Inspection on 17/09/07 for The Grange Care Home

This inspection was carried out on 17th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Grange Care Home 28/06/06

The Grange Care Home 05/09/05

The Grange Care Home 14/04/05

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 Lisbeth Scoones Key Unannounced Inspection 17th September 2007 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 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 Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 252394 F/P 01303 252394 thegrange@ashwoodhealthcare.co.uk Ashwood Court Healthcare Ltd Mrs Carol Weeks Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2006 Brief Description of the Service: The Grange is a large extended 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 and a quiet room/conservatory on the ground floor. There is also a spacious porch with seating, where residents are able to relax. The property has two floors and the home has a shaft lift. Following a recent extension, there are 28 single bedrooms, 20 of which have en suite facilities. The home is situated in Folkestone, close to local shops and other public amenities including the local bus service. The current range of weekly fees is from £312 - £475 with additional charges for chiropody, toiletries and hairdressing. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 17th September 2007 and comprised discussions with the registered manager Mrs C Weeks, proprietor Mr Ibrahim, other staff, residents and three visiting relatives. A tour of the premises was undertaken and documentation inspected. These covered care plans, complaints and accident records, menus, duty rotas, staff training, employment records and polices and procedures. The inspection visit was further informed by information obtained prior to the visit. The manager completed an AQAA (annual quality and audit), which provided a detailed account of the home’s compliance with the National Minimum Standards. 5 Comment cards completed by residents, 4 relatives, 5 staff and one health professional were returned. The great majority of these were very positive and are incorporated in the report. A complaint received was investigated under the local authority adult protection procedures. The home is working towards implementation of an action plan. What the service does well: The environment is homely, pleasant and well maintained. The management and staff are very welcoming to visitors. The proprietor is very much involved with the home and visits regularly in a supportive role to the manager and staff team. The manager has developed a good relationship with GP’s and district nursing staff. Over 50 of the care staff are NVQ trained. A Quality Assurance programme is in place and residents/relatives and staff are regularly surveyed. A summary of responses is maintained and shared including the action taken to rectify any deficits. The manager is proactive in improving the service. She is receptive to comments, requirements and recommendations made by the CSCI and other authorities. She is keen to implement these as soon as possible. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with information about the services the home provides. However, this needs further updating. Residents are assessed prior to admission to ensure that the home can meet their needs. EVIDENCE: A Statement of Purpose and Service User Guide (Welcome Pack) have been produced giving details of the facilities and services available within the home. These documents are available in the entrance hall. The information needs further updating to reflect the additional beds and other details. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 9 All prospective residents are invited to visit the home to have an opportunity to view the premises and the vacant room and to meet with staff and residents. Before moving into the home an in-depth pre-assessment of need is undertaken. Care needs are thus identified and the judgement made of the home’s capacity to meet these needs. Evidence of such assessments was seen. On moving into the home a trial period is agreed with the resident, with a review of the placement at the end of this period. Each resident is given a written copy of the ‘terms and conditions’ of their stay which includes the fees charged. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in an individual care plan but these could be further improved following care review. Residents’ health care needs are met. Residents are protected by the home’s medication procedures. However, the recording of the medication administration needs further attention. Residents are treated with dignity and respect for their privacy. EVIDENCE: The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 11 The manager has continued to upgrade the residents’ care plans. These are informed by risk assessments and reviewed monthly. A ‘Key worker’ system is in place. Key workers are very much involved in the care planning and monthly review process. It was recommended that where a review identifies a change in care need, this be reflected in the care plan. Information about resident’ “life history’ is obtained when possible. Care planning records include accidents and incidents records and visits by the GP and other health professionals. Residents are involved in the writing of and sign their care plan. The care of residents on the district nurses’ caseloads at The Grange has recently been transferred to the residential home team. A community sister commented that staff always appear helpful and open to suggestions. The manager said that, since the new set-up, communication had greatly improved. The manager confirmed that all staff complete a ‘safe handling of medication’ course, prior to having the responsibility of giving medication to residents. The home actively encourages residents to self medicate following risk assessment. Medication administration charts were examined and had in general been well maintained and are regularly audited. However, additional evidence needs to be put in place to ensure that “gaps” are explored and acted upon and that “as required and “as directed” medication is recorded clearly. It was further recommended that the use of non-administration codes be reviewed. The manager must ensure that all medication is stored in a temperature-controlled environment that does not exceed 25 degrees Centigrade. Residents and visitors spoken with praised the staff for their attentiveness, support and kindness. It was observed that staff interacted with the residents and their visitors in a respectful manner. A relative spoken with said that he was very satisfied with the care provided and that the management and staff were very approachable. A member of staff said that the manager was particular about respecting the residents. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in an environment where they have opportunity to be involved in a range of activities and where their choices are encouraged and respected. EVIDENCE: During this inspection visit, many residents were taking part in keep fit exercises. Residents spoken with said they liked to join in these activities, which the home regularly arranges. A residents said” they arrange for Bingo to be played which I love.” Activities sheets are maintained evidencing residents’ participation or otherwise. Three annual events are held such as a BBQ. The manager said that residents have recently suggested that the home organises more frequent outings. This is currently under discussion. Residents were visited in their own room as well as the communal areas. Residents said that they did not feel restricted in any way and said that they are encouraged by staff to make choices in how they spend their time. A The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 13 resident said how much she liked spending time in her room involved in her own choice of personal activities. She said she likes to join the other residents in the dining room for some mealtimes. A visitor said, “My friend has all the care she needs but at the same time has the freedom to do as she wishes”. A relative said, “ If I ever have to go into a care home I hope it is the Grange”. Residents said that the food was generally good with a choice of menu and their requests were always taken into account. During the visit the kitchen was visited and the chef spoken with. Fish and chips or chicken pie and a freshly made chocolate cake were noted. For those residents deemed at risk of not eating or drinking enough, food and fluid charts have been introduced. Relatives and friends are welcomed at the home and this was evidenced during the visit. A relative said that she always was made to feel very welcome on arrival, with refreshments offered. She said there were no restrictions on visiting times or length of time she stayed. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s complaints procedure. Residents are protected from abuse but not all staff have had current adult protection training. EVIDENCE: The home’s complaints procedure is included within the written information given to residents on admission, including the written ‘terms & conditions’. Residents said that they know how to make a complaint and would always talk to the manager. A relative said that the manager was very approachable and would feel confident that any concern would be taken seriously. Recently, a complaint was investigated following the adult protection procedures. The manager is implementing the action plan resulting from this investigation. The manager is aware that there has been a delay in providing all staff with adult protection training or updates. This is currently being addressed. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a recently extended and improved environment which is clean, comfortable and well-maintained. However, an infection control issue must be addressed. EVIDENCE: The home offers residents a comfortable and ‘welcoming’ environment. A member of staff said, “the home is a very happy and caring environment which is lovely to work in”. Residents are encouraged to personalise their own room according to their tastes and wishes. Since the previous inspection, the home has been extended comprising 8 additional en-suite bedrooms, an extension to the dining area and a ‘quiet The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 16 room. The garden areas are well maintained. The additional bedrooms have been provided with French windows leading to a decked area with flowerpots and seating. Those residents spoken with said how much they enjoy their private outside space. The home provides a safe environment and radiator covers have been installed to protect the residents from scalding. See also standard 38. Communal areas are nicely furnished. Residents spoken with said the home was very comfortable and that it was always clean with no unpleasant odours. It is evident that the home ensures that all bedroom furniture is of a good standard. A recently vacated room is to be redecorated and the furniture replaced. The home provides a clean envelopment. A resident said,” It is a very nicely kept home.” Since the previous inspection the sluice facility has been moved. However, this area needs attention in respect of hand wash facilities for staff, a cleaning schedule to be followed by staff and COSHH information. A toilet is without a wash hand basins and this must be addressed. Infection control training for staff should include such issues. See standards 30 and 38. Following the inspection visit, it has been confirmed that the infection control issues are being addressed. A delay was noted in the servicing of a lifting device. This was immediately addressed. In respect of maintenance, the kitchen floor must be replaced and the suitability of the washing machines reviewed. See also standard 33 in respect of a development plan for replacement and maintenance. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff in sufficient numbers who receive adequate training to meet the needs of residents. The home’s recruitment procedures protect the residents. EVIDENCE: On the day of the visit, the home was staffed by the manager and 4 carers, two domestic staff and the chef. In discussion with residents and staff it was evident that there is a good understanding of residents’ individual needs. Residents said they were well supported by the manager and the staff team. The home is committed to train staff at NVQ standard. A staff member spoken with said she was looking forward to doing her level 3. Currently 68 of the care staff are NVQ trained. Newly recruited staff undertake induction training compliant with Skills for Care standards. A member of staff said, “I was given a step-by-step guide of everything I need to know. Each training section was completed by myself and the manager so we both know it is completed.” The manager said that a new The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 18 form has been introduced to ensure that all new staff have a good understanding of the company’s policies and procedures. A sample of staff files was examined and evidenced that POVA and enhanced CRB checks are carried out. The late return of a CRB check was explained. It was recommended that interview notes be maintained. The manager said that new documentation to strengthen the recruitment process has recently been introduced. A training matrix is available demonstrating the training planned and received. As already referred to, Adult Protection and Infection control training has been booked. All staff receive the statutory training as well as Dementia care, challenging behaviour and medication training. A member of staff said that the manager had arranged training for her at South Kent College. The need for every member of staff to have an individual training and development assessment and profile was discussed. The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are safeguarded by living in a well managed home. However, the home must ensure that additional senior management support is made available. Good quality assurance systems are in place, which could be enhanced by a development plan. Residents’ financial interests are safeguarded. Staff are well supported and supervised. Some staff supervision is overdue. The home provides a safe environment for its residents but must ensure that lifting equipment is serviced when due and that infection control measures are reviewed. EVIDENCE: The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 20 The manager has been in post for 3 years and is committed to provide the best possible care for the residents. She has a management qualification and has obtained the Registered Manager’s Award. Feedback from residents both during the visit and from surveys received praised the manager and the staff team. Residents commented that the home offers a very relaxed environment where staff respect choices made. Recently the assistant manager left. At the inspection visit, no “senior” care staff had been appointed to assist and support the manager in her managerial role. This issue was discussed with the proprietor and has since been addressed. The atmosphere within the home was noted to be relaxed and friendly A member of staff said that the manager is a very supportive person. Staff are well supported by the manager, with a process of regular one to one supervision and annual appraisal in place. Due to the recent departure of the assistant manager, some supervision sessions are overdue. The home is committed to quality assurance. A resident said, “Everything is excellent”. Residents meetings are arranged at regular intervals, from which feedback on the service is obtained. Further feedback is obtained through questionnaires given to residents/relatives. Evidence was seen of the recent responses received and how these had been collated for further action to be taken as necessary. The proprietor visits the home regularly and writes a monthly formal progress report. See standard 19 in respect of a development plan. The home keeps some finances on behalf of residents for safekeeping. Systems are in place for recording of all money transactions, with receipts kept for money spent on behalf of the resident. From information received it is ascertained that the home provides a safe environment. A Fire risk assessment is in place and staff receive regular fire safety training. The fire alarm system is checked weekly. In respect of safety, see also standards 19 and 26. 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 The Grange Care Home (Commendable) 3 Standard Met (No Shortfalls) Version 5.2 Page 21 DS0000041005.V349402.R01.S.doc 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 2 3 Standard OP9 OP18OP30 OP26 OP38 Regulation 13 (2) 13 (6) 13 (3) (5) Requirement That additional arrangements for the recording of medication administration be made That all staff are provided with adult protection training That the home provides a safe environment re infection control (including staff training) and safety of equipment Timescale for action 30/09/07 30/09/07 30/09/07 The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 23 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 4 5 Refer to Standard OP1 OP30 OP31 OP33 OP36 Good Practice Recommendations That the Service User Guide and Statement of Purpose be updated in accordance with the standard and Regulation That every member of care staff has an individual training and development assessment and profile That additional senior staff be appointed That an annual development plan be devised That all care staff receive staff supervision at least 6 times a year The Grange Care Home DS0000041005.V349402.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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