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Inspection on 07/07/05 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 7th July 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 provides a spacious, comfortable and homely environment, with a secure, well maintained and usable garden. Residents and visitors commented on the helpfulness and sensitivity of staff and said that "nothing is too much trouble". There is a high emphasis on maintaining residents` dignity. Meals are varied, nutritious and well presented and residents` dietary needs, likes and dislikes are taken into consideration. The home maintains good links and relationships with families and friends, who are encouraged to visit and made welcome.

What has improved since the last inspection?

Various new systems have been introduced to enable better monitoring of incident reporting, staff employment checks and staff training.

What the care home could do better:

Whilst pre-admission assessments are generally carried out, they should be completed for all residents together with confirmation to prospective residents and/or their families or care managers confirming that their needs can be met. Medication Administration Records must specifically identify where medication is not given according to the prescription (eg where a resident does not wish to take it) and the storage of medication has yet to be changed to meet the September timescale referred to in the previous inspection report. Some form of fixed screens should be provided in shared rooms and risk assessments must be prepared around the use of portable folding screens. There should be a programme of providing locks to bedroom doors and all locks must allowstaff access in the event of an emergency. There should also be a lock for the laundry room.

CARE HOMES FOR OLDER PEOPLE The Grange Residential Care Home 2 The Street Kennington Ashford Kent TN24 9EX Lead Inspector Sue Gaskell Unannounced 07 July 05 09:30 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 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 H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Grange Residential Care Home Address 2 The Street, Kennington, Ashford, Kent TN24 9EX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01634 270674 01634 270674 Mr Malcolm Brown Friend Mrs Karen Whiting Registered Care Home 29 Category(ies) of Older Persons over the age of 65 registration, with number of places The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29.03.05 Brief Description of the Service: The Grange is a large detached listed double property, with a converted barn extension. It is registered to provide accommodation, personal care and support for up to 29 older persons. There is a spacious enclosed garden with mature trees, plants and landscaped features, including a safely fenced fishfilled pond. A large raised terrace runs along the entire rear of the premises and another deck area off one of the lounges, overlooks the pond which has an attractive, free flowing water feature. 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. All have private washing facilities, and 7 rooms have en-suite facilities. Bedrooms are fitted with TV and telephone points as well as individual call alarms. The ground floor consists of a generous sized dining room, 2 separate spacious lounges (one of which also has a dining area), a large conservatory, kitchen and laundry. There is parking for several vehicles at the front/side of the home. The home is decorated and furnished to a very high standard throughout. The grounds and exterior facilities are also well maintained and offer total privacy within the urban setting. Mrs Karen Whiting is the Registered Manager and is responsible for the day-to-day running of the home. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over a period of 4 hours. The inspector looked around the building and inspected a number of the records. At the time of the inspection there were 25 residents in the home and staffing comprised the registered manager, 3 carers, 2 domestic assistants, a cook and kitchen assistant. The owners have a high level of input to the home and were also on the premises and assisted staff and residents during the inspection. The inspector spoke with 3 residents, 1 resident’s relatives, the registered owner and registered manager and 2 members of staff. What the service does well: What has improved since the last inspection? What they could do better: Whilst pre-admission assessments are generally carried out, they should be completed for all residents together with confirmation to prospective residents and/or their families or care managers confirming that their needs can be met. Medication Administration Records must specifically identify where medication is not given according to the prescription (eg where a resident does not wish to take it) and the storage of medication has yet to be changed to meet the September timescale referred to in the previous inspection report. Some form of fixed screens should be provided in shared rooms and risk assessments must be prepared around the use of portable folding screens. There should be a programme of providing locks to bedroom doors and all locks must allow The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 6 staff access in the event of an emergency. There should also be a lock for the laundry room. 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 H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 standard(s) 3,6 Whilst generally prospective residents’ needs are assessed there are occasions when this has not been carried out. Without such an assessment there is no assurance that care needs can be met. EVIDENCE: Whilst there is a format for recording pre-admission assessments, one had not been completed on a recently admitted resident. There is also no confirmation to prospective residents and/or their families or care managers confirming that their needs can be met. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10 The care planning system is sufficiently detailed to ensure that all residents’ needs will be met. Whilst medication policies and procedures are generally sound, and adhered to, there are still shortfalls in recording and storage. Personal support is offered in a manner which respects residents’ rights to choice, respect and dignity. EVIDENCE: There are care plans in place for all residents, with reference to residents’ health, personal and social care needs, risk assessments and clear guidelines on how to minimise any risk. Whilst medication was seen to be generally appropriately recorded, medication administration records must specifically identify where medication is not given according to the prescription (eg where a resident does not wish to take it) and the storage of medication has yet to be changed to meet the September timescale referred to in the previous inspection report.. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 standard(s) 12,15 Residents’ experiences of life in the home meets and satisfies their needs and expectations and they are helped to exercise choice and control over their lives and daily activities. Residents are assisted with maintaining contact with their previous way of life, and their families and friends are made welcome. Residents’ tastes, choices and dietary needs are well catered for, with a varied selection of food and drinks available during the day and evening. EVIDENCE: All of the residents spoken to, and two relatives who visits the home on a daily basis, confirmed that residents are frequently encouraged to say what they would like, in terms of personal care, activities, menus etc., and that any suggestions are acted upon. Residents and the visitors confirmed that visitors are always made welcome and offered hospitality. The meal served during the inspection was seen to be appetising and nutritious and residents confirmed that the food is generally of a high standard. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 standard(s) 16,18 The home’s complaints process is satisfactory and there is evidence to show that residents’, or others’ concerns are taken seriously and responded to appropriately. Staff have a good understanding of adult abuse issues and of the home’s procedures to protect residents from abuse. EVIDENCE: The home has a complaints form to record complaints, and records are made of day to day issues. Residents and relatives confirmed that they would feel comfortable in mentioning anything to the owners or manager and confident that any concerns would be resolved. The manager and other staff referred to procedures and ongoing training in adult protection and have showed a willingness to consult with local authority care managers and adult protection co-ordinators. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 standard(s) 19,26 The home is generally well decorated and maintained and residents live in comfortable surroundings. Residents in shared rooms lack a permanent form of privacy and do not have the means of controlling who has access to their rooms. EVIDENCE: Whilst there are some areas which are in need of maintenance and decoration, this was being carried out at the time of the inspection as part of an on-going programme. The only form of screening is shared rooms is by portable folding screens. No risk assessments have been carried out for these screens. One resident has been provided with a key to her room but this is not lock is over a type which could prevent access in the event of an emergency. Other bedrooms have not been provided with a lock and whilst the inspector was informed that residents are asked whether they would like a lock fitted, the provision of locks prior to asking would enable residents to make a true choice. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staffing levels are adequate and staff morale is high with a low turnover of staff. The procedures for the recruitment of staff are sound and offer protection for people living in the home. Staff are trained and competent. EVIDENCE: Staffing at the time of the inspection comprised a manager, 3 care staff and kitchen and domestic staff. Although recruitment, training and supervision records were inspected, the manager and staff confirmed that there is a good level of induction and further training and that all necessary checks on staff are undertaken prior to employment. All of the residents spoken to confirmed that day staff and night staff are kind, sensitive, helpful and cheerful. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 Whilst residents benefit from a well managed home, the registered manager currently lacks the qualification necessary to meet this standard. The record keeping and health and safety systems are generally sufficient to safeguard residents’ welfare, rights and best interests, but there are some health and safety issues requiring attention. EVIDENCE: The registered manager said that does not intend to become qualified at this stage although she has attended a number of shorter courses. The records showed that fire alarm systems are tested regularly and all maintenance certificates were up to date. However, there was no risk assessments around the use of portable folding screens, a lock on one bedroom door is of a type which might not be accessible in the event of an emergency and there was no lock on the laundry door. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x 3 x x 2 The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 16 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Carry out pre-admission assessments on all residents. There must also be evidence of confirmation to prospective residents and/or their families or care managers confirming that their needs can be met. Medication records must include a record of the reason why medication has not been administered. Storage should be reviewed according to the timescale on previous inspection report. Some form of fixed screening should be provided in shared rooms. Risk assessments must be prepared around the use of portable folding screens. Bedroom door locks fitted must be of a type which enables access in the event of an emergency The laundry door should be lockable when not in use.. Timescale for action 31.07.05 2. OP9 13 30.09.05 3. 4. OP24 OP38 16 13 30.09.05 30.09.05 The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 17 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. Refer to Standard OP24 Good Practice Recommendations Commence a programme of providing locks to bedroom doors. The Grange Residential Care Home H56-H05 S23557 The Grange V237536 070705 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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