Inspection on 20/04/10 for The Grange Nursing Home

This inspection was carried out on 20th April 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Grange Nursing Home 12/01/10

The Grange Nursing Home 23/11/09

The Grange Nursing Home 27/11/07

The Grange Nursing Home 04/12/06

The Grange Nursing Home 22/11/05

The Grange Nursing Home 17/05/05

The Grange Nursing Home 25/01/05

The Grange Nursing Home 20/07/04

Similar services:

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The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: The Grange Nursing Home 72 Upper Northam Road Hedge End Southampton Hampshire SO30 4EB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beverley Rand     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: The Grange Nursing Home 72 Upper Northam Road Hedge End Southampton Hampshire SO30 4EB 01489790177 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): carolynr@tgnh.co.uk Mr Roy Clive Northover,Mrs Heather Northover,Mrs Angela Louise Northover Name of registered manager (if applicable) Mrs Carolyn Sarah Ryves Type of registration: Number of places registered: care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 63. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability (PD) Dementia (DE) Date of last inspection 0 0 0 Over 65 0 63 0 Care Homes for Older People Page 4 of 24 Brief description of the care home The Grange is a care home providing personal care and nursing care for up to 63 people over the age of 65 years and who may also have a physical disability or have a terminal illness. The Grange is owned by three partners and is a family business. It is located in Hedge End a large village close to the edge of the city of Southampton and there is easy access to motorway links. The home is close to shops and other community amenities. The establishment was purpose built and opened in 1991. It is a three storey building that has a large open communal lounge dining room on the ground floor and another two lounge diner areas on the first floor and lower ground floor. There are 2 passenger lifts that provide access to the first floor. There is a large well maintained garden with a patio area that is accessible to people living in the home. The home has a website and people interested in living there or staying for a short respite stay are provided with a brochure containing information about the service that it provides and are encouraged to visit. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to the home on 20 April 2010. Over a period of 7 hours, two inspectors looked at records relating to care plans, staff recruitment and staff training, medication records and health and safety records. Before the visit we gathered information from other agencies; including the Local Authority/Adult Safeguarding Team. We also received the AQAA (Annual Quality Assurance Assessment from the home. This is a self-assessment that provides information about the home, what they do well, and where further improvements are planned. A Commission pharmacy inspector visited the home on 12 January 2010 to look at the systems in the home for managing service users medication. We made regulatory requirements to make sure that people living in the home receive their medication as it has been prescribed by their doctor, at all times. Care Homes for Older People Page 6 of 24 Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We were unable to assess whether there are improved outcomes for service users. Evidence: Further to our last key inspection, the provider agreed voluntarily not to accommodate any new service users. This means that we were not able to assess any new preadmission assessments during this inspection and the quality rating will remain the same as last time. We were also unable to assess whether the requirement from the last inspection had been met and it is therefore raised again in this report. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning systems have improved but closer attention is needed to ensure that accurate and up to date information is available to all staff. Service users have improved access to health care professionals. Medication systems have improved but there is still room for improvement to ensure service users needs are met. Evidence: Service users have a care plan in their rooms, which includes a pen picture of the individuals likes, dislikes and preferences with regard to personal care. The home has a new care planning system which is computer based and care plans were generally much improved since the last inspection. However, some of the up to date information was only available on one computer terminal and not on the one which was accessed by the staff. This meant that some information was no longer relevant. The care plans included risk assessments and a good level of detail which showed that service users were supported to undertake their personal care, or aspects of care, where this was possible. There was clear information about individual preferences, such as if a person did not like talcum powder. Daily notes were completed and were well written with details regarding the support provided. Care Homes for Older People Page 11 of 24 Evidence: We looked at charts which documented if a service user was turned in bed and these were much clearer than we saw at the last inspection. We could see when people were turned, at what time and to which side they were turned. The charts showed that people were turned according to timescales defined in their care plans. Similarly, we also saw that charts for recording food and fluid intake were now fully completed. A wound care file is maintained which is used to monitor the healing process. A new camera has been purchased for this purpose. The home has a new system for administering medication and improvements have been made since the last inspection. We visited the home to undertake a random inspection of medication systems 12th January 2010. We found that since the inspection last year and following input from staff of the local Primary Care Trust action has been taken to improve the handling of medicines within the home. However, we also found that the home had failed to ensure that all service users received their medication as prescribed and the seriousness of this issue meant that a service user was at risk of harm. Two requirements were made in this regard. During this key inspection,we found that records for five service users were not completed which meant that no-one could be sure service users had received their medication as prescribed. Two of these records showed that some of the medication was, out of stock which meant that these people did not get their medication. One person was prescribed paracetamol four times daily when required, but was being given it regularly, three times a day. The medication administration record showed the home was out of stock for eight doses over three days. At the last inspection we identified concerns around service users not receiving their medication as prescribed and we made requirements about those concerns. The requirement in this regard was not met and is being dealt with outside of this report. Care plans were in place to guide staff on dispensing medication that is precribed to be given when required. Medication, including controlled drugs is stored appropriately. Some medication is kept in a locked fridge and a record is kept of the daily temperatures. However, the record showed maximum temperatures of 10, 13 and 17 had been recorded yet this extremely high temperature had not apparently been raised as an issue of concern. The record also showed inaccurate minimum reading on three occasions. We Care Homes for Older People Page 12 of 24 Evidence: discussed this with the manager who was unclear as to how the temperature should be taken and said she would talk to the person responsible for maintenance. We were told later that whether the issue had been ongoing and that staff had been shown how to use the thermometer. Staff told us a new thermometer would be bought. We saw staff interacting with service users in appropriate ways and saw that daily notes were written in a respectful way. Eight completed surveys said that staff, always listened to them and acted on what they said. Seven answered, usually and one sometimes. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoy the activities and meals. Evidence: The home has an activities programme and employs staff solely for this purpose. We saw photographs of Christmas activities in the hall as well as photographs of other activities around the home. The home has a branch of the Womens Institute. Some service users have made photo/name tags in craft sessions for their bedroom doors. For those service users who are nursed in bed, staff told us that they go in regularly to talk to them and put music on if they wish. The activities team also go in. All the completed surveys agreed there were activities to take part in. Visitors are welcome to the home. Two completed surveys said service users liked the food, sometimes but the remainder answered, usually and, always. We saw morning drinks had been provided in two handled cups and we were told drinks were available at any time. We saw that some people had pureed and soft food, as needed. We saw there was a bowl of fresh fruit in the kitchenette area of one of the dining rooms. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know how to complain. Safeguarding procedures are in place and the managers knowledge of this area has improved. Evidence: The home has a complaints procedure which is displayed where service users and their representatives can see it. Twelve out of fifteen completed surveys showed that service users did know how to make a formal complaint. Since the previous key inspection the home has been subject to an investigation under the local authoritys safeguarding adults procedures which involved the participation of the manager and provider. The home agreed to voluntarily suspend any new admissions after the last key inspection. The local authority has concluded its investigations and the home is now taking new service users. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean and spacious environment but attention should be given to the use of sluice rooms. Evidence: The home has ample communal space where service users can watch television or undertake activities. There are also quiet areas where service users can spend time with their families. There is a garden and courtyard where service users can spend time. Bedrooms are personalised with photographs, ornaments and so on. The decoration of the bathrooms has been improved to make them more homely. There are now thermometers in the bathrooms so that staff can test the bath water before they support a service user to bath. We found that potentially hazardous cleaning fluids were not securely stored and this is included in the Management and Administration part of this report. Fourteen completed surveys said the home was, always fresh and clean and one said, usually. The home has a separate laundry and we spoke to a service user who said the laundry always came back on the same day, was ironed and put away. Care Homes for Older People Page 16 of 24 Evidence: The home has sluice facilities, but we saw that one had no hand washing facilities and another one had no waste bin. Staff told us that they only used one of the sluice rooms which serviced the whole home. This means that staff were walking up and down stairs with bedpans which had been used. The manager needs to ensure that sluice facilities support infection control policies to reduce the risk of cross infection. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a larger staff team who have received training. Robust recruitment procedures are in place to protect service users. Evidence: The home has recruited new staff and increased staffing levels with particular regard to weekends. This, along with the reduced numbers of service users has meant that outcomes have been improved for the service users living in the home. Nine of the completed surveys said that staff were, always available when they needed them and six replied, usually. We looked at the recruitment files for three new staff and found that they all contained the necessary pre-employment checks and that these checks had been completed before the people started work. However, we noted that there was room for improvement with regard to the completion of employment histories for each of these staff. The manager told us that as there have been less service users there has been more time to ensure training is up to date. Training has included moving and handling; fire safety; health and safety; equality and diversity; palliative care; infection control; medication handling; safeguarding; nutrition and wound management. Care Homes for Older People Page 18 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have benefited from improvements in the home, but greater attention is needed to reducing health and safety risks. Supervision needs to be more regular to ensure service users benefit from having staff who are well supported. Evidence: The manager has made improvements to the home since the last inspection and all but one of the issues we asked the home to address have been done. The manager is now accessing external supervision for her role. The home has a formal quality assurance system in place and the manager told us in the annual quality assurance assessment that the home encourages service users, their relatives and staff to give their opinions. Surveys are available if people wish to complete them. There is a framework in place for staff supervision but it lacks a systematic approach. Some staff are only having supervision once in three months. The National Minimum Care Homes for Older People Page 19 of 24 Evidence: Standards indicate that staff should receive six supervision sessions a year. Some staff do receive supervision more frequently. The home has records which demonstrates that equipment such as hoists are serviced regularly. Records are also kept which show that fire safety systems are checked regularly. We found a cupboard upstairs in the hallway which was unlocked and contained a cleaners trolley. Cleaning fluids included an old bleach bottle which was labeled as tea tree and lemon with a handwritten label; furniture polish; a bottle of thickened bleach; toilet cleaner; another bottle with a handwritten label of sink cleaner and tea tree; glass cleaner; disinfectant and tea tree. In the downstairs conservatory, which service users and relatives use, there was an unlocked double cupboard under the sink. The cupboard had childproof locks, but one was broken and the other could be undone easily. Inside there was a bottle of table cleaning fluid. We found a bottle of cleaning fluid in the same cupboard at the last key inspection. Other storage cupboards containing cleaning fluids were locked, but the key was on a hook on the wall next to the door. They were placed slightly higher but could be reached without having to reach too far. Windows are fitted with restrictors to minimise risks to service users but we saw that two upstairs windows had had the restrictors bypassed by staff who were working in the room. This practice can lead to risks for service users. All these issues were brought to the attention of the manager. Care Homes for Older People Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre admission assessments must be carried out on all prospective residents by a suitably trained person. Residents will be confident that their assessed needs are known and that they can be met if they live at the service. 31/12/2009 2 9 13 Systems must be put in place to ensure medicines are given as prescribed. Medications must be given as prescribed so that residents receive their medications safely. 11/02/2010 Care Homes for Older People Page 21 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 13 The registered person must ensure that sluice facilities are fully equipped and used in a way which minimises the risk of cross infection. This will reduce the risk of infection for service users. 17/09/2010 2 36 18 All staff must have regular supervision. This will ensure that staff are supported in their work with service users. 17/09/2010 3 38 13 The registered person must ensure that hazardous cleaning fluids can not be accessed by vulnerable service users. This will reduce the risk of harm to service users . 17/09/2010 Care Homes for Older People Page 22 of 24 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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