Inspection on 04/01/06 for The Grange Nursing Home

This inspection was carried out on 4th January 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange Nursing Home 17/01/07

The Grange Nursing Home 06/12/05

The Grange Nursing Home 08/11/04

The Grange Nursing Home 22/07/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Grange Nursing Home Farnham Road Liss Hampshire GU33 6JE Lead Inspector Tracey Box Unannounced Inspection 4th January 2006 10:00 The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 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 DS0000011480.V275267.R01.S.doc Version 5.1 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 Adults 18-65. 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 DS0000011480.V275267.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Grange Nursing Home Address Farnham Road Liss Hampshire GU33 6JE 01730 895590 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) Robinia Care Limited Mrs Marion Cloete Care Home 15 Category(ies) of Learning disability (15) registration, with number of places The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Grange is a care home providing accommodation and nursing care for up to fifteen younger adults with learning and physical disabilities. The Grange is a large detached house located in the small rural village of Liss. The accommodation for service users is on the ground and first floor, connected by stairs and a passenger lift. It comprises of eleven single and two double bedrooms, none of which have en-suite facilities. There are three lounge/dining rooms on the ground floor, one of which has a soft play area. The home has a large, secure garden, which is accessible for service users, and well maintained, also within the grounds is a sensory room and a hydrotherapy pool. The home is owned by Robinia Care Limited, a national company who own a number of care homes within Hampshire and other local authorities. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The people living at The Grange prefer to be referred to as service users, therefore will be referred to throughout the report. The inspector witnessed good interacting between all service users and staff who were participating in activities that service users seemed to enjoy, which included watching television and spending one to one time with staff sitting close by. The inspectors looked at records and asked staff for their views of working in the home. The inspector saw the layout within and surrounding the home, which appeared clean and comfortable, providing a pleasant environment for the service users. What the service does well: What has improved since the last inspection? The home has a full complement of staff, Staff morale is high resulting in an enthusiastic, multicultural workforce that works positively with service users. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 (Standards 2 was assessed during the previous inspection). Practices need to be improved to ensure service user’s contracts with social services are available at the home. EVIDENCE: The home did not have any records of the social services contract for each service user they provide funding for. Each Service users contract with Social Services is held at the Robinia head office, this is common practice within Robinia homes. The home must ensure copies of service users contracts with social services are held within the home to enable the manager to monitor contractual obligations to provide additional staffing in order to support service users appropriately. THIS REMAINS A REPEAT REQUIREMENT FROM 6/11/05. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed during the previous inspection. EVIDENCE: These standards were assessed during the previous inspection. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Service users participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. The home actively promotes appropriate personal, family and sexual relationships. Practices within the home demonstrate that individual rights and responsibilities are respected and recognised. Dietary needs of service users are well catered for with a balance and varied selection of food available that meets individual’s dietary requirements and choices. EVIDENCE: Staff explained that Service users are encouraged, in line with their care plan and risk assessments, to participate in social activities, both within the home and the community. Records of activities are recorded in the individuals care plan and daily records, these include daily activities such as art, games, awareness of the world by looking at stories in newspapers/magazines, listening to stories on audio tape, cooking and nutrition, as well as visits to the cinema and shopping. Staff confirmed they often support service users in going The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 11 to the pub, or to local areas of interest. Staff record on a daily basis what each service user has participated in and whether or not the service user enjoyed or benefited from it, this information then feeds into the service users review where a timetable of activities is discussed and devised. Care plans reflect the individuals cultural beliefs and individuals sexual preferences, the staff explained at present service users do not wish to partake in relationships, other than friendships outside the home. Should the need arise, service users would be fully supported and staff would follow the homes policy on personal and sexual relationships. Staff confirmed they would obtain support from outside agencies (an advocate) should it be required for any service user. The inspector witnessed the visitors book that detailed family and friends visits to the home. Staff reported there are no restrictions on visiting, unless stated in an individuals care plan. A copy of Service users rights and responsibilities are held in the service users guide, the home’s statement of purpose, and in each individual service users contract. The inspector saw the home’s menus displaying a variety of nutritious meals, which included an alternative. Food storage areas and fridges were well stocked with fresh and tinned produce, the menu displayed a variety of nutritious meals. The inspector saw a record of individual’s food intake, staff said this helps them to ensure service users are receiving a balanced diet that they enjoy. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Service users receive personal support in the way they prefer and require. Comprehensive procedures ensure service user’s physical and emotional health needs are met. Service users are protected by appropriately trained staff, who follow the homes policies and procedures for dealing with medicines. EVIDENCE: The care plans and risk assessments states how the individual wishes to receive their personal support and are reviewed on a monthly basis or as needs change with the service users agreement. Daily records comment on individuals daily activities, physical and emotional health and behaviour, records of visits to outside agencies, such as doctor, dentist, optician are kept on the individuals file, this enables the home to monitor and track the information recorded. The inspector sampled two care plans, both included guidance of how to meet the individual’s physical and emotional health needs, and most recent visits to healthcare professionals. One member of staff said “I find the information in the care plans very useful and detailed, it includes trigger factors to be aware of for behaviour and seizures, and what to do about an incident when it occurs.” The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 13 Staff confirmed they receive a variety of training to support service users, including, communication, awareness of disabilities, diabetes, epilepsy and care planning. At the time of the inspection, staff administer all service users medication. Staff told the inspector that residents prefer them to store and administer residents medication for them. The inspector saw medication being correctly administered, staff followed the homes medication policy and procedure, the home administers from single blister pack system provided by a local pharmacist and correctly stores the medication in a lockable cabinet which is on wheels, which enables staff to take the medication to the area that the service user is in. The home use ‘Medicine Administration Record Sheets (MARS) system for recording the administration of medication. The records kept in conjunction with medication received and returned to the pharmacist were sampled and were found to be correct. Records of all staff trained to administer medication were found to be in order. The inspector saw a risk assessment completed by the manager for drug administration errors. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 (Standard 22 was assessed during the previous inspection.) The home has satisfactory procedures for protecting service users’ form abuse EVIDENCE: Staff follow comprehensive care plans and risk assessments for a service users who may harm others, the inspector found the records to be eligible and complete, staff confirmed the details in the care plan and risk assessments enable them to carry our their role effectively. The inspector saw the homes adult protection procedure, which includes the Department of Health “No Secrets” guidelines. The home has a copy of Hampshire’s guidelines for the Protection Of Vulnerable Adults. Staff confirmed they have attended abuse awareness training, and that abuse was covered during their comprehensive induction, the inspector sampled staff’s files include records of training and certificates. Staff said they discuss issues surrounding abuse policy and procedures at their monthly staff meetings with their line manager supervisions, and confirmed their awareness of the procedure and where to find it should it be required. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed during the previous inspection. EVIDENCE: These standards were assessed during the previous inspection. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed during the previous inspection. EVIDENCE: These standards were assessed during the previous inspection. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. The systems for service users consultation are good, with a variety of evidence that indicates service users views underpin all self monitoring, review and development by the home. The health, safety and welfare of service users are not fully protected. EVIDENCE: The manager circulates a service users survey, and the responsible individual completes monthly visits to the home as required in Regulation 26 of the Care Standards Act 2000. Robinia conducted a national satisfaction survey which included feedback about The Grange from relatives, social services and doctors, the results of this survey were not available. The manager confirmed quality issues are discussed on a one to one basis at staff supervision and within staff meetings. One fire door were wedged open with a chair, staff explained this is because a service user removed the previous door release, staff have reported this as a maintenance issue, however it has not been actioned, therefore the provider is The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 18 required to ensure each fire door is fitted with appropriate automatic door release. Staff receive adequate training on health and safety issues, as evident from the staff training plan, the inspector saw certificates for staff attending moving and handling training, first aid, food hygiene and Control Of Substances Harmful to Health. The home has risk assessments in place for the building and safe working practices for staff. Certificates showed the maintenance of services within the home were up to date. The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 2 x The Grange Nursing Home DS0000011480.V275267.R01.S.doc Version 5.1 Page 20 YES 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 YA5 Regulation 5 (3) Requirement The home must ensure copies of service users contracts with social services are held within the home. THIS IS A REPEAT REQUIREMENT FROM 6/11/05 The provider must ensure each fire door is fitted with appropriate automatic door release. Timescale for action 04/03/06 2 YA42 23(4)( c) (1) 04/02/06 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 DS0000011480.V275267.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 DS0000011480.V275267.R01.S.doc Version 5.1 Page 22 - 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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