff at this home was good. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 standard(s) 7 and 8 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The health needs of service users are well met with evidence of good multi-disciplinary working taking place on a regular basis. EVIDENCE: Care records for four residents were randomly selected for inspection and comprehensive information about the residents’ care needs was found. The staff action required was listed and a daily record of the care provided had been kept. A range of risk assessments had been completed to ensure that appropriate care was planned. For example, in each of the sampled files there was a pressure sore risk assessment stating what level of risk there was of residents developing pressure sores. Pressure relieving mattresses and cushions were being used by residents who were ‘at risk’ of developing sores. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 10 Nutritional risk assessments are carried out on all residents shortly after admission and these are reviewed at regular intervals. The registered manager and the senior nurse attended a nutritional screening study day in January 2005 and, as a result, have implemented changes in the way residents’ nutritional needs are screened. Access to specialist services, either privately or via the NHS, such as physiotherapy and dental care, is arranged by nursing staff. A private physiotherapist who was present during the inspection said she thought the home provided good care and found staff friendly and welcoming when she visited. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15. Activities are well planned and there are good opportunities provided for residents to maintain their interests and socialise with other residents. Care plans could be improved by including more information about residents’ recreational interests. EVIDENCE: Relatives and residents spoke highly of the care home and felt satisfied that it met their needs. A designated member of staff provides activities and stimulation through music, quizzes and games etc three times a week. A lounge supervisor who provides good communication and stimulation during the day further supports the residents’ social needs. The registered manager reported that the home is exploring ways of improving creative activities using the recently published document ‘Creativity Matters’. Family and friends reported that they are made welcome when they visit and the inspectors observed this practice. The care home maintains links within the community by enabling residents to attend the local church, sponsoring a local boys football team and welcoming students from local schools to undertake some work experience. A mobile library regularly visits the home. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 12 Residents meetings are held and in addition the activities organiser speaks individually to residents to gather their views. The registered manager undertakes satisfaction surveys and the results of the most recent were available for all to see in the entrance hall. A good variety of food is made available and the kitchen staff were working from a summer menu. The environmental health department visited the home in February and made no recommendations. Records headed ‘Plan of care for daily living’ could be improved by providing more information on residents recreational interests. Some records were completed well, others were incomplete and did not reflect the residents’ choice or interests. Some residents were recorded as being ‘retired’ under the heading occupation. It is recommended that more information is recorded as this may assist in identifying interests and promoting discussion or reminiscence. A relative expressed her thanks in a letter sent to the manager for the “wonderful 100th birthday party” given to her relative and for making it a “very special day”. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 and 18 The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. There was also evidence that staff training occurs on the protection of vulnerable adults from abuse. EVIDENCE: Records relating to two complaints were seen and evidenced that the registered manager had followed the home’s procedure and followed up any complaint asking complainants to indicate if they were fully satisfied or not. This completely closed the process and evidenced what action had been taken to resolve the issues raised. Relatives spoken to were clear that they would talk to the registered manager if they were unhappy with any aspect of the care their relative was receiving. Relatives informed the inspectors that they found the registered manager very approachable. The complaints procedure on display in the home refers to the National Care Standards Commission and this needs amending to the Commission for Social Care Inspection. Training for staff on the protection of vulnerable adults has occurred for some staff, though a recent planned training was cancelled and needs to be rescheduled. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 14 A publication from the Nursing Midwifery Council regarding the prevention of abuse was available in the staff room area. It was reported that all new adaptation staff, i.e. overseas nurses undergoing a period of training leading to UK nursing registration, have a copy and further copies have been ordered for other staff. The care home had not obtained copies of information for care staff from the Oxfordshire Multi-agency Codes of Practice and it is strongly recommended that this happens. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. The environment is pleasant and well maintained. Safety checks are carried out regularly and maintenance records are kept. EVIDENCE: The home employs a full-time maintenance man who arranges for day-to-day maintenance work to be carried out. Checks and any action taken are recorded in the maintenance records and these were found to be up to date and in good order. Bedrooms are redecorated to meet each new resident’s choice of colour scheme. Oxfordshire Fire Service and Environmental Health carry out routine inspections. The last fire service inspection was held on 10.12.03 and was satisfactory. The last environmental health inspection was on 18.2.05 and the report said: “Excellent standards of food handling, storage and overall cleaning. All documentation up to date and staff training carried out in June 2003”. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 16 There were no unpleasant odours in the communal areas and the home looked clean and tidy. There was, however, a slight smell of urine in two bedrooms and this was mentioned to the manager during the inspection in order that this could be dealt with at the time. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. EVIDENCE: The number of staff on duty for 48 residents was: Early: Afternoon: Evening: Night: 2 2 2 2 registered registered registered registered nurses nurses nurses nurses and and and and 8 6 7 3 carers. carers. carers. carers. Duty rotas for the period 15th May to 11th June were inspected and showed that this number of staff is the normal staffing level, except that at night the number of registered nurses is sometimes reduced to one and the number of carers increased to four. Also on duty are members of staff responsible for maintenance, social activities, catering, cleaning, laundry and administrative tasks. A member of the care staff said she was completely satisfied with her working conditions and praised senior staff for the support she received. Also, a student nurse who was on her last day of a three-week placement said she had been very happy in the home and had received good support and learning opportunities. She considered the care that residents received was good. She The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 18 thought that staff morale was high and said, ‘It’s a happy home and a nice place to work’. The manager organises a wide range of training opportunities for his staff as shown by the training programme for the period 27th January to 17th November 2005. This ensures that the skills and knowledge of staff are being maintained and kept up to date. Training is arranged at different times throughout the day and evening for the convenience of staff. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 35. This home is well managed and the manager is supported well by the senior staff to provide clear leadership throughout the home. All staff demonstrated an awareness of their roles and responsibilities. EVIDENCE: Mr. Mead (registered manager) is a registered nurse and has completed NVQ level 4 in management. He has managed The Grange Care Home since 1984 and has developed extensive knowledge of caring for older people. Prior to 1984 he worked in the NHS where he held senior nursing posts. A relative wrote on a comment card returned directly to CSCI, “The manager of this home has a very caring and professional attitude and always seems well informed about his residents.” The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 20 Another relative said, “I have found that any comments made about my mother’s care are dealt with in a constructive manner. From my own experience this is an excellent care home”. The atmosphere in the home throughout the inspection was pleasantly relaxed and the inspectors received many comments from residents and relatives about the good standard of care provided and the manager’s ‘open door’ approach. Members of staff were complimentary regarding the training opportunities and the way in which they are supported by senior staff. It is the home’s policy only to hold money on behalf of residents in exceptional circumstance. At the time of inspection money was being held for one resident. The amount of money received for this resident was recorded and receipts had been retained of all expenditure showing that the money remaining was correct. However, a running total of income and expenditure would make it easier to see more quickly when the accounts are audited that the money remaining is correct. The views of residents and relatives are sought about a range of matters. The manager sent out 49 questionnaires in December 2004 and 26 were returned. Comments were generally good with no general themes of dissatisfaction arising and the results were displayed in reception. The next survey is planned for September 2005. There is also an in-house audit carried out by the maintenance person three times a year to check on all aspects of the home, such as décor and furnishings, maintenance etc. Action is taken based on the findings. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 4 4 3 x 3 x x x The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 12 18 35 Good Practice Recommendations Provide more information in care plans on residents’ recreational interests. Obtain a copy of the Oxfordshire Multi-agency Codes of Practice on the Protection of Vulnerable Adults and incorporate the information provided into staff training. Keep a running total of income and expenditure in the residents money records held by the home on behalf of residents. The Grange Nursing Home H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burgner House 4630 Kingsgate Oxford Business Park (South) Cowley, Oxford, OX4 2SU 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 H57_H08_S27178_The Grange_V225798_050705_Stage 4.doc Version 1.30 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. 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. 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