CARE HOMES FOR OLDER PEOPLE
The Grange Nursing Home Keighley Road Colne Lancashire BB8 0QG Lead Inspector
Mrs Marie Matthews Unannounced Inspection 6th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Grange Nursing Home Address Keighley Road Colne Lancashire BB8 0QG 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) 01282 866054 01282 866054 thegrange.colne@fshc.co.uk Alliance Care (Dales Homes) Limited Mrs Dianne Elizabeth Clarke Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (2) of places The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The service must, at all times, employ a suitably qualified manager who is registered with the Commission for Social Care Inspection. The service must at all times, staff the home in accordance with the notice issued by the previous registration authority dated 21st January 2002 Within the overall registered number of beds for older people (OP) 38 may be available for those service users requiring personal care and 38 may be available for those service users requiring nursing care. Within the total number of 40 beds, 2 are avaiable to named service users who fit into the category of younger adult with a disability (PD). These beds are available as long as these service users remain in the home. 27th June 2005 4. Date of last inspection Brief Description of the Service: The Grange Care Home is a converted and extended Victorian house, which provides accommodation for up to forty people who require nursing or personal care. The current registration includes thirty-eight places for older people and two places for younger people with a physical disability. The home was converted from the original house and has had additional accommodation added. The home is situated in a quiet residential area on the outskirts of Colne close to shops and on a main road bus route. There is car parking in the grounds of the home. Lawned areas with mature trees surround the home and there are outside seating areas to the front of the building. The garden is well maintained and easily accessible to those residents who need to use a wheelchair. There are thirty single rooms and five shared rooms. Eighteen of the single rooms and three of the shared have en-suite toilets and hand wash basins. Two shared bedrooms have an en-suite bathroom. There is a passenger lift between floors. Communal areas in the home include three lounges and a dining room and there are seating areas in the reception hall. The Grange Care Home is part of the Four Seasons Health Care Group but registered to Alliance Care (Dales Homes) Ltd. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted at The Grange Care Home on 6th December 2005. The inspection involved looking at records, talking to management, staff and eight residents, a tour of the home and generally looking at what was happening in the home. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There were thirty-five people living in the home on the day of the visit. The home was assessed against the National Minimum Standards for Older People. This report should be read with the inspection report of 27th June 2005 for the reader to get a complete overview of the home. What the service does well: What has improved since the last inspection? The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 6 Information about the home and people’s rights had been updated and was available in resident’s rooms. This made sure that people had enough information to help them to make a good choice about whether the home would be right for them. Medication policies and procedures had been reviewed and provided safe systems in all aspects of medication. The home had employed an activities organiser. Residents said the home provided appropriate activities and entertainments. One resident said ‘there is always something to keep me busy’ another said ‘there are things going on but you don’t have to join in’. On the day of the visit a group of residents were going out for lunch. The home had responded quickly to concerns raised about food being left to go cold and routines had been looked at. Residents were very happy with the meals and said there was always a choice on the menu and special diets were available. The food served looked appetising and nutritious and was served hot. Care staff were seen giving prompt support to those residents that needed. One resident said ‘the food is very good’ another said ‘ we are always well fed’. The routines of the home had been looked at to make sure there were enough staff on duty at all times to meet resident’s needs. Residents said there were enough staff to look after them properly. One resident said ‘there are enough staff and there is always someone to help me’ another said ‘we are well looked after and I feel safe’. Residents said ‘staff are lovely’. The home had made sure that staff had the training and skills to meet the needs of residents in their care. 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 DS0000022465.V270732.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. The home provided current and future residents and their representatives with enough information to enable them to make an informed choice about admission to the home. The home obtained detailed information about prospective residents to ensure the home was able to fully meet their needs. EVIDENCE: Information about the home had been updated and was available in resident’s rooms. A contract of admission had been given to all residents or their relatives so that they were clear as to their rights within the home. Two resident’s care plans were looked at and all had had their care needs assessed before admission to determine whether the home could look after them properly and whether their needs could be met. The assessments were detailed.
The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 9 All residents had a care plan; however one resident’s plan did not include all their care needs as indicated in the assessment. (See standard 7). The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. The standard of care planning was good and involved residents but staff still needed to include all information from the assessment to ensure they had a good understanding of how to meet the resident’s health needs. The policies and procedures for the management of medication had improved and ensured that resident’s medication needs were safely met. EVIDENCE: Two residents care plans were looked at. The plans were clear, well-organised and included action to be taken by staff to ensure resident’s needs were met. One of the plans did not include some needs that were assessed before he came into the home. A wide range of risk assessments were included in the plans. Staff needed to make sure that once a risk had been identified there should be a plan to detail preventative action particularly in relation to falls and prevention of pressure sores. There was evidence to support that resident’s, or their relatives, had been involved in the development of their care plans. Reviews had taken place monthly and the care plan reflected any changing needs. Two residents said staff had talked to them about their care.
The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 11 Medication policies and procedures had been reviewed and guided staff to provide safe systems in all aspects of medication. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. The home provided a range of suitable activities to meet the social needs, expectations and interests of the residents. The home provided a varied menu and people were able to exercise choice and control over what they ate. EVIDENCE: The home had recruited an activities organiser. Four residents said the home provided appropriate activities. One resident said ‘there is always something to keep me busy’. Another said ‘there are things going on but you don’t have to join in’. A number of residents were getting ready to go out for lunch. Others were looking forward to the Christmas party and Nativity concert. The lunchtime routine had been reviewed following concerns about food being left to go cold. Residents made positive comments about the standard of the meals. The food served looked appetising and nutritious and was served hot. Residents said there was always a choice on the menu and special diets were catered for. Care staff were seen giving prompt and discreet support to those residents that needed. One resident said ‘the food is very good’ another said ‘ we are always well fed’. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 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 the following standard(s): 16. The home had a clear complaints system and residents knew whom to speak to and were confident their concerns would be taken seriously. EVIDENCE: Clear records had been kept. Residents said they would know whom to speak to and were sure their concerns would be resolved. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26. The standard of the environment, both inside and outside, was good and provided residents with an attractive, comfortable, safe, well maintained and homely place to live in. Recent investment had improved the appearance of the home creating comfort and safety for people who lived in and visited the home. EVIDENCE: Residents were happy with their rooms. Comments included ‘my room is very nice’, ‘I couldn’t ask for better’ and ‘I have been able to bring my own things in to help me settle and to make it feel more like home’. One resident said ‘the home is always clean and bright and doesn’t smell’ and the home is ‘beautifully decorated’. Since the last inspection the home had been painted outside and double glazed windows had been fitted. Valves had been replaced to ensure a constant hot water temperature and adjustable beds had been provided for a number of residents whose care needs required specialised equipment.
The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 15 The home did not have a sluicing disinfector. The registered manager said this would be resolved when the current system was in need of replacement. At the time of the inspection the home was unable to meet this standard. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The staffing numbers were sufficient to meet the needs of the residents. The standard of recruitment practices was not consistent and this potentially left residents at risk. The home had improved the provision of appropriate training to ensure staff had the skills to meet the needs of residents in their care. EVIDENCE: The registered manager had reviewed the routines of the home to make sure there were enough staff on duty to meet resident’s needs. Residents said there were enough staff to look after them properly. One resident said ‘there are enough staff and there is always someone to help me’, another said ‘we are well looked after and I feel safe’. Residents said ‘staff are lovely’. Two staff recruitment files were looked at. One file did not have appropriate checks in place prior to commencing. The application form on the second file had not been fully completed. Staff passport photographs, as a means of identification, were not clear. Staff had received appropriate training and a number of staff were waiting to commence NVQ training. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. The registered manager has the necessary skills and experience to manage the home and ensure it meets its stated aims and objectives. EVIDENCE: Mrs. Diane Clarke is the registered manager of The Grange Care Home. Mrs Clarke, a qualified nurse, has many years experience caring for elderly clients and extensive management experience. She is due to complete the Registered Managers Award training. A number of residents made positive comments about the registered manager. They said she was ‘good at her job’, ‘helpful’ and ‘very kind’. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X X The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement Timescale for action 16/01/06 2. OP8 13 3. OP29 19 The registered person must ensure the resident care plans are generated from the assessment and set out in detail the action to be taken by care staff to ensure all needs are met. Timescale of 29/08/05 not met. The registered person must 16/01/06 ensure once a risk is identified appropriate interventions to reduce the risk are documented in the care plan. Timescale of 29/08/05 not met. The registered provider must 19/12/05 operate a thorough recruitment procedure. 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. Refer to Standard OP26 Good Practice Recommendations The registered person should review the provision of sluicing facilities in the home in order to meet the
DS0000022465.V270732.R01.S.doc Version 5.0 Page 20 The Grange Nursing Home 2. 3. 4. OP27 OP28 OP31 requirements of this standard as regards nursing homes. The registered person should include a clear means of identification (photograph) on staff recruitment files. The registered person should ensure that 50 care staff are qualified to NVQ level 2 in care (or equivalent). The registered manager should obtain a relevant management qualification. The Grange Nursing Home DS0000022465.V270732.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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