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Inspection on 08/01/07 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 8th January 2007.

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

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

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

Staff were kind and considerate when helping residents. Residents explained the admission process; this includes a gradual introduction to the home and a detailed pre-admission assessment. This helps new residents adjust and settle into living in the home. Individual care plans are well detailed, regularly reviewed and updated. Staff were more involved in planning and evaluating care and the plans this helps staff give residents the care they need. The management overviews these plans and this helps to provide a consistent staff approach. Residents, where able, described good relationships with the staff and said they were all polite and helpful. Staff were friendly and relaxed and showed a good understanding of residents needs. Arrangements for residents to maintain contact with their family and friends are good. Visitors confirmed that they are always made welcome and kept informed and involved. 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. Meals were seen as a relaxed and social occasion. Hygiene practices were good protecting the health of residents and staff. The home is well staffed with a skilled, consistent and trained staff team giving security to residents. Staff recruitment and training records were clear and concise and contained all relevant information. The vetting process helps protect residents. The staff have a good understanding of residents individual needs. More than fifty percent of staff are qualified to National Vocational Qualification in Care level 2 (NVQ) or above providing residents with a trained, skilled staff team. The residents were very complimentary about the staff.

What has improved since the last inspection?

Since the last inspection several bedrooms, the laundry and areas of the home have been redecorated, refurbished, fitted with new lighting, new furniture and washing machines and driers purchased, relatives, residents and staff commented on these positive changes. Staff have continued to undertake training and spoke of using this knowledge in their practice.

What the care home could do better:

To continue the development of quality assurance systems this will respond to resident need and develop the service.

CARE HOMES FOR OLDER PEOPLE The Grange Rest Home 37 Watershaugh Road Warkworth Morpeth Northumberland NE65 0TX Lead Inspector Mary Blake Key Unannounced Inspection 8th January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Rest Home Address 37 Watershaugh Road Warkworth Morpeth Northumberland NE65 0TX 01665 711152 01665 513091 val@nortoncare.co.uk 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) Norton Care Limited Mrs Barbara Penrose Care Home 23 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (9) The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 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 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 fees range from £378 to £383 per week. The statement of purpose, service user guide and last inspection report are available at the entrance. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, the second of the year and took place over one day and involved one inspector. A brief tour of the ground floor was undertaken. Residents care records, staff rota plus additional statutory records were examined. Case tracking was undertaken, this involved following the care of individual residents. The manager, three staff, one ancillary staff and ten residents and one relative were spoken to. 17 resident questionnaires and 15 relative questionnaires were received prior to the inspection. These were generally very positive, some comments were raised about access to dental care and visits from the local clergy, which the manager is currently addressing what is within her remit. What the service does well: Staff were kind and considerate when helping residents. Residents explained the admission process; this includes a gradual introduction to the home and a detailed pre-admission assessment. This helps new residents adjust and settle into living in the home. Individual care plans are well detailed, regularly reviewed and updated. Staff were more involved in planning and evaluating care and the plans this helps staff give residents the care they need. The management overviews these plans and this helps to provide a consistent staff approach. Residents, where able, described good relationships with the staff and said they were all polite and helpful. Staff were friendly and relaxed and showed a good understanding of residents needs. Arrangements for residents to maintain contact with their family and friends are good. Visitors confirmed that they are always made welcome and kept informed and involved. 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. Meals were seen as a relaxed and social occasion. Hygiene practices were good protecting the health of residents and staff. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 6 The home is well staffed with a skilled, consistent and trained staff team giving security to residents. Staff recruitment and training records were clear and concise and contained all relevant information. The vetting process helps protect residents. The staff have a good understanding of residents individual needs. More than fifty percent of staff are qualified to National Vocational Qualification in Care level 2 (NVQ) or above providing residents with a trained, skilled staff team. The residents were very complimentary about the staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 & 5 Intermediate care is not provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes a detailed pre admission assessment and liaises with the residents and family prior to admission. Residents and relatives have opportunities to visit before admission to the home. EVIDENCE: Care plans had good information to ensure that the home can meet the needs of the prospective resident. The Manager is involved in the decisions and in the majority of instances visits the residents prior to their admission. Residents and relatives spoke of visiting the home prior to admission and that this was useful to reduce anxiety and make the settling in process easier “my sister and I assessed the Grange together and liaised with the Manager with a view to admitting our mother for respite care” “my mother went to the Grange for a weeks respite and I was so impressed with the care”. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are having their needs met by the staff in the home and the staff are skilled in providing the care in a sensitive and dignified manner. This is shown in the documentation and care plans in place. The residents receive their prescribed medication in line with safe working practices. The medicines in the home are well managed and safely disposed of as necessary. EVIDENCE: Two care plans were examined; they were of a satisfactory standard, with relevant risk assessments for the prevention of falls, nutrition, moving and assisting, continence promotion and mental health status. The plans are regularly reviewed and updated. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 10 The care plans showed that the residents have access to all NHS services and facilities, although there is a problem with accessing local dentist “problems with finding a local dentist” the manager is aware but this is not within her control. A number of assessment tools are in use, and they were reviewed monthly, and were dated and signed by the author. Daily reporting of residents care was generally satisfactory, and the changing health care and mental health care of residents was reviewed and up dated “the staff are always alert to any change in their residents general disposition and are quick to investigate any signs of unhappiness or ill health”. The medicines in the home are well managed and safely disposed. The medicines were stored safely. Two residents medications were examined as part of the case tracking both were satisfactory. The controlled drugs procedures were satisfactory. The manager is to undertake an audit to address the minor issues identified. These systems ensure that residents receive their medication in a safe and appropriate way. Staff were treating residents with respect and dignity. Personal care was given in privacy. Staff used residents preferred name at all times. Residents and relatives were complimentary about the staff in the home and felt that they were able to have privacy in their own rooms “our mother needed a high degree of care and attention when she returned to the Grange from hospital. The staff brought her back from deaths doorstep we cannot speak enough of each member of staff” “through her illness my mum always looks well dressed” “it is a comfort to know that she is so well cared for by every member of staff and management of the Grange” “this is the second elderly member of my family who have lived in the Grange, and I am truly grateful to all members of staff and management for all their care” “ I hope my mother can live out the remainder of her life in this environment of such special care” “The atmosphere is warm and loving”. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the flexibility of their routines for daily living and activities. Arrangements for residents to maintain contact with their family and friends and the local community are suited to each individual’s needs and vary accordingly. There is a social programme in place. The food served is good and the residents are happy with the quality and the quantity. EVIDENCE: Residents were generally happy and enjoyed being able to move freely around the home “quite happy to wander from lounge to my own room”. Residents who could not have a conversation with the inspector appeared to be “happy” in that they were smiling with the staff or were enjoying spending time with other residents. Residents and relatives commented “enjoy joining in will have a go at anything” “X has always strived to generate interest in all her activities, her enthusiasm is a real uplift for all the residents” “like the entertainers and dancing” “I would like to see more activities available” “would like to see the vicar visit and give a service” “ I would like a vicar to visit”. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 12 “There are activities but I don’t want to take part. I like just chatting to the activities person and the rest of the staff”. “Our mother is very limited in her mental responses but the staff involve her in everything possible” “I join in when I can” The Registered Manager is currently reviewing social activities and links with the church and a new coordinator has recently been appointed, this will hopefully provide interesting opportunities for all residents. The majority of the residents were moving around the home and were being encouraged to do so even when they were at some risk of falling. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives commented “based on our experience our mother has a very easy and loving rapport with all of the staff, so she can let them know if she is unhappy and they would be quick to detect her mood change” “no matter how busy they are, they stop and listen to our requests or queries and respond to any action we feel is required for our mother, they are equally quick to offer helpful suggestions regarding her care and welfare”. “It is refreshing to visit at all different times of the day and in our view it is a top of the league establishment”. The residents are encouraged to go to places in the local area and families are encouraged and supported to take residents out and about. The residents’ bedrooms were personalised reflecting individual choices and preferences. Residents said they were happy with the decoration Residents take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. All residents, who could, said that they are able to make choices about how they spend their day. Lunch served on the day was observed. The meal was good all of the residents enjoyed the food, which was well cooked. Unobtrusive and discreet staff support was on hand. The tables were nicely set. Mealtimes were a relaxed and social occasion “meals are very good” “plenty of variety and fresh fruit”. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that making it available in a variety of places makes the residents and relatives aware of the complaints policy. Complaints are managed satisfactorily and the necessary action taken. The records of complaints and Protection of Vulnerable Adults referrals are kept to ensure that audits can be carried out. Staff had completed or it was planned for training in the Protection of Vulnerable adults and this is necessary to ensure that residents are protected. EVIDENCE: The complaints procedure is in the service users guide and copies are displayed in the home. Two of the residents said that they knew problems were dealt with and how this would be done. Residents and relatives commented, “ I can talk to anyone” “nothing to complain about everyone helpful” “nothing to complain about very happy here, life is what you make it” “I have had no cause for complain so far” “I have nothing but praise for the Grange”. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 14 The Registered Manager stated that all staff were aware of the whistle blowing policy and informing the Manager of any incidents or issues of which there are concern. Staff confirmed this. It was clear from the training records which staff had completed Protection of Vulnerable Adults training and further training is planned. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe environment. There are good communal areas. There are suitable toilets and baths. The bedroom areas are personalised and comfortable. The home is clean, hygienic with no offensive odours. EVIDENCE: The location and layout is suitable for the residents who live here. There are lounges and a dining room that are pleasantly decorated and furnished. Residents were able to use a range of lounges and there was a range of television and audio equipment available for their use. Bedrooms were well decorated and personalised. Residents and relatives commented, “Her room is always tidy” “beautiful like Buckingham Palace”. The home was very clean with good hygiene practices evident. There were no offensive odours. The laundry was in the process of being refurbished with new industrial washing machines and driers recently installed. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 16 Relatives commented “the home is maintained to the highest standards of cleanliness at all times” The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures there are adequate numbers of staff on duty that have appropriate skills and experience to care for the residents. Staff recruitment records were clear and concise and contained all relevant information. The vetting process helps protect residents. Staff training was well organised with specialised dementia training being undertaken this improves staff skills to meet these needs. EVIDENCE: Staffing rotas showed that there are enough staff are on duty to meet the necessary staffing levels. When sickness and staff holidays occur home staff usually cover, agency staff are not used. The home operates the following staff levels 8am to 3pm 4 carers, 3pm to 9pm 3 carers, 9pm to 8am 2 carers. In additional there is excellent ancillary support. Residents and relatives commented, “The staff are always busy and cheerful” “The staff always communicate with the residents” “the staff and care at the Grange is excellent” “my mother in law is thriving although she is not aware of this” “care is very good, excellent, friendly patient staff” “ always someone around” The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 18 One resident commented “not enough staff on duty, it would be nice if there were a few more staff now and again just to sit and talk to”. There is an in house training programme in place and more than 50 of the staff having NVQ level 2 in care or above. The training programme is up to date for all staff and significant amounts of training are being given to the staff in health and safety, statutory and care practices. Staff said that they are undertaking or had completed NVQ level 2 or over and the home has an induction and training programme for all staff working in the home. Two staff recruitment files were examined and were satisfactory. The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is well run and managed by an experienced, trained person. There are systems in place to organise the home taking into account the needs and wishes of the residents. Good quality systems are established. Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted or protected and the manager ensures safe working practices in the home in line with the company policies and procedures. EVIDENCE: The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 20 The residents and staff made positive comment about the Registered Manager and staff team; they gave examples of improved practices and of the staff team taking time to listen and respond to any concerns they may have “the manager can see and be seen” I think Barbara and the staff at the Grange have been wonderful with my mother, especially as she has gone through a bad patch” “of the three care homes x has been in, this is the best” “Find the home and staff excellent” Regular meetings had been held for residents, relatives and staff with variable attendance. Twice a year questionnaires are given to all residents and relatives and any issues addressed, it was discussed with the manager that publication of these results of the surveys may be helpful to residents, families and supporting professionals. Monthly proprietor visits are undertaken with good written reports and any issues addressed. The home has an annual development plan. Accidents are recorded effectively with accident analyses being completed by the Manager. The system for checking resident’s monies was satisfactory. System testing had been undertaken and maintenance certificates were available The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 21 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 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange Rest Home DS0000040702.V302911.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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