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Inspection on 05/10/06 for The Grange Residential Care Home

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

This inspection was carried out on 5th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 home prepares clear and comprehensive care plans, which assists staff in providing consistent and appropriate care. Residents and their families are encouraged to feel "at home". The food is varied, nutritious and well presented. The home provides a safe, clean environment.

What has improved since the last inspection?

Medication storage facilities. Further improvements have been carried out to the premises, eg screens provided in shared rooms and locks on the laundry door and bedroom doors.

What the care home could do better:

Fit new locks to all bedroom doors. Ensure all bedrooms are decorated to the same standard. Encourage more staff to undertake NVQ training.

CARE HOMES FOR OLDER PEOPLE The Grange Residential Care Home 2 The Street Kennington Ashford Kent TN24 9EX Lead Inspector Mrs Sue Gaskell Unannounced Inspection 5th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Residential Care Home Address 2 The Street Kennington Ashford Kent TN24 9EX 01233 621824 01233 663028 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 Malcolm Brown Friend Mrs Diane Kathleen Friend Mrs Karen Ann Whiting Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 27th November 2005 Brief Description of the Service: 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. The fees are currently in the range of £303 to £361 per week. Mrs Karen Whiting is the Registered Manager and is responsible for the day-today running of the home. Accommodation is arranged on the ground and first floors: the third floor provides office and storage space as well as the owners’ private residence. 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 Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 5th October 2006 between 10.00am and 4.30pm, with a short follow up visit on 17th October. There were 28 people living at the home. The inspector spoke to 5 residents, 1 resident’s visitor, the registered owners and 3 members of staff. The residents are generally independent and able to make their views known. Their comments included “I was told when I moved here that this is your home and we want to make it as nice as possible”. The inspection process consisted of information collected before and during the visit to the home, and residents’ feedback after the site visit finished. Other information seen included incident report forms, assessment and care plans, medication records, duty rota and staff employment and induction paperwork. What the service does well: What has improved since the last inspection? What they could do better: Fit new locks to all bedroom doors. Ensure all bedrooms are decorated to the same standard. Encourage more staff to undertake NVQ training. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 6 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 Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents know what services can be offered and can be confident that their needs can be met. EVIDENCE: At the time of the inspection the manager was out with another senior staff member, carrying out a pre-admission assessment. The files of residents admitted since the last inspection included clear and comprehensive preadmission assessments carried out by the home with supporting information from care managers. All residents are issued with terms and conditions of residence. Residents said that either they, or a relative, had either visited the home and then made a decision, or that the home had been recommended by relatives or friends. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 9 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): 7,8,9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for dealing with their medication. Residents are able to make choices and are treated with respect. EVIDENCE: All files were seen to include assessments and risk assessments on various aspects of daily living including mobility, nutrition, and emotional needs. They also include as much of the resident’s life history as possible, together with details about their family and interests, prepared with the resident’s or family’s assistance. The files were clearly set out and easily accessible to staff. Residents, where possible, have signed to acknowledge that a care plan has been prepared according to their wishes. There were clear guidelines on how best to assist residents and these were seen to have been reviewed regularly or as and when residents’ needs have changed. All of the residents and visitors The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 10 who spoke with the Inspector praised the staff and said that assistance with personal care is provided in a sensitive manner. Medication administration records were seen to be clear and current, and there are sound systems in place for the receipt and disposal of medication. The home has a current copy of the medication guidelines and 3 members of staff confirmed that they have undergone recent and regular training. The storage of medication has now been re-located to a more appropriate area and the home has also sought advice from the pharmacist on any other facilities that may be needed. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 11 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): 12,13,14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Daily life meets the residents’ lifestyle preferences and expectations. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. EVIDENCE: Residents said that they are frequently asked whether they need anything and that they are encouraged to make choices wherever possible. One resident’s relative who was interviewed said that she visits on a very regular basis and also confirmed this. Staff were seen to knock at the bedroom door and wait for permission before entering. Residents said that they enjoy a range of activities such as quiz mornings, arts and crafts, visiting entertainers and occasional outings to places of interest. 2 volunteers were holding their regular weekly quiz and then a “PAT” dog owner, together with the dog, also visited during the inspection and the residents clearly enjoyed both of these events. The staff generally note down who has joined in each activity. The resident’s relative said that visitors always made welcome and offered refreshments or lunch. The food served on the day of the inspection appeared appetising and nutritious. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 12 The dining room is cosy and the tables were laid in an attractive manner. Staff made sure that residents were seated comfortably. There was a wide range of fresh fruit and vegetables in the food store, together with good quality food products. Residents and their visitors said that the food is always good and that tastes and choices and well catered for, with a varied selection of food and drinks available during the day and evening. One resident said that she often asks for something other than that on the menu and this is never a problem. There was also reference in one resident’s file to her particular dietary needs and the importance of ensuring that she is not given food or drink which would have a bad effect on her medication. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 13 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): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can be confident complaints will be listened to and dealt with appropriately and they will be protected from abuse. EVIDENCE: A service user guide is issued to each resident and includes the home’s complaints procedure. Five residents and one resident’s regular visitor said that they would feel comfortable in mentioning any complaints to the managers or staff, but several said that they “couldn’t think of anything to complain about”. Two members of staff said that there had been training in adult protection and that they were aware of the home’s adult abuse procedures. The homes policies and procedures manual and staff handbook include sections on confidentiality and “whistle blowing”. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 14 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): 19, 24 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean environment. The bedrooms, communal areas and garden provide an attractive environment. EVIDENCE: All parts of the building were seen to be clean and there were no obvious health and safety issues or hazards to residents. The home is generally very well maintained and decorated but there were several areas requiring attention in the near future, in particular a second floor bedroom and the small sitting room. The inspector acknowledges that the owners have said that they would like to renovate these rooms but it has been difficult as the residents using the rooms would find it difficult to adjust to living in other rooms. However the rooms will be in need of attention and a solution should be found as son as possible, Other bedrooms are decorated and furnished to a very good standard with colour co-ordinated bedding, curtains etc. Since the last inspection shared The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 15 rooms have been provided with curtain style screening to provide some privacy. Also the home has fitted a lock on the door to the laundry and commenced a programme of fitting locks on residents’ bedroom doors. The home has a safe and secure garden, and the residents said how much they enjoy using it in the summer. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 16 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): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers are appropriate to meet the daily needs of the residents. Residents are protected and supported by the home’s recruitment and induction training procedures. EVIDENCE: The staffing levels at the time of the inspection appeared adequate to meet residents’ needs and the low turnover of staff has had a beneficial effect on staff competency and consistency. Two established member of staff said that they has received on-going training and the newest member of staff said that she had received induction training. The staff files included application forms, references, CRB checks, and evidence of identity. Although there is less than 50 of staff with NVQ training there was evidence to show that the staff group as a whole have received sufficient training in the past.. The inspector watched staff whilst they were working and there was nothing to suggest that they were not competent or that there was any cause for concern. Whilst staff referred to the high level of support from the registered person, and the excellent working atmosphere, there has been a lack of formal recorded supervision. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 17 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): 31,33,35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The current management arrangements ensure that the home is being run in a way that benefits residents and staff. The record keeping, and health and safety systems are generally sufficient to safeguard residents’ welfare, rights and best interests. EVIDENCE: Although the registered manager has said that does not intend to become qualified at this stage, she has previously showed a good level of competency. The written procedures showed that the manager, together with the registered owners, have been continuously improving many of the management systems. All records, policies and procedures were seen to be in place, up to date, and easy to understand. The registered person said that quality The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 18 assurance questionnaires have previously been issued to residents and or their families and that this is due to be done again shortly. Staff referred to regular handover periods and said that the registered manager and registered owners are always available to discuss any issues either on a daily basis or through informal supervision. All outstanding requirements and recommendations have been carried out by the registered owners since the last inspection. The records showed that fire alarm systems are tested regularly and all maintenance certificates were up to date. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X 3 X 4 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 X X 4 The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 20 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard OP24 OP30 OP31 Good Practice Recommendations Complete programme of redecorating rooms and fitting safe and appropriate locks on bedroom doors. Encourage staff to complete NV2 training. Encourage the manager to complete training. The Grange Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Residential Care Home DS0000023557.V300670.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!