CARE HOMES FOR OLDER PEOPLE
The Grange Chertsey Ruxbury Road St Annes Hill Chertsey Surrey. KT16 9EP Lead Inspector
Mr D Griffiths Unannounced Inspection 02 September 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 Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Grange Chertsey Address Ruxbury Road St Annes Hill Chertsey Surrey KT16 9EP 01932 562361 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 Chertsey (2002) Ltd To be confirmed CRH (PC) 46 Category(ies) of Old age, not falling within any other category registration, with number (OP) 46. of places Dementia - over 65 years of age (DE(E)) 16. Sensory Impairment over 65 years of age (SI(E)) 8. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE. 2. Within the category OP (Older People), sixteen may be within the category DE(E) and eight may be SI(E). Date of last inspection 09 December 2004 Brief Description of the Service: The Grange is a large detached property set in spacious private gardens. A number of staff live on the premises. The staff team consists of: Manager (Not yet registered), Deputy Manager, Senior carers, Care Assistants, Cook, Catering Staff and Cleaners, with the regular involvement and support of the proprietor. The service provides twenty-four hour care for up to forty-six older people. All bedrooms are single size and all have en-suite facilities that include a toilet, basin and bath. There are spacious communal areas that include two lounges, two dining rooms and a bright and airy conservatory looking out onto the main gardens. The service provides a range of activities and events for residents to attend both in-house and within the local community. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of two to be undertaken in the Commission for Social Care Inspection Year April 2005 to March 2006. It was an unannounced visit and took place over a period of 8 hours. Lead Inspector Damian Griffiths was assisted throughout the inspection by Mrs Diana Mc William, Manager (not yet registered with CSCI) representing the establishment. The inspector met four residents with a variety of care needs including dementia and sensory impairments. Family and representatives were able to contribute to the inspection report by completing two comment cards. Responsible Individual, Mr Sean Costelloe accompanied the Inspector in a tour of the premises. It is recommended that the reader should also look at the previous report that can be accessed by using the CSCI website details on the last page of this report. The inspector would like to thank the staff and residents for their time, assistance and hospitality during this inspection. What the service does well:
The Grange can be easily accessed via the car park at the front of the building and the gardens and grounds were bright and cheerful and in good order. Residents care plans were easy to read and very informative containing information relevant to the needs of the individual resident. There was a commitment to provide a range of activities that suited the needs of the residents and to ensure that there were regular opportunities available for special social events to be held at the home. Resident’s spiritual and cultural needs were respected and supported. Residents are encouraged to continue to remain as independent as possible and the home has good policies and procedures in place. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 6 The Grange is currently engaged in a refurbishment programme of the service and takes care to ensure that the home was kept clean, tidy and comfortable for the residents. Management and staff continue to foster good relationships with residents and their representatives. 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.
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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 Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Detailed and comprehensive assessments for new residents have been completed and were available for the Inspector’s attention. New residents and their representatives were involved with the assessment process. EVIDENCE: Four assessments were inspected and one included the most recent admission to the home. The assessments were comprehensive and formed the basis for residents care plans, which were all easy to read. Areas assessed included personal care and well being, details relating to personal preferences and details of any specialist involvement; i.e. contact details were available for the relevant consultant psycho-geriatrician. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 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 and 11 Care plans sampled showed details relating to health and social care needs and whether residents were self-medicating. Those residents interviewed commented on the sensitive and caring manner of the staff providing this service EVIDENCE: Four samples of care plans were inspected: these included details of residents with sight and hearing impairments, and residents with levels of dementia. All care plans were very comprehensive and contained health and social care information that included; pressure sore prevention, fall and fracture risk assessment, record of weight and blood pressure. Daily records were up to date and care plans had been regularly reviewed and signed by the residents. Two residents who were self-medicating had received a risk assessment, were fully aware of their medical needs and appreciated their independence and the sensitive way the staff team support them. Tablets dispensed were recorded in accordance with policy and procedures.
The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 10 Medication was suitably secured and included blister packed prescriptions. All medication was suitably labelled, and the drug returns book stamped. Staff had signed records and samples of their signatures were in evidence. Staff were observed to knock before entering residents rooms and always addressed the residents by first name. A letter from a recently bereaved family thanking the Grange for their services and the quality of care was observed. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 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 and 14 Social activities were well managed, creative and provide daily variation, individual choice and interest for the residents. Residents were able to benefit from regular opportunities to entertain family and friends and have fun within the home environment. EVIDENCE: Residents can chose from a list of activities on the notice board and there is an activities book available that is regularly updated. General activities provided included: puzzles, quizzes, bingo, and sing-along. The most popular activity of the residents reported was the opportunity for informal reminiscence and the manager wishes to develop this further. Residents with dementia were observed during the inspection receiving one-toone staff support and were able to complete their own routines, thus providing and promoting feelings of well-being necessary to achieve a quality of life. There have been regular open day events including a ticketed BBQ with jazz band, and there will be a pantomime production performed at the home during the Christmas period. Resident’s spiritual needs were supported by the Roman Catholic and Church of England faiths and cultural needs were catered for.
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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 The home provides a clear and comprehensive complaints policy and procedure. EVIDENCE: There have been no complaints recorded in the complaints log since the last inspection. The complaints procedure clearly explains that blame is not apportioned to those who feel the need to make a complaint and contact details for CSCI were in evidence. Residents consulted felt safe and well cared for at The Grange and letters of commendation sent by relatives were in evidence. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 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) 19,23 and 26. There is a clear development and refurbishment plan for the home that does not detract from the standard of the environment, which is providing the residents with an attractive and homely place to live. A minor hazard was identified. EVIDENCE: The responsible individual confirmed that he intends to complete the refurbishment of the home. A schedule of refurbishment work to be undertaken was available and included: a redecoration programme, upgrading lighting, replacement carpeting, handrails, skirting boards and doors. Residents’ rooms are refurbished as they become vacant. The premises are being modernised in a sensitive way reflecting the age of the building and the requirements of a modern care home. The home improvements already completed include a new boiler system, refurbishment of the cellar area and a new refrigerated storage room.
The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 15 A potential trip hazard was identified on the first floor caused by the removal of an archway leaving a square space of floor exposed in the carpet capable of catching a walking stick or walking frame. This could compromise the welfare of residents. The inspector was informed of future development plans for eight new rooms to be developed, subject to planning approval. Resident’s rooms had been personalised and contained all the necessary furniture required to live comfortably. Communal areas were exceptionally clean and tidy, and residents were observed reading newspapers, enjoying refreshments and relaxing. Please see requirements section of this report. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 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 and 30 Residents are served well by a range of skilled staff. There was a robust recruitment procedure in place that helps ensure that this provision continues. Staff and residents benefit from the management commitment to provide continuous professional development for staff. EVIDENCE: The Grange provides a full range of staff that compliment the management team including; Care Assistants, Administrative support, Kitchen Manager and catering staff, cleaning and maintenance staff. Two new staff files inspected were in good order all the appropriate checks, such as CRB, proof of identity, and references. Clear job descriptions were in place. The Manager (not yet registered) was committed to supporting staff to achieve the required NVQ level 2. A staff training room is well equipped and enhances training provided on site. Staff records were inspected and showed satisfactory attendance of required training courses. These included: Food Hygiene, Fire Safety, Health and Safety, Safe Medication Administration, Safe Moving and Handling, and Protection of Vulnerable Adults. The Grange has enrolled for the ‘Investor In People Award’. Please see recommendations section of this report.
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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 and 38 The Manager (not yet registered) is committed to undertaking training to enhance her professional development. Recent investment has significantly improved the facilities at the home and despite the programme of improvements that were underway the residents enjoyed a clean and homely environment. A minor hazard was identified, caused by the refurbishment of the home. EVIDENCE: The Manager will be continuing with her professional development by registering on a NVQ level 4 management-training course later this year. The Grange has shown its commitment to improving the quality of life for the residents by updating and improving the premises. A potential trip hazard was identified on the first floor caused by the removal of an archway leaving a square space of floor exposed in the carpet capable of
The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.doc Version 1.40 Page 19 catching a walking stick or walking frame. This could compromise the welfare of residents. The manager is required to ensure the safety of the residents by undertaking regular risk assessments. The health and safety requirements for COSHH, Legionnaires disease, safe water temperatures and insurances were in place. Lift maintainance and gas certificates were in place. It was recommended that Fire Safety and Food Hygiene Training be updated for staff, as this was not in evidence. It was recommended that the Environmental Health officer be contacted to complete the 2004 inspection of the cellar and cold storage area. Please see recommendations and requirements section of this report. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.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 Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 x
COMPLAINTS AND PROTECTION 2 x x x 3 x x 4 STAFFING Standard No Score 27 3 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 x 3 x x x x x x 2 The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.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 38 Regulation 13(4)(a) Requirement All parts of the home that are accessible to the residents must be free from hazards by providing regular risk assessments of the premises and making safe any hazards exposed due to the refurbishment process. Timescale for action 01/10/05 2. 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. Refer to Standard 38 38 Good Practice Recommendations It is recommneded as goodf practice that the service contact the Environmental Health Officer to re-assess the cellar area following its refurbishment. It was recommended as good practice that staff have regular Fire Safety Training updates and Food Hygiene Training. The Grange Chertsey H09 H58 s13655 the Grange v241169 020905 Stage 2 unn.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
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