Inspection on 16/02/00 for The Grange Rest Home

Inspecting for better livesKey inspection reportCare homes for older peopleName: Address: The Grange Rest Home 37 Watershaugh Road Warkworth Morpeth Northumberland NE65 0TX   The quality rating for this care home is: two star good serviceA quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jim Lamb   Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the thingsThis box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.This is what people staying in this care home experience:Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement.Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 organisationOur duty to regulate social care services is set out in the Care Standards Act 2000.Care Homes for Older PeoplePage 2 of 27 Reader InformationDocument Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.ukInternet addressCare Homes for Older PeoplePage 3 of 27 Information about the care homeName of care home: Address: The Grange Rest Home 37 Watershaugh Road Warkworth Morpeth Northumberland NE65 0TX 01665711152 01665513091 val@nortoncare.co.ukTelephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) :Norton Care Limited care home 23Number of places (if applicable): Under 65 Over 65 11 3 9dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home0 0 0The Grange is situated on the outskirts of the village of Warkworth. Converted from a house to create a home that is registered to provide care for 23 older people, of which 11 may have dementia and 3 may have other mental health needs. The home is on two floors with passenger lift to all levels, there are a variety of aids and adaptation to allow residents to move freely around the home although in common with many residential homes located within converted buildings, the design and layout presents some limitations for residents with physical disabilities. All of the bedrooms are currently single occupancy and there are no ensuite facilities. There are sufficient communal lounges and dining areas. There is public car parking at the rear of the building. Care Homes for Older People Page 4 of 27 Brief description of the care home The home does not provide nursing care. The fees are 424.00 per week. The statement of purpose, service user guide and last inspection report are available at the entrance.Care Homes for Older PeoplePage 5 of 27 SummaryThis is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good serviceChoice of homeHealth and personal careDaily life and social activitiesComplaints and protectionEnvironmentStaffingManagement and administrationpeterchartPoorAdequateGoodExcellentHow we did our inspection: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. How the inspection was carried out. Care Homes for Older PeoplePage 6 of 27 Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, relatives, staff, the manager and visitors,looked at information about the people who use the service and how well their needs are met,looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable,and checked what improvements had been made since the last visit. We told the manager/provider what we found. What the care home does well: The home provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The home makes a full assessment of a persons needs before deciding if it can meet all those needs. The home draws up plans to meet the care needs of its service users. Service users health care needs are also fully assessed and properly met. The home stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The home is kept clean and hygienic and free from odours. The home has enough staff to meet the needs of service users, and staff numbers are being increased as the home fills up. The home is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the homes policies and accounting systems. The health and safety of the service users and of the staff are protected by the homes policies and systems. What has improved since the last inspection?Care Homes for Older PeoplePage 8 of 27 The home has continued to make improvements to the environment, there are new carpets in several areas, and new furnishings. The dining room has been completely refurbished to a high standard, and there are plans to refurbish the laundry. New care plan formats have been devised, and these reflect the holistic needs of the service users. What they could do better: As part of the homes safeguarding procedures, the home should obtain a copy of the Department of Heath (DH) guidance No secrets. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535.Care Homes for Older PeoplePage 9 of 27 Details of our findingsContentsChoice 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) Outstanding statutory requirements Requirements and recommendations from this inspectionCare Homes for Older PeoplePage 10 of 27 Choice of homeThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money.This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with enough information about the service to enable them to make a choice about whether this is where they want to live.Evidence: The care records for four service users were examined. These showed that the manager makes sure that a full assessment of a new service users needs is carried out by the persons social worker before they come into the home. The manager also carries out her own assessment, to be doubly sure that the home can meet all of the new persons needs. More detailed assessments are carried out once the new service user has come into the home. These include assessments of risk, of nutritional needs, social needs, moving and handling needs and of behavioural needs. A dependency rating scaleCare Homes for Older People Page 11 of 27 Evidence: (cape) is also completed. Skin care assessments are also carried out for those at risk of developing pressure sores. As a result of all these levels of assessment, the manager can clearly demonstrate that all the service users are in a home that can give them the care that they need. A newly updated service users guide is available, and this information is available in large print. All are provided with a contract explaining the homes terms and conditions, and fees.Care Homes for Older PeoplePage 12 of 27 Health and personal careThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes.This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is clear enough to ensure that staff have the information they need to meet the assessed needs of the service users.Evidence: There are comprehensive assessments in the service users care plans. There is also a comprehensive risk assessment of service users. There are advocacy arrangements, as well as family input to represent service users. Care plans are drawn up with service users and their relatives input. Plans are amended and reviewed on a regular basis. There are new care plan formats in place, the plans are very person centred and are based on activities of daily living. The staff are working hard to implement the new care plan formats for all the service users. The manager will ensure that these also include social interests, emotional and psychological needs where necessary.Care Homes for Older People Page 13 of 27 Evidence: There are systems in place that will ensure that the placement and the service users plans are reviewed annually. These involve the care managers and the service users representatives. The service users confirmed that their privacy and dignity are respected at all times. One service user said, The staff are very good indeed, they would never enter my room without knocking first, and then waiting for me to answer their knock. They have all got nice manners and are very helpful. Another said, The staff always respect me and the other residents, they are always very polite, and i think they do a very good job. Service users care records showed that they have access to a wide range of external health care services. G.Ps visit when necessary. Service users are referred for specialist health care if appropriate. One service user said, i still have the same doctor that i had before i came here, and i receive very good health care. The staff always give me my medication at the correct time, and i can see my doctor on request. The medication systems were examined for ordering, receiving, administering and disposal. The medication systems are managed well. All staff have had accredited medication training. Appropriate systems and procedures are in place for the management of controlled drugs. Staff who have completed relevant training administer medication. A sample of medication records was examined. These include photographs for identification purposes. Clear directions were recorded and each dose of medication was signed for, or a code entered to verify the reason not given. Privacy and dignity issues are built into the homes policies and procedures and staff training. All personal care and medical examination/treatment is carried out in private. Service users said that they are able to make decisions for themselves, and that they are happy with all aspects of the care that they receive. Many were very complimentary about the staff.Care Homes for Older PeoplePage 14 of 27 Daily life and social activitiesThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes.This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are offered a good quality lifestyle, which includes varied social contact and activities.Evidence: Each service user has a social skills assessment carried out. All service users and their representatives participate in this process. The completion of the skills assessment should be used to assist staff to implement more detailed social care plans. The home employs two activities co-ordinators, and there is a programme of activities.The activities programme is based on service users interests and choice. Apart from daily activities, entertainers frequently visit the home. The home has plans to purchase a mini bus this year, and this will enable them to organise frequent outings to places of interest. All service users are supported to maintain very close links with their families. They can choose who they want to see and when.Care Homes for Older PeoplePage 15 of 27 Evidence: One relative said,This is a wonderful place, the care here is first class, i never have to worry about my relative, and all the staff are very good. The homes menus are based on the known likes and dislikes of the service users. At least two hot meals are provided each day. The menus are varied and well balanced. The cook had good knowledge of the service users dietary needs. Special diets are provided when necessary. All those spoken to said that the meals were very good and that they were always offered a choice. Within the service there is evidence of a good awareness and understanding of equalities and diversity. Staff are able to translate understanding into positive outcomes for service users in the areas of race, ethnicity, age, sexuality, gender, disability and belief. The service consistently promotes equality and diversity rather than just meeting needs in a reactive manner. The service encourages and delivers updates in new legislation, guidance and best practice. There is ownership of the equality and diversity agenda by staff at all levels, and they are encouraged to contribute to developments.Care Homes for Older PeoplePage 16 of 27 Complaints and protectionThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections.This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints management is effective, and this results in service users being protected from harm and abuse.Evidence: There is a complaints procedure. It contains details of how to contact the CSCI to make a complaint, if complainants are not happy with the homes investigation and response. The procedure is written in a way that ensures service users fully understand its contents. Three service users said that they had been given copies of the procedure and that staff always listened to their concerns and always dealt with them fairly. One service user said,If i had a concern, i would immediately inform the manager, she always listens, and makes sure that things are put right, all the staff are good, and they go out of their way to make things right. The home keeps a record of complaints. During the last twelve months there has been one complaint received, this involved the Adult Protection Team and was appropriately investigated and resolved. The home has a Whistle Blowing policy, and a copy of the Local Authorities Vulnerable Adults procedures. The home does not have a copy of the Department of Healths document, NO SECRETS. Staff should be aware of theseCare Homes for Older People Page 17 of 27 Evidence: procedures and have easy access to them. The manager agreed to obtain a copy as soon as possible. Safeguarding adults training is ongoing for all staff. Service users can deposit small amounts of cash for safe keeping, and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded and had two signatures for each entry. There was plenty of evidence of personal spending. Receipts are obtained for purchases and numbered and cross-referenced to the transaction. Weekly checks of balances and cash are carried out.Care Homes for Older PeoplePage 18 of 27 EnvironmentThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it.This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a very comfortable and safe environment for those living there.Evidence: The home was exceptionally clean, well decorated and well maintained. The grounds were tidy, safe, attractive and accessible. As well as a front courtyard, there is an additional front/side garden The home has an appropriate amount of sitting, recreational and dining space. There are enough rooms for a variety of activities to take place. The are two lounges, both attractively furnished and decorated and homely. During the last year, there has been some improvements made to the environment. There are new carpets in the corridors, stairs and landings, several bedrooms have been refurbished and decorated, and the dining room has been refurbished and provides a highly attractive place for service users to dine. Service users can see visitors in private in their own rooms if they wish. Furnishings and fittings were domestic in design and in very good condition. All bedrooms are highly personalised and colour co-ordinated to each persons individual taste.Care Homes for Older PeoplePage 19 of 27 Evidence: All doors have privacy locks and room sizes meet the minimum required. Service users bedrooms have opening windows and restrictors are in place where needed. The rooms were centrally heated and the heating level could be controlled within each bedroom. Radiators and pipes were guarded. Lighting was bright and domestic in design, and there was emergency lighting throughout the home. Water valves at water outlets ensure water is provided close to 43C to prevent scalding. The home was totally free from offensive odours. The laundry facilities are well organised. The washing machines have the specified programme to meet disinfection standards. There are plans in place to refurbish the laundry area.Care Homes for Older PeoplePage 20 of 27 StaffingThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes.This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised.Evidence: Staff levels on the day of the inspection met the agreed level for the number of service users. On the day of the inspection there were 23 service users. In addition to the manager, the required numbers of staff were on duty: 1 senior and 4 care staff between 8am and 3pm, and 1 senior and 3 care staff between 3pm and 10pm. There are 2 night staff between 10pm and 8am. There are 40 domestic hours, 30 laundry, 32 hours maintenance, 36 activities and 36 catering hours. All staff were over 18 years of age and those left in charge were at least 21. The training needs of the staff are identified in supervision and appraisal sessions. The homes training programme meets the National Training Organisation requirements for the first six months.Care Homes for Older People Page 21 of 27 Evidence: Staff receive at least three days paid training each year. The service has a rigorous staff recruitment and selection process to ensure that all appropriate checks and references are in place prior to employment. The service has a good staff training and development programme in place. All statutory training was up to date and 75 of the staff team has completed NVQ level 2/3.Care Homes for Older PeoplePage 22 of 27 Management and administrationThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers.This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the proprietor in providing good leadership throughout the home, with staff demonstrating a clear awareness of their roles and responsibilities.Evidence: The manager had obtained relevant qualifications, including the Registered Managers Award. She had extensive experience and displayed the professional competence required to manage the home. There was evidence that the staff team worked hard to improve the lives of the people living at the home. Staff and service users felt that the managers style of leadership was fair, supportive and understanding. The majority of service users had requested that the home take on day-to-day responsibility for overseeing their money. A safe was available to ensure that theirCare Homes for Older People Page 23 of 27 Evidence: money could be kept secure. Staff signatures had been obtained for all money spent on behalf of service users and receipts had been obtained and attached to their financial balance sheets. Financial records showed evidence of regular audits. The home does not acting as an appointee for any of the service users. A quality assurance system had been developed to monitor the quality of care provided in the home. For example, quality surveys had been sent to people living at that the home and their relatives. The manager confirmed that she intends to send surveys to other professionals visiting the home. The home has a detailed annual development/business plan in place. All staff working at the home had received supervision at least six times during the last 12 months. Supervision sessions were used to provide staff with feedback on their performance, and training needs. A range of health and safety records were examined and found to be up to date. A tour of the premises identified no health and safety concerns. An audit of the homes fire records confirmed that the required fire prevention checks had been completed. For example, the homes emergency lighting and fire extinguishers had received monthly visual checks. An up to date fire risk assessment was in place. The homes accident records contained the required details. The homes lift and hoisting equipment had been serviced. All gas and electrical appliances had been subject to the required safety checks. A range of workplace risk assessments had been completed.Care Homes for Older PeoplePage 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No ROutstanding statutory requirementsThese are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.No. Standard Regulation Requirement Timescale for actionCare Homes for Older PeoplePage 25 of 27 Requirements and recommendations from this inspection:Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.No. Standard Regulation Requirement Timescale for actionStatutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.No. Standard Regulation Requirement Timescale for actionRecommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.No. Refer to Standard Good Practice Recommendations118The service must obtain a copy of the Department of Health (DH) guidance NO SECRETS.Care Homes for Older PeoplePage 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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