Inspection on 23/08/05 for The Grange Centre

This inspection was carried out on 23rd August 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange Centre 08/12/06

The Grange Centre 25/10/05

The Grange Centre 18/11/04

The Grange Centre 11/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Grange Centre Rectory Bookham Surrey KT23 4DZ Lead Inspector Kenneth Dunn Unanounced 23 August 2005 09:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Grange Centre Address The Grange Centre, Rectory Lane, Bookham, Surrey, KT23 4DZ 01372 452608 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) The Grange Centre Mrs Jeanette Thompson Care Home (PC) 20 Category(ies) of Learning disability over 65 - LD(E) - 4 registration, with number Sensory impairment (SI) - 20 of places Physical disability over 65 - PD(E) - 4 Sensory Impairment over 65 - SI(E) - 4 Learning disability (LD) - 20 The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Condition One The Home may accommodate up to 4 residents within the categories LD(E), PD(E) and SI(E) 2 Condition Two The age range of the persons to be accommodated will be: 20 - 65 YEARS, with up to 4 OVER 65 years 3 Condition Three It is a condition of registration that those services currently provided in the Main House of the Grange Centre will cease as from 15/11/04 4 Condition Four The services currently provided in the Main House of the Grange Centre will as from 15/11/04 be provided from the Gloucester Lodge site in the units referred to as the Willows, Maples and the Cedars Date of last inspection 18 November 2004 Brief Description of the Service: The Grange Centre is situated in its own expansive grounds on the outskirts of Bookham in Surrey. The service is registered to provide residential care for up to 20 service users in the category of Younger Adults with Learning disability, Sensory impairment and Physical disability. The service has also provissions in place for 4 named service users over sixtyfive years of age. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was the home’s first inspection for the year 2005/2006. This was an unannounced visit, which meant that staff and residents were not aware that it was due to happen. Inspectors spent the first part of their visit in discussion with the manager and staff, checking the shared parts of the home and looking at care plans and reports. The home has been developed and improved in recent years and there are additional plans were now in place for further work to be done. Care and health plans were found to provide a good level of information about each individual, based upon a sound assessment of their needs and aspirations. The second part of the inspection was spent with the residents, who spoke about their day and life in the home. The positive comments made by service users during this inspection indicated a high level of satisfaction with the service and the support offered by the staff. What the service does well: What has improved since the last inspection? Further improvements had been made to the care plans with each service user having a person centred plan developed specifically for them, which recognised who they were, which people were important in their lives etc. The training and development of staff continues to improve, with supervision being undertaken by the manager and deputy on a regular basis. The service is working towards having all staff either NVQ trained or registered to undertake NVQ training. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 6 The home’s statement of purpose and service user guide have been revised and adapted to make them easier for residents to understand. 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 Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 5 The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 9 The home was found to be operating effectively in respect of standards 2 and 5, which were reviewed during this inspection. There is a good quality of information available at the home and the inspector was confident that this would help prospective service users to make an informed choice as to whether the home would be a suitable place to live. EVIDENCE: The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 10 The home has recently reviewed and revised both its statement of purpose and service user guide and provided copies to CSCI. Both documents had been made more user friendly and designed with the user group in mind. There was also evidence that staff took time to explain these documents to service users, both in-group meetings and on a keyworker basis. Sampling of care plans provided evidence that the home has established a sound process of assessing residents’ needs and aspirations and this was being enhanced by the development of person centred planning. Each service user has an individual contract. These were seen to be in place in their individual files and wherever possible they have been signed by the service users themselves or alternatively their representatives. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 The service users’ individual plans are clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences with in depth risk assessments. EVIDENCE: During the inspection service users informed the inspector that they were aware that care plans were in place and that they contained information about them, their needs and “what they wanted in the future”. The manager explained that the service had introduced and been developing person centred planning to ensure that care plans focussed on the individual. The staff and the manager discussed the holistic approach they use in the day-to-day care packages they offer the service users to ensure that a true and accurate picture of the person was maintained. Discussion with service users and staff provided evidence that the service users were actively encouraged to be as independent and to be in control of their own lives as possible. The inspector reviewed a series of risk assessments, which have been produced in consultation with each individual, and as far as possible any restrictions were only applied where the level of risk was considered unacceptable. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 16 & 17 The service users have opportunities for personal development, to take part in appropriate activities within the home and in the local community. They are supported and enabled to maintain and develop appropriate personal and family relationships. Meals are well balanced and varied. Systems are in place to ensure that service users’ rights are respected. EVIDENCE: The relationship between the service users and staff was observed to be relaxed and friendly, creating a warm and homely feel. In discussions with the service users present during the inspection they could not talk highly enough about the staff and the help they gave them and just how pleasant they were. The inspector was informed that they were encouraged and supported to be as independent as they were able and because of this they were able to lead busy and interesting lives, which include attending college, day care, leisure activities, shopping, theatre, home time for life skills development, and the church. Evidence indicated that residents rights were only limited where risks were assessed as being unacceptable. For example after an incident in the local village (which did not involve anyone form the service) it was deemed inappropriate for service users to walk into the shops on their own. This was The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 13 fully explained to all service users and detailed on individual files and risk assessments. The service users were able to confirm that the staff helped them to keep in contact with relatives and friends. One service users explained to the inspector that it was her birthday on the day of the inspection and that she had decided to hold her party with her friends at the centre and them she would travel to stay with her brother for a few days and have a second party. During the inspection one visitors arrived as he was passing he just decided that he would pop in to visit one of the service users. There was no formality about this he was “welcomed and made to feel very comfortable” by the staff. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 All personal care, healthcare, support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Sound policies and practices are in place for the administration and management of medications. EVIDENCE: Evidence gathered from discussions with the service users and staff, substantiated by care plans indicated that the home worked hard to ensure that the service users’ personal care needs were consistently met. The care plans provided further evidence that service users’ healthcare needs are being met. Service users are all registered with a local GP and referrals to other health care professionals are obtained, as necessary, from the GP surgery. The manager informed the inspector that after a series of risk assessments had been completed all service users at the Grange Centre were assessed to be capable of self-medicating. In conjunction with the risk assessments the service users are assisted to various degrees by staff in the handling and administrating their medications. Documentation indicated that this could be minimal with staff auditing service users medications on a regular bases to a more involved role where staff monitor the service users closely every time they administer their medication. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 All required policies and procedures are in place to ensure that service users feel their views will be listened to. Policies are in place to protect service users from abuse and neglect. Staff training minimises the possible risk of harm and abuse. However small issues have not been recorded and as a result have caused problems for staff and service users and their representatives. EVIDENCE: All of the service users, who spoke to the inspectors, knew whom they could talk to if they had a problem or worry. They felt that staff were always willing to listen to them and help in any way that they could. This was confirmed by the observed interactions between residents and staff. Two service users felt that they would be more than happy to contact external agencies if the thought they should. The same service users stated that they understood the role of the CSCI and would happily contact “their” inspector if they had any issues that they felt needed to be “sorted out”. The manager stated that all staff have completed vulnerable adults protection procedures training and were thereby aware of the action to take should they have a concern or if an allegation of abuse was made. The inspector has received information from the representatives of a service user, it was felt that there was a lack of “urgentness” over issues they have raised with staff. It was felt that the lack of recording of their concerns caused unreasonable stress and has resulted in them loosing faith with the care being offered at the home. The inspector discussed these issues with the manager and it was agreed that all concerns and minor issues must be recorded and logged in the same way as a formal complaint. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The location and layout of the home is suitable for it’s stated purpose. It is accessible, safe and well maintained. The home was found to meet service users’ individual and collective needs in a comfortable and homely way. EVIDENCE: The service is split into three distinctive units each one with its own personality and offer the service users an attractive home, which is considered homely, very comfortable and safe. There is real genuine ownership of the service by the service users. The service users that were present during the inspection talked with pride about their home and the security it offered them and was previously stated one service user wanted to stay at home for her birthday party. The home is maintained at a very high level and was found to be clean and hygienic throughout. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 & 35 All interactions observed between staff and service users evidenced a high degree of respect and skill in working with the individual service users at the home. Staffing is kept under review and provided to meet the needs of the service users at all times. EVIDENCE: The relationship between the service users and staff was observed to be relaxed and friendly, creating a warm and homely feel. The service users are encouraged and fully supported by the staff and the manager to be as independent as they were able. The individual service users files reviewed by the inspector detailed the measures taken to support and advance service users in their current skills and in developing new ones. Training and development of staff has been given a high priority. This continues to improve, with a detailed training programme in place and with supervision being undertaken by the manager and deputy on a regular basis. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38 & 39 The service users benefit from the management approach of the home, it provides an open, positive and all-inclusive atmosphere. The systems for service user consultation have been devised specifically to enable the service users to make their views known. EVIDENCE: During the inspection the interactions observed by the inspector between the manager, staff and service users indicated that the service is open encourages positive and inclusive atmospheres. Various systems are in place to ensure that the staff are able to obtain the service users’ views on all issues concerning their life at the home. One of the main methods used is regular service users meeting with the manager and staff. The manager also employed careful monitoring and observation of the individual service user’s reactions and actions in all situations. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 19 The inspector reviewed a recently completed service users survey, a very percentage of the comments indicated that the service users were very content with the service they received at the Grange Centre. Throughout the inspection the service users who were present expressed ownership of the home and felt fully supported by a very stable staff group and the manager. Two service users informed the inspector that they have never been so happy, they further explained what it was all down to the mix of service users, the style of the building, the staff and the manager. Both had lived in the service for a number of years and had seen it develop and become what it is today which they considered to be home. The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Grange Centre Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x x x H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 21 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 YA22 & 23 Regulation 22 (1,3 & 4) Schedule 4.11 Requirement The manager must review and audit the complaints policies and procedures to ensure that all issues and minor concerns are recorded and given the same priority as a formal complaint. Timescale for action 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Grange Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Centre H58 - H09 s13657 Grange Centre v223891 230805 Stage 4.doc Version 1.40 Page 23 - 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. 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