Inspection on 14/04/05 for The Grange Care Home

This inspection was carried out on 14th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Grange Care Home 17/09/07

The Grange Care Home 28/06/06

The Grange Care Home 05/09/05

The Grange Care Home 23/11/04

The Grange Care Home 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Grange Care Home 22 Cornwallis Avenue Folkestone Kent CT19 5JB Lead Inspector Penny McMullan Unannounced 14th April 2005 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 Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Grange Care Home Address 22 Cornwallis Avenue, Folkestone Kent CT19 5JB 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) 01303 252394 01303 252394 thegrangecarehome@tiscali.co.uk Ashwood Court Healthcare Limited Registered Care Home 20 Category(ies) of Older Persons aged 65 and over registration, with number of places The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23 November 2005 Brief Description of the Service: The Grange is a large detached property situated in its own grounds, with well maintained gardens at the front and back of the home. There are two lounge/dining rooms on the ground floor. There is also a spacious porch, where service users are able to relax. The property has two floors and the home has a shaft lift. There are 20 single bedrooms, 12 of which have en suite facilities. The home is situated near to Folkestone, close to local shops and other public amenities including the local bus service. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over one day. Half of the time was spent with the service users/relatives and the rest of the time was spent in the office talking to the proposed Registered Manager and staff. The proposed Registered Manager has been in place for nine months and said that she is in the process of completing the application form and this will be forwarded to the Commission without further delay. There was an additional visit made to the home with regard to an anonymous complaint on 15 March 2005. At the time of this inspection the proposed Registered Manager was not aware of the report. This was forwarded to the Registered Provider on 30 March 2005. The home had actioned one requirement and at the time of the inspection the review of staffing levels had not taken place, as the timescale for this review is 30 April 2005. There were seven issues raised in the complaint, three issues were partially upheld, one was upheld and three were not upheld. The additional visit letter is available on request to members of the public or other enquirers. Ten people who use the service were spoken to, two relatives who were visiting the home at the time of the inspection; one care manager and five members of staff. The people who use the service were spoken to in their individual bedrooms, the lounge and dining room. What the service does well: People who use the service said that overall the care was good in the home and the carers do their best. They said that the home provided good food and the cook was always making sure they were happy with the food being provided. They said that the home was well looked after, tastefully decorated and furnished. The grounds are always well maintained and they were looking forward to using the garden once the weather has improved. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 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 Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 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) 1, and 3. Standard 6 does not apply to this home. The home is carrying out pre assessment visits to prospective service users and ensuring that the required information about the home and the services is being provided. The absence of accurate information being recorded on the assessment of needs form results in the needs of the people receiving the service not being met. EVIDENCE: The home is carrying out assessment of needs for all service users. Some assessments did not reflect the full identified needs outlined by the placing authority care plan. One service user who had recently been admitted to the home said that the Manager had discussed all aspects of her care and said she was very happy with her placement. Relatives confirmed that the home had provided a Statement of Purpose and Service User Guide. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 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) 7,8,9,10,11 The care planning system is not consistent to provide staff with the information they need to meet the service users needs. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet users needs. The health needs of service users are well met with eveidence of good multi disciplinary working takling place on a regular basis. Service users safety, health care and general well being is at risk due to the lack of recording medication changes and refusal of medication. EVIDENCE: Information recorded in the care plan was insufficient. Risk assessment forms have been completed but there is no safe practice of work. Some care plans did not contain moving and handling risk assessments and in one case a risk assessment was not signed and dated. The plans do contain substantial information, which needs to include outcomes for service users, and in some cases how the identified needs of service users will be met. Health care needs are monitored and recorded in the service user plan and some care plans had been reviewed. The home is supported by the District Nurse, Continence Nurse and access specialist services through the GP. The The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 10 people who use the service confirmed they visit their own GP and one service user who is able to self medicate was happy with the arrangements in the home. Changes in medication require clear instructions to be recorded on the MAR sheets and there were gaps in the recording when service users refused their medication. The proposed Registered Manager said that she is going to audit medication records in the future. People who use the service said that staff were now knocking and pausing before entering their bedrooms and their privacy is upheld. The home has a policy on death and dying and the proposed Registered Manager said that she is currently looking into accessing bereavement training for all staff. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 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) 12,13,14,15 The home endeavours to provide activities to meet the needs of the service users. Visitors are welcomed by the home and family contact is encouraged. Service users are supported to exercise choice over their lives. The home provides a well balanced nutritional diet and the overall provision of meals is of a good standard. Service users confirmed choice and variety of meals and special diets are catered for. EVIDENCE: The people who use the service said that they are able to go to the Tuesday club, and join in activities as they wish to. They said that not all of the people who live in the home are interested in some of the activities provided. Music exercise sessions are held fortnightly and the people who use the service are asked if they wish to go out and staff record this information. Visitors are frequent and relatives said that the home was always welcoming and they could visit the person in the privacy of their own room, the lounge and in the seating area in the porch. Any restriction on visiting is agreed with the person using the service or representative or family member and sensitively monitored and recorded. One professional visitor said the home was providing good care and the service user was very happy with the services being provided in the home. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 12 The people who use the service said that they were able to personalise their rooms with their own possessions and were aware of their records but did not express a wish to view them. Four service users said they were very happy with their rooms and one service user was looking forward to moving to a larger room. Service users said that the food was good and the home provided a well balanced diet. The cook informs them what is for lunch and tea the next day and they are able to choose and request alternatives if they wish to. They said the food was well presented and on occasions he will cook a curry, sweet and sour chicken or pasta. Service users also said that they discuss the menu at the residents meetings and are able to request additional choices to be added to the menu. The Cook ensures that the people who use the service are able to participate in the menu changes and asks them if they enjoy the meal on a regular basis. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 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) 16,18 The Home has a satisfactory complaints system in operation. Everyone is aware of how to raise concerns or complaints and the procedure is on display in the home for all services users, relatives and visitors to access if required. It is recommended that the home continue to provide all staff with adult abuse training to ensure staff has a clear understanding of protection of vulnerable services users. EVIDENCE: The people who use the service were all aware of whom to complain to if they had any concerns. None of the ten service users spoken to had any complaints or concerns to make. The complaints procedure was on display in the porch and there is a record of all complaints/concerns. One service user had raised a concern, which had been recorded, and actioned appropriately. The home has received one anonymous complaint made directly to the Commission, which resulted in an additional visit on 15 March 2005. This complaint is referred to in the summary at the beginning of this report. The home is providing Adult Protection training for staff and five have currently completed the training. Staff spoken to was aware of adult abuse and the home is ensuring that all staff receive the Adult Protection Training. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 14 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) 19,21,2526 The home is well maintained and decorated to a good standard providing service users with an attractive and homely place to live. There is a potential risk to service users that some of the radiators within the Home have not been covered. There are polices and procedures in place for the control of infection, however the separation of the sluicing facility is recommend to reduce the risk of infection. EVIDENCE: The people who used the service said that the home is well decorated and kept tidy including the gardens. Routine maintenance is carried out on regular basis and there are no outstanding issues from the last Environmental Health visit. The home is in the process of fitting two new fire doors on the immersion heater cupboards. There are 12 en suite bedrooms and there are adequate toilet and bathing facilities to meet the needs of the service users. The sluicing The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 15 facility is located in the bathroom on the first floor and the home needs to review this situation, as the sluicing facility should be located separately from bathing facilities. The home is in the process of fitting radiator guards and the radiator in the lounge by the dining room table is not currently covered and was hot to touch at the time of the inspection. The home needs to carry out a risk assessment on this radiator and provide the Commission with a date of completion when the fitting of the guards will be completed. The service users said that the home is cleaned and always free from offensive odours. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 16 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) 27,29,30 In order to comply with moving and handling risk assessment and to minimise the risk to service user and staff the home must review staffing levels and provide two waking night staff. Insufficient staff on duty is having a detrimental impact on the standard and consistency of care offered within the Home. EVIDENCE: The home is providing induction training linked to TOPPS. During the inspection staff were being assessed for NVQ and no replacement staff were covering direct care to the service users. The home must ensure that adequate staff are on duty when the NVQ assessor is working with the staff. There are only two members of care staff rostered for the afternoon shift; the Manager and Deputy Manager can be called upon for part of the shift but in general are not providing direct care. One service user has been assessed as requiring two carers at all times to carry out the moving and handling care but the home has only one waking night staff on duty and one sleeping night staff and during the afternoon there are only two carers on duty therefore there are times when there are no carers available on the floor to meet the needs of the other service users. A review of the staffing levels has been requested. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 17 People who use the service said that the recruitment and retention of staff is a problem, as some members of staff do not stay for move than a few months at a time. During the last week three members of staff have left and two new members of staff have been recruited. The proposed Registered Manager said that the recruitment process is ongoing and there is a problem with recruiting and retention of staff despite induction and training. The proposed Registered Manager said that she is in the process of updating the training matrix and will forward a copy to the Commission. The proposed Registered Manager also stated that all staff is commencing foundation training in May. The new members of staff are receiving mandatory training and updates are also being provided for existing staff. Staff spoken to was aware of the recruitment requirements, two written references, CRB/POVA checks. They said they had shadowed experienced carers, were completing an induction linked to TOPPS and had received terms and conditions of employment. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 18 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) 31,33,35,38 The Manager is required to apply to the Commission to become the Registered manager and complete the Fit Person Interview. The system for service user consultation is good and relatives and other stakeholders are included in the survey. There are policies, procedures and systems in place to ensure the safety of the home however the recording of weekly fire drills is not being carried out. Service users and staff are potentially at risk if current risk assessments do not identify a safe practice of work. EVIDENCE: The proposed Registered Manager Mrs Carol Weeks has completed the Registered Manager Award and is waiting for the assessment. She has over 18 years experience in care and has held a senior position for 8 years. She has been in her current post for nine months and is currently applying to the The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 19 Commission to become the Registered Manager. At the time of the inspection she demonstrated her knowledge of the client group and is committed to meeting the national minimum standards. To date the commission has not received the application and she has stated that this will be forwarded in the near future. The people who use the service said that they had received questionnaires and there had been a residents meeting the day before. They confirmed that the home is ensuring that all concerns are addressed and they are able to have their say. They said that in the past there had been a problem with overseas staff speaking their own language in front on the service users. The Manager addressed this issue and this was no longer the case. Staff confirmed that supervision was taking place. The proposed Registered Manager said that the questionnaires had been completed and were currently with the Registered Provider to be summarised. The survey included relatives and other stakeholders. There are clear recording systems in place to ensure service users are supported to manage their own finances. All transactions and recorded and receipts provided. There are secure facilities within the home. The home is in the process of completing the recommendations outlined in the last fire risk assessment. Weekly fire testing is not being recorded. Mandatory training is being updated on an ongoing basis and the new members of staff are receiving the required training. Accidents/incidents are being recorded and monitored in the service user daily contact sheets. All of the necessary checks are in place to comply with health and safety regulations and environmental risk assessments have been implemented. However some risk assessments require further detail to outline a safe practice of work. Induction training is taking place and all staff are booked to complete the foundation training in May 2005. The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 2 x x x 2 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x 3 x x 2 The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 21 yes 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 7,8,38 Regulation 12,13,15 Requirement Risk assessments must identify a safe practice of work. This is a requirement from the last inspection timescale 31/12/04 Clear, concise information must be recorded on the assessment forms Service user plans require to be developed to include outcomes and all plans require to be reviewed on a monthly basis Changes in medication require clear instructions to be recorded on the mar sheets. Staff must complete the mar sheet correctly when administering medication Staff must clearly record when service users are refusing their medication and monitor that healthcare needs are being met To record fire testing on a weekly basis Timescale for action Revised timescale 31/6/05 31/6/05 31/6/05 2. 3. 14, Sch 3 7 3 15 4. 8,9 12,13 31/6/05 5. 38 13 22/4/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 22 The Grange Care Home 1. 2. 3. Standard 21 25 27 To review sluicing facility location in the home. this is an outstanding recommendation from the last announced inspection on 18th May 2004. To advise the Commission when the fitting of radiator covers will be completed To review staff levels in line with the Residential Forum in Care Homes for Older People The Grange Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 11th Floor, International House, Dover Place Ashford Kent TN23 1HU 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 Care Home H56-H05 S41005 The Grange Care Home V221789 140405 Stage 4.doc Version 1.20 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. 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!