Inspection on 05/12/07 for The Grange Residential Hotel

This inspection was carried out on 5th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Grange Residential Hotel 02/03/07

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 Graham Thomas Unannounced Inspection 5th December 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Residential Hotel DS0000061643.V351201.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.V351201.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.V351201.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 1st March 2007 Brief Description of the Service: The Grange Residential Hotel is a large, detached, grade two listed property on the edge of the Devon village of Ipplepen. Newton Abbot, a market town, and the holiday area of Torbay are a few miles away. The home is located about 150 yards from the village centre near the shops and Doctors surgery. Accommodation is arranged on two levels with a shaft lift and stair lift servicing the first floor. There are ample parking spaces at the front with level access to the front door. A large lounge on the ground floor is complemented by a large dining room with a small conservatory leading to the secure, attractive garden at the rear of the home. In all there are fifteen bedrooms, five of which are on the ground floor. Three bedrooms are suited to shared / double accommodation if required. Some rooms have assisted en-suite bathing facilities. The Grange Residential Hotel caters for men and woman over the age of retirement who may have a degree of physical disability and memory problems. The home came into the possession of its present owner in August 2004 who, with his Registered Manager and team of workers have made many positive changes to the building and the culture of the home. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before our visit to the home, the Registered Manager completed and returned an Annual Quality Assurance Assessment (AQAA) to the Commission. We sent surveys to people living in the home, relatives, staff, Care Managers and health professionals. Four were returned by people living at The Grange, four by relatives or advocates, seven by staff, three by health professionals and one by a care manager. We visited the home and spent one and a half days there. During our visit we toured the premises and spoke with four people living in the home. We also interviewed two care assistants and spoke with cleaning and cooking staff. Records were examined including a sample of care plans and staff files as well as other documents concerning the running of the home Time was spent with the registered Manager discussing and clarifying issues which arose during our visit. What the service does well: What has improved since the last inspection? • There are better review of individual care plans and better recording of falls so that peoples’ changing needs can be monitored DS0000061643.V351201.R01.S.doc Version 5.2 Page 6 The Grange Residential Hotel The programme of activities has been further improved in response to feedback from people living in the home. • More information has been made available to staff in how to protect vulnerable people from abuse • The home has been working with the Fire Authority to improve the fire safety arrangements • Staffing has been increased and there is better more training available. • What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grange Residential Hotel DS0000061643.V351201.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.V351201.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): Standards 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into The Grange have enough information to make an informed choice EVIDENCE: In the Annual Quality Assurance Assessment completed by the Registered Manager, she stated: “We have offered opportunities for prospective clients to spend the morning or afternoon with us as a ‘taster’ visit”, and “We have promoted and encouraged our residents to exercise their rights and choices by providing relevant information and opportunities” This process was confirmed by one person who had recently moved into the home who wrote: The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 9 “I came in for day care for 8 weeks before moving in. I enjoyed it very much. When a place was available I found it easy to settle in. I made lots of friends” In the home’s foyer there was ample information about the home including a “Statement of Purpose”, “Service User’s Guide” and copies of previous inspection reports. Individual files contained assessments made by the Manager before people had moved in to ensure the home could meet their needs. Where individuals had moved in at short notice, an assessment and care plan had been promptly produced. The Care Manager who responded to our questionnaire stated that assessment arrangements always ensured that the right information was gathered to provide the service required by individuals. This was confirmed by the content of individual files in which information had been gathered from referring authorities prior to the person moving in. The home does not routinely provide accommodation and support for people who need only intermediate care. The Grange Residential Hotel DS0000061643.V351201.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): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the Grange receive a generally respectful and attentive standard of personal and health care. However, practices concerning the administration of medicines are not sufficiently safe. EVIDENCE: Various observations and comments were received in questionnaires concerning the care and support provided by the home. Of the four people living in the home who responded, two felt they always received the care and support they required and one felt this was usually the case. All the relatives and friends who responded felt this was always the case. Comments included, “They are both co-operative and sensitive to (father’s) needs. They accommodate his needs well”, and The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 11 “My mother is very satisfied and my family are full of praise for the care she gets” A care manager felt that health care needs were always properly monitored and catered for. The three health professionals believed this was always or usually the case, one adding, “Certainly as far as continence issues are concerned” People with whom we spoke during the visit felt that they were generally well cared for. Each person supported by the home had an individual plan of care. Information about each person was held in three separate files. One contained basic details, a second contained daily and weekly records and a third contained monthly care plan reviews. The possibility was discussed with the Registered Manager of rationalising this system to provide a single, divided file for each person for clarity and ease of reference. Files were held in a passageway between the foyer and kitchen and were not securely stored. Other information such as daily and weekly notes were also stored insecurely in the kitchen. Information such as weight charts for several people were held in a single file. An Information log for staff contained a number of personal references to individuals rather than referring the reader to the individual plan. This means that the confidentiality of personal information could be compromised. The information contained in individual files was sufficiently detailed to indicate the care each person required. Each plan included information on the person’s personal and healthcare needs, a personal biography and risk assessments. Since the last inspection visit a ‘falls log’ has been introduced. Some information in the plans was disorganised and therefore difficult to follow. For example, one file contained two risk assessments concerning selfmedication in different parts of the file. These showed that the risk assessment had been changed but the organisation of the file meant that there was potential for confusion as to which was the current assessment. The dietary information concerning this person was apparently contradictory. A physical health assessment stated that the person had difficulty in swallowing and required a soft diet. A dietary preferences list indicated that there were no special dietary needs. Discussion with the home’s cook, however, showed that she was aware of the person’s particular needs. A very thorough system was in place to review the individual plans including daily reports, weekly updates and regular reviews with the Registered Provider. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 12 Healthcare needs were identified in individual plans and there was evidence to show health issues had been identified and referred to appropriate health professionals. One healthcare professional commented that the home was… “…Always very quick to respond to any requests I make to the home or suggestions to change things” Other comments from Healthcare professionals included, “Cares on an individual basis and liaises with other agencies”, and “Generally cares well for the mental / physical wellbeing of the clients – especially considering many of these clients are confused” The system for administering medicines in the home was inspected. Risk assessments were seen in files concerning individuals’ ability to administer their own medication. As previously stated, in one instance the organisation of the file gave rise to the potential for confusion over this issue. Medicines were found insecurely stored in one person’s room. This person had been assessed as unable to administer his own medicine due to confusion. Following discussion with the Registered Manager these medicines were removed. Other medicines were stored in locked cupboards near the care plans. Syringes of insulin for one person which had been prepared by the District Nurse were insecurely stored in the kitchen refrigerator. Eye drops were also stored in this refrigerator. Records of the refrigerator temperatures for the previous month indicated a range between 9.1oC and 16.3oC, well above the recommended storage temperatures for medicines requiring cool storage. These matters were the subject of immediate requirements made during the visit. Following the visit the Registered Provider confirmed that a secure refrigerator had been on order prior to our visit but that another had been obtained and put into use to meet the requirement made. After our visit it was also found that the recording thermometer was faulty. However, it remains a matter of concern that the viability of any medicines requiring cool storage was potentially compromised for a prolonged period while the issue of the fridge temperature remained unaddressed. Most tablets were provided in a “monitored dosage system”. This means that tablets are placed in blister packs arranged into individual doses by the supplying pharmacist. Other medicines had been supplied in individual boxes or bottles. The latter medicines were all stored in a portable container. One pack of tablets was found loose in the container and returned to its original box by a carer when this was pointed out. Another loose pack of tablets was found for which there was no original box. The blister packaging on one of these tablets was broken though the tablet remained in the pack. It was not possible to identify to whom these belonged. Two people had been prescribed the same tablets. These had both been packed into one of the original boxes and the names of both people hand written over the original prescription label which The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 13 had been partially removed. As the quantity of the tablets received was not recorded on the medicines administration record, it was not possible to establish the number remaining for each person. One person’s prescribed ear drops which had expired in August 2007 were found in the cupboard. This medicine should have been returned to the pharmacy for disposal. Four gaps were noted on the medicines administration record where eye drops had not been signed for. It was therefore unclear as to whether the drops had been administered or not. Records showed which members of staff were able to administer medicines. There was also useful information for staff about the purpose of the medicines being administered. Our observations during the inspection showed that people’s dignity and privacy were respected by staff. Staff were seen knocking on doors before entering and closing doors when personal care was being given. It was noted that none of the shared facilities including toilets and a walk in shower had locks on the doors. A previous requirement for frosted glass on bathroom windows was discussed with the Registered Manager. She stated that this was being addressed as part of the refurbishment work relating to the requirements of the Fire Authority. People were addressed respectfully and kindly by staff. Our discussion with people living in the home confirmed that this was usually the case. One relative commented that he had… “…never seen any discrimination – never any ageism or poor behaviour when dealing with mental Health issues” The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the Grange are well supported to maintain their social interests and contacts. There is a commendably varied and interesting range of activities on offer. EVIDENCE: During our visit, people living in the home spent time in their rooms or sat together in the lounge according to their wishes. Staff spent time talking with people and encouraging them to engage in activities. One person stated in a questionnaire returned to us that, “The home is very lively and we have lots of activities to suit everyone” A very full activities programme was advertised including visiting entertainers. At the time of our visit, people were looking forward to the programme organised for the Christmas period and the visit of staff from a local bird sanctuary who were to bring birds of prey to the home. This programme also included Holy Communion, a buffet party with a visiting church choir, belly dancing and a harpist. In discussion, people living in the home confirmed that they were able to opt out of these activities if they wished. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 15 Three visiting relatives were seen while we were at the home. They received a warm and friendly welcome from staff and confirmed in discussion that this was usually the case. Visiting arrangements were displayed in the home’s foyer and indicated that a meal could be taken in the home for a modest charge. Relatives made many positive comments about the way they were helped to stay in touch with people living in the home. Comments included: “There has been no case where..(my relative).. has desired to keep in touch (memory loss) but they are sensitive to his situation” “We are kept informed of all health and social issues – without having to ask” “Whenever I phone or visit, Vicky or on of the others always brief me on any issue in progress” Private telephone lines are available in each room. There is also a private telephone booth in the home. The home assists people to join activities in the local community by providing transport. On the first day of our visit, the cook was preparing a lunch time meal. This comprised of roast lamb and fresh vegetables, which were being prepared. A cauliflower cheese was being prepared for one vegetarian and puddings were adapted to suit the needs of two people with diabetes and one person who was on a weight reducing diet. A list of individual preferences was available in the kitchen and the cook confirmed that alternatives were on offer if requested. For example, on the previous day, two people had taken salmon instead of the pork chops on offer. Staff confirmed that people took breakfast in their rooms. Toast porridge and cereals were available according to individual preference. One person living in the home commented, “Excellent meals. I am diabetic and my needs are catered for. A lot of variety and special treats sometimes” We observed a meal being taken in the home’s dining room. People ate the meal with relish and made positive comments. Discreet assistance was offered by staff where required. Some people took the meal in their own room by individual preference or due to illness. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Grange can feel confident that staff will listen to and act upon their concerns. There are sufficiently robust systems in place to safeguard people from abuse EVIDENCE: The home has a complaints procedure which was clearly displayed in the foyer along with information about independent advocacy. No complaints about the home had been received by the Commission since the last key inspection. People who returned questionnaires were confident that staff would listen to their concerns. The comments included, for example, “The manager is always available if you have a problem. We all have problems at times and it’s lovely to have someone to go to”, and “The manager has always informed me to let her know if I have a problem and know it is in confidence” Relatives were equally confident and all stated that concerns were always addressed. They remarked, “At every visit one of the staff has addressed questions or concerns”, and The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 17 “Even when my mother’s complaints were unwarranted (she was sick without realising it) the home informed us” The staff files we examined showed that staff had received training in safeguarding vulnerable adults from abuse earlier in the year. Those staff with whom we spoke were clear about the action they would take if they suspected or witnessed abuse. Small amounts of money are held for people living in the home. This is securely stored and records maintained of all transactions. The home’s staff do not otherwise involve themselves in individual finances. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the Grange benefit from a homely and comfortable environment in which safety measures have been improved. EVIDENCE: The home is located about 150 yards from the village centre near the shops and Doctors’ surgery. Accommodation is arranged on two levels with a shaft lift and stair lift servicing the first floor. There is ample parking space at the front with level access to the front door. A large lounge on the ground floor is complemented by a large dining room with a small conservatory leading to the secure, attractively laid out garden at the rear of the home. In all there are fifteen bedrooms, five of which are on the ground floor. Three bedrooms are suited to shared / double accommodation if required. The individual care plans of those sharing rooms contained agreements to this arrangement. A kitchen and laundry are also sited on the ground floor. To the The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 19 rear of the kitchen there is a former bedroom which the Registered Manager stated was to be converted to office accommodation. Shared toilet facilities are located close to the lounge area and on the first floor. There is also a walk in shower on the first floor. At the time of our visit the first floor toilet facility was out of order and awaiting repair. It was noted during our visit that staff assisting people to access the shared toilet on the ground floor were experiencing considerable difficulty due to the confined space. The Registered Manager stated that plans were being considered to resolve this difficulty by modifying this room and part of a neighbouring bedroom. An adjoining bungalow called “North Grange” is connected by a passageway to the main building. This provides office accommodation for the Registered Manager and live-in accommodation for some staff. Staff refer to this as “the bungalow” The Grange is furnished in a comfortable and homely style. People living in the home confirmed that they were able to bring items of furniture to the home if they wished. Since the last key inspection a number of improvements to the home’s environment have been made. These were identified in the Annual Quality Assurance Assessment returned by the Registered Manager and confirmed by our own observations. Examples include: • New en suite facilities in some rooms and assisted baths where these are provided en-suite • Extra signage to comply with fire regulations • Replacement of furniture in the conservatory and some individual rooms • Improved lighting in the lounge and dining areas In response to the requirements made at the last key inspection, the Registered person has produced a safety certificate and risk assessment for an electric wall heater. Risk assessments have also been produced for freestanding electric heaters. The registered Manager stated that the Fire Authority have been consulted in respect of fire risks in the home. Some safety and maintenance issues were drawn to the attention of the Registered Manager during our visit. Concrete had eroded away from a metal bar protruding from the conservatory threshold. This presented a trip hazard. A window restrictor in one room overlooking the glass-roofed conservatory was not attached. The fire door to one bedroom was catching on the recently fitted carpet, impeding its automatic closure. These issues were reported to maintenance personnel during the visit for urgent attention. A trip hazard continues to be presented by the protruding end of the stair lift track at the top of the stairs. The Registered Manager stated that consultations were taking The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 20 place with the Fire Authority concerning proposed changes to this part of the building in order to eliminate this hazard. On inspection, all areas of the home were clean and free from offensive odours. Antibacterial hand gel was provided in the foyer for visitors. Liquid soap, hand gel and paper towel were provided in shared toilet facilities. Staff were seen wearing disposable gloves and aprons for cleaning and personal care tasks. The walls and flooring in the home’s laundry were cleanable. These measures help to control the potential spread of infections. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at The Grange are supported by experienced, and caring staff. Practices concerning the recruitment of new staff are not sufficiently robust to ensure the safety of people living there. EVIDENCE: There is a stable core staff group in the home who are very well regarded by people living at The Grange and their relatives. Some of these staff have worked in the home for many years. Numerous positive comments were received in the questionnaires returned to us, such as (from residents), “The staff are marvellous. Nothing is too much trouble. They always have time to listen to me no matter how small my problem is” and, “They are always there when I need them and very supportive” (from relatives) “The team there are all very caring and very attentive to the people there” Professionals also mentioned that staff were friendly and caring. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 22 In the last twelve months additional staff have been employed to cover more demanding periods of the day. A full time maintenance and groundsman has also been employed as well as extra domiciliary staff at the weekends. Six of the seven staff who responded to our questionnaire felt that there were always or usually enough staff. On the first day of our visit, the manager was taking the last day of a period of annual leave. There were two carers, one general assistant, a cleaner and a cook on duty providing support to 15 people. Staff said that they were “stretched” during this period. However on the second day it was clear that staff had enough time to spend time with people talking and engaging in more structured activity. Staffing at night consists of one person remaining awake in the home and a staff member who is on-call after 8:00pm and sleeping in “North Grange”. At the last Key Inspection, the Registered Provider was asked to review this arrangement. The Registered Manager stated that there were plans to employ an additional care assistant to work until 10:00pm Three staff files were examined. These included ancillary staff and care assistants, some of whom were foreign nationals working in the United Kingdom with work permits. There was no file and no information available concerning one part-time member of staff The files seen contained references, evidence of identity checks and criminal records checks. Staff from abroad had work permits. Some of these staff worked in another home belonging to the Registered Provider. Confirmation was seen that authority for this arrangement had been granted by the Home Office. The Annual Quality Assurance Assessment returned by the Registered Manager stated that the home was fully committed to equal opportunities. Contracts for individual staff were examined. Discussion with foreign staff revealed that an issue had arisen about their holiday entitlements. These staff confirmed that the issue had been satisfactorily resolved. However it was noted that the wording of their contracts in this area was different from those supplied to UK staff. Since the last key inspection, new training opportunities had been introduced for staff. New staff had been registered to undertake National Vocational Qualifications. Copies of staff training and other training records were seen in staff files. Some of these certificates such as, for example, those relating to infection control and first aid stated that they were valid for one year and had not been updated on their expiry. Some staff had not received training appropriate to their roles. For example, the home’s cleaner had received no training in the Control of Substances Hazardous to Health (COSHH) or infection control. There was no overall training plan. Such a plan would help to monitor training, identify gaps in staff knowledge and skill and alert the manager to necessary training updates. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 23 Induction arrangements for new staff were in place. During the visit we discussed changes to the national induction training standards with the Registered Manager and subsequently provided information about the revised scheme. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 24 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, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home have benefited from improvements made in its management since the last inspection. However, issues relating to the health and safety of those living and working in the home indicate that improved monitoring is required. EVIDENCE: The Registered Manager has a National Vocational Qualification (NVQ) at Level 3 in Care and at Level 4 in Management. She also holds an a NVQ assessors award. Feedback from the staff group on this occasion indicated that they felt well supported. Discussion with staff during our visit and examination of staff files confirmed that they received regular supervision. Six of the seven staff who The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 25 responded to our questionnaire stated that they met with the manager regularly and the others stated that they met often. The staff commented that “This is very helpful. It shows how you can improve on your weaknesses and know your strengths as a carer” “A mini weekly meeting and a monthly appraisal is done to evaluate our working status” “We have a weekly meeting every Thursday to discuss the needs of the residents and a monthly self-appraisal to evaluate our working status.” Evidence was seen that people living in the home, relatives and other agencies were consulted about the quality of the service provided. A thorough system of monthly review of this information was in operation until January 2007. The system helped to identify areas for potential improvement and implement necessary changes. This was discussed with the Registered Manager who explained that a monthly review was too onerous. However, following discussion it was suggested that this could be reinstated on a quarterly basis. Health and safety issues were examined. Staff files showed evidence of training in health and safety topics though this training required updating in some instances (see ”Staffing” above). The staff identified as involved with the preparation of the evening meal had not all received training in food hygiene. The home’s cleaner had not received training relevant to her role (see ”Staffing” above). Personal records concerning individuals living in the home were not securely stored (see “Health and Personal Care”). There were no records concerning one staff member (see “Staffing) Accidents had been recorded and reported to the Commission in accordance with regulation and a new falls monitoring system put in place. Documentary evidence was seen of recent electrical system and personal appliance tests. Evidence was also seen of the servicing of the home’s boiler and AGA oven. Other documents were seen concerning the maintenance and repair of the homes equipment and facilities. Since the last key inspection an enforcement notice has been served on the home by the Fire Authority. The Registered Provider has informed us that the key aspect of this notice has been complied with. The Registered Manager stated that an emergency evacuation plan was in place in the event of a fire. Temperature records for a the kitchen refrigerator showed temperatures ranging between 9.1oC and 16.3oC during the month prior to our visit. This is well above the temperature recommended for safe food storage and was the The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 26 subject of an immediate requirement. Following our visit the Responsible Individual wrote to inform us that the thermometer was faulty. However it remains an issue of concern that the safety of food supplied to people in the home was potentially compromised for an extended period without the issue being addressed. Practices concerning the transfer of laundry to the laundry room continue to pose potential infection risk. At the time of our visit bedding was being changed. The bedding removed for laundering was wrapped in one of the sheets and dragged / carried through the home. One staff member stated that the usual practice was to drag this through the kitchen into the laundry area (though during our visit it was taken via an external entrance). However on two occasions we observed bedding being carried through the kitchen for laundering. Neither the home’s cleaner not the part-time staff member who changes bedding had received training in infection control. The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 27 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 Refrigerated medicines must be securely stored (Immediate Requirement) Confirmed as met in letter of 14/12/07 by Registered Person Medicines requiring refrigerated storage must be stored at the correct temperature (Immediate Requirement) Confirmed as met in letter of 14/12/07 by Registered Person The Registered Person must consult with a Pharmacist concerning the efficacy of the medicines currently stored in the kitchen refrigerator (Immediate Requirement) Confirmed as met in letter of 14/12/07 by Registered Person Each individual’s medication must be stored separately, preferably in its original packaging and clearly labelled with the prescriber’s instructions Records concerning medication DS0000061643.V351201.R01.S.doc Timescale for action 08/12/07 2 OP9 13(2) 08/12/07 3 OP9 13(2) 08/12/07 4 OP9 13(2) 14/02/08 5 OP9 13(2) 14/02/08 Page 29 The Grange Residential Hotel Version 5.2 must provide a clear audit trail so that they can be readily accounted for. 6 OP19 13(4) The threshold of the door to the conservatory must be repaired and/or modified to eliminate the trip hazard it presents 14/02/08 7 OP29 19(1) The Registered Person must not 17/12/07 employ any person in the home unless he has obtained in respect of that person the documents specified in the Care Homes Regulations 2001 as amended. (Timescale of 1/6/07 for related previous requirement not met) (Urgent requirement made in a letter dated 10/10/07) Confirmed as met in letter of 14/12/07 by Registered Person All confidential records 01/03/08 concerning people living in the home must be securely stored (Previous timescale of similar requirement 1/7/07 not met) Records concerning all staff as specified in the Care Homes Regulations 2001 must be maintained 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. (Previous timescale of 1/7/07 not met) There must be a clear policy for all staff that laundry is not carried through the kitchen. The Registered Manager must ensure DS0000061643.V351201.R01.S.doc 8 OP37 17(1) 9 OP37 17(2) 14/02/08 10 OP38 OP30 13(3) 31/03/08 11 OP38 13(3) 31/03/08 The Grange Residential Hotel Version 5.2 Page 30 that by appropriate supervision of staff, this policy is being put into practice. (Previous timescale of 1/7/07 not met) 12 OP38 13(3) Food requiring refrigeration must be stored at a safe temperature in accordance with good practice guidance (Immediate Requirement) Confirmed as met in letter of 14/12/07 by Registered Person The safety of all foods stored in the kitchen refrigerator must be reviewed (Immediate Requirement) Confirmed as met in letter of 14/12/07 by Registered Person 07/12/07 13 OP38 13(3) 07/12/07 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 OP7 Good Practice Recommendations Records concerning more than one person living in the home should not be held in one file or log book other than on a temporary basis. When referring to personal information, staff information logs should refer the reader to the person’s individual record rather than giving details in the staff log. Unused and out of date medicines should be returned promptly to the supplying pharmacy for disposal. Employment contracts should conform to the home’s stated commitment to equal opportunities. The Registered Manager should produce an overall staff training plan. 2 3 4 OP9 OP29 OP30 The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 31 5 OP37 Care plans should be clearly organised so that current information is clearly distinguishable from previous records The Grange Residential Hotel DS0000061643.V351201.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Devon Area 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. 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