Inspection on 02/03/07 for The Grange Residential Hotel

This inspection was carried out on 2nd March 2007.

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

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

Other inspections for this house

The Grange Residential Hotel 05/12/07

The Grange Residential Hotel 05/01/06

The Grange Residential Hotel 23/06/05

The Grange Residential Hotel 18/02/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Grange Residential Hotel Townsend Hill Ipplepen Newton Abbot Devon TQ12 5RT Lead Inspector Megan Walker Key Unannounced Inspection 13:00 2nd March 2007 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 Hotel DS0000061643.V321079.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 Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Residential Hotel Address Townsend Hill Ipplepen Newton Abbot Devon TQ12 5RT 01803 813656 01803 813656 suttonr@btconnect.com 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) Ogwell Grange Ltd Victoria Jane Kay Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (17) The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, not falling within any other category (OP) maximum 17 Physical disability over 65 years of age (PD (E)) maximum 17 Date of last inspection 5th January 2006 Brief Description of the Service: The Grange Residential Hotel is a privately owned care home registered for up to seventeen residents within the categories of Dementia - over 65 years of age (17), Old age, not falling within any other category (17), Physical disability over 65 years of age (17). It does not provide intermediate care and it is not registered to provide nursing care. The Grange Residential Hotel is a grade-two listed building situated in the small rural town of Ipplepen, a few miles from the market town of Newton Abbot, and the holiday area of Torbay, in the county of Devon. It is located about a kilometre from the town centre, near shops and the local medical practice. The home is a large detached property on two levels with a shaft lift and stair lift servicing the first floor level. It has a good number of parking spaces at the front with level access to the front door. There is a large lounge on the ground floor and this is complimented by a large dining room with a small conservatory leading to the secure, attractive garden at the rear of the home. There are five single bedrooms on the ground floor and three double and six single bedrooms on the first floor. The fees at The Grange Residential Hotel range from £363.00 to £450.00. Additional extras include hairdressing, chiropody, newspapers, special interest journals and magazines, and any sundry items, all at commercial rates. The Registered Provider gave this information to the Commission in January 2007. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork part of this inspection was unannounced and took place on Friday 2nd March 2007 between 13h00 and 18h45. Two inspectors undertook this visit that included talking to residents and staff, observation of interactions between staff and residents, and residents with residents, a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The Registered Manager, Ms Victoria Kay, was present at the time of this visit. Part of the time was spent talking with her about the dayto-day routines, as well as the management of the home. In addition other information used to inform this inspection: • The Pre-inspection Questionnaire completed by the Registered Manager. • The previous two inspection reports • All other information relating to The Grange Residential Hotel received by the Commission since the last inspection. Of approximately 40 Comments’ Cards and Surveys sent out, the Commission received back – • 2 Residents “Have Your Say About “The Grange Residential Home” Care Homes Surveys • 5 “Relatives/Visitors” Comment Cards • 10 Care Workers Surveys 1 telephone call from staff • 1 General Practitioner (G.P.) • 2 Health/Social Care Professional in contact with the home There are nine requirements and four “Good Practice” recommendation made as a consequence of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Health, safety and the welfare of the people who use this service need to be of utmost priority. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 6 For the safety and protection of everyone who uses this service, recruitment procedures need to be more robust. The storage of medicines within the home needs to be more robust to ensure that the prescribed medicines/ dressings/creams & lotions are in date and in use with the correct person. For 17 residents, some of who may have dementia, having only one member of staff on duty in the home between 20h15 until 08h00 is putting the residents and the staff member at too much risk. 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 summary of this inspection report can be made available in other formats on request. The Grange Residential Hotel DS0000061643.V321079.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 Hotel DS0000061643.V321079.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have the information they need to make an informed choice about where to live. EVIDENCE: One resident who returned a survey to the Commission confirmed that they/their family had received sufficient information about the home before moving in. Another family member explained that the circumstances of her relative moving into The Grange Residential Hotel had meant that it all happened quickly. There had however been an opportunity to “meet and speak to the owners prior to moving in”. On the day of this visit, in the main hallway there was a table with lots of information available for visitors and prospective residents should they wish to The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 9 read it. This included a copy of the home’s Statement of Purpose and Service User’s Guide. There were also copies of the last two inspection reports. Pre admission assessments and social services care plans were seen in a number of care plans examined during this visit. There was no evidence that prospective residents had been informed in writing that their assessed care needs could be met at the home. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are well planned for, however, may be compromised by low numbers of staff on duty for some shifts. EVIDENCE: A General Practitioner who returned a survey to the Commission wrote: “Excellent working relationship. Appropriate referrals and requests for home visits. Complex patients well catered for.” One resident who spoke to the inspectors praised the staff for the way in which they looked after residents. Throughout this visit, observation of staff found them to be attentive to the people in their care. They were caring, providing assistance when it was needed in a discreet, unobtrusive manner and with endless patience. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 11 The plans of care examined included up to date information about the needs of the people living in the home. These were accessible to staff at all times. A daily statement is also written about each person (in a separate file) that includes their well - being, activities for the day and if there has been any Drs visits or tasks (such as blood tests) carried out during the day. The manager said she updates the care plans based on written and verbal updates from the carers. In the Pre-Inspection Questionnaire completed by the Registered Manager, it lists five admissions to an “Accident & Emergency” Department. The Commission did not receive any other notification about any of these admissions. There was no evidence of falls’ risk assessments on the care plans we examined. One staff member who returned a survey to the Commission wrote: “There is a lot of pressure on certain days of the week with the care duties due to the workload with more vulnerable service users living at the home”. Staff raised concerns about the dependency levels of residents. They felt that these had increased with more residents having mental health care needs as well as dementia care needs. Other staff wrote similar comments and suggested that at least one extra care assistant in the mornings and overnight would be of benefit to the residents in their care. It was found during this visit that one resident has been provided with a “sleep suit” to wear at night, as recommended by the nurse specialist for continence support at Newton Abbot Hospital. The Registered Manager was advised at this time, that there must be a thorough assessment to show the need for the use of this garment; written consent from the resident or an independent advocate on the resident’s behalf; an assessment that shows the levels of risk to the resident’s ability to move about freely; and what measures were in place to ensure that the resident was not being restrained against their free will in any way. A tour of the premises found that residents had freestanding electrical heaters in their rooms. A care assistant suggested to one resident that the fan heater (that was on) was possibly the cause of them feeling drowsy and unwell. The resident was unhappy about the fan heater being turned off. The care assistant was reluctant to turn it off in spite of her concerns for this person’s health because the resident “liked it on”. Also, whilst the occupant of the room slept, an overhead wall heater in the bedroom’s en-suite was found turned on. Within reach of the heater a tap was running into a wash hand basin. This was overflowing because the plug had been put in. On entering the bedroom, it smelt acrid and of something electrical burning. In view of the risk to health and safety, an immediate The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 12 requirement letter was sent to the provider requiring the heater to be disconnected. Prescribed medicines are dispensed via the ‘blister pack’ system. A local pharmacist provides these to the home. The carer demonstrating the system said that the carers dispensing the medication sign the MARS (medication administration record sheet) once the resident has taken their medication. She also said that all care staff have completed a course on ‘Safe Handling of Medicines’. The medicines are carried around the home in a locked box and stored in a locked cupboard, adjacent to the kitchen, when not in use. The controlled drugs are stored in a locked drawer under the medicines cupboard. The keys to this drawer and cupboard were hung on a keyboard in the kitchen when not in use. This system is not in accordance with laid down legislation around the storage and management of controlled medicines. Next to the medicines cupboard was shelving that contained a number of pots of creams and dressings with no residents’ names on them or dates of opening. The carer was unsure why these were kept where they were. This practice is not robust as it allows for communal pots of cream or dressings to be applied to a resident without being prescribed. A carer was seen using general scissors (taken from a holder on the desk in the kitchen), that she did not clean, to open a dressing pack (taken from the shelving area) in order to dress a wound. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents find the home offers a genteel lifestyle that satisfies their expectations. EVIDENCE: During this visit a number of residents spent most of the day sitting in the lounge. The reception on the television in the lounge was poor, however the Registered Manager said it is not usually like that. The residents in the room at this time predominantly had dementia care needs so were unable to comment about the quality of the picture on the screen in front of them. Discussion with one resident found that they could choose to stay in their rooms or use any of the communal rooms in the house. Some residents preferred to visit each other in the privacy of their rooms where they felt they could talk without interruption. A resident spoke about the garden and how they could sit outside during good weather. Other residents were seen around the house participating in activities of their choice. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 14 One resident who spoke to the inspectors said that friends who lived locally came in to visit regularly. Relatives who returned comments cards to the commission inferred that they could visit when they chose – “There is always a pleasant and welcoming atmosphere at the Grange”. “ X is very happy and recognises The Grange as her home. The staff are always helpful, kind and cheerful.” Residents were complimentary about the food prepared for them at The Grange Residential Hotel. The daily menu was seen displayed prominently in the main hallway. Two cooks are employed to work at the home, one Monday to Fridays, and one at weekends. Conversation with the cook working at the time of this visit found that she was aware of the importance of nutrition and diets particularly for older people. During this visit one resident was walking around the home. Carers recognised that the resident needed to have a drink and encouraged them to do so several times. When the resident said no the carers did not persist but tried again later, this demonstrated a good awareness and understanding of peoples needs. At teatime two care assistants were seen preparing the food. Residents were offered a choice of a hot or cold meal. Most of the residents ate in the dining room although some chose to have their meals in their bedrooms. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents and their families can be confident that their complaints will be taken seriously and acted upon. EVIDENCE: During a tour of the premises it was noted that in the main hallway there was a box with notepaper and envelopes for “Compliments, Comments and Complaints.” There were also leaflets about an independent advocate scheme. Since the last inspection The Grange Residential Hotel has not received any complaints that it has reported to the Commission. The Commission has not received any complaints however as a consequence of this inspection residents, staff and relatives raised as matters of concern, issues about staffing. [SEE Staffing] The complaints procedure was displayed within the home. A member of staff confirmed that a “Safeguarding Vulnerable Adults” training session had been run in-house for staff during February 2007. It was confirmed that 12 staff from the home attended this training session. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 24, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained home with their personal possessions around them in their bedrooms. There were some potential fire hazards that could put everyone who uses the service at risk. EVIDENCE: A tour of the premises found that each bedroom was personalised and individual in style. Some residents had brought in pieces of their own furniture for use in their bedrooms. Most of the bedrooms had an en-suite. There was a discrepancy about one of the two toilets on the upstairs landing. Staff reported that it had been out of action for several weeks however the Registered Manager stated that this was a recent problem (the overhead The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 17 cistern was cracked). She also explained that consideration was being given to the possibility of expanding this part of the building to build an en-suite into a bedroom that currently has only a wash-hand basin. On this same landing there are a bathroom and a “wet room”. It was noted during this visit that neither facility had a wash hand basin nor did either of the two toilets mentioned above. Also in the bathroom the window had clear glass with a net curtain. This room overlooked the back garden and houses to the rear. Although not immediately overlooked, there was no evidence of any provision of a blind or curtain for personal privacy when the light was switched on. The stair lift was found to pose a potential trip hazard at the top of the stairs because the tracking protrudes across the doorway of Bedroom 5. One bedroom, on entering was very hot and stuffy. It was found that the resident had a small electric fan heater turned on 4 feet from the chair and 5 feet from the bed. The family had provided this heater at the request of the resident. Freestanding heaters introduce risk and, although this heater had been safety tested, every effort should be made to minimise risk. At the time of this visit there was only one toilet available for residents’ use when they are downstairs. The Registered Manager confirmed that this was an issue that had been reviewed. She explained that there was a future possibility of making some alterations to an existing en-suite and bedroom that would permit another communal toilet to be fitted on the ground floor. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care needs risk being compromised by low levels of staff on some shifts, and the need for a more robust recruitment policy that offers equal opportunities to all staff, and mandatory training. EVIDENCE: At the time of this visit there were two care assistants on duty as well as the Registered Manager, and the cook who finished at 14h15. Discussion with residents and staff about the rota found that there was a general feeling of staff being overstretched. A resident commented that in their opinion, “staff shortages meant that care is sporadic, especially at night.” The Commission also received anonymous surveys with written comments that there was racial discrimination in the treatment of staff. A resident verbally commented during this visit that, in their opinion, the staff from overseas were “exploited – they are asked to do and expected to do things that the English staff are not.” However, observation during this visit of both overseas’ staff as well as English staff found them all doing the same tasks to meet the care needs of residents. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 19 The Registered Manager wasn’t included anywhere on any of the rotas. Information received from the registered provider indicates that the manager’s normal working week amounts to 63 hours / on call 24hrs a day 7 days a week. The rotas confirmed the staff statements that there are only two care assistants on duty at any one time. Also the rotas show that on Saturdays there is a change of staff at 14h00 (still only two on each shift) and Sundays two care assistants work a 12.25 hr shift each. From the rotas provided to the Commission it was noted that no-one was shown exceeding the European Working Directive of forty-eight hours, including overtime, in any seven day period. Some staff lived adjacent to the home and the Registered Manager informed the inspectors that these staff are on call overnight. This was not shown on the rotas. Evidence was found during this inspection that some staff were employed to work at another care home, owned by the same company. Also cross-reference of the rotas for the two homes show some staff on both rotas for the same shifts thereby raising questions about staff cover. The staff contracts of employment inspected were found to be for the other home and the job description was generic, written in relation to the other home. The Registered Manager was advised at the time of this visit that each staff member employed for work at The Grange Residential Hotel must have a job description for the post in which s/he was employed, and a contract. The Registered Manager was also advised as a good practice recommendation, to write to the Home Office to inform the relevant department that staff requiring work permits to work in the United Kingdom, were in fact employed to work in two different care homes (only one work permit seen during this visit was applicable for The Grange Residential Hotel). A risk assessment/ handover sheet seen during this visits identified six residents as “very high risk” of wandering and falling. A staff member, when asked, confirmed that two or three residents were likely to wander during the nighttime. The night carer is expected to assist residents to the toilet every two hours. Inspection of the Accident Book found that between 19th December 2006 up to and including 26 February 2007, there had been recorded five falls between 21h30 and 06h30, when one waking carer (and one sleeping carer) were on duty, and one fall at 08h30, about the time of staff changing over for the day shift. In the Pre-Inspection Questionnaire completed by the Registered Manager, it lists five admissions to an “Accident & Emergency” Department. The Commission did not receive any other notification about any of these admissions. The Registered Manager was prompted by the inspectors to advise a care assistant to change a pair of disposable gloves that she had put on when starting her shift. Instead of changing her gloves after each task (including assisting residents to the toilet, treating a wound of a resident who had cut The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 20 themselves, and food preparation), the inspectors saw that she washed her hands still wearing the gloves and continued to the next task. There was no evidence that new staff received an accredited induction-training programme, although the home operates a three-day induction programme for new staff. There was no evidence that staff were appropriately supervised to ensure that they understood and were putting into practice any mandatory training they may have done, such as Infection Control, Basic Food Hygiene, or Health and Safety at Work. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of some people who use this service may be at risk by some poor safety working practices. EVIDENCE: On the day of this visit the Registered Manager was present and made herself available to assist the inspectors about the running of the home. The Registered Manager has a National Vocational Qualification (NVQ) Level 3 in Care and a NVQ Level 4 in Management. She explained that she works approximately four days per week, Tuesday to Friday, although this was variable. In addition to managing The Grange Residential Hotel, the Registered Manager is also listed as the Deputy Manager of the other care home mentioned above. As her hours were not recorded on the duty rotas The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 22 sent to the Commission, it was not possible to confirm exactly how many hours the Registered Manager would, on average, work at The Grange Residential Hotel each week. A resident said that from their observation and in their opinion, there was a tension between the staff and the Registered Manager. During this visit it was observed that the Registered Manager took responsibility for administrative tasks. Staff commented both verbally during this visit and in writing that this approach was, for them, problematic, because they felt “unsupported” & “Left to get on with the job”. There was also a request for regular staff supervision and “more direct communication from care manager to the care team members”. Quality assurance systems and management of residents’ monies was not discussed in detail during this inspection. However, in the foyer, there was information about the home and its facilities, and opportunity for visitors to make comments or suggestions by way of comment slips which could be completed and returned anonymously. A tour of the premises found that residents had freestanding electrical heaters in their rooms. Also, an overhead wall heater in an en-suite was a matter of concern for the inspectors during this visit. The Registered Provider has subsequently informed that Commission that a qualified electrician would check it, and reconnected if found to faultless. All portable electrical appliances seen around the home during this visit had certificates of annual testing. The Registered Manager confirmed that all other maintenance checks recorded in the Pre-Inspection Questionnaire were correct and had been completed when required. During the tour of the home an adjoining door between two rooms was found. The manager said that she believed that this was a fire door. The signage near to the two rooms did not indicate that this door was to be used as a fire exit. Outside one of these bedrooms the stair lift protrudes across the door. This poses a trip hazard to anyone leaving the room and, more so, in the event of evacuation of the room in an emergency. The last Fire Safety Officer’s inspection was in July 2003. The Registered Manager felt that it would be beneficial to request a visit to the home in the near future and the inspectors endorsed this as good practice. The Environmental Health Officer had completed an inspection at the home in February 2006. It was recommended then that the upright freezer and chest freezer should be replaced. During this visit the upright freezer was found to be in need of defrosting, and the chest freezer was very rusty along the bottom edges and the front panel. The Registered Manager agreed that these were both due for renewal. The Registered Manager was advised during this visit to contact the local Environmental Health Department about “Safer Food, Better Business” training for staff in order to implement a new kitchen routine The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 23 that would comply with the Food Standards Agency regulations and recommendations. Observation of poor practices by staff found that they did not have a comprehensive understanding of prevention of cross infection. Some practice issues have been identified in other parts of this report. With regard to laundry, a care staff member explained that soiled items were thrown away rather than sluiced and washed. Access to the laundry is either through the kitchen or out through the front door of the home and back in through a side entrance. There was a difference of opinion amongst staff about how they would move laundry to and from the laundry room. The Commission has not been notified of any incidents affecting the health, safety or well being of any of the residents in accordance with the Care Standards Act 2001 legislation. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 24 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 3 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X 3 2 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X 2 1 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement “13 Further requirements as to health and welfare (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. “ Timescale for action 01/07/07 2 OP10 12 (4a) The safekeeping and safe administration of medicines, creams and dressings must be reviewed to ensure residents are benefiting from robust and safe procedures at all times. “12 Health and welfare of 01/07/07 service users (4) The registered person shall make suitable arrangements to ensure that the care home is conducted – a) in a manner which respects the privacy and dignity of service users; 1) Care plans must show clearly the reasons for using sleep suits at night, assessments for use The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 26 of sleep suits, and written consent from the resident or an advocate on behalf of the resident if they are unable to give informed consent themselves. There must also be clear evidence on the care plan to show that use of such clothing is not restricting liberty of movement or compromising the individual’s dignity by limiting their freedom of choice. 2) Suitable screening or frosted glass must be provided for bathroom windows to ensure that people using those rooms are able to do so in a private and dignified manner. 3) Confidential information about residents must be kept secure and recorded on their individual care records. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 27 3 OP19 13 (4a,c) “13 Further requirements as to health and welfare (4) The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated” All freestanding heaters used within the care home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. 01/05/07 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 28 4 OP19 13 (4a,c) “13 Further requirements as to health and welfare The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated” Further to the Immediate Requirement issued at the time of this visit, and the written response from the Registered Provider to the Commission, regarding the overhead wall heater in an en-suite bathroom – • If this heater is to be reinstated, a copy of any report and safety certificate issued by a qualified electrician regarding this heater must be sent to the Commission. • This overhead wall heater situated must be assessed for the risk it presents to anyone using that room and action taken to minimise any identified risk. 01/05/07 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 29 5 OP19 23(4) “23 Fitness of premises 01/06/07 (4) Subject to paragraph (4A) the registered person shall after consultation with the fire and rescue authority – (a) take adequate precautions against the risk of fire, including the provision of suitable fire equipment; (b) provide adequate means of escape; (c) make adequate arrangements – (iii) for the evacuation, in the event of a fire, of all persons in the care home and safe placement of service users;” All rooms must be assessed as part of the home’s fire risk assessment. Action must be taken to minimise any risks identified during the assessment of rooms for fire hazards. A fire risk assessment must be available for the staircase with the stair lift. Suitable preventative measures must be in place to address the trip hazard caused by the track of the stair lift. The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 30 6 OP27 18 (1a) “18 Staffing (1) the registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; The Registered Provider must assess the current practice of having only one care worker on duty in the care home after 21h00 until 08h00 for any risk it presents to residents, and take action to minimise any identified risk. The Registered Provider must assess the current staffing ratios for any risks it presents to residents, and take any action to minimise any identified risk for people using the service and for staff. The Registered Provider must assess the current staff deployment in the care home. Any identification of care staff undertaking too many different tasks during any one work period, and thereby compromising the care and safety of the people using the service, action must be taken to ensure this is minimised. 01/05/07 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 31 7 OP29 Sch. 2 “Schedule 2 INFORMATION AND DOCUMENTS IN RESPECT OF PERSONS CARRYING ON, MANAGING OR WORKING IN A CARE HOME. The Registered Provider must operate a thorough and robust recruitment procedure based on equal opportunities and ensuring the protection of people who use the service. Evidence of this will be via a clear audit trail of information kept on individual staff files. 37 Notification of death, illness and other events The Registered Person must inform the Commission of any incident that affects the health, safety and welfare of the residents. 01/06/07 8 OP38 37 01/05/07 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 32 9 OP38 13(3) 16(2j) 23(1a2j) “The Registered Person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home;” Arrangements must be made to ensure that anyone using the upstairs’ toilets, bathroom or ‘wet’ room has easy access to a wash hand basin. Care staff training must be kept up to date in infection control, health and safety, and those care staff involved in food preparation, must receive training in basic food hygiene practices. There must be a clear policy on sluicing soiled garments or linen. The Registered Manager must ensure that by appropriate supervision of staff this policy is being put into practice. There must be a clear policy for all staff that laundry is not carried through the kitchen. The Registered Manager must ensure that by appropriate supervision of staff, this policy is being put into practice. 01/07/07 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 33 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 OP27 Good Practice Recommendations The Registered Person should consider the employment of a kitchen assistant: a) This should ensure that staff are not jeopardising the care needs of residents because they have to do too many different tasks during their shift. b) This should ensure that standards relating to food, and food hygiene are fully met. The Registered Provider should consult with residents, relatives, and staff to ascertain why they felt that there were insufficient care staff, and whether care staff do have sufficient time to spend with residents to meet their needs in an manner that is unhurried and does not put residents and/or staff at risk of injury or harm. The Registered Provider should consider the installation of a sluice or purchase of a washing machine with a sluicing cycle. The Registered Provider should consider seeking advice and guidance from the Health Protection Agency on good practice for infection control methods. 2 OP27 3 4 OP38 OP38 The Grange Residential Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Hotel DS0000061643.V321079.R01.S.doc Version 5.2 Page 35 - 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. 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