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

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

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 Adequate. 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

Resident needs are assessed using clear and comprehensive assessment tools, both by the home and by Social Services. Care plans encompass all aspects of health care, and are regularly reviewed.

What has improved since the last inspection?

No specific improvements were identified during the Inspection.

What the care home could do better:

The delivery of care could improve by staff implementing the training they receive, to promote and improve resident`s care, health and welfare. Improvements to care plans and daily records could be made by the inclusion of resident`s aspirations and involvement with regards to activities and recreational pursuits, which would evidence a holistic approach to care. Managerial practices could be improved to provide opportunities for residents and staff to contribute to the day-to-day running of the home and the development of care practices.

CARE HOMES FOR OLDER PEOPLE The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT Lead Inspector Linda Clarke Unannounced Inspection 4th January 2006 11:30 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 & Residential Home DS0000060078.V272864.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 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 & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Grange Nursing & Residential Home Address Smeeton Road Saddington Leicester Leicestershire LE8 0QT 0116 2402264 0116 2404420 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) Mr Banesh Laxmilall Bhatoolall Mrs Stephanie Anne Reed Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (12), Physical disability of places over 65 years of age (40) The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person under the age of 55 falling within category PD (physical Disability) may be admitted to the home. The home may admit the person of category PD (Physical Disability) named in registration variation application number V41794 dated 7th January 2003. 16th June 2005 Date of last inspection Brief Description of the Service: The Grange Nursing and Residential Home is registered to accommodate upto forty older people, within the categories of older persons and physical disability. The home is located in quiet village of Saddington, Leicestershire, near to adjoining the villages of Great Glen, Kibworth Beauchamp and Fleckney. The home benefits from a village setting in pleasant surroundings. Car parking facilities are available to the rear of the home. The home is approximately 12 miles from Leicester City centre and accessible by car. The home is a large, traditional style house with bedrooms on two floors. The upper floor accessible by stairs, stair lift or the passenger lift located at the centre of the home. The home has 23 single rooms and 8 double rooms of which two rooms have en-suite facilities. There are two large comfortable lounges and the dining area is situated off the main lounge. The staff team consists of trained nurses and care staff providing nursing and personal care to residents. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Inspection that took place between 11.30am and 4.00pm. When undertaking Inspections, the Commission for Social Care Inspection focuses on the outcomes of individuals staying in the home. To support this, four residents were ‘case tracked’. This means that the care records and care plans of residents were checked; the residents were spoken with where possible. The Nurse in Charge contributed to the Inspection. What the service does well: 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 Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 6 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 & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Standard 6 not applicable. The admission process is well managed with residents needs being assessed ensuring staff have the appropriate information to meet individual needs. EVIDENCE: Four care files of residents ‘case tracked’, contained assessments that had been completed by the home’s manager or Registered Nurse, in addition for those individuals funded by Social Services a comprehensive assessment undertaken by a Social Worker accompanied the homes own assessment. An Individual Placement Agreement was in place, outlining the terms and conditions of occupancy for those individuals funding by Social Services. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. Residents are generally looked after well in respect of their health and personal care, improvements could be made to the delivery of personal care in some cases, and poor moving and handling practices may put residents at risk. EVIDENCE: The care plans and records of four individuals were viewed, two of which were in receipt of nursing care, whilst two were in receipt of residential care, one of which was accessing respite services. Care plans were detailed focusing on physical aspects of care consistent with health promotion and well-being, which included consideration given to the risk of the individual falling. One care plan for an individual in receipt of nursing included a plan of care focusing on motivation. Care plans could be improved if they were to incorporate information as to how individual’s cultural, social and recreational interests were to be met. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 9 Daily records were also viewed, these focused on the individuals health care and well-being, greater detail could be incorporated to reflect there day to day lives, by the inclusion of their participation in activities, receiving of correspondence, the expression of choices and requests along with relative contact, thus evidencing an holistic approach to care. The Inspector observed two examples of poor practice in relation to moving and handling of a resident, in addition to this one resident advised the Inspector of how she was moved and handled by staff, a relative visiting also advised the Inspector as to how her relative is moved, all confirmed poor practice. The Inspector spoke with one member of staff after witnessing poor moving and handling that confirmed she had received the appropriate training, and was aware that she had not put this into practice. An immediate requirement was issued, which requires the Responsible Individual to submit to the Commission for Social Care Inspection, information as to how the health and welfare of residents is to be promoted, in relation to the moving and handling of residents. Records evidenced that residents had frequent access to General Practitioners, which visit the home on a weekly basis, with all residents being reviewed twice monthly. Various health care professionals support residents at The Grange Nursing Home, which include District Nurses, Chiropodists and Opticians. One residents when asked as to the care she receives from staff, stated that some staff are ‘rough’ when helping her to dress, which causes her discomfort, the lady went onto say that when she brings this to the attention of care staff they are then gentle. The Inspector spoke with two sets of visitors during the Inspection, one set of visitors were generally satisfied with the care of their relative however they felt that their was a lack of attention to detail with regards to the grooming and appearance of their relative, they confirmed that this had been brought to the attention of the staff group, some improvements had been made but they were still not completely satisfied. The second group of relatives were generally happy with the care their relative received. The Inspector spoke with five residents, all but one was happy with the care they received, four spoke positively of staff. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14. Residents experience a homely life style and visitors are encouraged to visit. Various formal and informal activities take place, the frequency and variety of which could be improved and increased. EVIDENCE: A non-denominational church service is held in the home monthly, to which some residents attend. Planned activities include visiting musicians and singers; with an occasional film show taking place. As part of the Christmas celebrations the local Brownie-Guides visited to sing Carols. Relatives were seen visiting on the day of the Inspection, other residents spoken with confirmed that they receive visits from family and friends. The range and frequency of activities and recreational pursuits could be increased, providing residents with greater choice and stimulation. Residents should be consulted as to whether current arrangements meet their expectations and needs, and offered an opportunity express their ideas and needs. Daily records should reflect resident’s participation in activities and recreational pursuits, including contact with relatives and friends and record resident choices. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards within this section were not inspected; these were inspected at the inspection, which took place earlier in the year. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards within this section were not inspected; these were inspected at the inspection, which took place earlier in the year. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards within this section were not inspected; these were inspected at the inspection, which took place earlier in the year. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35 Managerial practices could be improved to provide opportunities for residents and staff to contribute to the day-to-day running of the home and the development of care practices. EVIDENCE: The position of Registered Manager is currently vacant; two Registered Nurses are currently overseeing the day-to-day running of the home. A system of Quality Assurance needs to be developed to ensure that residents, relatives and visiting professionals are provided with an opportunity to comment as to the day to day running of the home, which should include aspects of resident care. The minutes of staff meetings were viewed; the most recent staff meeting having taken place in excess of twelve months ago, the day to day running of The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 15 the home would improve should staff meetings be held on a regular basis, to promote a positive and inclusive atmosphere for staff, enabling them to gather information, and discuss best care practices. A majority of residents or their families manage their finances; the Responsible Individual manages some aspects of two resident finances. The Responsible Individual confirmed that the Secretary of the home is responsible for the administration of these finances. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 16 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X X X X The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 13(5) Requirement The Registered Person to ensure that service users safety is maintained and promoted by the adoption of correct moving and handling procedures. The Registered Person to ensure that care staff deliver personal care in an appropriate manner, which promotes the dignity and welfare of residents, which does not cause harm and distress. Timescale for action 31/01/06 2 OP10 13(6) 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP7 OP12 Good Practice Recommendations It is recommended that care plans and daily records, evidence a holistic approach to care, with consideration being given to social, cultural and recreational needs. It is recommended that aspects of care, which are a specific task for nursing staff, be highlighted within the care plan, for ease of reference. It is recommended that the variety and frequency of DS0000060078.V272864.R01.S.doc Version 5.0 Page 18 The Grange Nursing & Residential Home 4 OP32 activities improves and that residents are consulted on the current arrangements to establish as to whether their needs are being met. It is recommended that regular staff meeting take place, to promote a positive and inclusive atmosphere for the benefit of resident welfare. The Grange Nursing & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 & Residential Home DS0000060078.V272864.R01.S.doc Version 5.0 Page 20 - 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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