Inspection on 12/10/09 for The Grange Residential Care Home

This inspection was carried out on 12th October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange Residential Care Home 05/10/06

The Grange Residential Care Home 27/11/05

The Grange Residential Care Home 07/07/05

The Grange Residential Care Home 29/03/05

The Grange Residential Care Home 29/12/04

The Grange Residential Care Home 05/02/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Grange Residential Care Home 2 The Street Kennington Ashford Kent TN24 9EX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Cochrane     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: The Grange Residential Care Home 2 The Street Kennington Ashford Kent TN24 9EX 01233621824 01233663028 thegrange1989@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Malcolm Brown Friend,Mrs Diane Kathleen Friend care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category ; Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Grange is a large detached property on the outskirts of Ashford. It is registered to provide accommodation, personal care and support for up to 29 older persons. Mrs Karen Whiting is the Registered Manager and is responsible for the day-to-day running of the home. Accommodation is arranged on the ground and first floors: the third floor provides Care Homes for Older People Page 4 of 39 Over 65 29 0 Brief description of the care home office and storage space. There are 2 passenger lifts. The home has 21 single rooms and 4 double bedrooms, 7 of which have en-suite facilities. Bedrooms are fitted with TV and telephone points as well as individual call alarms. The ground floor consists of a dining room, 2 separate lounges (one of which also has a dining area), a conservatory, kitchen and laundry. There is a large well maintained and enclosed garden, including a safely fenced fish pond, and parking for several vehicles at the front/side of the home. Facilities such as health centres, a hospital, shops and churches are within a ten minute drive. The fees are currently in the range of £326.63 to £385.10 per week. Information about the home, including the inspection reports from the Care Quality Commission are available on request. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit to the service was an unannounced Key Inspection which took place over two days. We went to the home on 12th October 2009 at 10:00a.m and finished at 3:30 p.m. The deputy manager helped with the inspection process at this visit as the registered manager and the providers were not available. We returned to the home on 15th October 2009 between 12.00 pm and 1.30 p.m to speak to the registered manager and the providers about what we had found at the first visit. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. They told us things about the home and the support and care they receive and give. The visit included talking with residents and the care staff. General observations were made during the day of how people are supported. We had a look around the home and various records were inspected. We looked at and discussed residents individual support plans and their risk assessments. We looked at Care Homes for Older People Page 6 of 39 medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We sent six surveys to people who live at the home, six to the staff and five to visiting professionals. We received back three from residents, five from staff and two from visiting professionals. These will be referred to in the report. We also took into account the things that have happened in the service; these are called notifications and are a legal requirement. Since the last inspection there has been a social services led safeguarding adults alert at the home. This means that concerns have been raised and they are being investigated by the local safe guarding team. This is to make sure the people living at the home are safe and their needs are being met. They have had advice and input from multidisciplinary agencies. The alerts have now been investigated and closed. Further visits by specialist teams will be arranged to the home to monitor improvement of the service. This will ensure the residents are being well cared for. Following this inspection we issued a Code B notice. This informs the recipient that we believe, under the Care Standards Act 2000, an offence has been committed, that we have taken evidence that demonstrates this breach and makes clear what the rights of the individual receiving the notice are. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? There have been improvements to the homes environment. There is a newly built laundry room which means there is the space to wash and sort out peoples clothes. Residents told us that the laundry facilities are very good. The said their clothes are clean and their own clothes end up in their rooms. The carpet in the main corridor has been renewed and the small lounge re-decorated. Care Homes for Older People Page 8 of 39 What they could do better: Shortfalls were identified at this inspection. The providers and the registered manager are now aware of these and told us that they will be addressed. The manager said she will be working to improve the service and provide an improvement to the lifes of the residents. The providers of the service have told us they will be supporting her to do this. We feel confident that now the shortfalls have been identified that the registered manager and providers will be pro-active in addressing them. Since completing the inspection we have been told by the registered manager that improvements have already been made and there are plans in place to address the shortfalls. Peoples contracts do not tell them how much they are paying for the service they receive. The personal and health care/support required by some people is not being consistently monitored and met. The systems that are in place to check that care planning is being effective are not picking up the shortfalls. Some care plans have not been updated to reflect changing health and personal needs of people. This means that people may not be getting the appropriate and correct care and support. People told us that they would like to do more things in and out-side the home. They said It would be nice to go out more. I enjoy the music and quizzes, but they dont happen enough. Processes and procedures in the home do not protect the residents from all types of abuse. The care needs of the people who are more highly dependent are not being identified, monitored and met. Staff have not received safe guarding training and therefore do not know what constitutes all forms of abuse. This means that people maybe at risk. Staff have not received the specialist training and there are also shortfalls in induction and mandatory training. This means that staff may not have the skills and knowledge to look after people in the way that suits them best. The service needs to make sure that the staff working at the home have been recruited and appointed using robust policies and procedures. We found that staff had not been fully vetted and checked before they began to work with vulnerable people. This means that residents may not be fully protected. The service is not being managed pro-actively and effectively and run in the best interest of the people who live there. The registered manager is not demonstrating the skills and abilities to ensure that all of the residents have their individual care needs met, in a safe and caring environment. The providers of the service had not identified the shortfalls highlighted in this report. Care Homes for Older People Page 9 of 39 Quality assurance has not been developed to make sure the people living at the home and stakeholders views impact on the improvement and development of the service. The quality assurance systems are not in place to make sure that the home is being run in the best interests of the people who live there. At the time of the visit the staff were not receiving the supervision they needed to make sure they are supported to their jobs effectively and safely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information about the service is not up to date and is not easy to access. People do not know exactly how much they are paying for the service they are receiving. People can be sure they will receive a thorough assessment and that all their preadmission needs are identified. Evidence: We saw the Statement of Purpose and Service Users Guide written by the service. This is information which tells people about the company, the home and the service it provides. The Statement of Purpose was not a stand alone document. The information was kept in separate files and folders and was fragmented. It was not easily available to people who use the service or their relatives. We did see information about the homes Care Homes for Older People Page 12 of 39 Evidence: philosophy of care and its aims and objectives. It gave some information about the environment and explained about peoples rights. It referred to the services policies and insurance and financial matters. This information we saw had not been updated to tell people about the present situation in the home. A Service Users Guide was available. The deputy manager told us that everyone receives a copy of the guide when they move into the home. It contains most of the information that people need to know about the home. The guide is not written in a format which would make it more suitable for the people who use the service. Each person has a contract with the home and this tells them what they will be paying for, the service they will receive and the terms and conditions. We saw that each person or their representative signs their own contract with the provider. There is a generalised range of room fees available but this does not tell people as individuals the amount they will be paying to stay at The Grange. The registered manager told us she would incorporate this into peoples contracts. The home has a pre-admission assessment procedure. We looked at three assessments of the most recent people to move to The Grange. We saw that the registered manager visits prospective residents in their own home, in hospital, or in their existing placement to carry out a pre-admission assessment. This helps the service decide on whether they will be able to offer the person the support and care they need. The assessment looks at the prospective residents physical and mental health, personal care and social needs. It looks at care needs that include breathing issues and sleep patterns. It also considers peoples mobility and nutritional needs. It also looks at their life history, cultural and religious needs. Some people also had an assessment done by the local social services care management team. The deputy manager told us the home will not accept any resident unless they are confident that they can give the care and support that they need. The home does not offer intermediate care. Care Homes for Older People Page 13 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that all their identified needs will be met and that all risks will be minimised. Action needs to be taken to ensure that the homes medication policies and procedures are adhered to and fully protect the safety of residents. Evidence: Each person living at the home does have a care plan. Some of the plans focus on what people cant do instead of looking at what people can do. They do not promote independence and do not maximise peoples abilities. Some are done to a better standard than others. Some contain detailed information about how people like to have things done and give direction and guidance to staff about how to meet their individual needs some do not. We looked at 3 of the care plans in detail and at specific details in one other plan. We found that there are shortfalls in the personal and health planning for the people who live at The Grange. We found when peoples conditions change, deteriorate or for those who have more complex needs, there is a risk that they may not receive the Care Homes for Older People Page 14 of 39 Evidence: care that they need. The plans did contain a profile of the person so the reader had some background information to build a picture of the persons past life and what was important and meaningful to them before they came to live at the home. The plans did not follow through the areas of need and support that had been identified during the assessment. One person assessment indicated that they may be at risk of falling another was identified as being on medication that needed close monitoring. There was nothing in the care plan to say how this would be done. Peoples health needs were identified but there was nothing in the plan to give direction and guidance to staff on how support the person in the best way. Some of the plans we saw did give guidance on how to deliver personal care with regards washing and bathing. They explained the individual support that was needed with regards to the number of staff and manual handling support that was required. Others were scant with information on how people like to be supported. The plans did not indicate how all aspects of personal care had been given. The plans were not up dated to reflect peoples changing needs. For example some people have diabetes and this was recognised in their care plans. However there was no individual information on what staff should do if the persons blood sugar became too high or too low. On one occasion we found that when some health needs were identified no action had been taken. When specialists appointments happen or when district nurses or doctors visited there was nothing documented about the outcome of the visit and the care plan had not been updated to reflect the changes in the care and support needed. We saw that one persons cognitive abilities had deteriorated and they were confused and wandering. There was no direction or guidance in the care plan to tell staff how to best manage the situation in a consistent way that would best meet the needs of the person. Staff are relying on verbal communication between each other to keep themselves up to date instead of referring to care plans. This will mean that residents are at risk at not having the care they need or receiving care that is not in their best interest. Care plans are not being used as a daily working tool. Daily records are kept but they do not give a clear picture about how residents spent their time and do not relate to the individual care plans. There are some risk assessments in place but these need to be further developed and more individualised Care Homes for Older People Page 15 of 39 Evidence: to ensure that all risks have been identified and kept to a minimum. One risk assessment stated that a persons medication needed to be checked as they were able to give their own medication but there was nothing to say this had been done. The care planning does not incorporate individual preferences and choices about how people would like to be looked after. At present care needs are met in a task orientated way. Plans mainly focused on what people could not do instead of promoting independence and self-esteem. When we spoke to the registered manager she did recognise the shortfalls and knows what improvements have to be made. She told us that the care plans would be reviewed and updated to reflect peoples changing needs. The registered manager and deputy manager told us that they planned to develop the care plans into a different format which will be more person centred and look more at the individual needs of the residents. It is the responsibility of the provider to make sure that this does happen. The registered manager does make sure that each resident is registered with a local doctor. We looked at medication procedures in the home. Medication is stored in a trolley and cupboards. We did find that drugs could be kept more securely and safely. Part of this issue was addressed immediately by the deputy manager. She told us the procedure would be reviewed to reduce risks. The AQAA told us that staff had received medication training. We looked at the medication people are receiving. There was evidence to show that on some occasions staff had not signed to say that prescribed medication had been given. This indicated that people did not receive their medication as they should. No reason was given documented to say why this had happened. A lot of the residents were prescribed topical creams but these had not been signed. The staff did tell us that they did apply the creams and some people apply their own topical creams. Care plans did not reflect this and prescriptions were not signed to say it had been done. Procedures are not being adhered to make sure people receive their medication as prescribed. We saw there was no guidance or direction for staff on when to give medication on when required basis. This means that people cannot be sure they will receive their medication when they need it and they cannot be sure they will not be given extra medication. Care Homes for Older People Page 16 of 39 Evidence: Hand written entries had been signed by two people. We found that the home did not have any evidence in place to show that they check the ability of people who self medicate. There was a brief risk assessment available for one resident who is self medicating. But this was not adhered to. It said that staff were to regularly check the persons medication. But there was no evidence available to say this had been done. There was nothing in the care plan to show how this was being managed to make sure the person was supported and monitored. Requirements will be made in the report. Through observation and from talking to the residents and staff there was evidence to show that privacy and dignity is up-held. People were called by their preferred name and staff were observed knocking on peoples bedroom doors before they entered. They also explained if they were going to do anything and why. We saw that people are well dressed in clothing appropriate for the season and appeared well kept. Some staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Care Homes for Older People Page 17 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide some of the residents with some opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents but due to lack of staff training food may not be prepared and served safely. Evidence: Some activities happen at the home but these are limited. We were told by the residents and staff that some activities are provided. There is a weekly session of movement to music and regular quiz/ bingo evening. We were also told that there are occasional out-side entertainers that visit the home to play music or have a sing a long but this is not done on a regular basis. Some people said that they liked being in their rooms listening to music, watching T.V or reading and they are happy doing this. We did see some residents enjoying each others company but we also observed that some people are left for long periods with little contact or activity. There is little Care Homes for Older People Page 18 of 39 Evidence: evidence available to show how people spend their time and what they do during the day. There is no record kept of whether people participated in any activity, if they enjoyed it or if they chose not to. Some people are able to make decisions about how they spend their time. This shows that some people are being supported to do what they like and enjoy helping them live a fulfilling life. We saw that the people who are less able and have difficulty communicating have limited opportunities. People told us and it was also reflected in the surveys we received from staff and residents that people would like to do more activities but they said that staff did not have the time. One survey said Some residents need to be more mobile. They need more activities Some people do go out with relatives. There are regular visits from the hairdresser. The homes AQAA told us that over the next 12 months they do plan to provide more activities and entertainment. They said they are going to organise more outings, either for sightseeing or to an event or place of interest and restart film shows and music club. We did not speak to any relatives during the visit but we were told by residents that their family and friends can visit whenever they want and they are made to feel welcome at all reasonable times and no restrictions are imposed. Residents are able to receive their visitors in the privacy of their own rooms or in the communal areas. The home do have regular residents meetings and the AQAA told us that they are considering a Friends of The Grange forum, to meet quarterly, to discuss all issues concerning residents wellbeing. The people spoken to felt they are able to have some choice in regards to their day to day life. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the limited choices they are offered. The home does need to evidence and demonstrate more how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their lifes. The home employs 2 cooks who work 3 days per week each, on the remaining days extra care staff or the provider do the cooking and also do tea. We did find that none of the staff including one of the cooks had no up to date food hygiene training. Some Care Homes for Older People Page 19 of 39 Evidence: staff had no training at all but were at times involved in preparing food. Sometimes the provider of the service cooked the meals. This is a serious shortfall as it leaves people at increased risk. (Staff Training will be looked at in more detail in the Staffing section of the report). At times during the visits to the home we saw that staff congregated in the kitchen area. We asked the registered manager about this. She told us that staff access the home via the kitchen door. This in itself increases the risk of infection. It also means that whoever is cooking is distracted from what they are doing. Staff are also delayed from getting to the residents. The manager told us this practise would be reviewed. The service told us that they have a 4 weekly menu and an alternative choice of meal is always on offer. Special diets are catered for. One person told us that they have a vegetarian diet. Residents said they enjoy their meals and there is always enough to eat and the food is good. A record is kept of food eaten by the residents. This will ensure that any dietary problems are quickly identified and the appropriate action taken. We observed the lunchtime meal being served and saw that it was relaxed and unhurried, with people taking their time to enjoy their food. The meal was well presented and looked appetising. Care Homes for Older People Page 20 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service who have complaints or concerns will be listened to and the concern/complaint acted on. They cannot be sure they will be protected from all forms of abuse. Evidence: The home has a complaints procedure, which meets the national minimum standards. It has not been updated to tell people about the CQCs new address. The complaints procedure is available within the home and the residents we spoke to and staff are aware of how to make a complaint. Not all residents will be able to independently make a complaint and there are no systems in place that will support and assist them if they have any concerns. The registered manager told us there have been no complaints made to the home since the last inspection. Residents did tell us if they had any concerns then they would tell the manager. They said that she would listen. There has been one safe guarding adult alert raised since the last inspection visit and following this visit to the home we raised another safe guarding alert. The local social services have responded to this. This means that a concern is being looked at by the local social services safe guarding adults team. The concerns have been investigated Care Homes for Older People Page 21 of 39 Evidence: and the alert is now closed. The management of the home is working pro-actively. The home is being supported by specialist services to ensure the improvements continue and people are getting the care and support they need. At the time of writing the report the safe guarding adult alert remains open. We also found that staff have not received training in safe guarding adults. This leaves people at risk as staff may not know what constitutes the different forms of abuse that can occur to elderly vulnerable people in a care situation. The home did have a copy of the Social Services Adult Protection procedures but it was a 2005 copy and out of date. We looked at a selection of staff files and found that one person had been working at the home for without a Criminal Records Bureau (CRB)police safety check. One person had a police safety check CRB but the POVA check was not included on it. The registered manager said she would address this immediately. This means that people were left at risk because of the homes recruitment procedures did not check staff suitability thoroughly. The home does have policy and procedures to protect the residents monies and valuables. Care Homes for Older People Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider continues to improve and maintain the home to make sure that that people live in a comfortable and homely environment. However some practises to maintain safety and prevent the spread of infection in the home need improving to fully protect people from the risk of harm. Evidence: We looked around different parts of the home. We looked at all the communal areas and some of the residents bedrooms. The Grange is set in pleasant surroundings with large, well-maintained gardens. Since the last inspection improvements have been made to the homes environment. They have built a new laundry room. This has provided improved working conditions and made the laundry process more efficient. They have renewed carpet in the main corridor and redecorated the small lounge. The residential accommodation in the home is set on the ground and first floors of the building. It adequately furnished to a good standard and well maintained. There is plenty of communal space to meet the needs of service users with separate dining area, two lounges and a conservatory on the ground floor. Residents bedrooms are comfortably furnished and are personalised to meet their individual needs. Residents we spoke to said that they like their rooms and they can Care Homes for Older People Page 23 of 39 Evidence: furnish their rooms however they choose. One lady said, I brought things with me from my old house. it almost feels lie home. Maintenance is done on a when required basis. The service does not have a planned maintenance and renewal programme with timescales for the ongoing up- keep and improvements within the home. The providers do a lot of the work themselves. The AQAA told that over the next twelve months they do plan to refurbish the toilets and a bathroom. They also sadi they are going to renew carpet in entrance hall, two stairways and a first floor corridor. They also plan to use the old laundry room for macerator and bed-pan washing facility. We did see that the home provides the necessary equipment and aids to meet the needs of the residents. People who are in shared rooms have divider curtains to make sure their privacy and dignity is maintained. They told they are happy to share the room and this was discussed with them before they came to live at the home. The home is clean and fresh and people told us it is always like this. They told us they are warm and comfortable. There are the facilities available in all the appropriate areas for hand washing and the home has the appropriate facilities for the disposal of clinical waste. The laundry room is well equipped and people told us the laundry service is good. Staff told us that soiled laundry is collected separately and is transported safely through the home. It is washed at the required temperatures. However we did find that soiled laundry is not transported in the recommended red bags which can be put straight into the washing machine also staff have not had the necessary training in infection control. This means that people might be at risk of cross infection. The registered manager told us that procedure will be reviewed. Care Homes for Older People Page 24 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff but they do not have the required skills and knowledge to care for the people who live at the home. Recruitment practises are not robust enough to fully protect the people living at The Grange. Evidence: The home have dedicated staff team. Some who have worked at the home for many years. The AQAA told us, this provides continuity for the residents who like to see familiar faces. Staff really get to know the residents. The staff know each other well and are therefore willing to help cover for holiday and sickness making the use of agency staff a rare occurrence. We looked at the staff duty rota and we spoke to residents and staff. We did receive some conflicting views on staffing levels. Some people told us that they sometimes have to wait quite a while when they press their call bell. Others said that staff get to them very quickly. Some people said that there are not enough staff available to do activities or often they are too busy to sit and have a chat. The registered manager told us there is sufficient staff on duty to look after people. She told us that staffing levels are kept under constant review and are altered depending on the level of Care Homes for Older People Page 25 of 39 Evidence: support and care needed by the residents. If people need to attend appointments then extra staff are brought in to accompany them. She said that she would review how staff are using their time. We did observe that people where alone in the lounge areas for considerable periods of time. The home also employs ancillary staff to undertake cooking, cleaning, laundry. The home has an NVQ programme for care staff and the service told us that they have not reached the target of having 50 of care staff with NVQ level 2. The manager said that they are encouraging and supporting staff to enrol for NVQ 2 and 3. At the time of the visit the staff working at the home had not received the necessary training to give them the skills and competencies to meet the needs of the people living at the home. A training matrix had been developed but no training had been planned. Most staff had received fire training and some staff had received training in first aid. This was due to be updated on 22nd October 2009. No-one had up to date training in food handling/hygiene and staff are preparing meals. Some residents needed support to mobilise and transfer but staff had not received training in moving and handling. There was no training in infection control. Staff had not had training in safe guarding vulnerable adults. Staff we spoke to were able to tell us the obvious forms abuse and the action they would take but they did not have the knowledge about the less obvious aspects. Mental Capacity Act (MCA) and Deprivation of Liberties training had not been accessed. There were some leaflets available to people giving some information about this legislation. Staff had received no specialist training. For example there are people at the home who have diabetes but there has been no training for staff in this. This means staff may not have the knowledge skills and competencies to look after individuals in the way that suits them best. We saw no evidence that new staff receive induction training that is linked to skills for care. This shortfall has left people at risk as they may not be receiving the care and intervention that they need. A requirement will be made in the report. It is the responsibility of the provider to make sure staff have the necessary training to look after people in the safest and best way to meet their individual needs. Care Homes for Older People Page 26 of 39 Evidence: Since our visit to the home we have been informed that all the necessary training has now been sourced and planned for. The registered manager told us the training matrix is now completed and from now on all training will be on going and kept up to date. We looked at six of the staff files, these included two of the most recently employed staff. We found that the staff files kept at the home do not contain the information needed to make sure all the necessary checks and information has been gathered so a decision can be made to whether the staff are suitable to work with vulnerable people. Staff are working in the home without being appropriately vetted. One member of staff had no references, no Criminal Record Bureau (CRB) check and the providers had not applied for a Protection of Vulnerable Adult Check (POVA). They had been working at the home for 3 years. The registered manager told us she thought checks done at college would be sufficient. We saw that one CRB did not contain a POVA check. Three members of staff did not have two references. We found that full employment history was not requested on the application form and gaps in employment had not been explored at interview. There were no up to date photographs of the staff on their files. Due to these shortfalls a requirements will be made. Care Homes for Older People Page 27 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are shortfalls in the management and quality assurance systems of the service. The required health and safety checks are undertaken. Evidence: Mrs. Karen Whiting has been the registered manager of The Grange for the past twenty years. She has completed an NVQ 2 and told us that she does plan to start NVQ3. At the time of the visit she told us that she is unsure about whether or not she wants to do the necessary qualifications to demonstrate that she has the knowledge, competencies and skills to manage the home effectively and in the best interests of people who live there. The expectation of the commission is for a registered manager of a home to continually develop their knowledge and keep up to date with training. The commission would expect the manager of the service to have achieved or be working towards a recognised management qualification. Care Homes for Older People Page 28 of 39 Evidence: The registered manager has not kept up to date with the changes that have been happening in social care and was unaware of some procedures and legislation. The providers of the service are at the home on a daily basis but there is no evidence that they are providing the supervision for the registered manager. The manager does have has an understanding of the key principles and focus of the service but we did identify shortfalls throughout the inspection process with regards the care and support for the residents. This means that some care needs have not been met. These shortfalls should have been identified and addressed by the manager. She is now aware of the shortfalls within the home and told us that these will be addressed. The manager said she will be working to improve the service and provide an improvement in the lifes of the people at The Grange. The providers of the service have told us they will be supporting her to do this. We feel confident that now the shortfalls have been identified the registered manager and the providers will be pro-active in addressing them. It is the providers responsibility to make sure the home is managed in the best interests of the people who live there and to make sure that all their needs are met. We received an AQAA when we asked for it but it did not give a picture of how the service was performing and what improvements had been made since the last inspection. Information was vague and non-specific. We saw no evidence that any quality assurance was taking place within the home. Surveys/ questionnaires have not been sent out residents, relatives or other people who have an interest in the service. The outcome from a quality assurance programme is to make sure that the people who live in the home and other stakeholders are able to voice their opinions on the service and influence a development plan for the home. As the home had not completed the programme, there is currently no development plan in place. Procedures are in place to strengthen safe practises. The home has informed us that all the relevant checks and inspection of equipment and systems have been done. An accident book is maintained. All fire assessments and checks are done at the required intervals. The manager told us water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and are within the stated ranges. The manager is aware of untoward incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely. A record is kept of any accidents or incidences. Care Homes for Older People Page 29 of 39 Evidence: There are shortfalls in areas of mandatory training. Staff also have not completed induction training to ensure that staff are assessed as having the knowledge and skills to do their job well. Care Homes for Older People Page 30 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The manager develops and 31/01/2010 agrees with all residents user/representative an individual support/care plan, which includes all the health, social and personal care required, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations. The plans need to be used as working tool. The plan needs to be implemented and updated to reflect the changing needs of the residents. Daily records need to contain relevant information about the day of the residents. So that every service user has their health and social care needs fully documented to enable the staff to meet Care Homes for Older People Page 32 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action these needs. Regulation 15 of the Care Homes Regulations 2001 requires you prepare a written plan as to how the residents needs in respect of their health and welfare are to be met. Failure to comply with this regulation is an offence. 2 8 12 All health care needs of the 30/11/2009 residents must be identified, documented, support action agreed and those needs must be monitored closely for improvement or deterioration. To ensure that proper provision is made to meet the health and welfare needs of the residents. Regulation 12 of the Care Homes Regulations 2001 requires you promote and make proper provision for the health and welfare of service users. Failure to comply with this regulation is an offence. 3 9 13 All medication administered 31/10/2009 needs to be signed for at the time it was given. Staff competencies need to be Care Homes for Older People Page 33 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action checked regularly. Assessments need to be in place for those who self administer medication All medication needs to be stored and recorded according to the Royal Pharmaceutical Guidelines There needs to be individual guidelines in place for residents prescribed when required medication. So residents can be certain that their administration records are a true account of what they have been administered, and so that service users are not exposed to risk from unaccounted for medication. Regulation 13 of the Care Homes Regulations 2001 requires you to make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Failure to comply with this regulation is an offence. 4 18 13 The Providers must make sure that clear, proactive steps have been taken to 30/11/2009 Care Homes for Older People Page 34 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action protect all people living at the home from all forms of abuse. So that people know that they are in safe hands at all times. Regulation 13 of the Care Homes Regulations 2001 requires you to make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Failure to comply with this regulation is an offence. 5 27 18 The staff must have the skills and competences to meet the assessed needs of the residents residing in the home. There needs to be planned programme of training in place that is ongoing by the timescale given. So that residents needs can been met and that their health and wellbeing be promoted, and that they are in safe hands, limiting risk from abuse. Regulation 18 of the Care Homes Regulations 2001 31/12/2009 Care Homes for Older People Page 35 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action requires you ensure that there are, at all times, suitably qualified, competent and experienced persons working in such numbers that are appropriate for the health and welfare of service users. Failure to comply with this regulation is an offence. 6 29 19 The providers must make 30/11/2009 sure that there are thorough and robust recruitment procedures and practises in place which are adhered to. So that unsuitable persons can be excluded from working with vulnerable people. Regulation 19 of the Care Homes Regulations 2001 requires you obtain the documentation specified in paragraphs 1 to 9 of Schedule 2. Failure to comply with this regulation is an offence. 7 30 12 All staff must receive the 30/11/2009 training they require to meet the assessed needs of the residents residing in the home. So that service user needs can be safely met and that Care Homes for Older People Page 36 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action their health and wellbeing be promoted, and that they are in safe hands, limiting risk from abuse. Regulation 12 of the Care Homes Regulations 2001 requires you conduct the home to promote and make proper provision for the health and welfare of service users. Failure to comply with this regulation is an offence. 8 31 9 The Providers must make 31/12/2009 sure that there are systems and plans in place that ensure that the home is carried on and managed in a manner that protects the health, welfare and safety of people living in the home. Regulation 9 of the Care Homes Regulations 2001 requires that the manager must be competent and possess the qualifications, skills and experience necessary for managing the care home. 9 33 24 The Providers need to make 31/12/2009 sure that there are effective quality assurance and quality monitoring systems in place. The views of residents or representatives, Care Homes for Older People Page 37 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action stakeholder need to be taken into consideration to improve and measure success in achieving the aims, objectives and statement of purpose of the home. To implement a Quality Assurance Program and provide a development plan for the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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