Inspection on 27/11/07 for The Grange Nursing Home

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

Other inspections for this house

The Grange Nursing Home 20/04/10

The Grange Nursing Home 12/01/10

The Grange Nursing Home 23/11/09

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:

Flint House

St Vincents

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Grange Nursing Home 72 Upper Northam Road Hedge End Southampton Hampshire SO30 4EB Lead Inspector Tim Inkson 27 th Unannounced Inspection November 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Nursing Home Address 72 Upper Northam Road Hedge End Southampton Hampshire SO30 4EB 01489 790177 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) carolyn.ryves@zen.co.uk Mrs Angela Louise Northover Mr Roy Clive Northover, Mrs Heather Northover Mrs Carolyn Sarah Ryves Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (8), Physical disability of places over 65 years of age (40), Terminally ill (8), Terminally ill over 65 years of age (40) The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the categories of PD or TI can only be admitted between the ages of 52 and 64 4th December 2006 Date of last inspection Brief Description of the Service: The Grange is a care home providing personal care and nursing care for up to 43 people over the age of 65 years and who are may also have a physical disability or have a terminal illness. There is a condition attached to the registration that no more than 8 people may be accommodated between the ages of 52-65 years. 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 two-storey building that has a large open communal lounge dining room on the ground floor. Bedroom accommodation comprises 29 single rooms of which 24 have en-suite facilities. There are 7 double rooms all with en-suite facilities. 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 are provided with a brochure containing information about the service that it provides and are encouraged to visit. They are also given details of the website of the Commission for Social Care Inspection (“commission”) in order to access or obtain copies of reports of inspections of the home. A copy of the most recent report of such inspections done by the “commission” is included in the home’s Service Users Guide that is also made available to people interested in living in the home and is more detailed than the home’s brochure. At the time of the site visit to the home on 27th November 2007, its fees ranged from £570 to £770 a week and this did not include the cost of hairdressing, chiropody treatment and journals/magazines. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 27th November 2007, starting at 09:10 and finishing at 16:10 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and other facilities. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 43 people. Of these 5 were male and 38 were female and their ages ranged from 57 to 100 years. Although at the time of the site visit there were no individuals from minority ethnic groups being accommodated. The home had provided care and support to at least one such person within the previous 12 months. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. People both living and working in the home, their relatives and friends and local health care professionals were canvassed for their views about the home using questionnaires before the site visit took place. Their responses were taken into consideration when producing this report. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the registered manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 10th October 2005, such as, complaints and statutory notices about incidents/accidents that had occurred. What the service does well: People living in the home were safe and believed that staff looked after them properly and treated them with respect. They were able to make choices for themselves and exercise personal autonomy as far as was reasonably possible. Views about the food the home provided and the activities that the home arranged in which people could participate and benefit from were positive. Careful consideration had been given to the installation of signage, orientation aids and equipment in order to enable people with a range of disabilities and diverse needs to retain as much independence as possible. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 6 The ethos of the home was open and transparent with the views of the people living in the home, their relatives and friends and staff working there listened to and valued. Management systems and procedures in the home worked well including, the administration of medication, dealing with complaints, quality monitoring, and health and safety. Staff had confidence in the effectiveness and approachability of the home’s manager. There was a strong commitment to staff support, training and development. The latter was reflected in the high proportion of care staff (88 ) with a relevant formal qualification that ensured that they were able to fulfil their roles and responsibilities and meet the needs of people living in the home. 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. The summary of this inspection report can be made available in other formats on request. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and their relatives/representatives were confident that the home could meet their needs. This was because the help that individuals required was identified before they moved in to ensure that the level of support and care they required could be provided. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with the actions that the home took to identify the help and assistance that people needed. As on the last key inspection of the home on 4th December 2006 there was evidence on this occasion from the documents examined and discussion with people living in the home and or their relatives. That admission to the home of individuals had all been planned by and with staff with the appropriate knowledge and skills. The home’s manager said that registered nurses always carried out the assessments of the needs of people wishing to move into the home. The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of a person’s needs when they actually moved into the home. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 9 There was documentary evidence that assessments of individuals needs were reviewed regularly and revised as necessary when circumstances changed. The home does not provide intermediate care. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs were met. The home had plans of care that individuals, or someone close to them, had been involved in making. People unable to manage their own medication were supported by the home to manage it in a safe way. Individuals’ right to privacy was respected and the support they got from staff was given in a way that maintained their dignity. EVIDENCE: The care plans were examined of the same sample of 4 residents as in the section above i.e. “Choice of Home”. Among the sample was an individual who was receiving treatment to a wound. The documents examined were comprehensive and the plans were based on the assessments that the home carried out in order to identify what help the individuals needed. Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. The plans examined set out the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 11 required e.g. hoist to transfer. They also included details of how individuals specific needs were addressed e.g. method of communication. Where the care plans examined referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place. Records indicated that risk assessments and care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and relatives/representatives about the abilities of staff the care and support that they provided included: • • • • • • “The staff are brilliant, they help me with bathing …”. “The staff are very good, they help me with whatever I need ...”. “They treat their residents as individuals …”. “Cater for individuals and not as a mass …”. “Relates with each individual… deals with their needs methodically… care with toileting is good …” “My father has been at the Grange 16 years and in all that time he has been happy, well cared for and his health has improved”. My mother has been at the Grange for 20 months and during that time she has been treated with what borders on love, also kindness and dignity. The staff are exemplary, everything is clean, including my mother who is doubly incontinent. I consider myself very lucky to have found a nursing home of which I cannot speak of or praise highly enough”. • One relative describing the help that her mother with advanced dementia received said, “In five and a half years we have never had a tear…they are very kind”. Responses in questionnaires returned by people living in the home indicated that 55 believed that they always received the care and support that they needed and 45 usually. Responses from relatives, friends and advocates indicated that 65 thought that the home always met the needs of the person that they knew living in the home, 27 usually and 8 (i.e. one respondent) never. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 12 The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Individuals and relatives said that people received treatment from among others, doctors, podiatrists and opticians. At the time of the site visit an optician was visiting a person living in the home and q doctor also called to see an individual who was very ill. It was also clear that the home had developed good working relationships with and used the support of a range of specialist health care professionals including among others speech and language therapists. One member of the home’s staff was a qualified aroma-therapist and during the site visit was available to provide individuals with therapeutic massage. The response in a questionnaire returned by a general practitioner that visited the home indicated that that they were satisfied with the overall care provided by the home and that the home worked in partnership with the surgery. That staff in the home demonstrated a clear understanding of the care needs of people living there. Also that specialist advice given was incorporated into people’s plans of care and medication was managed appropriately. Care plans included specific details about how the eye, dental and foot care needs of the individual would be met. There were clear documented wound care plans that indicated how they were treated. Progress with healing was monitored. Individuals’ health was monitored routinely and regularly e.g. weight, blood pressure and temperature and medical equipment was regularly checked and serviced. The registered manager had delegated responsibility to registered nurses to take a lead in the home for all aspects for one of the following areas: • Infection control • Nutrition • Wound management The individuals concerned were expected attend relevant training courses and to keep up to date with best practice and cascade that to nursing and care staff in the home. They would also advise and monitor situations when staff were dealing with matters within their specific area of expertise. It was apparent from responses in questionnaires returned by staff working in the home, discussions with staff during the site visit and training records seen. That nursing and care staff in the home had also attended training in a range of clinical subjects/areas such as catheter and wound care. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in locked and secured medicine trolleys in locked rooms and cupboards and where required in a medical refrigerator. Controlled drugs were stored securely and appropriately. A sample audit of controlled drugs indicated that the records were accurate and up to date. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 13 Medicines were given out from their original containers and staff responsible for giving them out included registered nurses and care staff with a National Vocational Qualification in care at level 3. All had been assessed as competent and completed training in the ”safe management of medication”. Good practice noted during the fieldwork visit included: • Sample copies of the signatures of the staff that gave out medication • Records being kept of the temperature of the refrigerator used for storing some medicines to ensure that it was working effectively. • The dating of some medicine containers when they were opened. At the time of the fieldwork visit no person was looking after his or her own medication. The importance of offering people the opportunity to do so based on an assessment of their ability/competence and recording the outcome of the assessment was part of a general discussion about the implications of Mental Capacity Act 2005 and individuals rights. People spoken to during the site visit confirmed that staff promoted their privacy and dignity and were polite and respectful. All shared bedrooms that were viewed were provided with screens to help with these important matters. One person spoken to said, “They always knock on my bedroom door. It does not matter who it is”. The response in a questionnaire returned by a general practitioner that visited the home included the following comment. • “I am always greeted with a nurse ready and waiting to show me to the appropriate patient. The care staff are organised to get patients into a private room promptly”. The home was “highly efficient” when caring for people who were terminally ill or dying. The wishes of individuals about dying and terminal care and the arrangements they wanted after death were discussed and recorded. A person centred plan of care developed was developed that included reference to the person’s particular religious or cultural needs. Pain control was recognised as essential to a person’s comfort and signs of distress were monitored. The home worked closely with relevant external professionals and specialists. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and according to the choices and preferences of those living in the home. EVIDENCE: A member of the home’s care staff organised many of the activities that took place in the home and in which people living there could participate. She indicated that within a short period she would be employed as the home’s activities organiser and her time would be entirely dedicated to this. She said that she had done an arts and design course at college and attended a course about reminiscence. She was enthusiastic about her role and indicated that she and other staff spent time with individuals who either chose not to join in organised activities or were unable to do so because of their frailty, “chatting with and reading to them”. Responses in questionnaires returned by people living in the home indicated that 40 thought that there were always activities arranged by the home that they could take part in, 40 usually and 20 sometimes. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 15 Comments from relatives and friends about what they thought the home did well included the following: • • “Organising things for patients and evenings for relatives that we all enjoy”. “Nice social atmosphere, plenty of activity/entertainment, good food, staff friendly and helpful”. “The Grange is open and welcoming with I the main very helpful and cheery staff. Ther are regular visits by musicians and singers and activities and events organised by the staff themselves”. • Organised activities that had taken place in the home in the few weeks preceding the site visit included a quiz evening, a themed Italian evening, and Halloween party. Some people living in the home were involved in a small “social enterprise” making cosmetics that were sold with any profits going to charities chosen by the people involved. The process of making the cosmetics provided not only interest and meaning but also sensory stimulation form the materials used including oils and perfumes. People living in the home spoken to about the home’s activities also referred to bingo and visiting singers and musicians. Some also indicated that they appreciated regular visits that clergy made to the home. It was also apparent from discussions with people living in the home that daily routines were flexible and individuals were able to exercise choice about matters such as when they got up and went to bed. All those who responded to the questionnaire i.e. 100 , also indicated that they thought the staff always listened to and acted on what they said. • • “They know what time I like to get up and go to bed, I like my breakfast in bed”. “I have my breakfast in my room and then at about 10 o’clock I have a wash … I could stay up as late as I wanted but I like to go to bed around 7:00 p.m.”. People living in the home and visitors that were spoken to during the site visit confirmed that there were no restrictions concerned with visiting the home. Individuals visiting the home also said that that they were always made welcome. The home did not manage the financial affairs of anyone living there or look after money on behalf of anyone. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 16 There was information in the entrance of the home about organisations that could provide impartial advice, information and guidance to people living in the home and/or their relatives/representatives. Sensitive information that the home held about individuals was kept in the managers office the home had written policies and procedures about maintaining confidentiality and the right of people living in the home to access their personal files and case notes. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided. On the day of the site visit there was a choice of 3 main meals for lunch and a selection of sweets and a similar choice for the evening meal. The menu for the day was on display on a white board in the communal lounge/dining room. Individuals were asked what they wanted to select from the choice the day before but it was apparent from discussion and observation that the home’s catering staff provided enough to allow for people to change their minds. One individual spoken to said, “ they brought me the same pudding as S but I wanted ice cream and they changed it without any problem”. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plans and that information was also readily available in the home’s kitchen. Special diets and individual and special needs were catered for e.g. soft and pureed meals and diabetic. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for pureed meals were prepared separately. There was some discussion about the length of time that some people had to wait for their food at the main meal of the day. It was apparent that the home had looked into this and tried a variety of ways of providing meals, including 2 sittings. The meal that was observed was relaxed and unhurried and those who required were given help sensitively. From the level of conversation among some people it was definitely a social occasion. Response in questionnaire returned by people living in the home indicated that 55 always liked the meals in the home, 36 usually and 9 sometimes. Descriptions from people living in the home spoken to about the food ranged from “good” to “excellent”. One of the registered nurses in the home had a lead responsibility for nutrition and was working with Southampton University on research about nutrition and older people. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people had concerns with their care, they or people close to them knew how to complain. Any concern was looked into and action taken to put things right. The care home safeguarded people from abuse and neglect and took action to follow up any allegations. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. There was a lot of information about the home displayed prominently in this are including copies of the home’s Statement of Purpose and Service Users Guide, pictures of the home’s staff and details about social activities with photographs of recent events. Despite information about the home’s complaints procedure being accessible and readily available, responses in questionnaires returned by people individuals living in the home (11) and relatives and friends (11) indicated that the following knew how to make a complaint. 82 of those living in the home 64 of friends/relatives One person spoken to said, “They gave me information about the home and it covers everything, they have a copy outside. It tells you where to go and who to see about complaints”. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 18 A record of complaints made to the home was kept that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been 1 complaint made to the home in the previous 12 months. It was apparent from the details kept by the home that it had been resolved. We (the “commission”) had received no complaint about the home during the same period. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Where subsequent to a risk assessment it was considered necessary for some form of limitation to be imposed on the actions of an individual e.g. restrict movement to prevent falls (by installing bedrails). Written permission/consent was obtained from all interested parties including the individual concerned where they understood the need for such preventative measures to be taken. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable, safe and well maintained. The home’s procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was evidence that people living in the home were involved in decisions about the colour schemes in communal areas. The home employed a maintenance operative who checked many of the home’s systems including fire safety and hot water. The home’s communal area comprised a large lounge and dining room, that was separated by some walls into smaller more “discrete” There were also other small areas throughout the building where individuals could have more The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 20 privacy. There were patio doors that opened onto an enclosed garden and ramps provided wheelchair access to that outside area. The home’s assisted bathing facilities included a wet room/shower. Hoists and other suitable equipment was readily available for transferring and assisting people with poor mobility and weight bearing difficulties. Staff were seen using such equipment appropriately and safely. In order to promote the independence of people living the home railings were installed in the corridors of the home. Symbols/signage were also installed on the doors of facilities such as toilets and bathrooms indicating their use to provide help to people who may have impaired cognitive abilities. These signs also had a raised surface area to assist individuals with impaired vision identify the use of the rooms. There was some discussion about the use of different colours for doors of toilets to make them readily identifiable. Pictures that had some significant meaning to the occupant had been placed outside several bedrooms as a further orientation aid. There was a loop system in the large communal room to provide support for people reliant on hearing aids. The home had comprehensive procedures in place concerned with infection control and a registered nurse had lead responsibility in the home for ensuring procedures were followed and updated when necessary. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. There was also an antibacterial gel dispenser at the front entrance to the home and the manager said it was the intention to install several more throughout the building. Staff carried personal dispensers with them. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Responses from people living in the home who were canvassed for their views indicated that 10 out of the 11 thought that the home was always “fresh and clean” and 1 usually. Some slight odour was noted during the site visit in the entrance area and in one bedroom that was viewed. This was brought to the notice of the manager. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People had safe and appropriate support as there were enough trained and competent staff on duty at all times. They could have confidence in the staff at the home because checks had been done to make sure that they were suitable to care for them. Peoples’ needs were met and they were cared for by staff who had relevant training and support from their managers. EVIDENCE: The care team working in the home comprised, 10 registered nurses and 25 health care assistants. Out of the latter 22 (i.e. 88 and increase since the previous site visit on 4th December 2006) had a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2 and a further 1 was working towards the qualification. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 08:00 to 14:00 2/3 6/8 9/10 14:00 to 20:00 2/3 4/5 6/7 20:00 to 08:00 1 3/4 4/5 Registered nurses Health Care Assistants Total The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 22 The home’s registered manager was supernumerary and she was not included on the care staff rota. Apart from registered nurses and health care assistants the home employed other staff and these comprised: • • • • • • Chefs Administrator Kitchen assistants Housekeepers/cleaners Laundry assistants Maintenance operative People living in the home that completed questionnaires indicated that there were always or usually staff available when they needed them. Staff spoken to during the site visit all indicated that staffing levels in the home were adequate and all expressed enthusiasm about working in the home. A large number referred to opportunities for training as well as positive and supportive working relationships. Comments included: • • • • • • “It is a nice friendly atmosphere and we work well as a team”. “We work as a team and I know that if something is difficult for me I can always count on my co-workers”. “Everyone pulls together if we are short of staff”. “Normally we have 7 or 8 care staff in the morning and 5 in the afternoon, that is enough”. “Great emphasis on training”. “Regular staff training and teaching sessions including, manual handling updates, study days (off site) reading material in office information always available”. “ We are encouraged to further our training and keep up to date”. “staff numbers vary at times due to holiday and sickness and staff leaving but there are sufficient to meet needs and usually a good staff ratio”. “The nurses give training on various subjects if they have been on a course they pass on the information that they have learnt. We are an NVQ centre and the matron and deputy are keen to train staff to gain DS0000011449.V350061.R01.S.doc Version 5.2 Page 23 • • • The Grange Nursing Home NVQ. Staff also do research on different topics and do brief talks to other staff so we share our knowledge. Sometimes we have people come into do talks. For example this could be about catheters, wound care and dressings”. • “An induction schedule was discussed with me when I started, completing each part of the induction with the clinical lead nurse. Trained staff and care staff are required to give training sessions to each other. Staff are required to research a particular relevant subject and then give a presentation. I have participated in independent training on tissue viability which I found useful and relevant to my role”. “We are trained to NVQ level 3 if we wish, we have regular training sessions and health and safety training in fire and manual handling”. “We have lots of training, not only do we have people come into the home we get sent on training days and also have a lot of in house training given by nurses or care staff which is all very useful and relevant to our work. It gives me confidence in how to give care” • • The home was an accredited NVQ centre and the commitment of its management team to staff training and development was reflected in the responses from staff in questionnaires returned (22). All staff i.e. 100 indicated that they were being provided with training that was relevant to their roles, helped them understand the needs of service users and kept them up to date with new ways of working. All new staff received comprehensive induction training and health care assistants completed a common induction standards programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions. Staff spoken to confirmed that they participated in regular individual supervision sessions. The home’s manager kept a central record of all training that staff had completed and could identify readily the training needs or requirements of any individual in the home’s staff team. The staff team appeared to be stable with only 4 members of the care/nursing team leaving in the previous 12 months. Staff spoken to expressed a degree of pride in working at the home and comments in questionnaires about what they thought that the home did well included: • “Good communication with relatives – relaxed atmosphere – always organising activities – invite relatives for meals – well organized with DS0000011449.V350061.R01.S.doc Version 5.2 Page 24 The Grange Nursing Home good flexible routines - very clean and smells fresh – relatives meetings”. • “We have 2 monthly relatives meetings to discuss any concerns as do the service users, we find these most helpful. The relatives sometimes have no concerns but like to sit and chat together over coffee”. • • • “Give support to relatives – management support staff whether this is work related or personal – we try to have lots of activities e.g. bingo, product making, music time, massage and exercise” “ “All service users and their relatives are always involved in care planning and any changes happening in the home, be it changes of décor – service users are given the chance to choose a colour – all carers are doing NVQ training”. One member of staff spoken to about the home described it as “really homely” aid that he would be happy for his parents to be accommodated in the home. The records were examined of 2 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 4th December 2006. It was apparent that all the necessary pre-employment checks to ensure among other things that they were suitable to work with vulnerable adults had been completed before they had started work in the home. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership and her management style was open and transparent. There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home EVIDENCE: The home’s manager is a registered nurse and she had obtained a relevant management qualification (The Registered managers Award) that indicated that she had the skills and knowledge considered necessary to enable her fulfil her role. She was also an NVQ assessor and had been responsible for the day to day running of the home since 2001. She was supported by a deputy manager who had the same qualifications. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 26 From discussion with the registered manager, and from observation and discussion with staff, people living in the home and visitors it was evident that the registered manager was; knowledgeable; organised; highly motivated; enthusiastic; responsive; concerned; held in high regard; communicated a sense of direction; and kept up to date with developments in health and social care. Comments from staff about the management of the home included: • • “They are very supportive. You can talk to them about anything”. “We have regular meetings with the manager to assess how our work is going, if we are happy etc. Our manager is around most of the time and we can always get hold of her and she is happy to see anyone whenever the need arises and we have regular appraisals”. The home’s open management style as illustrated by the comments above also included regular staff meetings and staff spoken to indicated that the home’s management listened to ideas and suggestions made by them and that they contributed to the way the home was run. • “If there are problems to discuss they throw the ball in our court”. The homes manager was prepared when we asked for the AQAA to be returned. It contained clear information that was fully supported by relevant and appropriate evidence. It included a high level of understanding of the importance of equality and diversity and evidence confirmed during the site visit (see below) that the home listened to people that are accommodated in the home and their relatives/friends. The AQAA indicated that the home’s management were self-aware and recognised area where the home still needed to improve and set out ways that this would be achieved. Surveys and meetings were used by the home to get the views of people living there and their friends and relatives about the quality of the service that was provided. As a result of consulting people and listening to them the communal lounge dining room was redecorated and the way the space was used was changed and the home’s activities programme was changed. Informal means of obtaining peoples views were also used on a day-to-day basis. This was exemplified by the chef going around the dining area asking people for their views about the meals. The management team also audited/checked the home’s systems and procedures to ensure that they were working properly e.g. medication, accident analysis, care plan audits and reviews of wound care. There were a range of written of policies and procedures available that helped inform staff working practice. The home’s registered manager was reviewing The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 27 them and updating them as necessary and during the site visit some were identified as in need of further amendment e.g. staff recruitment. The home did not look after any money on behalf of any people living there. Relatives and/or representatives of individuals were invoiced when a person received a service such as chiropody or hairdressing. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents Staff spoken to said and records examined confirmed that that they attended regular and compulsory fire and other health and safety training. Guards covered all radiators in the home and restrictors were fitted to windows above the ground floor. There was an accredited moving and handling trainer on the staff team and there were hoists, and other equipment in the home to promote safe working practices. The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X N/A X X 3 The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations The Grange Nursing Home DS0000011449.V350061.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000011449.V350061.R01.S.doc Version 5.2 Page 31 - 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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