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Inspection on 06/12/05 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 6th December 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

The activities that service users participate in are exactly as the individual has requested as part of the review process. The activities are timetabled accordingly and include educational opportunities at colleges, attending day centres and recreational activities. Service users benefit from the home employing a dedicated driver to maintain educational and recreational activities, this enables service users to access activities of their choice whilst ensuring staff levels remain adequate within the home. The arrangements for the induction of staff are good with staff demonstrating a clear understanding of their roles.

What has improved since the last inspection?

The homes statement of purpose and service users guide has been updated. The manager stated that all service users went on a holiday away from the home for the first time this year. Staff moral has improved since the home has been fully staffed and that this has resulted in an enthusiastic, multicultural workforce who work positively with service users. Two staff have attended Strategy for Crisis Intervention and Prevention training.(S.C.I.P). Service users health has improved since the shower trolleys are cleaned regularly and the home have developed an `infection control committee` which consists of domestic and care staff and registered nurses. The committee will meet monthly to discuss issues and ways of improving practices. Results ofthis are then feedback to the remaining staff and service users at monthly staff meetings. The inspector received verbal confirmation from the company`s client finance officer that Robinia Care Ltd have stopped claiming each Service users` Disability Living Allowance (D.L.A.) to cover the cost of transport, this came into effect at the end of July 2005.

What the care home could do better:

First impressions of the home would be considerably improved if the outside of the building was decorated. Two service users would benefit from their worn bedroom carpets being replaced. The home has three separate lounge/dining rooms for service users. The service users who use two of the three lounge/dining rooms would benefit from new sofas and dining chairs. The manager must ensure the homes Policies and procedures are specific and relevant to the home and that they are reviewed annually. The provider must develop a policy and procedure for the charges to service users for the cost of transport, and include the cost in the individual`s contracts.

CARE HOME ADULTS 18-65 The Grange Nursing Home Farnham Road Liss Hampshire GU33 6JE Lead Inspector Tracey Box Unannounced Inspection 6th October 2005 09:30 The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 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.V256540.R01.S.doc Version 5.0 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.V256540.R01.S.doc Version 5.0 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 M M Cloete Care Home 15 Category(ies) of Learning disability (15) registration, with number of places The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2004 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 accessabile for service users and well maintained, also within the grounds is a sensory room and a hydrothapy 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.V256540.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over five and a half hours. The people living at The Grange prefer to be referred to as service users, therefore will be referred as this throughout the report. The inspector witnessed good interacting between the majority of service users and staff who were participating in activities that service users seemed to enjoy, including going for a drive in one of the homes minibuses, watching television, relaxing in the soft play area and spending one to one time with staff sitting close by. The inspector looked at records and asked staff for their views of working in the home. The manager showed the inspector 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 homes statement of purpose and service users guide has been updated. The manager stated that all service users went on a holiday away from the home for the first time this year. Staff moral has improved since the home has been fully staffed and that this has resulted in an enthusiastic, multicultural workforce who work positively with service users. Two staff have attended Strategy for Crisis Intervention and Prevention training.(S.C.I.P). Service users health has improved since the shower trolleys are cleaned regularly and the home have developed an ‘infection control committee’ which consists of domestic and care staff and registered nurses. The committee will meet monthly to discuss issues and ways of improving practices. Results of The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 6 this are then feedback to the remaining staff and service users at monthly staff meetings. The inspector received verbal confirmation from the company’s client finance officer that Robinia Care Ltd have stopped claiming each Service users’ Disability Living Allowance (D.L.A.) to cover the cost of transport, this came into effect at the end of July 2005. 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.V256540.R01.S.doc Version 5.0 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.V256540.R01.S.doc Version 5.0 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): 2,5 A comprehensive procedure for assessing the needs and aspirations of potential new service users is in place to ensure the service users and the homes needs are met prior to admission. Service user’s statement of terms and conditions were inadequate as their content had limited detail regarding additional payments and fees. EVIDENCE: The inspector looked at four service users files which included two recent pre placement assessment forms which were completed by the service users’ social workers and the home’s manager. The information included educational and recreational wishes, likes and dislikes, profile of general appearance, medical and social history and comprehensive risk assessments for all activities. Service users are supported by family/representatives in the completing the assessment, this ensures as much information as possible is included in completing a full assessment. The manager explained that prospective service users are invited to spend a day at the home with their own care staff, if that is successful, the service user is invited to spend a night at The Grange. The next stage of the assessment process involves the service user, their relatives and social worker meeting with the manager of The Grange where they all discuss the assessment, and whether or not the service user wishes to live at The Grange, if the home is able to meet their needs. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 9 Four service users statement of terms and conditions were looked at, they included a list of extras the service user would be expected to pay for or contribute to, the following had a fixed fee: hairdressing, chiropody, physiotherapy with a physiotherapy assistant, one to one staffing, attendance at the resource centre. The following fee was stated as variable: homeopathic remedies, annual holiday, direct damage to furnishings, fittings, property, entry fees to leisure and recreational activities. The inspector received verbal confirmation from the company’s client finance officer that Robinia Care Ltd have stopped claiming each service users’ Disability Living Allowance (D.L.A.) to cover the cost of transport, this came into effect at the end of July 2005. The manager confirmed the providers Robinia Care Ltd were producing a policy/ guideline on transport fees to service users, and will be included in the service users contract or statement of terms and conditions. The home did not have any records of the social services contract for each service user they provide funding for, the manager explained these contracts are held at the Robinia head office, this is common practice within Robinia homes, however the manager is unable to monitor contractual obligations to provide additional staffing to support service users unless head office provides the information. The home must ensure copies of service users contracts with social services are held within the home. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 10 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): 6,7,9 Service users’ individual plans reflect their assessed and changing needs and personal goals. Practices within the home demonstrate that service users are encouraged to make decisions about their lives and to take risks as part of an independent lifestyle. EVIDENCE: The inspector read four service users care plans which included comprehensive risk assessments on all areas from personal care needs, physiotherapy/manual handling assessment, wheelchair assessment, epileptic seizure assessment to travelling in a vehicle, going on holiday, attending activities, such as horse riding (including a risk assessment carried out by the physiotherapist regarding the riding stables), swimming, a concert, fire evacuation and daily activities. Care plans explore individuals sexual preferences, the manager 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. All are reviewed monthly or more frequently if necessary. One member of staff said the care plans are reviewed almost daily, any changes are discussed The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 11 with the service user and agreed before any action is taken. Care plans and risk assessments are also reviewed at the service users six month review, where relatives/representatives, day placement representative and social workers are invited if the service user wishes, the inspector saw minutes of a service users review who had recently moved to the Grange, the reviews were held monthly for three months, and then every three months for the first year. All of the file seen included detailed minutes from the reviews which included names of people who attended and what was discussed. Each service user has a timetable of daily activities, which is devised and agreed with them at their review. This timetable is included in the individuals care plan, evidence of the activities taking place were found in the individuals daily notes, which included details of alternative activities which took place when the day centre was closed. The home operates a keyworker system, which means each service user has a named member of staff who has specific responsibilities for the service user. A member of staff said “ I often spend one to one time with the resident I am keyworker to, we may spend time doing an activity, this promotes a relaxed atmosphere so that the service user feels able to communicate their wishes and we get to know one another.” The inspector saw staff communicate with service users in their preferred manner, as stated in their care plan. ‘Makaton’ sign language was being used to facilitate communication. The manager explained “service users communicate in many different ways, usually a facial expression or body language informs us of whether or not the individual is happy or agrees with the outcome!” The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 12 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): These standards will be assessed at the next inspection. EVIDENCE: These standards will be assessed at the next inspection. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 13 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): These standards will be assessed at the next inspection. EVIDENCE: These standards will be assessed at the next inspection. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 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): 22. Service users views are listened to and acted on. EVIDENCE: The inspector spoke with the manager and staff, who confirmed the way they ensure service users views are listened to is to communicate in the style and pace appropriate to the individual, spend one to one time with service users, arrange regular review meetings, form positive relationships with families, friends and outside agencies. The manager confirmed staff use a variety of ways to enable service users to make choices, for example, when choosing which clothes to wear, the staff member will arranging the options in front of the service user and prompt the service user to look and point to their choice. The same system is used when choosing to redecorate/ refurbish of areas within the home and where to go on holiday. The home has a clear complaints procedure, devised in pictures and words, which is held in each service users guide and statement of purpose. The inspector observed staff listening to the service user, and responded appropriately to meet the individuals needs. The inspector received four service user comment cards, all were completed on behalf of service users by their relatives, all stated they were aware of who to speak to if they were unhappy about anything. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 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): 24,30 The home is safe, clean and hygienic, however, some areas within it require attention to ensure it is a comfortable and pleasant environment for service users to live in. EVIDENCE: The manager showed the inspector around the home and the garden, and the sensory room and hydrotherapy pool, all appeared well maintained, however bedroom carpets in two bedrooms were worn and need replacing, and the sofas and dining room chairs in lounge/diners one and three need replacing to provide more appropriate comfortable seating to meet the needs of the service users. One service user showed the inspector his bedroom, which he shares with another male service user. The room was brightly decorated and had posters and the service users photographs on the walls, and other personal effects. The service user seemed proud to show off his room, which was clean and warm. The manager explained service users are encouraged to furnish the room with personal belongings, furniture and pictures to make it feel like home. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 16 The rest of the home appeared clean, warm and no offensive odours were detected. The home’s radiators and pipe work are safe ensuring that all potential hot surfaces are kept to low temperature. Some bedrooms had special adaptations to ensure the safety of the service user, risk assessments and care plans confirmed this. The garden is well maintained and is accessible to service users. The inspector witnessed the homes procedures to ensure hygiene is maintained, staff were seen to use protective clothing whilst completing their cleaning and food preparation and serving duties. The inspector saw certificates of staff who have attended Infection control and food hygiene training, staff confirmed they found the training useful. The home have developed an ‘infection control committee’ which consists of domestic and care staff and registered nurses. The committee will meet monthly to discuss issues and practices. Results of this will be feedback to the remaining staff and service users at their monthly staff meeting. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 17 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): 32,34,35 Service users needs are met by staff who are well trained, supportive and in sufficient numbers. The home operates robust recruitment, induction, training and development procedures to ensure that ensure service users’s are not put at risk. EVIDENCE: The manager confirmed the only vacancy the home have is twenty hours domestic and explained the procedure for the recruitment of new staff. The staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to sample three different staff records and found that they were detailed with the necessary checks taken to ensure staff are fit to work at the home. The manager confirmed that the home’s induction programme has been assessed against the Skills for Care Council induction standards. One member of staff who had recently started working at The Grange, stated she had completed induction training and Learning Disability Award Framework, which included training on, policies and procedures of the home, learning disability, epilepsy, visual impairment, Autism, syndromes relevant to the needs of the service users and communication-“This is my first job in the care sector, I feel that the induction training I have done so far has given me the base training to enable me to start a career in this field.” “I attended a The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 18 course about ‘Makaton’ this helps me to communicate with the service users very well.” Staff are working towards their National Vocational qualification level 2 and 3 and the Certificate In Working with People with Learning Disabilities One staff member said “ I feel I have adequate training in order for me to carry out my job, I can just ask if I want training, I don’t have to wait until a meeting or my supervision.” Staff explained “we work well together as a team, during staff meetings we talk openly and share ideas and support one another, this helps us meet the needs of all service users.” One member of staff said “I feel we have adequate staff on duty to meet the needs of the service user.” The manager confirmed staffing levels are adequate, the rotas showed that there were ample staff on duty to meet the service users joint and individual needs taking a small group of service users for a drive in the morning, and in the afternoon a small group of service users went for their horse riding lesson. Staff were seen to be spending one to one time with service users who require additional support, this was reflected in the individuals care plan and on the staff rota. The manager is positive and supportive of staff development and training, the inspector saw records which show staff receive regular supervisions, annual appraisals and various staff meetings that are minuted. Certificates showed staff had received all mandatory training, the manager explained there is always someone on duty who has attended Strategy for Crisis Intervention and Prevention (S.C.I.P.) training. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 19 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): These standards will be assessed at the next inspection. EVIDENCE: These standards will be assessed at the next inspection. The Grange Nursing Home DS0000011480.V256540.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X 2 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Grange Nursing Home Score X X X X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000011480.V256540.R01.S.doc Version 5.0 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 YA 5 Regulation 5 (3) Requirement The home must ensure copies of service users contracts with social services are held within the home. Timescale for action 06/11/05 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.V256540.R01.S.doc Version 5.0 Page 22 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.V256540.R01.S.doc Version 5.0 Page 23 - 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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