Inspection on 25/09/07 for Walton Grange Christian Residential Home

This inspection was carried out on 25th September 2007.

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

Walton Grange Christian... 18/04/07

Walton Grange Christian... 27/06/06

Walton Grange Christian... 08/03/06

Walton Grange Christian... 27/09/05

Walton Grange Christian... 13/12/04

Walton Grange Christian... 28/06/04

Walton Grange Christian... 24/11/03

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

CARE HOMES FOR OLDER PEOPLE Walton Grange Christian Residential Home 12 Avenue Road Doncaster South Yorkshire DN2 4AH Lead Inspector Ian Hall Key Unannounced Inspection 25th September 2007 09:00 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 DS0000008004.V350484.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. DS0000008004.V350484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walton Grange Christian Residential Home Address 12 Avenue Road Doncaster South Yorkshire DN2 4AH 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) 01302 328439 F/P01302 328439 NONE Mrs Sandra Walton Mrs Sandra Walton Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places DS0000008004.V350484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2007 Brief Description of the Service: Walton Grange is a Christian care home registered for 22 older people. The Christian approach is offered to those people for whom Christianity is important. It does not intrude into the lives of others who attach no importance to religion. The home does not discriminate against potential residents on the grounds of non-belief. The building is a large Victorian property situated on a wide tree lined avenue with similar properties on both sides. Walton Grange is registered to provide personal care for people with dementia. Staff has received additional training to equip them to meet the care needs of people with this condition. Walton Grange offers single room accommodation. Ten rooms have en-suite facilities. All bedrooms are fitted with locks to enable people to lock their individual bedrooms. Staff have a master key to facilitate entry in case of emergency. Lounge areas and other communal spaces provide both television and quiet areas. Information gained on the 25th September 2007 indicates the current fees are £416.00 with additional charges made for newspapers, hairdressing and toiletries. These fee charges only applied at the time of inspection, more up to date information may be obtained from the home. DS0000008004.V350484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Progress made since the last inspection was reviewed. A limited number of the National Minimum Standards were examined at this inspection (with emphasis on the ‘key standards’), and the previous requirements. The person in charge at the inspection was Mrs S Walton, home owner/ manager. The inspector spoke to people who use the service, the staff and visitors to the home. Personal and communal living areas were inspected. Recording systems including risk assessments, care plans, menus, complaint files and staff files were examined. Feedback of the findings was given to the homes owner/manager before the inspector left the home. What the service does well: People using this service continue to express satisfaction with the care provided at the home. Staff promote people’s dignity and privacy. People said that ‘nothing was too much trouble for staff’ and that the home was ‘home from home’. Leisure and social activities arranged both within and outside the home were enjoyed by the people at the home. The storage, ordering, administration and disposal of medication procedures were satisfactory. Activities were organised within the home to stimulate people who use the service and enhance their quality of life. People were given the opportunity to exercise their right of choice regarding the activities and provision of meals. Positive comments were received regarding the food provided. The general comments were that: “The food is good” “We get a choice” Staff had completed a number of training courses; they were positive and keen to develop their level of skill and knowledge. DS0000008004.V350484.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home’s manager should enrol for additional training for the Registered Manager’s Award and National Vocational Qualification level 4 training and assessment in practice. Care assessments and daily recording of care provided require additional detail and information to ensure development of effective plans that meet people’s care needs. Review existing Adult Protection Policy and Procedure to ensure there are effective and robust communication channels in place with timely responses to any concern raised, by each tier of the home’s staff and management. Provide refresher Adult Protection training for staff and share lessons learned from recently concluded adult safeguarding investigations. Provide senior care staff with detailed job descriptions and training that confirms the boundaries of their responsibilities and when to involve higher management in any decision making process. Continue to redecorate the home and refurbish/replace furniture in accordance with the home’s action plan. Quality Assurance systems need further expansion to ensure that the service provided is measured and responds to the views of people who live at the home, their advocates, visitors and employees. DS0000008004.V350484.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000008004.V350484.R01.S.doc Version 5.2 Page 8 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 DS0000008004.V350484.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. Pre admission assessments did not all demonstrate that individual needs had been planned for before the service users moved into the home. Information was provided to enable people to choose whether Walton Grange is the home for them Individual written contracts detailing terms and conditions of residence provided information for people who use the service. DS0000008004.V350484.R01.S.doc Version 5.2 Page 10 EVIDENCE: The preadmission assessment for a prospective person had not been completed even though a pre admission visit had been made. There was no initial care plan prepared in readiness for his admission. Not all case files examined contained completed copies of care assessments, care plans, many sections lacked detailed individual needs and abilities. Local authority contract reviews had not all been completed in a timely manner, despite the actions of the homes management team who should have been more assertive in requiring this information. This means that staff are not fully informed about the individual and their specific needs. Staff confirmed that any specialised equipment that may be required is obtained before any person is admitted to ensure people’s health and wellbeing is maintained. Intermediate care is not provided at the home. DS0000008004.V350484.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. Health and personal care was not satisfactorily promoted due to lack of information for staff. Safe systems for the ordering, storage and administration of prescribed medication were in place to protect people using the service. EVIDENCE: The case files examined lacked detail within care assessment they consisted mainly of tick box responses and lacked individual detail of needs and abilities. This had resulted in incomplete areas within care plans. Therefore staff were unclear about the actions they should take to care for the person. DS0000008004.V350484.R01.S.doc Version 5.2 Page 12 The care plans overall were adequately compiled, they promoted dignity, privacy and encouraged independence. They contained adequate information to enable people who were not familiar with the individual to meet most care needs effectively. Risk assessments had been recorded and evaluated, however one had failed to promote one person’s safety. The inspector discussed areas where improved information within daily records would reflect the quantity and quality of service/care provided. There was written evidence of consultation and support from doctors, psychiatrists and specialist nurses such as community psychiatric nurses. chiropodist, ophthalmic and dental care had been recorded. Specialist equipment had been obtained and used to maintain peoples wellbeing such as pressure relieving mattresses. Staff were seen knocking on bedroom doors and waiting to be invited before entering. Staff were seen interacting with people and showing empathy for their needs. Staff were observed administering medication and helping people to take their prescribed medicines. Records were correctly maintained and medicines stored safely. There were a range of policies and procedures to provide guidance for staff and maintain people’s safety. Staff had received accredited training for safe administration of medicines. None of the people living at the home was responsible for their own medication although this facility is available. DS0000008004.V350484.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. People were encouraged to maintain and develop social and independent living skills within the home and local community. People were encouraged to eat a healthy and varied diet. EVIDENCE: A personal history describing peoples lives and interests had been documented, it included religious and cultural needs to inform basic lifestyle issues such as diet and dress, and how staff, sometimes in conjunction with families should act to meet these. People were encouraged to choose their own clothes to wear each day, decide when to bathe, where to sit and select their own meals. Staff confirmed that nourishing drinks and snacks were readily available throughout the day. DS0000008004.V350484.R01.S.doc Version 5.2 Page 14 The meals served on the day of the inspection appeared well cooked and well presented. Staff were observed to encourage and assist with meals as needed. Four people were spoken with about the food, three said they liked the food; the other person was not able to clearly say due to problems associated with dementia. Mealtimes were unhurried with extra portions available as required. Portions were adjusted to each person likes and needs. Specialist diets were available for those requiring this service. People were encouraged to eat healthily. There was a four weekly menu with records kept of each persons food consumption. Alternative meals were available if they did not like the planned meal. The home does not employ an activities co-ordinator. Care staff were observed to organise activities on either a one to one or small group basis. Care plans and daily records referred to activities that people had taken part in and their participation such as watching TV, listening to music, reading newspapers, watering plants, visits to church, trips out with staff, locally to shops, garden centres, park and home visits for those people that have relatives. DS0000008004.V350484.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. The complaints policy and procedure and staff training require review to ensure protection for people living at the home. EVIDENCE: People did receive information that would enable them to make a complaint. Two complaints had been received and investigated by the DMBC Adult Protection team. A person’s care needs had significantly changed, however these had not been identified and responded to. This had resulted in a person’s care needs not being fully met and being left at risk that could have been avoided. Policies and procedures for dealing with complaints require review to ensure they are robust and fit for purpose. Additional staff training to improve communication and ensure timely and effective responses by senior staff and management had not been provided. DS0000008004.V350484.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. The home was clean, odour free and homely, bedrooms were furnished to meet their needs. Specialist aids and adaptations that promote independence and safety were not available in all toilet and bathing areas. EVIDENCE: Work in progress included redecoration of lounge areas, addition of a sun lounge and improvements to the secure garden area. DS0000008004.V350484.R01.S.doc Version 5.2 Page 17 Aids and adaptations had been removed during refurbishment of some toilet and bathroom areas this reduces people’s opportunities to maintain their independence and presents a safety risk. A range of colours had been used to individualise and improve the appearance of the bedrooms. A number of families had assisted with personalisation of bedrooms with favourite items and memorabilia. New carpeting and furniture had been provided in some bedrooms. Additional items of furniture were identified that needed early replacement and updating. The secure gardens were accessible to people who live at the home whenever the weather was suitable. DS0000008004.V350484.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. Staff had received training to meet the people’s general and specific needs. A range of training was available for staff. Appropriate support and guidance was offered to new staff, enabling them to safely care for people. Staff files included the required information. The home operated a recruitment policy that promoted the protection of people. EVIDENCE: People living at the home said that staff were always busy and worked hard. Staff undertook cleaning, laundry and some kitchen duties in addition to their care role. The numbers of care workers and ancillary staff on duty was able to meet the people’s needs. The staff were well motivated and enthusiastic about their work. They confirmed that not only were they well supported in their work but actively encouraged and supported to develop personally. The manager is supporting DS0000008004.V350484.R01.S.doc Version 5.2 Page 19 staff to progress and increase their skills and competence. Staff are undertaking NVQ training some at level 3. Training had been provided to increase staff awareness of dementia care this promotes good practice and people’s rights. Staff have undertaken statutory training and updates i.e. fire prevention, basic food handling & hygiene. The numbers of staff who had achieved National Vocational Qualifications exceeded the minimum 50 recommended by the National Minimum Standards, a number of staff had completed their NVQ training and assessments and were awaiting NVQ certificates. DS0000008004.V350484.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service and seeking the views and experiences of people who use the service. Management systems had failed to properly supervise staff. This had an impacted negatively upon the care and services provided to people who live at the home. EVIDENCE: The manager has not attained her NVQ 4 Managers Award, as required by the Care Standards Act 2000. She is also the homes owner and has in excess of 25 years caring experience. DS0000008004.V350484.R01.S.doc Version 5.2 Page 21 Visitors to the home stated that they had ready and easy access to the homes management and that they felt confident in them. Staff stated here was always a senior member of staff on duty at the home with advice and support readily available. Responsibilities were shared between senior members of the team. The manager monitored case files and the personnel files to ensure policies and procedures were adhered and enabled her to identify where improvements were needed in these areas. Staff files contained evidence of completed statutory checks required to protect vulnerable adults. The managers system for meeting the training needs of staff was under review. This enabled her to ensure staff had the necessary skills to provide the care and service that the service users require. The home assisted 2 service users to manage their pocket monies. The monies held and records maintained were correct. The homes quality assurance and audit system required updating to ensure that people who lived at the home were assured that the care and services provided were continuously reviewed and of the highest standard. Meetings were held for people who live at the home, their advocates and the staff team. This enabled people to have a voice in the running and management of the home. Health & Safety at Work risk assessments have been reviewed to maintain continued safety for service users, visitors and staff at the home. Statutory checks and servicing of equipment are undertaken and records maintained. The Environmental Health and Fire Prevention Services inspection the reports were positive the home met all requirements to provide a safe environment for service users. DS0000008004.V350484.R01.S.doc Version 5.2 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. 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 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x 2 x x x x 3 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 2 x 2 x 3 x x 3 DS0000008004.V350484.R01.S.doc Version 5.2 Page 23 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. Standard OP31 Regulation 10(3) Requirement The registered manager must register to attain a level 4 NVQ and the registered managers award. Previous timescale 30/09/07. Written confirmation of the action taken must be sent to the local office of CSCI by 05/12/07 An effective quality assurance and quality monitoring system, based on seeking the views of people using the service must be implemented. This must be used to measure success in meeting the aims, objectives and statement of purpose of the home. Previous timescale 30/09/07. Written confirmation of the action taken must be sent to the local office of CSCI by 05/12/07 Policies and procedures must be reviewed to reflect good practice Previous timescale 30/09/07. Written confirmation of the action taken must be sent to the local office of CSCI by 05/12/07 Pre-admission assessments must be documented to demonstrate DS0000008004.V350484.R01.S.doc Timescale for action 30/11/07 2. OP33 24 30/11/07 3. OP33 24 30/11/07 4. OP3 14 30/11/07 Version 5.2 Page 24 5. OP7 15(2) 6. OP18 22 7. 7. OP18 OP22 13(6) 23(2)(n) 9. OP30 18(1) that the home is both able to meet a prospective person’s care needs and a plan to meet the identified needs is in place. Assessments and daily recordings must include additional detail and information to ensure the development of effective plans that meet people’s care needs. The Adult Protection Policy must be improved to safeguard people living at the home, especially communication and speed of response. Adult Protection training must be provided for all staff. Hand rails and other aids to promote safety and independence must be put in place. Provide senior care staff with detailed job descriptions and training that highlights the boundaries of their responsibilities and when to involve higher management in decision making. 30/11/07 30/11/07 30/11/07 30/11/07 30/11/07 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 Standard Good Practice Recommendations DS0000008004.V350484.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000008004.V350484.R01.S.doc Version 5.2 Page 26 - 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. 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