Inspection on 28/11/05 for Uphill Grange

This inspection was carried out on 28th November 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.

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 23/05/05

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 North Somerset BS23 4TX Lead Inspector Alison Murray Unannounced Inspection 22nd November 2005 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 Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Uphill Grange Address Uphill Road South Weston Super Mare North Somerset BS23 4TX 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) 01934 635422 01934 419384 Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) To be appointed Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 26 persons aged 50 years and over requiring nursing care May accommodate up to 18 persons aged 65 years and over requiring personal care Manager must be a RN on parts 1 or 12 of the NMC register. Staffing Notice dated 03/12/2001 applies Date of last inspection 23/05/05 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. She has passed a fit person interview, to become the registered manager. Until CSCI receives all the necessary references, she cannot be formally registered as manager of the home. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection, over 4 hours were spent in the home. There were 26 residents in the home, with another in hospital. A large group of residents were in the panelled lounge making Christmas table decorations. They were happy to chat informally with the inspector. Other residents were consulted individually in their own room. Detailed conversations were held with a group of three staff, and also with Miss Stevenson and her deputy, Ms Mabena. Other staff were observed as they went about their work. What the service does well: What has improved since the last inspection? It was pleasing to see that improvements noted at the last inspection have been sustained. The ongoing programme of re-decoration continues to make the home look more welcoming and homely. The company has finalised its terms and conditions of residence. This has now been issued to all residents Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3 and 4. Standard 6 does not apply Prospective residents and their relatives are given clear information about Uphill Grange, and the service it offers. Care needs are comprehensively assessed before admission to the home. Staff are given additional training if required to ensure that these needs can be met. EVIDENCE: Since the last inspection, the statement of purpose and service user guide have been amended to contain information about the specific range of services offered at Uphill Grange. These are clearly written in accessible language. The company have now issued all residents with a copy of the terms and conditions of residence. This includes clear information about how the fee is calculated, and what it includes. Miss Stevenson said that she visits all prospective residents before admission to the home. At this visit, she completes a comprehensive assessment of the Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 9 physical and emotional needs of the prospective resident. Care records contained copies of this assessment. One person was recently admitted for a respite break. He visited the home with his family before making a decision to stay. This person has very complex needs. Miss Stevenson liaised with other health professionals to ensure that staff received additional training in order to meet his needs. It was apparent that the placement had been very successful. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 10 and 11 Residents care needs are well met at Uphill Grange. Staff liaise effectively with other health professionals to ensure that the residents have access to a wide range of services. They are treated with friendly respect by the staff team. EVIDENCE: Care records of 5 residents were reviewed. Each contained a detailed admission assessment. Care plans were in place for each area of identified need. Care plans had been reviewed every month, but in some cases needs had changed in between reviews. This was reflected in the daily reports, but not in the care plan. Conversations with staff confirmed that they were aware of these changes, and had delivered appropriate care. It was apparent that a significant number of residents were not able to attend to their own personal hygiene. All those consulted during the inspection were neatly dressed, with well-groomed hair. Several residents were unwell, and being nursed either in bed, or in reclining armchairs. All looked peaceful and comfortable. They all had at least one drink and a call bell readily at hand. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 11 Care charts confirmed that their position was changed regularly, and fluids offered. Care records indicated that a number of the residents were assessed as at risk of developing pressure sores. The use of pressure relief equipment was not recorded in the care records. Visits to their rooms confirmed that all been provided with pressure relieving mattresses and seat cushions. Residents consulted during the inspection were keen to tell how their health had improved since admission to Uphill Grange. One person said that staff had worked very hard to heal long-standing pressure sores. Together they had negotiated a programme of care to meet his social and health needs. This resident said that his condition had improved so much, that he was now receiving regular physiotherapy, with a view to returning home in the long term. Another resident has been admitted for terminal care. The hospice team visit regularly to support both the resident and the staff. Nurses at Uphill Grange have contacted other health professionals to ensure that care needs are met. All the staff observed during the inspection treated the residents with dignity and respect. There was a very friendly informal atmosphere in the home. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 the following standard(s): 12 and 15 Residents are given the opportunity to join in a wide range of activities. They enjoy the food provided, and appreciate the choices they are offered. EVIDENCE: Photographs and news clippings of recent events were displayed around the home. Over the summer months, residents took part in a sunflower growing competition, garden fete, and numerous birthday parties. A regular newsletter tells residents and their relatives about the planned activities for the month. Several people said that they were looking forward to the Christmas party. During the inspection, a large group of residents were making Christmas table decorations, using holly and ivy from the grounds. Staff were on hand to help less able residents. There was lots of laughter, and friendly competition to see who could make the best decoration. A number of residents praised the food offered at the home. One person said that he was trying to loose weight. The cook had been to see him, to discuss what food he should be choosing from the menu. He said that she ‘let him cheat every now and then’. Another person said that there was always a choice of main meal ‘but if you don’t like it, as long as you let them know, you can Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 13 have something different’. Staff said that they were able to make snacks for residents in between meals. They gave an example of a resident who had very little appetite, but sometimes ‘fancied a bit of cheese on toast’. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 Residents feel able to discuss areas of concern with the staff. The manager conducts a thorough investigation into complaints or concerns about the home. EVIDENCE: In conversation, staff demonstrated a sound awareness of adult abuse issues. They were very clear what they should do if they felt that a resident was at risk. Residents said that they would have no hesitation raising concerns with Miss Stevenson or her staff. Since the last inspection, one complaint has been sent directly to CSCI. Miss Stevenson is completing an investigation into the issues raised, and will send a report of her finding to CSCI. A brief review of this during the inspection showed that Miss Stevenson has been thorough in her investigation. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 the following standard(s): 19, 21, 25 and 26 The ongoing programme of redecoration has made the home look brighter and more welcoming. Until guards are fitted to all radiators, there is a risk of residents being burnt, should they fall against them. Concerns raised at the last inspection about laundry practices have not been addressed, and pose a fire and infection control risk. EVIDENCE: Since the last inspection, the maintenance person has decorated a number of bedrooms, and started to repaint the first floor corridors. His work is of a high standard, and has significantly enhanced the appearance of the home. 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. At present the company has no plans to do this. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 16 Since the last inspection, hot water temperatures have been within the recommended limits. Guards are fitted to some of the radiators. Unguarded radiators in some bedrooms were extremely hot to touch. They placed residents at risk of burns or scalds. 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. Washable incontinence sheets were hung to dry directly above a trolley containing clean crockery and cutlery. This is poor practice, and is an infection control risk. It also poses a potential fire risk. This was raised at the last inspection, but has not been addressed. It will be discussed in more detail later in the report. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. Staffing levels meet the needs of the current residents. EVIDENCE: 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. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 37 and 38 Miss Stevenson is settling well into her role as home manager. Concerns about the basement area of the home identified at the last inspection have not yet been addressed, and continue to pose a fire risk to everyone in the home. EVIDENCE: Since the last inspection, Miss Stevenson has successfully completed a ‘fit person’ interview to become the registered manager of Uphill Grange. CSCI are unable to complete the registration process until they receive all the necessary references. Miss Stevenson said that she plans to complete a recognised management qualification within the next year. Staff and residents said that they liked her style of leadership. They said that they felt that she had the right balance between ‘ being approachable, and being the boss’. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 19 The records reviewed during the inspection were up to date and accurate. Mrs Matthews, the regional manager for the company visits the home regularly. She sends a report of these visits to CSCI. Miss Stevenson has notified CSCI of any significant events in the home. The dining room, kitchen, laundry and storage areas are located in the basement. 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. Since the last inspection, Miss Stevenson has carried out a risk assessment of this area. The risk assessment clearly states that laundry is not to be hung up to dry in the basement corridor. Despite this, on the day of inspection, laundry was hung up to dry on strings suspended from the walls. Miss Stevenson said that she has obtained estimates to fit fire doors along the basement corridor. She sent these to the company estates department, but has not yet received a response from them. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X 2 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X 3 2 Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 2 3 4 5 6 Standard OP7 OP8 OP25 OP26 OP31 OP38 Regulation 15.-(2) 12.-(1) 13.-(4) 23.-(4). 13.-(3) 9.-(1) 23.-(4) Requirement Care plans must be updated to reflect resident’s changing needs. The use of pressure relief equipment must be recorded in the care records. Guards must be fitted to radiators. Laundry must not be hung to dry in the basement corridor. Miss Stevenson must successful a recognised management qualification. Risk management strategies to minimise identified fire risk in the basement area must be implemented. Not met within previously agreed timescale of 30/06/05 Timescale for action 28/11/05 06/12/05 28/02/06 28/11/05 30/09/06 28/02/06 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 Good Practice Recommendations DS0000020290.V255317.R01.S.doc Version 5.0 Page 22 Uphill Grange 1 2 Standard OP21 OP28 An accessible communal bathroom should be provided on the first floor Staff should be encouraged to enrol on NVQ training courses. Uphill Grange DS0000020290.V255317.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street 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. 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