Inspection on 18/04/05 for Upton Grange

This inspection was carried out on 18th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Upton Grange 17/05/07

Upton Grange 25/05/06

Upton Grange 18/08/05

Upton Grange 10/11/04

Upton Grange 19/07/04

Upton Grange 18/02/04

Upton Grange 05/11/03

Upton Grange 07/01/03

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

CARE HOMES FOR OLDER PEOPLE Upton Grange 214 Prestbury Road Macclesfield Cheshire SK10 4AA Lead Inspector Judith Morton Unannounced 18 April 2005 10:00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Upton Grange Address 214 Prestbury Road Macclesfield Cheshire SK10 4AA 01625 829735 01625 820266 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) Cheshire Residential Homes Trust Ms Jacqueline Ross Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/11/04 Brief Description of the Service: Upton Grange is one of three care homes owned by the Cheshire Residential Homes Trust, which is a charitable non-profit making organisation. It provides care for older people who have personal care needs only. There is one bedroom available for a person to stay for short-term respite. A committee manages the care home. The home is close to Macclesfield town centre. There are a number of shops, and other facilities located nearby. There are adequate car parking facilities available at the home. Upton Grange is a two-storey extended building and service users are accommodated on both floors. Access between floors is via a shaft lift or the stairs. Service users accommodation currently consists of 25 single bedrooms of varying sizes, all of which have en-suite facilities. Communal space consists of 2 lounges and a dining room. There is a large private garden with walkways and sitting areas available for service users. There is also an enclosed courtyard seating area. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place over 6¼ hours. A tour of the premises took place and care files for 4 of the residents were inspected. This included the file for one person who was having a respite break at the home. The manager was on duty at the time of the inspection and a further 2 staff, 5 residents and 1 visitor to the home were spoken with. CSCI comment cards were left for 10 residents, 4 relatives, 1 GP and 2 for Social Workers or other visiting professionals to complete. What the service does well: What has improved since the last inspection? The care planning documents and action plans to guide staff on how each resident’s needs were to be met had been improved. This made it easier for staff to find information and check they were carrying out all the actions necessary to meet people’s needs. The manager had reviewed the care plans regularly, which showed that the care plans were being kept up to date to make sure that residents’ needs were being met. The carpet in the corridor outside bedroom 27 has now been replaced. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 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 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 4. Progress has been made in making sure that all needs are assessed before people move in so that new residents and their families are sure that all their needs can be met at the home. There is a clear and consistent care planning system in place, which provides the staff with adequate information so that they can satisfactorily meet the residents’ needs. EVIDENCE: There was a Statement of Purpose and Service User Guide available, which clearly outlined the service that a resident could expect to receive if they lived in the home. In each of the resident’s files looked at there was an assessment of needs, which had provided the information for the care plan. The manager had devised a new method of recording residents’ needs and how these should be met. The records were clear and information could be easily found. She and staff had updated them when required. The manager had reviewed them monthly and signed to say this had been done. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 9 Service users and their relatives were involved in the initial assessment and identification of specific needs and how these should be met. This was confirmed through discussion with a relative during the inspection. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 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. Residents’ needs were, on the whole, being well met with evidence of good multi-agency working taking place. Staff treat the residents with respect, and make sure that their privacy and dignity is upheld. However, risk assessments are needed to make sure that residents who buy or administer their own medication are not at risk of taking medication that could cause them problems. EVIDENCE: Residents’ individual plans of care were set out in a form that covered all aspects of their needs. The information is easy to access and the manager had reviewed the care plans monthly. Staff will need guidance from the manager to ensure the care plans continue to be completed as the manager intended. However, the daily recordings, with statements such as “all care needs met”, and “care given according to care plan” did not identify which needs had been met and what had been done to meet them. It was recommended that residents should be consulted about how their day had been, whether they felt their needs had been adequately met, whether they had enjoyed their meals or the activity. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 11 Records were kept of how health needs were being met and it was suggested that the person making the record should sign them. One resident said she was waiting for a visit from her GP who arrived later. Some residents bought non-prescribed medications for themselves but there were no risk assessments about this. For example, one resident, known to suffer from depression, visited the pharmacy to buy non-prescription medication for himself and this needed to be monitored. Residents confirmed that they could receive their visitors in their room or could go out with them. Staff would knock on their door before entering their room. Staff were observed to speak to the residents with respect and address them by their preferred name or title. The manager confirmed that arrangements in the event of a resident’s death at the home are discussed with relatives or representatives rather than with the resident themselves. However, it was recommended that staff at the home should discuss this subject with each resident to make sure that their own views have been taken into account. It may be helpful to provide training or guidance for staff on how to deal with this sensitive subject. See Requirements 1 and Recommendations 1, 2 & 3 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 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 and14 Residents were very pleased with the level and variety of activities that were provided for them but said they would like to go out more often. They also said they thought the food was good, so they had sufficient food that they enjoyed. EVIDENCE: All of the residents spoken with said that they were able to spend time in their own room if they wished and they could choose whether or not to join in any of the organised activities. They spoke highly of the range of entertainment and activities that were provided for them. A number of residents spoken with said they would like to go out more often, possibly on a day trip, but acknowledged that the weather played a large factor in this. They did say that they had the use of the large, well-maintained garden in the summer. Residents confirmed that visitors were able to call at any time and they could go out with them as long as the staff were aware that they were doing so. Residents said they were able to maintain a degree of independence and make choices about how they spent each day. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 13 Residents spoken with were pleased with the food provided and they felt they received sufficient to eat and drink, commenting on the additional mid morning and afternoon coffee/tea and biscuits. See Recommendation 4 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 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 As there was no evidence of complaints being made to the home, it was not possible to judge how they would be dealt with. Staff at the home were using the Protection of Vulnerable Adults procedures that came into force in July 2004 EVIDENCE: There was a book kept in the dining room in which residents could write if they had any complaints. This had rarely been used. The home had a complaints procedure, which was included in the Service User Guide and displayed on the notice board in the hall. The manager said there had been no complaints and was advised to keep a log of complaints to include the details of any complaints made, action taken, outcome and how and when the outcome was fed back to the complainant. This would enable her to establish if there is a common theme to complaints and to change systems to avoid similar complaints arising. The manager and staff were aware of the policy on reporting poor practice or abuse but did not know about the Protection of Vulnerable Adults (POVA) procedures introduced in July 2004. The manager was not aware that staff should not start work at the home until an enhanced disclosure from the Criminal Records Bureau had been applied for and POVAfirst check obtained. Advice was given about a number of web site addresses from which the information could be obtained. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 15 Training on protecting vulnerable adults from abuse should be provided for all staff so that residents could be kept safe from harm and abuse. See Requirements 2 &3 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 16 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 home was warm, well lit and welcoming, providing a comfortable, safe environment for residents. All areas of the home were clean and well maintained. Residents’ were encouraged to bring items with them when they moved into the home to personalise their own rooms. EVIDENCE: The home was warm and comfortable on the day of the unannounced inspection. There were decorators painting the outside of the window frames. The carpet in the corridor outside bedroom 27 had been replaced as required at the last inspection. The quality of the furnishings was very good, in keeping with the period of the house and the expected lifestyle of the residents. The shared rooms were large, bright and airy. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 17 All of the bedrooms viewed were well furnished and many rooms were large enough to provide the resident with an additional sitting area where they could watch their television or listen to the radio. The residents had also brought some items from their own homes, including small items of furniture, ornaments and photographs. All of the bedrooms had en-suite facilities. The resident in room 17 told the inspector that she had asked for a new room because the pipes that run around the bottom skirting board were too hot and would burn the top of her feet. She could not get close to the window and felt she needed to do this to help with her breathing. The inspector felt the pipes and it was clear that they carried the hot water; they were also evident in all of the rooms viewed in that part of the building. The pipes must be boxed in to ensure the safety of the residents. There were a number of entries in the hot water temperature records that showed the hot water temperature had exceeded 43 degrees centigrade, once by as much as 17 degrees. There were no risk assessments or action plans to describe what safety measures had been put in place while the problem was being rectified. See Requirements 4 & 5 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 18 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 The training provided for staff was sufficient to enable them to meet the needs of the residents and ensure their safety. Residents are protected by the recruitment procedures used by the home but the manager needs to follow the Protection of Vulnerable Adults (POVA) procedures that were introduced in July 2004 in order to protect them fully. However, steps need to be taken to tighten up security to ensure that residents remain safe at all times. Additional safety needs to be provided to the residents in that all people entering and leaving the home must sign the visitor’s book. EVIDENCE: Staff receive induction and ongoing training relevant to their role and many of the staff have achieved NVQ level 2. The manager and deputy manager are both NVQ assessors. Staff files checked showed that a thorough checking process was being followed in recruitment but the manager was not aware of the Protection of Vulnerable Adults (POVA) procedures introduced in July 2004. She was advised where this could be obtained from the internet. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 19 The inspector observed that visitors to the home, including contractors and a GP, had not signed the visitors’ book when they entered and left the home. Steps should be taken to ensure that this is done so that staff are aware of who is in the home and that all visitors have left, in order to keep residents safe. See Recommendation 5 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33, 36,37 and 38 The residents spoken with all said they were happy and found the staff to be approachable and friendly. Staff thought the manager was approachable and was very much involved in the day-to-day care of the residents. Steps need to be taken to consult residents about the way the home is run and formal supervision of the staff should be introduced to monitor staff’s practice and development needs. EVIDENCE: The manager has worked in the home for the past fifteen years and is currently undertaking NVQ level 4 training. She continues to provide a ‘hands on’ approach and therefore is able to observe the practice of the other staff within the home. It was clear from records that this was happening regularly. However, formal, recorded supervision at which staff practice, understanding or policy and procedures, and development needs was not taking place. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 21 There are no formal systems in the home to obtain residents’ views about how the home is run. Policies and procedures were available for the staff to ensure they were consistent in their professional practice and that resident’s rights and best interests are upheld. The fire alarm was being checked weekly and there was a fire drill book completed by the home. A recent visit from a fire office of Cheshire Fire Service had resulted in four recommendations being made. Two of these had been implemented and one was under further consideration by the Committee that runs the home. Appropriate safety and evacuations procedures are in place. See Recommendations 6 & 7 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 3 2 x x 3 2 3 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 23 NO 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 9 Regulation 12 Requirement Risk assessments must be undertaken on residents who obtain and use non prescribed medication. A record of complaints made must be maintained to include information on how it was dealt with, the outcome of any investigation and how the complainant was informed. The manager must obtain information about the Protection of Vulnerable Adults (POVA) processes and staff must receive training on protecting people from harm and abuse. The hot water pipes must be boxed in in bedroom 17 and any other bedrooms where they are exposed. Risk assessments must be carried out and implemented in relation to the hot water temperature exceeding 43 degrees centigrade. Timescale for action 01/06/05 2. 16 17 01/08/05 3. 18 13 01/08/05 4. 25 23 01/08/05 5. 25 23 01/06/05 6. 7. 8. 9. 10. Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 24 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. Refer to Standard 7 7 11 Good Practice Recommendations The records of care given should be specific and link in with the care plan. Residents should be involved as much as possible in the content of the daily recordings. A system of checking residents views about their daily care should be considered. The residents own wishes about what to do in the event of their death should be established and recorded clearly on their file. The manager should consider providing the staff with guidance and/or training on approaching residents about this subject. Steps should be taken to establish the feasibility of day trips being provided more regularly. The visitors book should be completed by all visitors when they enter and leave the home. Residents views about the way the home is being run should be sought. Staff should receive formal, recorded supervision at least six times a year. 4. 5. 6. 7. 12 28 33 37 Upton Grange F51-F01 S6599 Upton Grange V221717 180405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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