Inspection on 29/06/06 for The Old Grange

This inspection was carried out on 29th June 2006.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Grange 18/06/07

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 The Old Grange College Road Cheshunt Herts EN8 9LT Lead Inspector Mrs Alison Butler Key Unannounced Inspection 29th June 2006 10:00 The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 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 Old Grange DS0000064341.V301924.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 Adults 18-65. 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 Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Grange Address College Road Cheshunt Herts EN8 9LT 01707 646567 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) Grange Care Services Limited Paul Anthony McManus-Wood Care Home 7 Category(ies) of Learning disability (7), Physical disability (3) registration, with number of places The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Not applicable: New Service Brief Description of the Service: Old Grange is a listed building close to Cheshunt town centre and provides care for people with a learning disability, with up to three people with a physical disability. Fees for the services are £900-£1,600 per week. Additional charges are made for newspapers, toiletries etc. (this is correct as at 29/06/06). The home is provided on three floors, the ground floor is able to accommodate up to three people with a physical disability. The middle floor can only accommodate mobile residents. The top floor consists of two self-contained flats (these are to be registered for Domiciliary care). Each bedroom is fitted with a telephone socket and a portable telephone is available for the residents. On the ground floor there is a lounge/diner and a separate seating area. The kitchen has lowered worktops to allow residents to take an active part in the preparation, cooking and serving of meals. Upstairs there is a sleep in room that has some storage space for staff, a toilet and a shower. The laundry is situated on the first floor and is equipped with a washing machine with a sluice cycle. A small office is in the ground floor and does not impinge on the residents’ communal space. There is a secluded and secure rear garden that is fully wheelchair accessible and a small car park The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Due to an administration error this is the first inspection since the home was registered in July 2005. It was conducted with the manager who is due to leave the company in the coming weeks, staff and residents at home. A tour of the premises took place. Care, staff and administration records were checked. Two residents on the top floor live in self-contained flats and are only provided with a fourteen-hour a week care package. A discussion took place with the director of care to apply to be registered for Domiciliary care for those two flats. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose, Service Users Guide and the complaints procedure should be put into a user friendly format to enable residents to make an informed choice of whether they would like to live at the Old Grange and how to make a complaint should they so need to. Some risk assessments must be more detailed to reduce the risk as far as possible and others should be made more individualised to the resident. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 6 A medication review should take place for the individual who no longer requires the prescribed medication. A risk assessment must be carried out where the temperature of the storage area may exceed 25ºC. Training must be arranged for all staff in regard to moving and handling as all staff had not receive this training for a period in excess of a year. Photographs must be obtained for all staff working in the home as per the regulations. The proprietor must ensure that regulation 26 visits are conducted and a report forwarded to the Commission For Social Care Inspection on a monthly basis. The annual quality review has still to be actioned at the Old Grange, which reviews the service and looks at ways of improving over the coming year. 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 Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the home. The home is not providing the care as per the Statement of Purpose. Residents are only admitted following a full assessment of need by a competent individual. EVIDENCE: The information provided in the statement of purpose requires updating in line with regulation 4 and a copy to be forwarded to the Commission For Social Care Inspection. The Service User Guide is not provided in a format that is easy to understand by the residents. The manager stated they have a programme to put the information into a pictorial format. This should provide the residents and/or their representative with the information they need to make an informed choice about whether to live at the Old Grange. Both these documents need to be kept under review and should any changes occur the Commission For Social Care Inspection should be informed of these changes within 28 days. Residents’ needs had been fully assessed prior to admission, they are then taken on a 28-day trial, after which a review is carried out to ensure they able to meet their needs and the resident wishes to remain. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 9 The home is currently providing care for two residents who only require 14 hours per week, which is not in line with the statement of purpose. The organisation is to apply for a domiciliary care service that will allow them to provide the care required by those individuals and it will then cancel two residential places. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the home. Resident’s needs are reflected in the care plans. Risk assessments are in place although not for all risks and they need to be individualised. EVIDENCE: Care plans examined gave details of how individuals would like their needs met. The plans are broken into different sections for example things I need help with, my domestic skills and experience, things I enjoy doing, my ideal weekday, and my ideal weekend. Prior to admission of the recently admitted resident, the manager had received a comprehensive assessment from the funding authority. The resident appears to have settled in well. A review of their care package is taking place next week to look at their care and ensure they are happy with this provision as well as living at the Old Grange. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 11 Risk assessments are in place for residents some require more information on how to minimise the risk, for example radiators that although are not covered have thermostats fitted. Other risk assessment should be individualised to that person. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16, & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the home. Residents are encouraged to engage in activities and meals of their choice. The staff encourage inclusion into the local community. EVIDENCE: Residents are supported to maintain links with family and friends. Residents have a weekly timetable within the care plan. The newly admitted resident has a programme that consists mainly of in-house activities at the moment. The staff are exploring in consultation with the individual possible courses etc. at the local colleges that they might attend in September 2006. Staff and residents were seen to interact well with each other. Staff appear to be knowledgeable about the needs of the residents. The menu is displayed in the kitchen and any changes are added. The menu looked varied and healthy. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the home. All health and personal care support is well maintained within the home, ensuring that individual needs, choices, preferences, privacy and dignity is met at all times. EVIDENCE: The information contained within the care plan describes how the individual likes their needs to be met, what they are able to do themselves. There has been input received from other professionals to meet the individual needs and a request for a physiotherapist has been sought. Examination of the storage and administration of the medication showed that a new recording system should be explored to make the system clearer. A discussion took place with the manager and they would look at adopting a system already in place at one of their other homes to achieve this. A risk assessment must be put in place for the storage area as on the day, it was extremely warm and this may affect the storage of certain medicines if it exceeds 25ºC. Included in the risk assessment was the length of storage of the medicines if the temperature became to high and medication could loose its effectiveness. One person’s medication requires reviewing, as it is apparent that they no longer require it. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the home. There is a complaints procedure in place. Residents are protected from abuse. EVIDENCE: A copy of the complaints procedure is available, although it is yet to be put in to a user-friendly format for the residents to understand. The address of the Commission For Social Care Inspection is included in the complaint procedure so that anyone is able to discuss their concerns if they so wish. The complaints folder was examined and the action taken had been documented but not all the complaints had had the outcome recorded. Staff are aware of the Adult Protection procedure and there is a whistle blowing policy available. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the home. The home creates a homely environment and is well maintained. Bathroom and toilet facilities are adequate and meet the needs of the residents. Staff maintain a good standard of cleanliness and hygiene. EVIDENCE: A tour of the premises was conducted and the staff had maintained a good standard of cleanliness. The individual bedrooms are large and contain an ensuite bath or shower. There are three bedrooms on the ground floor, which are able to meet the needs of people who have a physical disability. A further two bedrooms are located on the first floor and these are only able to accommodate mobile residents. On the top floor are two self-contained flats, which are to be registered under a Domiciliary Care Agency to meet the needs of those living there. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 16 There is a spacious lounge and dining area with a separate sitting area. A wellfitted kitchen is on the ground floor, which has some low level units to enable those in wheelchairs to take an active part in the preparing, cooking and serving up of meals. On the first floor is a laundry. On the top floor is a staff sleep in room. Those residents’ rooms seen were individualised with their own personal items, such as pictures, posters and ornaments etc. Specialist equipment is available for example wheelchairs, hoists and tracking. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the home. Adequate staffing levels are provided to meet the needs of the residents. Robust recruitment procedures are in place including a criminal records bureau check. Training is provided, although moving and handling training requires updating for all staff. EVIDENCE: Examination of the rotas showed that there were adequate staffing levels to meet the needs of the residents. There are three staff covering the core daytime hours, with one waking night staff and one sleep in staff covering the night. A proposed training plan is in place, moving and handling training must be booked before the planned date of December 2006 as the majority of staff have not received training in the last year on this subject. The newly admitted resident suffers from epilepsy so additional training is being organised to ensure that their needs can continue to be fully met. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 18 Two staff have attained at least an NVQ level 2. Three staff are working towards a NVQ award, there is a registered nurse who is also working towards an NVQ level 4, this will enable them to meet the standard of 50 of care staff achieving an NVQ award. Staff records examined showed that all the required information was available with the exception of photographs, which must be obtained. Discussions took place with staff who were very knowledgeable about the needs of the residents, one member of staff is able to communicate with a resident in Bengali, which has enabled her needs to be identified more effectively. The resident also understands English if it is spoken slowly. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 &42 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the home. The home is run for the benefit of the residents. There is a quality monitoring system in place although it is yet to be completed. The residents’ health, safety and welfare is promoted and protected. EVIDENCE: There was a welcoming atmosphere to the home at this unannounced inspection. A quality assurance is in place and questionnaires are sent out to residents, relatives and professionals, these are then sent to head office where they are evaluated and a report written which contains an action plan on areas to work on. This has still to be actioned at Old Grange. They have an annual audit, which concentrates on the policies and procedures and paperwork it is hoped that homes will achieve 80 efficiency. The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 20 Fire records were checked and were well documented and up to date. One Regulation 26 reports has been received since April 2006, the proprietor must ensure that the Commission For Social Care Inspection receive these on a monthly basis giving information on the conduct of the home. A wide range of risk assessments are available although the risk assessment for those radiators that are unable to be covered should give more details of how the risk is to be minimised for example a thermostatic valve is in place. These have been dated and signed. The Old Grange DS0000064341.V301924.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 Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NA 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 YA9 Regulation 13(4) Requirement Timescale for action 31/08/06 2 YA20 3 4 4 YA32 YA34 YA39 5 YA39 The manager must ensure the risk assessments are written for an individual to allow them to take reasonable risks 13 (2) The manager must Explore a better medication recording system that is clearer to understand A risk assessment must be put in place to ensure the temperature does not exceed 25ºC A review of an individual’s medication must take place. 18 (1) (c) The manager must ensure that all staff receive up to date training in Moving and Handling 19(1)(b)(i) The manager must ensure all staff have a photograph in place 26 The proprietor must ensure that reports are received by the Commission For Social Care Inspection on a monthly basis 24 A quality report should be completed which reviews and provide an action plan to improve the service provided at the Old Grange and a copy must be sent to the Commission For DS0000064341.V301924.R01.S.doc 31/08/06 30/09/06 31/08/06 31/08/06 31/10/06 The Old Grange Version 5.2 Page 23 Social Care Inspection. 6 YA42 13 (4) Those risk assessment identified 31/08/06 at the inspection must give more detail on how to reduce the risk and protect all who use and visit the service 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 YA1 Good Practice Recommendations The Statement of Purpose and the Service User Guide should be produced in a user friendly format to enable the residents to make an informed choice about the home they may wish to live in. The complaints procedure should be put into a userfriendly document to enable residents to understand how to make a complaint. 2 YA22 The Old Grange DS0000064341.V301924.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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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