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Inspection on 23/05/05 for The Grange Nursing Home

Also see our care home review for The Grange Nursing Home for more information

This inspection was carried out on 23rd May 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

On welcoming the inspector into the home staff advised of the fire evacuation procedures and domestic amenities. The residents spoke highly of the staff and the service they provided, "they are very kind and helpful," said one. The management are open to new ideas and methods of working as seen by their recent use of another organisation to provide training in dementia.

What has improved since the last inspection?

The manager and staff team had worked hard to meet the requirements from the last inspection. The majority of policies and procedures had been reviewed or renewed. The staff had received training in working with people with dementia. The manager stated that the staff had been very enthusiastic about the content of the course. Other work required had been completed or was nearing completion at the time of the inspection.

CARE HOMES FOR OLDER PEOPLE The Grange Nursing Home 22 Grange Road New Haw Addlestone KT15 3RQ Lead Inspector Mrs Sue McBriarty Announced 23 May 2005 rd 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 Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Grange Nursing Home Address 22 Grange Road New Haw Addlestone Surrey KT15 3RQ 01932 344940 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) Mr D M Bailey Helena Nora Grafton Care Home 24 Category(ies) of OP - Old Age (24) registration, with number of places The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accomodated will be : 60 years and over Date of last inspection 14th October 2004 Brief Description of the Service: The Grange Nursing Home is located in a residential road in New Haw, Addlestone. It is close to the town centre and all local amenities. The home provides nursing care for twenty four service users who are elderly. Accommodation is provided in single and shared bedrooms. There is an open plan lounge and dining area. The lounge overlooks a well maintained garden to the rear of the home. There is space at the front of the property for car parking. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the first for 2005 – 2006. During this inspection the inspector spoke to five (5) residents, three (3) family members and four (4) staff including the manager. Twenty eight (28) comment cards were received by the CSCI. The comment cards had been part of a quality audit undertaken by the home and were permitted to be used for this inspection. The cards were from service users, family members and other visiting professionals. The manager had also provided a pre-inspection report. Records sampled during this inspection included care plans, risk assessments, training information and personnel files. A tour of the home took place and all the communal areas and four bedrooms were seen. Food preparation and menus were seen but not sampled. This home prefers the use of the term ‘residents’ , the inspector has used this preferred name throughout the report. What the service does well: What has improved since the last inspection? What they could do better: The home lost its ‘resident’ painter and decorator and this is reflected in the present décor of the home that required work. This is noted within the body of the report. The home needs to remain mindful of refurbishment and decorating needs as they arise and ensure that work undertaken is of a standard that is acceptable. Please contact the provider for advice of actions taken in response to this The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 6 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 H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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) 1, 2, 3, 4, 5 The home provided prospective residents with the information required to make a decision about moving in. All the service users had a contract with the home making clear the terms and conditions of their stay. EVIDENCE: The pre-inspection report and the document seen evidenced that the statement of purpose had been updated since the last inspection. Prospective service users and their families were able to visit the home before deciding whether the home is the right one for them. The home provided a contract with those residents who pay privately for the service; those funded by Social Services had a separate method of contracting. The residents had signed those contracts sampled. The requirements made at the last inspection, to update the statement of purpose and the statements of terms and conditions had been met. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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, 10, 11 Progress had been made on updating the care plans to ensure they met Standard 7 of The National Minimum Standards. The home had a policy on supporting people at the time of their death. EVIDENCE: At the time of this inspection the majority of care plans and risk assessments had been updated and those sampled evidenced that they had been recently reviewed. Further work was required to ensure that wherever possible residents sign their own care plans. Where this is not possible the home should seek a representative to sign on their behalf. The care plans sampled included the social and health care needs of the residents. A requirement has been made to ensure that service users or their representatives’ sign the care plans or a statement is included that the residents representative had refused. The home had been collating information about the social history of the residents in order to ensure that they could talk about what was important to them from their past. The histories included the previous interests and hobbies and wherever possible these interests had been included as part of the care plan. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 10 Observations made by the inspector and discussions with the residents evidenced that their right to privacy was upheld. All twenty eight comment cards received noted that they were able to see the person they were visiting in private. The residents care plans and risk assessments were accessible to staff and residents and were kept in a lockable area of the home. All of the residents and family members spoken to praised the staff members for the service they provided and the way they offered help and support to the residents and their families. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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, 14, 15 The home continues to make good progress in providing activities for the residents. Family members and friends were able to visit the home throughout the day. The residents were provided with a varied and nutritious diet. Further work is recommended when dealing with resident’s money. EVIDENCE: The manager and staff team had worked hard to review the activities of the residents. A new system of assessing residents and how they might take part in an activity had been introduced. The system enables the manager to assess a person’s level of response and how they might be able to take part in any activity. The home was planning further work in this area to ensure that the staff members were able to provide a sensory activity programme to those who required one. For example feeling clothing to try and help someone make a decision about what they might wish to wear during the day. The requirements from the last inspection had been met. A member of the staff team had been sent on a training course to enable them to provide gentle exercise to those residents who were able to take part. The home had also been working with another organisation that supports people with dementia. The organisation had discussed the type of activities that people with dementia would benefit from. The manager stated that further work is needed to ensure that the care plans reflect that work. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 12 The comment cards, family members spoken to during this inspection and the manager stated that family and friends were welcome into the home. Family members are able to benefit from the home’s offer to take part in meals free of charge. The residents of this home are older people and the home had not considered fully the need to have a policy on relationships and sexuality however it was recognised that older people may also form new relationships and that a policy would be a useful way of ensuring support in a consenting relationship and protection for other relationships. Wherever possible the residents were able to make choices and decisions. One person spoken to said that the staff team do listen and will try and help them do what they wish. This included taking them out in the car to visit places of interest. A copy of previous menus was provided within the pre-inspection report. Of the twenty-eight comment cards received eight were from service users. Of the eight four liked the food provided and four sometimes liked the food provided. During this inspection a number of people were asked what they thought of the food and all stated that the majority of the time they liked what was offered. The food seen on the day was freshly cooked, well presented on the plate and nutritious. The inspector saw evidence that the majority of food provided was cooked from fresh and the home received regular deliveries of fresh vegetables. The residents could choose whether to eat in the dining area or in their own rooms. The home had a policy of not dealing with resident’s money, however recently they had become involved with assisting with resident personal allowances. The home did not have a policy in place to ensure clear management of those finances. It is required that the home provide such a policy. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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 standard(s) 16, 18 The home had a complaints policy and procedure in place. Staff training is adequate to safeguard residents and the home had a policy in place for the protection of residents from abuse. EVIDENCE: The pre-inspection report noted that the home had not received any complaints within the last twelve months, neither had any adult protection investigations taken place during the same period. Staff received training in adult protection issues and the policy was last reviewed on 28th May 2005. A new concerns and complaints policy was introduced by the home in February 2005. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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, 20, 21, 22, 23, 24, 25, 26 The home provided adequate communal and individual space for the service users. Sufficient bathing and toilet facilities were provided. Further progress is required to ensure that the bathing and toilet facilities are safe and hygienic. Some work was required in the communal areas of the home. EVIDENCE: The bathrooms and toilet require work to make them safe and hygienic. The floor coverings were coming away from the skirting areas, and or were split. This made cleaning difficult and if the floor coverings continue to lift away will create a trip hazard. One bathroom had been partially re-floored to provide a level access shower. The new flooring in this room was raised above the remaining floor and was a trip hazard. The remaining flooring was poor and in one area missing. In another an assisted bath had been planned to be fitted however the bath was not big enough to accept the assisted hoist. Sealant had been used in the bath where a trial run of the assisted hoist had been unsuccessful. It is required that safe new flooring is provided and that the assisted bath be provided as originally planned. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 15 At the time of the inspection the bathroom and toilet provision was adequate for the needs of the residents. Work is also required in other areas of the home. The lower parts of the doors and some walls required repair and painting to cover the damage by wheelchairs. The stairs to the front of the house required repair where part of the outside step was coming away from the main stairs. The communal areas, laundry and kitchen were clean and adequate seating had been provided in the communal areas. Those residents’ rooms seen during this inspection had been personalised and were light and airy. One of the residents liked to be able to see out of the window and said, “that I like the fresh air and prefer to be in my room”. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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, 28, 29, 30 On the day of the inspection the staffing levels met the needs of the residents. Good progress had been made in respect of staff recruitment and training. EVIDENCE: The last inspection required that other staff working at the home such as hairdressers and chiropodists must also receive a criminal records bureau check (CRB). The applications had been made by the time of this inspection, however the completed CRB forms had not yet been received. Three staff had qualified at NVQ Level 2 and a further four were in the process of qualifying. The manager informed the inspector that there had been a delay in staff gaining the NVQ as she was currently the only assessor available. The manager had reviewed the home application pack and had made the adjustments required from the last inspection. All applicants will be expected to provide a full employment history in line with Schedule 2 of The Care Homes Regulations (as amended) 2001. This requirement has now been met. A staff member who had recently joined the home was sampled and the file contents met the requirements. The home required staff to undertake induction and foundation training and written evidence with signatures was now necessary. The manager advised the inspector that on occasion not all training is completed within the time The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 17 planned. It is recommended that where induction training cannot be completed within the time set by the home that this is documented. The pre-inspection report and training certificates seen during the inspection evidenced the provision of core training including for instance fire, adult protection and manual handling. As required at the last inspection staff had received training in working with people who have dementia. The requirement has now been met. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 18 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 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) 32, 33, 37, 38 Further work is required in a number of areas and requirements have been made to reflect this. EVIDENCE: The residents and family members spoken to during this inspection spoke highly of the manager and that they felt able to approach her directly if they had any concerns. The home had recently undertaken an audit of the home services and had based their queries on the comment cards used by CSCI. The responses have formed part of the basis for this report. The comment cards recorded that residents, family members and visiting professionals had a good experience of this home. The audit was considered to be good practice. The home had recently reviewed the policies and procedures. Some further work is recommended to provide policies and procedures for the following; The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 19 emergency and crisis, relationships and sexuality and management of resident’s money. Areas of the home do require work to ensure they are safe and hygienic. A clear policy in dealing with resident’s finances is also required. The home had applied for a variation in category in order to recognise the changing needs of the current service users. The CSCI are currently processing the application. A recent staffing review required by CSCI had led to a new staff post being in place, the manager now has an administrator to assist with the day to day office management of the home. The home had access to the internet and were in the process of setting up their email address. The internet will also enable the home to keep up to date with legislation and guidance pertinent to running a home. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 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 3 x 3 3 x x x 2 2 The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 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 OP7 Regulation 15 Requirement The registerd person must ensure that wherever possible the service user or their representative sign their care plan. The registered person must ensure that the flooring in the toilets and bathrooms are replaced. The registered person must ensure that the assisted bath is replaced with the correct depth of bath. The registered person must review the decoration of the home including repair needs and paint and repair those areas necessary. The registered person must ensure that the home provide a policy and procedure on dealing with service users money. Timescale for action 30th June 2005 2. OP19 23(2)(a) (b) 23(2)(a) (b)(n) 23(b)(d) 31st July 2005 31st July 2005 30th August 2005 3. OP19 4. OP19 5. OP14 12(1)(a) 30th June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 22 The Grange Nursing Home 1. 2. 3. 4. 5. Standard 12 13 30 37 It is recommended that the information provided through the activity assessment process be incorporated into the care plans. It is recommended that the home provide a policy on relationships within the home. It is recommended that where for any reason a member of staff cannot complete the induction programme within the given time limit that it is documented in their files. It is strongly recommended that the home provide a policy and procedure on dealing with emergencies and crisis within the home. The Grange Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 23 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 Nursing Home H58_s17612_The Grange_v218890_230505_stage4.doc Version 1.30 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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