Inspection on 15/09/05 for The Grange Rest Home

This inspection was carried out on 15th September 2005.

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

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

Other inspections for this house

The Grange Rest Home 04/10/07

The Grange Rest Home 24/05/06

The Grange Rest Home 21/04/05

The Grange Rest Home 19/10/04

The Grange Rest Home 22/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Grange Rest Home 11 Sackville Gardens Hove East Sussex BN3 4GJ Lead Inspector Jane Jewell Unannounced Inspection 15th September 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 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 Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Grange Rest Home Address 11 Sackville Gardens Hove East Sussex BN3 4GJ 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) 01273 298746 The Grange Rest Home Limited Mrs Suzanne Leahy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents to be accommodated is 25 The residents will be aged 65 years or over on admission Date of last inspection 21st April 2005 Brief Description of the Service: The Grange Rest Home is a privately owned residential care home for up to twenty-six older people. The home has been owned by the current providers since 1989. The home is an extended Victorian house, which is located near Hove seafront and close to transport links. The home is presented on three levels, ground, first and second floors. A shaft lift provides access to all floors with the first floor being split levelled, with several steps leading to the accommodation. Resident accommodation consists of twenty-five single bedrooms, eleven with ensuite facilities. There is a shared dinning room, two lounges a conservatory and enclosed rear garden. The front garden is paved to provide off road parking. The homes literature states that its aims are that each resident feels at home in warm, friendly surroundings and that they are as independent as is possible. That residents will be treated as an individual and with respect and dignity. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced routine inspection, which took place between 10.30am and 4pm. On the day of the inspection there were twenty-two residents living at the home. The inspection involved a tour of the premises, examination of the homes records, discussion with provider, manager, consultation with six staff on duty, nineteen residents and a relative. The focus of the inspection was on the quality of life for people who live at the home. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their hospitality and assistance during the inspection. What the service does well: What has improved since the last inspection? Some progress has been made towards addressing previous shortfalls in practices. This has improved resident’s safety in medication management, staff training, infection control and fire safety. The home is gradually undergoing refurbishment, which is near completion. Areas that have been refurbished have been done to a very high standard creating a comfortable and homely environment in which to live. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 6 What they could do better: Although good care practices continue this must be supported by improved standards of record keeping. This is to ensure that legislation is complied with and evidence that residents and staff are being protected by the homes practices. The management of risk must improve to ensure that risks faced and posed by residents are identified and managed effectively. Further work is needed to ensure that standards of infection control are improved. Regular input and monitoring by the provider must be undertaken in order to support the manager in achieving the homes aims and objectives. In response to the draft inspection report, the provided returned to the CSCI an action plan of how they intend to meet the requirements and recommendations made from this inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 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 Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 The home provides both prospective and existing residents with information about what services are provided and what to expect when living at the home. It was clear that the home continues to meet the needs of residents and provides a good quality of life for people living at the home. EVIDENCE: There is a range of information about the home and the services it provides, this includes a statement of purpose and service user guide. These are provided to prospective residents or interested parties and are displayed at the home. Residents are provided with a written contract of terms and conditions of residency following their trial period at the home. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. Documentation was examined for a recent admission to the home and this showed that the residents needs had been assessed by the manager and that their needs could be met at the home. As part of the assessment process the The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 9 manager also speaks to health care professionals and others who know and understand the perspective resident to help inform their assessment. All residents looked cared for and relaxed in their environment and all spoke positively about their life at the home, and said the following to describe how they felt: “Love it” “They do everything for you” “You have a good laugh and a joke” “I feel safe” “The best bit is the friendly atmosphere” “The home should be top of the list” “The staff encourage my independence but make sure that I am safe” “Everyone is so friendly”. Much good care practice was observed by the inspector, which included sensitive and respectful interactions between staff and residents. The home is able to meet the assessed needs of current residents. Where particular specialist needs have been identified the manager draws on the expertise of a range of healthcare professionals, including district and specialist nurses. Training in visual impairment was previously required and is about to be undertaken. A resident with a visual impairment said that staff were very understanding of their needs. A new resident said that although their relative viewed the home on their behalf, living at the home had met all of their expectations and that it was not as scary as they originally thought it would be. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Care planning continues to improve and there is a simple plan in place for all residents. Although information in plans are basic, staff remain knowledgeable about the individual care needs of residents. The health needs of residents are addressed with good links with health care professionals. Residents feel they are treated with respect and their right to privacy is upheld. Medication arrangements were found to be generally well managed. EVIDENCE: Five care plans were examined which recorded concise information about residents needs, including general health, daily routines, food, personal hygiene and specialist needs. Although the manager writes most care plans, staff consulted showed an in-depth knowledge of each resident’s needs and how these should be met. It was previously required to regularly review each care plan to ensure that any changes in needs and preferences are promptly identified. This had not yet been introduced for all care plans. Individual records are maintained for each resident of actions and events, the tone and style of which was respectful and none judgmental, however these were not being completed regularly. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 11 Basic personal risk assessments have been completed as part of the care planning process. These include the actions to manage identified risks. However, not all risks faced and posed by residents are assessed, including manual handling and smoking. This has been required in order to safeguard residents. One resident spoke of making their own GP appointments while others said that they asked staff to see a Doctor and this was always acted upon promptly. Records of medical intervention showed that the home continues to work closely with health care professionals including GP’s, District and specialist nurses, chiropodists, opticians and dentists to ensure residents receive the necessary health care intervention. Staff showed a good knowledge of the action taken, or required, to meet specific residents health needs but acknowledged that this level of information was not always reflected in written records. Based on feedback received from a resident, it has been recommended that they are reassessed by a continence nurse to ensure that sufficient aids are made freely available to them. Medication was overall well managed with the exception being to provide secure storage to medication that requires refrigeration. It is recommended that a controlled drugs register be used to record all controlled drug movements. Resident’s appearance was presented in a manner that preserved their dignity, namely appropriately clothing for weather conditions, which were laundered to a good standard and regular hairdressing input. Residents said that they are always treated with respect and any personal care is undertaken in private. Staff were observed knocking on bedroom doors prior to entering. Some personal care information was displayed in the kitchen, which is accessed by some residents and visitors. This practice has also been noted during previous inspections and does not promote residents privacy. The manager has been required to address this immediately and ensure that this practice is eliminated. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. Residents maintain contact with family and friends as they wish. EVIDENCE: Observation of the daily routines and discussion with residents confirmed that staff accommodate resident’s personal wishes with regard to meal times, going to bed, rising and bathing. Residents spoke of the many meaningful activities that they undertook, either by themselves or organised by the home. This included musical entertainers, gentle exercises, Bingo, board games, short walks and art classes. All residents consulted said that their time was suitably occupied and staff respected their wishes if they chose not to join in any organised activities. Many residents said that they enjoyed just being able to sit and talk with one another or with staff. Residents are able to keep pets in the home following agreement with the manager. The home now has a small dog, cat and large fish tank, which residents were extremely fond of and assist in looking after them. A frequent visitor to the home told the inspector how much they enjoyed visiting as they are made to feel welcome and that the atmosphere is always The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 13 very welcoming. They felt that they are kept informed and could approach any member of staff for information. Some residents have a private telephone line in their bedroom and they spoke of how this enabled them to keep in regular contact with their relatives and friends. During the inspection the cook was on leave and the main meal was being prepared by the manager. All residents consulted said how good a cook they were and described the food as: “Very good” “Smashing” “always nice” “Not deprived of anything” “Bang on” “You get a good choice of food” “Food is excellent” “First rate” and “Whatever you want they will get it for you” The meal prepared at inspection was plentiful and presented to a high standard. Individual preferences were observed to be respected and records of meals provided confirmed that a varied diet is provided. In line with feedback received during the previous inspection staff now rotate the serving of tables to prevent the same people waiting until last to be served. Mealtimes remain an important social function of the home, with residents observed to enjoy interacting with one another and staff in a relaxed atmosphere. The dining room is decorated and set to a high standard with much thought given to providing a comfortable and pleasant environment in which to eat and socialise. The kitchen was clean and provided suitable facilities for catering. The kitchen is at the centre of the home and is in constant use by staff, residents and visitors. Although it is clear the important social element of allowing free access this must be balanced with managing potential risks and maintaining infection control procedures. Namely protective clothing to be worn by all parties entering into the kitchen. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home continues to be operated in an open manner and has not had a formal complaint in many years. Residents feel able to raise any concerns with staff or management. The homes practices are designed to protect residents from abuse. EVIDENCE: There is an accessible complaints procedure for residents, their representatives and staff to follow should they be unhappy with any aspect of the service. No formal complaints have been received or recorded. All residents/visitors consulted said that they felt able to approach any member of staff/management with any concerns and where they have had to raise minor concerns then this has been acted upon promptly. There are clear procedures in place for staff to follow to report suspected abuse and staff undergo training in adult protection. Staff who have been interviewed across several inspections continue to demonstrate a full and sound understanding of all the issues involved, including whistle blowing and who to report concerns too. The homes practices in relation to resident’s finances, personal support and recruitment all promote the protection of residents. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26 Residents live in a homely environment with parts of it decorated and furnished to a very high standard. Major building works are being planned to improve toilet and bathing facilities. Standards of overall cleanliness were good. EVIDENCE: The home is well located in relation to the local community/ amenities and is close to Hove seafront. Over the last couple of years the home has undergone a major investment to improve the environmental standards. Areas that have been refurbished have been done to a very high standard creating a comfortable and homely environment in which to live. Areas that remain outstanding include four bedrooms, some bathrooms, external window frames and stairwells. It has been required over several inspections that a plan of redecoration and repair be provided with timescales in order to address these outstanding areas. This had not been undertaken and is again repeated in this report. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 16 The home is well maintained and it was clear that where maintenance issues are identified these are promptly acted upon. Communal space consists of a separate smoking and non-smoking lounge, dinning room and conservatory. All are decorated and furnished to a high standard and are popular with residents. It was previously required that suitable shading be provided in the conservatory as this area becomes extremely hot and uncomfortable to sit in. It was reported that blinds have been ordered and are due to be fitted shortly. There is a secure rear patio area with seating, tables and flowerbeds. Access is via a ramp with a handrail making it accessible to all residents. In line with previous requirements plans are in place to re-organise the cubicle ground floor toilets into a more suitable location and layout. This is involving some major building works and the creation of an additional bedroom. The provider was reminded that CSCI must be informed prior to any building works commencing. There are currently four baths, one of which is an assisted bath and an additional assisted shower. It has been previously recommended that further assisted facilities be provided. The provider plans to address this during the relocated of the ground floor toilets and convert a standard bathroom into a wet room on the first floor. All parts of the home inspected were observed to be clean. There are sufficient numbers of domestic staff employed to ensure that standards are maintained. Residents said that they were happy with the standard of cleaning in their bedrooms. Some strong odours were noted in two bedrooms, which the domestic staff were informed about and agreed to address immediately. Extensive laundry facilities are available in the basement. Residents stated that the standard of laundry was always good. Some improvements to infection control practices need to implemented in order to safeguard residents and staff, these were: • That protective clothing must be worn by any persons entering the kitchen. • That full protective equipment including eye protection must be made available for the disposal of human waste. • Due to the level of commode usage it is now recommended that sluice facilities be available for the safe disposal of human waste. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The numbers and competence of staff remain suitable to meet the aims, objectives of the home and the individual needs of residents. The staff group includes a core group who have worked at the home for many years and who clearly make a positive contribution towards the quality of life of residents. Staff training needs to be more organised to ensure that training needs are identified. EVIDENCE: All residents consulted continue to speak positively about staff. Comments made included “ Very very helpful” “Good carers every one” “ Very caring and gentle” and “Good fun and we have a laugh”. Staffing levels remain for two care staff, senior carer and manager to be on duty until 2pm. This is usually in addition to domestic staff and a cook. During the afternoon and evening there are two care staff and a senior carer. At night there are two staff on duty. All staff and residents consulted felt that there were enough staff on duty to meet the needs of residents and enable individual time to be spent. It remains clear that residents benefit from a stable core group of staff who have considerable experience in working with older people. Much good practice was observed by the inspector in the way that staff interact with residents showing much sensitivity, understanding and humour. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 18 Much commitment is shown towards providing staff with the opportunities to undertake NVQ qualifications and has resulted in many staff having attained this qualification. The recruitment records reviewed showed that a good standard of recruitment practices continues to be followed including obtaining the necessary CRB disclosures. Staff stated that they undergo compulsory training such as Moving and Handling, First Aid, food hygiene, adult protection and Fire. In addition new staff undergo a TOPPS induction programme. As at previous inspections it remains difficult to assess what training staff have undertaken, as training records need to be more systematically collated and recorded. This is so the manager has an easily identifiable written profile of training undertaken and outstanding for each member of staff to be able to plan more effectively the training needs of staff. Although started this has yet to be fully implemented. The manager has been required for some time, to implement a training and development programme which is linked to the homes aims, objectives and residents needs. This is yet to be completed and remains essential in order to ensure that staff training needs are identified. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,34, 35,36,37 and 38 The home continues to benefit from a well-established and motivated manager who clearly models good care practices. In order to ensure that they meet their legal requirements to improve standards of administration additional senior support has been recommended. Resident’s financial interests are safeguarded. Generally residents and staff are protected by the homes health and safety practices with the exception being infection control practices and management of risk. EVIDENCE: All persons consulted during the inspection spoke enthusiastically about the manager and how approachable and kind she is. She models good care practices and is very much resident focused. She has many years experience in managing the home and demonstrated in-depth practical knowledge of the daily running of a service for older people. However she readily accepts the difficulties she experiences with the administration elements of managing a care home. This remains evident in the slow progress made towards fully The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 20 meeting outstanding requirements, relating to record keeping and administration. It was also evident that this slow progress has been exacerbated by the lack of time she is able to be spend on management duties rather than on covering care or cooking duties. In order to address this it is recommended that a review of the management structure be undertaken. This is with a view to providing additional senior support enabling the manager to address their legal requirements of improving standards of administration. This is essential in order to underpin the good care practices noted and to provide the necessary evidence that residents and staff are being safeguarded by the homes practices. Although the provider visits the home they do not undertake the required monthly-recorded visits. This has been an outstanding requirement for some time and despite direct communication with the provider this has not been undertaken. This remains essential in order for the provider to meet their legal obligations as the registered owner and to support the manager in achieving the homes aims and objectives. Staff felt well supported by the manager to undertake their role. A senior carer has recently been delegated to undertake formal supervision sessions with staff. Staff said that areas that are discussed are practice issues, philosophy of care, and career development needs. Residents are encouraged to retain control of their own finances for as long as they are able to do so. Where the home supports some residents to manage their personal monies appropriate records are maintained. The home operates good practices in promoting residents rights to have regular access to their monies held by relatives. There is a policies and procedures manual which is readily available to staff and provides basic guidance for staff on the practices of the home. Essential policies that still need to be provided include: Maintaining confidentiality, recruitment and update infection control. The development of these polices will underpin the homes practices and further support the induction of new staff. Practices that were noted that promote the health and safety of resident’s, staff and visitors include: • A clear account of accidents, with no specific patterns identified. • Regular servicing and testing of fire safety equipment is undertaken. • Hot water mixer values are fitted to outlets accessible to residents and all those checked delivered hot water within the required safe temperature range. • Radiators have been fitted with guards to prevent accidental scolding. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 21 It has been previously required that risk assessments for all safe working practice topics be regularly reviewed to ensure that risks are identified and managed. This has not yet been undertaken. Not all windows had been restricted from the risk of accidental falls and this must be addressed as a matter of priority. The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 22 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 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 2 x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 3 2 2 2 The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 23 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 7 Regulation 15(2) (a&b) Requirement That care plans are reviewed at least once a month and recorded as having been reviewed. (First made inspection of 21/4/05 with timescale of 30/5/05 not met) That comprehensive written personal risk assessments are completed for all service users which are reviewed regularly and records the actions to manage identified risks. That secure refrigeration facilities are provided for the safe storage of medication. That personal care information is not displayed in communal areas. That staff wear appropriate protective clothing when entering the kitchen. That the ground floor communal toilets are reorganised to preserve the dignity and privacy of service users. (First made at inspection of 5/6/03 with timescales of 30/9/05 not met) DS0000014251.V249546.R01.S.doc Timescale for action 30/11/05 2 7 13(4)(c) 30/11/05 3 4 5 6 9 10 15 19 13(2) 12(4)(a) 13(3) 12(4)(a) 15/09/05 15/09/05 15/09/05 30/04/05 The Grange Rest Home Version 5.0 Page 24 7 19 23(2)(d) 8 20 13(4)(c) 9 26 13(3) 10 30 18(1)(i) 11 30 18(1)(c) 12 31 26 13 38 13(4)(c) 14 38 13(3) That a plan of re-decoration and repair is provided which includes all of the areas identified during the inspection. (First made at inspection of 19/10/04 with timescales of 30/9/05 not met). That shading is providing in the conservatory to prevent this area from becoming to hot. (First made at inspection of 21/4/05 with timescales of 30/5/05 not met). That full protective equipment including eye protection must be made available for the disposal of human waste. That a training and development programme is developed which is linked to the homes aims, objectives, service users needs and individual care plans. (First made at inspection of 19/10/04 with timescales of 30/7/05 not met). That staff receive specialist training in visual impairment. (First made at inspection of 21/4/05 with timescales of 30/7/05 not met). That records of visits by the Responsible individual are in accordance with the National Minimum Standard. (First made at inspection of 5/6/03 with timescales of immediate not met). That the risk assessment for all safe working practice topics be reviewed frequently and records significant findings. (First made at inspection of 22/4/04 with timescales of immediate not met). That infection control policies are reviewed and updated to include guidance for staff the use of protective clothing and disposing DS0000014251.V249546.R01.S.doc 30/11/05 30/11/05 15/09/05 30/11/05 30/12/05 15/09/05 15/09/05 15/09/05 The Grange Rest Home Version 5.0 Page 25 15 38 13(6) of human waste. That windows that pose a risk from accidental falls or security are fitted with restrictors. 15/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard 7 8 9 21 26 29 30 Good Practice Recommendations That daily notes are recorded for each resident on the events and actions that have occurred. That a resident is re-assessed by a continence nurse to determine the level of support aids needed. That a controlled drugs register be used to record the administration and storage of controlled medicines. That there is a ratio of one assisted bath to eight service users. (First made at inspection of 22/4/04). That suitable sluicing facilities are provided for the safe disposal of human waste and cleaning of commodes. That a policy on the recruitment of staff be developed. (First made at inspection of 5/6/03). That staff training records are more systematically collated and recorded, so that a written profile of training undertaken and outstanding is easily identified. (First made at inspection of 19/10/04). The Grange Rest Home DS0000014251.V249546.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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