Inspection on 23/05/05 for Uphill Grange

This inspection was carried out on 23rd May 2005.

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

Other inspections for this house

Uphill Grange 18/06/08

Uphill Grange 09/01/08

Uphill Grange 25/07/07

Uphill Grange 29/08/06

Uphill Grange 28/11/05

Uphill Grange 16/09/04

Uphill Grange 20/07/04

Uphill Grange 27/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Uphill Grange Uphill Road South Weston Super Mare Somerset BS23 4TX Lead Inspector Alison Murray |Announced 23 May 2005 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. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Uphill Grange Address Uphill Road South Weston Super Mare Somerset BS23 4TX 01934 635422 01934 419384 uphill.grange@fshc.co.uk Acegold Limited 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) Miss Emma Stevenson (awaiting registration) Care Home with Nursing 44 Category(ies) of Old Age - (44) registration, with number of places Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 26 persons aged 50 years and over, requiring nursing careMay up to 18 persons aged 65 years and over, requiring personal care. 2. Manager must be a RN on parts 1 or 12 of the NMC register. 3. Staffing notice dated 03/12/2001 applies Date of last inspection 16 September 2004. Brief Description of the Service: Uphill Grange is registered to provide personal care for up to 18 residents and nursing care for 26 residents. The home is a converted older property in the small village of Uphill, on the outskirts of Weston Super Mare. Accommodation is provided in single and two double rooms. The majority of these have en suite facilities. A large dining room, with a small lounge area, is situated on the lower ground floor. The two main lounges are on the ground floor, and overlook the large garden and surrounding countryside. A passenger lift ensures level access throughout the home. Acegold limited, a wholly owned subsidiary of Four Seasons Health Care, owns Uphill Grange. Miss Emma Stevenson was appointed home manager in November 2004. Her application to become the registered manager has recently been received by CSCI Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an encouraging announced inspection. At the last formal inspection in September 2004, concerns were raised about the standard of care in the home. Three additional visits have been carried out since then. These have demonstrated a steady improvement in the standard of care provided at Uphill Grange. This was confirmed at the inspection. This inspection took place over 8.5 hours. Comment cards were received from 4 residents and 3 relatives. Thirteen of the 29 residents were consulted individually. The inspector chatted with many others, and observed interactions between residents and staff. A total of 8 staff members were informally interviewed. Time was spent reviewing care records and in discussion with Miss Stevenson. All areas of the home were inspected. What the service does well: What has improved since the last inspection? There have been a number of staff changes since the last inspection. New staff have settled well into the home. Miss Stevenson and her deputy have worked hard to encourage a sense of teamwork. The deputy manager and trained nurses were seen to manage their shifts effectively. Care staff said that they were given the information and support they needed to care for the residents. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 6 Both staff and residents were keen to praise the efforts of the recently appointed activities organiser. His programme of activities has proved effective and popular. The care documentation now offers staff the guidance they need to meet the needs of the residents. Medication records are clear and drug ordering systems ensure that residents receive their prescribed drugs. The ongoing programme of re-decoration has made the home look more welcoming and homely. 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. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.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 Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.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, 2, 3, 4 and 5. Standard 6 does not apply, as Uphill Grange does not provide intermediate care. The needs of prospective residents are assessed before admission to the home. The statement of purpose and service user guide do not provide sufficient information for prospective residents to be clear about the range of services offered at Uphill Grange. EVIDENCE: The statement of purpose and service user guide have not been amended since Miss Stevenson started work in the home. The company has produced generic documents, but at the moment, these do not contain information specific to Uphill Grange. Despite having reached agreement with the Office of Fair Trading regarding the terms and conditions of residence, these have not yet been issued to people living in the home. The care records of three recently admitted residents contained a comprehensive pre admission assessment. Two of these assessments were carried out in the local hospital. The third was completed when the prospective resident and his wife came to look around the home. In each case, Miss Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 9 Stevenson had received a care management plan from the placing social worker. One of these gentlemen requires oxygen from time to time. Staff had liaised with his family to make sure that they had an adequate supply for his stay. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.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, 9, 10 and 11 The standard of health and personal care has improved since the last inspection. Care documentation provides staff with the guidance required to meet the needs of residents. Medicine administration records have also improved significantly since the last inspection. There is a good rapport between the staff and residents. EVIDENCE: The care records of 6 residents were reviewed. The standard of documentation had improved significantly since the last inspection. A specific care plan had been written for each area of need identified in the initial assessment. Additional plans were added when needs changed. These were all regularly reviewed and amended. A number of the residents have wounds that require dressing. Wound care plans showed that staff had consulted the Primary Care Trust specialist for advice. The majority of residents in the home have recently chosen to re-register with one named GP. During the inspection, he made his first visit to the home, to meet his new patients. The trained staff on duty showed a very good knowledge of the health needs of these residents. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 11 A significant number of the current residents are very frail. Although they were not able to express an opinion about the standard of care they received, all looked well. They were neatly dressed in appropriate clothing. Attention had been paid to hair and nail care. All the gentlemen were cleanly shaven. Two residents were being nursed in bed. Both looked very comfortable. Care charts confirmed that staff had changed their position and offered drinks regularly. One person said that he needed a specialist diet. He commented that staff monitored his condition and kept him on the ‘straight and narrow’ with regard to his diet. This person’s records contained a detailed nutritional assessment, and a care plan regarding his dietary needs. His weight and blood sugar had been monitored regularly. Residents consulted during the inspection said that the staff were kind and polite. Comment cards received from four residents prior to the inspection confirmed this to be the case. All staff on duty during the inspection were observed to treat the residents with dignity and respect. There was a relaxed an informal atmosphere in the home, with lots of pleasant ‘banter’ between staff and residents. Medicine administration procedures have also improved significantly since the last inspection. All the drug records and medicine storage facilities were inspected. These demonstrated good practice. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14 and 15 The programme of planned and informal activities offered at Uphill Grange, meets the needs and expectations of the vast majority of residents. Residents enjoy the meals provided. EVIDENCE: Since the last inspection, a new activities organiser has been appointed. He has consulted with staff and residents to put together a new programme of activities. Although one person commented that she would like more outings, other staff and residents were all keen to praise the initiatives he has introduced. The home newsletter and bulletin board provide residents with information about what activities are planned. Residents were enthusiastic about his ‘Tallest Sunflower Competition’. A certain amount of exaggeration was apparent, as they told the inspector how tall their seedlings had grown. During the inspection, the activities organiser took a ‘Corner Shop’ trolley around all the residents. He had stocked this with sweets and toiletries. All these items were being sold at cost price, and a price list had been given to residents in advance. Residents said that they really enjoyed being able to choose small ‘treats’ for themselves and their visitors. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 13 It was apparent that residents were able to choose where to spend their time. Some said that they preferred to spend their day in their own room. Many of the more mobile residents moved between the communal lounges, and an informal sitting area in the entrance hall. The majority of residents said that the food provided in the home is good. One person said that she would like more choice. Other residents said that they felt they were offered a good range of alternatives. The meal served during the inspection looked and smelt appetising. Staff offered discreet assistance where necessary. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaint procedure in the home is satisfactory. Staff demonstrate a good awareness of adult protection issues. EVIDENCE: The home has comprehensive policies and procedures in place. Comment cards received from residents and visitors confirmed that they knew of these procedures. Since the last formal inspection in September 2004, three complaints have been received by CSCI. All of these related to incidents that occurred before Miss Stevenson’s appointment as home manager. Four Seasons Healthcare cooperated fully in the investigation of these complaints. One complaint was upheld, one unresolved, and one was not upheld. No complaints have been received by either the home, or by CSCI since November 2004. All staff have received ‘in house’ training in adult protection procedures. Those consulted during the inspection demonstrated a good knowledge of these issues. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The ongoing programme of redecoration has made the home look brighter and more welcoming. This has yet to be completed, but Newly refurbished areas offer an attractive and homely place to live. EVIDENCE: Since the last inspection, the entrance hall and ground floor corridors have been redecorated. This makes the home look much brighter and more welcoming. The paintwork in the upper floor corridors looks shabby. Miss Stevenson hopes that this will be decorated soon. Furniture in the communal lounges has been re-organised, giving a more comfortable and homely feel to these rooms. Staff said that the new call bell system is a big improvement. A number of bedrooms have been also been redecorated, and some carpets replaced. All the residents consulted said that they liked their room. Most had Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 16 chosen to personalise these with small pieces of furniture and pictures. Appropriate equipment had been provided where necessary. At present there is no communal bathroom on the first floor. Residents’ rooms are fitted with baths, but few are able to access these. Miss Stevenson has discussed the possibility of converting one bedroom on this floor into an assisted bathroom. Residents’ rooms were all clean and tidy. No offensive smells were noted. The maintenance person records hot water temperatures every month. A significant proportion of these were much hotter than the recommended 43C. Miss Stevenson said that she would discuss this with the company estates manager. He planned to visit Uphill Grange the week after the inspection. Residents said that the laundry system worked well. The laundry is situated in the basement. There is little space in which to hang drying clothing. This had been strung along the walls of the basement corridor. This poses a potential fire risk. This will be discussed in more detail later in the report. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 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 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, 28, 29 and 30 Staffing levels meet the needs of the current residents. Recruitment procedures are robust, and staff are given the opportunity to attend a wide range of relevant training. EVIDENCE: A comment card received from a relative suggested that that there were not always enough staff on duty. Evidence at the inspection did not confirm these comments. Staff said that they were kept busy, but were not ‘too rushed’. Residents said that their call bells were answered promptly, and the staff kind and attentive. A review of the previous four weeks duty rota demonstrated that the home consistently met the staffing notice. Since the last inspection, staff have attended a wide range of training sessions. These covered both clinical and care issues relevant to residents in the home. None of the current staff have NVQ qualifications, but Miss Stevenson said that two were nearing completion of level 2 courses. Other staff are due to enrol in the near future. Staff records confirmed a robust recruitment procedure Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 18 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) 37 and 38 32, 33, 35, 36, Since the last inspection, the motivation of staff has improved significantly. This has impacted positively on the standard of care delivered. Management and monitoring systems require further development. Risk assessment of the building must be carried out to ensure that unnecessary risks to staff and residents are minimised. EVIDENCE: Since the last inspection there have been many staff changes at Uphill Grange. Miss Stevenson, and Ms Mabena, her deputy have worked hard to encourage and support the staff in the home. Staff consulted during the inspection demonstrated a strong sense of team work. They showed pride in the improvements they have made to the standard of the service. Miss Stevenson said that since her appointment, she has concentrated on improving the standard of care. She recognised that management systems Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 19 now require attention. The company has produced quality assurance and quality monitoring policies and procedures. These have not yet been implemented. A review of the admissions register and care records indicated that significant events have not always been reported to CSCI. The completed pre inspection questionnaire and accompanying information was not received at the CSCI office until the day of the inspection. Although it was clear that Miss Stevenson has received ongoing support from senior management team, reports of their visits have not been sent to CSCI every month. The dining room, kitchen, laundry and storage areas are located in the basement. Residents use the passenger lift to access the basement dining room. Stairs to the kitchen are for staff use only, and are gated. The rubber tread on these stairs in buckled, and poses a potential trip hazard. Doors to the laundry and kitchen were propped open. They were not labelled as fire doors, and were not fitted with automatic closure devices. There were no fire doors along the long corridor linking these areas to the dining room. Laundry was hung up to dry on strings suspended from the walls, and the area used for storage of some cleaning and paper products. The risk assessment of the home does not reflect these potential hazards. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 20 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 1 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 2 3 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 2 x 3 3 2 2 Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 21 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 1 Regulation 4.1 Schedule 1 5.1 13.4 Requirement The Statement of Purpose and Service User Guide must be amended to include home specific information, and reflect staff changes. All residents must be issued with a copy of the homes terms and conditions document. Action must be taken to ensure that the hot water temperature in areas accessible to residents is reduced to around 43C Significant events must be notified to CSCI A monthly report of the conduct of the home must be sent to CSCI A risk assessment of the basement of Uphill Grange must be carried out, in respect of fire safety. A copy of this must be sent to CSCI Risk management strategies must be implemented to minimise any identified risk. The worn treads on the staircase to the kitchen and laundry must be repaired or replaced. Timescale for action 23/07/05 2. 3. 2 25 23/06/05 23/08/05 4. 5. 6. 37 37 38 37 26 23.4 23/05/05 23/05/05 30/06/05 7. 38 Health and Safety at Work Act 1974 23/07/05 Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 19 21 26 28 Good Practice Recommendations The upper floor corridors should be redecorated. An accessible communal bathroom should be provided on the first floor Laundry should not be hung to dry in the basement corridor. Staff should be encouraged to enrol on NVQ training courses. Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Uphill Grange D53_20290_ Uphill Grange_ V220144_ 230503 stage 4.doc Version 1.30 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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