Inspection on 18/08/05 for Upton Grange

This inspection was carried out on 18th August 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 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 18/04/05

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 Announced 18 August 2005 09:30am 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 V237041 180805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Upton Grange Address 214 Prestbury Road Macclesfield Cheshire SK10 4AA 01625 829735 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 OP Old age (25) registration, with number of places Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 April 2005 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 residential 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 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 seating areas available for service users. There is also an enclosed courtyard seating area. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 6 ½ hours. Nine of the residents, one relative and four of the staff were spoken with. A number of completed CSCI questionnaires had been received from residents and care professionals prior to inspection. Lunch was shared with the residents and many then showed the inspector their room. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 6 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 V237041 180805 Stage 4.doc Version 1.40 Page 7 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) 2 & 5 Prospective residents can visit the home and there is information available so they and their relatives can see what is available before deciding to move into the home. Statements of terms and conditions of living at the home are given to residents so they and their relatives know what their rights and responsibilities are. EVIDENCE: There were contracts/statements of terms and conditions in the three files checked at the inspection. The resident and/or their representative had signed these. The manager said that visits from prospective residents and their families were welcomed. She was heard to explain this to a family member of a potential resident over the telephone. The home does not offer intermediate care so standard 6 is not applicable. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 8 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 &11 Residents’ needs were, on the whole, being well met with evidence of good multi-agency working taking place. Staff were generally well thought of by residents but need guidance about managing difficult behaviour so that they can give respectful care to all residents at all times. EVIDENCE: There were care plans available on the three files viewed. They were being reviewed monthly and changes identified. However, one resident’s health had deteriorated considerably but the change in her care needs and how these should be met were not reflected in her care plan. The manager was able to describe clearly the additional care that they were giving and a relative who was visiting daily, spoke highly of the attention that the resident was being given. The resident’s care plan was not due for review until a week’s time, when all the additional information would be added. However, care plans should be reviewed and updated as and when needs change so that all staff are fully aware of their responsibilities in delivering care. See Requirement 1 Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 9 There had been some improvement in the content of the daily records but they were still being completed without the residents’ involvement. It had been recommended at the previous inspection that residents should have some involvement in this recording so that it provided an accurate summary of their day. This recommendation is repeated at this inspection. See Recommendation 1 There was plenty of evidence, both written and verbally from residents, of health needs being met. Forms in residents’ care files showed the date and reason for visits from health care workers such as GPs, district nurses, diabetes nurse, chiropodist etc. Visits made by residents to, for example, dentists and hospital, were also recorded. Medication was being stored and administered safely, with accurate records of administration being kept. The staff were observed to knock on the resident’s doors before entering their rooms. Most of the residents spoken with individually said that the staff were, “delightful, caring, patient and kind”. However, one resident said “ the staff have to sometimes be firm with some of the more awkward” residents and was gave an example. One of the questionnaires returned prior to inspection also highlighted staff attitude as sometimes being a problem. The staff should address all residents with respect and should receive guidance and/or training on how to prevent or manage difficult behaviour more appropriately. See recommendation 2 The manager has begun the process of ensuring that the resident’s wishes in the event of their death are recorded on their file and also intends arranging training in bereavement and loss for all of the staff. See recommendation 3 Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 10 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 & 15 The variety of activities that were provided for the residents together with regular monthly day trips ensure that the residents are kept stimulated and active. Residents enjoyed the food provided so they received a varied and nutritious diet. EVIDENCE: There are a number of activities held at the home each month. These are planned in advance and include, music and movement, beauty mornings, hairdresser, games mornings, film night (with a big screen being used) and a number of artists who call at different times each week to sing and play music. There is also a ‘shop’ held on alternative Sundays at the home for those residents who are unable to go out. There was a mystery coach tour and picnic in July and a canal boat trip planned for August. A colourful leaflet is produced monthly with dates and times of activities and each resident is given a copy to keep in their room. The residents confirmed that they could receive visitors at any time and there was a notice advising this on the notice board in the hall. Some of the residents are able to go out independently and go for walks around the local area. One resident had been away on holiday for two weeks to stay with her friends. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 11 All of the residents spoke highly of the food provided. The lunch on the day of inspection was well cooked and presented. The lunch period was enjoyable and relaxed. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 12 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 & 18 Residents and their relatives are aware of who to complain to so their concerns are listened to and acted upon. There are adult protection procedures for the home but newly appointed staff need to receive training on awareness of abuse of adults so residents are protected from possible abuse and poor practice. EVIDENCE: The complaints procedure and information about who to complain to are included in the service user’s guide and there is a copy of the complaint procedure on display in the hallway. The manager has devised a complaints log book since the last inspection that which would ensure a complaint is followed through to the outcome of the investigation. There are policies and procedures available for staff on protecting vulnerable adults from abuse. Staff who have completed NVQ level 2 or 3 have covered some aspects of adult abuse awareness in their training. However, four new care staff have started working at Upton Grange since the last inspection and guidance or training on protecting vulnerable adults from abuse should be provided for them so that residents could be kept safe from harm and abuse. See Recommendation 5 Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 13 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 & 25 The home is generally well maintained to provide a comfortable environment for the residents. However, there are a small number of problems relating to safety that are being addressed but need to be completed quickly so that the residents are safe at all times in all areas of the home. EVIDENCE: The pipe work identified as needing boxing in at the last inspection had not yet been done but the manager said it was in hand. The pipes must be boxed in as soon as possible to ensure the safety of the residents. See requirement 2 The hot water system had been regulated for those sinks/bathrooms that were controlled through the main boiler so that the hot water was supplied at a safe temperature for the residents. However, there are still a small number of rooms where the hot water exceeds 43 degrees centigrade. Although the residents in these rooms all needed help with washing so staff would check the hot water temperatures for them, thermostats should be fitted to these sinks as soon as possible. See requirement 3 Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 14 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 & 30 Adequate training is provided for staff to ensure that they can meet the needs of the residents. Thorough checks need to be carried out on all new staff so the residents are protected fully from possible harm or poor practice. 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 and the home has now registered with The Cheshire Care Consortium for training in NVQ level 2- 4 and with the Care Management Council for general or specific training for all staff. This will include dementia care, diet and nutrition, bereavement and loss, plus audio and visual awareness and care. Staff files checked showed that a thorough checking process was being followed when recruitment for full time, permanent staff. However, the handyman was a temporary worker for the summer and the manager had failed to make adequate checks through POVA and CRB before offering him employment. The manager said she would apply for a POVA first check immediately. See requirement 4 The manager was now aware of the Protection of Vulnerable Adults (POVA) procedures introduced in July 2004 and had obtained the documentation for POVA first checks to be completed for all new staff. The inspector observed that since the last inspection the visitor’s book was now being completed when people entered and left the home. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 15 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) 33, 34, 35 & 38 Steps need to be taken to consult residents so they can have a say in how the home is run. The residents’ safety is assured through the regular health and safety checks conducted at the home. EVIDENCE: Although the home is being run well, there is still no formal system to obtain residents’ or their relatives’ views about how the home is run. Consideration is being given to having a suggestion box and a simple form which could be completed by anyone visiting the home as well as the residents. Policies and procedures were available for the staff to ensure they were consistent in their professional practice and that residents’ rights and best interests are upheld. As residents’ families mainly deal with their finances, staff at the home do not get involved with this. Small sums of money for service users to pay for items such as hairdressing and newspapers are kept at the home. These are held in a lockable tin and receipts of all monies going out or in are held. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 16 The fire alarm was being checked weekly and there was a fire drill book completed by the home. There had been a full evacuation drill the week prior to inspection. Although this had been a false alarm, the exercise had gone well and had not highlighted any areas of improvement. The home has alternative accommodation organised in the event that a full evacuation is needed but this was not used on this occasion, as the residents were able to return into the home very quickly. Other safety checks being carried out and recorded included environmental health, emergency lighting, electrical wiring and the passenger lift. A current Employer’s Liability insurance certificate was displayed at the care home. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 17 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 x 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 x x x x x 2 x STAFFING Standard No Score 27 3 28 3 29 2 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 x 3 3 3 x x 3 Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 18 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. 2. Standard 7 25 Regulation 15 23 Requirement Care plans must be updated as residents needs change. The hot water pipes must be boxed in in bedroom 17 and any other bedrooms where they are exposed. Thermostats must be installed to the sinks/baths where the hot water temperature exceeds 43 degrees centigrade. The manager must undertake all the required checks for all staff regardless of the likely duration of service, before they start working in the home Timescale for action 01/04/06 01/04/06 3. 25 23 01/04/06 4. 29 19 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 7 10 Good Practice Recommendations Residents should be involved in what is recorded in the daily diaries Staff must have guidance or training on how to prevent or manage difficult behaviours so that residents are treated with respect at all times. . F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 19 Upton Grange 3. 4. 5. 11 18 The wishes of all existing residents, in the event of their death, should be established and recorded clearly on their file. All staff should receive training on protecting people from harm and abuse. Upton Grange F51 F01 S6599 Upton Grange V237041 180805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, 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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