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Inspection on 07/07/05 for The Grange Rest Home

Also see our care home review for The Grange Rest Home for more information

This inspection was carried out on 7th July 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

It was seen and residents commented that staff were kind and considerate when helping them. Residents spoke of a gradual introduction to the home and there was a detailed pre-admission process. Meals are varied, well balanced and nicely presented offering good choice and nutritious food at all meals. All of the residents spoken to were pleased with the quality and choice available. Residents, where able, described good relationships with the staff and said they were all polite and helpful. Staff were friendly and relaxed with the inspector and were keen to discuss their work and the residents care needs.

What has improved since the last inspection?

The admission procedure and records are better detailed and give good information. Decoration and furnishings have continued to improve and the home looks more welcoming and homely. Individual care plans have continued to improve and it was apparent that staff were more involved in planning and evaluating care. Manager and staff have begun to address the specific needs of people with dementias.

What the care home could do better:

The registration of the home provides mainly for residents with dementia, this was discussed with the manager and it was agreed that policies, procedures, training and practices would be reviewed to reflect this. The owner, manager and staff to continue to develop their skills and the service to specifically meet the needs of residents with dementia/mental health needs and this must include pre-admission mental health assessment and care planning. Pre-admission documentation must ensure that the home does not admit residents outside of its registration category. The manager must ensure that adequate nutritional and falls risk assessments are undertaken and any actions are recorded within the residents plan. The health and safety needs of residents can be further improved through the removal of door wedges and provision of water at a safe temperature.

CARE HOMES FOR OLDER PEOPLE The Grange Rest Home 37 Watershaugh Road Warkworth, Morpeth Northumberland NE65 0TX Lead Inspector Mary Blake Unannounced 7 July 2005 9:30 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Grange Rest Home Address 37 Watershaugh Road Warkworth Morpeth Northumberland NE65 0TX 01665 711152 01665 513091 barbara.penrose@nortoncare.co.uk Norton Care Limited c/o Goldcare FM Ltd. Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Barbara Penrose CRH 23 Category(ies) of DE(E) - Dementia over 65 (11) registration, with number OP - Old Age (9 ) of places MD(E) - 3 The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 31st January 2005 Brief Description of the Service: The Grange is situated on the outskirts of the village of Warkworth with limited access to its services. 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 communal bathrooms and toilet faciltiies situated around the home. There are sufficient communal lounges and dining areas. There is public car parking at the rear of the building. The home does not provide nursing care. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home has recently changed to provide mainly for residents with dementia, this was discussed with the Registered Manager and it was agreed that policies, procedures, training and practices would be reviewed to reflect these changes. The inspection was unannounced, the first of the year and took place over one full day. A full tour of the premises was carried out. Residents care records and additional statutory records were examined. The manager, three staff and two residents were spoken to. What the service does well: What has improved since the last inspection? The admission procedure and records are better detailed and give good information. Decoration and furnishings have continued to improve and the home looks more welcoming and homely. Individual care plans have continued to improve and it was apparent that staff were more involved in planning and evaluating care. Manager and staff have begun to address the specific needs of people with dementias. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 6 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 Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 & 5 The Grange does not provide intermediate care Residents do not have up to date information about the home. The majority of residents move into the home having had their needs assessed and been assured how these will be met. Residents have the opportunity to visit the home prior to admission and generally satisfactory pre-admission assessments processes were in place in order to meet their needs. EVIDENCE: The statement of purpose, service user guide had not been updated to reflect the changes to the registration of the home. Discussion with residents, staff and the Registered Manager confirmed that their care needs had been assessed prior to admission, however there was insufficient information on the mental health care needs of the residents. Individual records for residents were examined for the last admission and assessments had been undertaken however these did not contain enough The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 9 information about mental health needs and indicated that the resident was not within the homes registration category. (This has been addressed since the inspection and prior to the issue of this report). The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 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 standard(s) 7 & 8 Residents personal and social care needs are set out in their individual plan of care; health care needs were not fully addressed. EVIDENCE: Individual residents plans of care were examined and have continued to improve. Residents are weighed regularly however nutritional risk assessments are not always carried out or actions detailed within the care plans. Residents were observed enjoying lunch that appeared tasty and nutritious, all commented on the quality and range of food served. A range of risk assessments are undertaken but there was insufficient documentation in relation to falls risk assessment. Residents have regular access to other health services such as doctor, district nurse, psychiatric nurses, dentist, chiropodist and optician. Outstanding requirement in relation to medication training for night staff is being addressed, with staff about to complete this training. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The food choices and quality of food on offer were sufficient to meet the needs of residents. The meals offer choice, variety and good nutrition EVIDENCE: Good quality fresh fruit was seen and residents all commented that the food being served was fresh, nutritious and tasty. Meals are taken in pleasant, well-lit dining rooms, well laid tables, with good staff attendance and supervision. Staff rotationally sit and have lunch with the residents. Lunch was seen to be a relaxed and social occasion. On examination of the menus and kitchen cleaning schedules these were regularly not followed, although food actually served was good and the kitchen was clean, following discussion with the Registered Manager it was agreed that she would explore this further with the cook. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 A satisfactory complaints system was in place and residents appeared confident that their concerns would be listened to, taken seriously and acted upon. EVIDENCE: The home has a complaint procedure, which is displayed, throughout the home. Examination of the complaint record indicated that there had been no recorded complaints since the previous inspection. The Commission has not been asked to investigate any complaints since the last inspection. Discussions with the residents and staff indicated that they felt confident with the Registered Manager and how she responds to any concerns they raise. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,25 &26 Residents live in well-maintained and comfortable surroundings however the home is not always safe. Residents do not have access to sufficient and comfortable bathrooms areas. The home is clean, pleasant and hygienic. EVIDENCE: Since the last inspection the home had continued to progress with the redecoration programme and residents and staff commented on the positive change. It was noted that door wedges were inappropriately used throughout the home. Bathrooms were not all being used and this should be reviewed. Communal toiletries were again evident. The water temperature of a bath (details given to the manager) was tested and was 50.8C, exceeding the safe temperature of 43’C. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 14 A tour of the building indicated that the home was well maintained and was clean and free from offensive odours. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Resident’s needs are met by the number and skill mix of staff at the home. EVIDENCE: Discussions with the Registered Manager, staff and examination of the staffing rotas confirmed that the home has remained consistently staffed, both during the day and night. The minimum numbers of care staff are 4 mornings 3 afternoons 3 evening and two during the night. Managerial assessment of the night staff is currently being reviewed by the Manager. All residents spoken to said that staff were kind and considerate. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36 and 38 Residents live in a home which is well run and managed. Staff are appropriately supervised. The health, safety and welfare of users and staff are not always promoted and protected. EVIDENCE: The Registered Manager’s leadership has been consistent and has ensured that residents receive consistent quality care. Discussions with the manager and staff and examination of sample records indicated that satisfactory supervision arrangements are in place. The use of door wedges and residents having access to excessive hot water do not promote or safeguard the health, safety and welfare of the people using the service. The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 2 x x x 2 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x 3 2 2 The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 18 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18(1)(a) Requirement To review managerial competence for night staff and maintain a record of this assessment.Outstanding as of 1st April 2005 but currently being addressed To provide medication training for night staff and cease secondary dispensing of medication.Outstanding as of 1st April 2005 but currently being addressed To remove communal toiletries and review this practice. Outstanding as of 1st March 2005 Update the statement of purpose and service user guide to reflect changes to the home and submit to CSCI The home must not admit any residents with primary mental health needs. To review mental health assessment and care plan recording, to identify and to include staff actions within the plan. To review nutrional assessment and care plan recording, to identify residents at risk and to Timescale for action 1st September 2005 2. OP9 13(2) 1st September 2005 3. OP21 12(4) 1st August 2005 1st September 2005 1st August 2005 1st September 2005 1st September 2005 Page 19 4. OP1 & OP37 OP7,OP8 & OP3 OP7& 8 6 5. 6. 12(1)(a) 15 7. OP 7 & 8 13(4)c The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 8. OP 7 & 8 13(4) b,c 9. 10. OP38 OP25 & OP38 23,(4) 13(4) include staff actionswithin the plan. To review falls risk assessment and care plan recording, to identify residents at risk and include staff actions within the plan To remove all door wedges Water temperatures to baths must not exceed 43c, steps must be taken 1st September 2005 7th July 2005 7th July 2005 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 Good Practice Recommendations The Grange Rest Home B53-B03 S40702 GrangeWarkworth V222099 070705 Stage4.doc Version 1.30 Page 20 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR 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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