Inspection on 13/09/07 for WCS - Attleborough Grange

This inspection was carried out on 13th 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 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

WCS - Attleborough Grange 20/01/10

WCS - Attleborough Grange 24/10/06

WCS - Attleborough Grange 16/02/06

WCS - Attleborough Grange 21/09/05

WCS - Attleborough Grange 06/12/04

WCS - Attleborough Grange 19/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE WCS - Attleborough Grange Attleborough Road Nuneaton Warwickshire CV11 4JN Lead Inspector Jean Thomas Key Unannounced Inspection 13th September 2007 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 WCS - Attleborough Grange DS0000004261.V343338.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. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Attleborough Grange Address Attleborough Road Nuneaton Warwickshire CV11 4JN 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) 02476 383543 02476 326704 admin@attleborough.f9.co.uk Warwickshire Care Services Limited Mrs Dorothy Collis Care Home 31 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (20) of places WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2006 Brief Description of the Service: Attleborough Grange was built in the early 1900’s and totally refurbished in 1995. A large extension was added to the rear and side of the original building providing purpose built accommodation. The home is one in a group of care homes owned by Warwickshire Care Services. The home is currently registered to provide personal care for people over 65 and has specialist registration for dementia care. The accommodation includes single bedrooms and one shared bedroom. Twenty of these rooms have en suite facilities. The home is designed for group living in four self contained units. Each unit has its own lounge/dining area and kitchenette facilities. Griff House is a specialist dementia care unit for eleven service users. In addition to long/short stay accommodation; the home also provides day care services for up to eight clients. Day care service has its own facilities and staff. The home has mature gardens and patio areas, which are accessible to the homes service users. These have been designed to meet the needs of the service user groups catered for at Attleborough Grange. Further developments are planned for the garden areas. Weekly fees are agreed depending on the assessed needs of an individual and on whether the accommodation has an ensuite facility. Additional costs are; hairdressing (£6 - £19), chiropody (£10), toiletries, outings and newspapers are variable in costs dependent on the individual’s wishes. The home purchase four daily newspapers (one for each unit). There may be additional costs for opticians and dentists etc. depending on an individual’s health care arrangements. The manager provided this information on the 13th September 2007. Copies of previous Commission for Social Care Inspection (CSCI) reports are available upon request at the home and there is a ‘display stand’ where a copy of the most recent report is kept for anyone to read. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the CSCI is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was a key unannounced inspection of the service, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Attleborough Grange will be referred to as ‘residents’. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. Two people living at the home were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ and where evidence of the care provided is matched to outcomes for residents. A tour of the building and several bedrooms was made and observations at a mealtime. The inspection took place over eight and three quarter hours on the 13th September 2007. The inspector had the opportunity to meet a number of the residents by visiting them in their rooms and spending time in communal lounges and dining areas and talked to several of them about their experience of the home. Residents on Griff house have a diagnosis of dementia and some had difficult engaging in conversation. General observations of working practices and staff interaction with residents were included in the inspection process. The manager and five staff members were spoken to. At the end of the inspection, feedback was given to the manager. Surveys were sent to ten residents and their relatives or representatives before the inspection visit to the service, of which five were received from relatives and one from a resident. Comments noted from residents relatives and representatives include, “They are genuinely kind and conscientious” “I feel they look after my sister very well” nothing is to much trouble” “I find them very helpful” “They are always their to help they can’t do enough for you, the home is always very clean, he likes all the meals provided.” and WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 6 “I have nothing but good to say of Attleborough Grange. I could not wish my mother to be with more caring people.” The one survey received from a resident shows service satisfaction. There were no additional comments made. All of the residents spoken to on the day of the inspection visit expressed satisfaction with the service. Comments noted include, “I have settled here very well and have no complaints” and “they look after me very well.” There were 30 residents residing at the home on the day of the inspection. The registered manager facilitated the inspection. An Annual quality Assurance Assessment (AQAA) document was completed by the manager and was received by the commission before the inspection visit to the service. Two shortfalls identified during the last key inspection visit were looked at to ensure compliance. Since the last inspection, there has been an allegation of abuse. This was in January 2007 and in the form of a complaint from a resident who expressed concern about the conduct of a staff member. In accordance with the local arrangements for safeguarding adults, the manager referred the allegation to social services the lead agency responsible for investigating allegations of abuse. A record of the investigation and the outcome were held at the home and showed that the staff member was to attend further safeguarding training. The inspector would like to thank residents and staff for their support and hospitality. What the service does well: The home has a homely and inclusive atmosphere. The home has a good admissions procedure that ensures only residents whose needs can be met will be admitted into the home. Staff were observed to have a good professional rapport with residents. The home provides a good standard of care and the documentation in the care plans provides guidance for staff and are regularly reviewed. The home ensures that residents’ health needs are being met. Residents were complimentary about the food and are provided with a variety and choice of meals. Residents live in a safe and comfortable environment and are able to personalise their individual rooms. Residents feel comfortable to and know how to make a complaint and feel that they will be listened to. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 7 Residents spoken to were complimentary about the staff working at the home. Staff receive regular training and supervision to ensure they are skilled and competent to meet the needs of the residents. There are suitably qualified staff on duty at all times. The home is well managed and staff spoken with were complimentary about the manager at the home. Staff work well together and pass information from one shift to the next verbally and in daily reports.. It was clear from observations and discussions that the manager and staff have a good knowledge of the needs of residents and were able to respond to them in a caring and reassuring manner. There is a structured quality assurance and quality-monitoring system in place to actively obtain feedback from residents and their relatives or representatives, to ensure the home is run in the best interest of residents. All relevant health and safety checks are regularly undertaken. 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. The summary of this inspection report can be made available in other formats on request. WCS - Attleborough Grange DS0000004261.V343338.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 WCS - Attleborough Grange DS0000004261.V343338.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): 1,2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives are provided with information about the home in order to make informed choice as to whether to live at the home. The preadmission assessment procedures ensure the residents admitted to the home can have their needs met by experienced staff. EVIDENCE: There is a range of well-documented information about the home and the service it provides. This includes a statement of purpose and a resident guide. Copies of these are available in the front entrance area of the home. Three residents spoken to confirmed that they had been given sufficient information about the service including a copy of the Service user Guide before reaching a decision as to whether the home could meet their needs and WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 10 expectations. A contract including the terms and conditions of occupancy was issued and was clear and was understood. One resident spoken to talked about a visit to the home before moving in and said she was made to feel welcome and was shown a vacant room that would be allocated to her should she decide to move in. A review of the care documentation confirmed that pre admission assessments are always completed, and are currently completed by the manager with support of the care manager. These assessments were found to be full and were used to ensure any new admissions to the home is suitable and that the home have the staff and the environment to meet the care needs of any new resident. The information contained in these assessments is transferred over to form the basis of the care documentation in the home. Intermediate all rehabilitative care is not provided at Attleborough Grange Care Home. WCS - Attleborough Grange DS0000004261.V343338.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide a good framework for the delivery of care and provide staff guidance on residents’ care needs. The home meets residents’ health and general needs. Procedures and practices in the home allow for the safe administration of medicines and the privacy of residents to be promoted. EVIDENCE: The care documentation belonging to three residents was looked at as part of the inspection process. These were found to include plans of care, nutritional assessment, personal histories and risk assessments. The care documentation was full and demonstrated that the care was reviewed and evaluated. For example, one resident who has verbal communication difficulties had guidance in the documentation to facilitate this vital need. Details of any moving and handling activity are included and provide staff with the information they need to ensure care practices are safe and residents needs are met. Staff spoken to confirmed that they received a full report on each resident WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 12 daily and read the care documentation that is kept in the ‘care station’. They felt that their views were taken into account when planning residents care. There is a key worker system in place and care plans are reviewed on a monthly basis. Information held showed that social services also visit the home and undertake annual reviews of the residents they are purchasing care for. Residents are weighed monthly and nutritional records are kept for individuals where staff may have concerns. Residents’ health needs are being met at the home and specialist advice is sought when the needs arise. Some residents observed to be wearing glasses confirmed that they receive regular eye checks. It was confirmed by the manager that there are policies and procedures in place for all aspects of dealing with medications, the content of these were read. The manager reported that staff with responsibility for administering medication have attended appropriate training. Medicines are dispensed in a Monitored Dosage System (MDS) (each medicine dispensed in a 28-day blister pack for ease of administration) in addition to traditional containers. The MAR charts held details of the quantity of medicine received, the times medicine was to be administered and the dosage. The inspection showed that medication was being generally well managed. The medication belonging to the two residents identified for case tracking were looked at and showed that medication held in the MDS was being administered as prescribed by the doctor and medication administered from traditional containers was not always well managed. For example, on the 10/09/07 there was no staff signature on the MAR chart to confirm whether the medicine ranitadine 150mg was administered as prescribed. Records showed that 56 tablets were received and five tablets administered. The number of tablets held were checked and showed that 53 tablets remained. This indicates that on two occasions medication was signed for but not administered. The manager was present during the audit and demonstrated a commitment to ensuring regular quality audits are carried out and the staff reminded of their role and responsibilities. The home provides a good service and has a history of compliance. There was no evidence to suggest that outcomes for the resident had been compromised. Therefore a requirement for improvement was not made at this time and the manager was given the opportunity to put things right. This will be looked at again during the next inspection visit. Throughout the duration of the inspection staff were observed treating residents respectfully. Residents were taken to the toilet without having to wait, toilet doors were closed and staff knocked on bedroom doors before entering. Staff were seen to provide any necessary support in a sensitive and WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 13 caring manner. Staff engaged residents and regular visits were made to those residents choosing to spend time in their room. Residents looked well cared for had their hair combed and fingernails were clean. Resident spoke positively about the staff. Comments noted include: They’re all nice girls and even though they’re busy they always find time to come and talk to me. One resident was concerned that her curtains did not close properly and she had lacked privacy at night. The room looked out onto the road. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals provide daily variation in interest to people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with family and friends. EVIDENCE: Information supplied by the home on the Annual Quality Assurance Assessment (AQAA) document to the commission before the inspection visit to the service showed that there was no one residing at the home that was from any minority ethnic communities, social or cultural groups with any specific needs or preferences. The inspector observed residents being able to choose where to spend their time and moving around the home freely. Set routines are avoided as far as possible and residents are able to determine when they would like to go to bed and what time they would like to get up in the morning. Residents are able to choose whether they would like to join in the activities provided which mainly take place in the home’s day-care centre, and include WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 15 dominoes, board games and movement to music. A religious service (church) is held at the home each week and open to anyone wishing to attend. Residents spoken to felt the activities and entertainment provided were appropriate and met their needs. Residents able to complete fulfilling activities are encouraged to do so and one resident carries out household tasks such as dusting and setting the dining tables ready for meals. On speaking to residents, it was clear that visiting is positively encouraged with no restrictions being imposed. Visitors are welcomed at the home and there is a visitors book that all must sign upon entering and leaving the home. Residents are able to receive their visitors in private if they wish. Residents are able to have their meals where they choose and to have extra portions if they desired. All residents praised the food and those requiring specialist diets such as diabetic and liquidised foods are catered for. At lunchtime on the day of the inspection, residents were offered a choice of Gammon (served with potatoes, peas and cauliflower), Lasagne, or Spaghetti Bolognese followed by a ‘Banana Angel delight’. The manager talked about the menus, which are to be revised to include what “heartbeat recipes.” The inspector was advised that the home is applying for a Heartbeat Award” which is a nationally recognised certificated Award given by the local council in recognition of ‘Healthy Eating’ and ‘Food Hygiene’. The manager reported that she plans to consult with residents about any proposals to change the menus. Food is transported to the units in hot trolleys where it is plated up by the staff in the kitchenettes. Observations at a mealtime showed that staff were available to offer discreet assistance when required. Residents were unhurried and could eat their meal at a pace suited to their needs. Records of food preferences and of food given to residents on Griff house are held. The inspection showed that residents are not routinely offered a snack meal in the evening. Access to regular snack meals and finger foods is particularly important for residents with dementia who may choose not to eat meals at conventional times. At 4:45pm, staff served tea to the residents on Griff house. One resident spoken to said she did not want the sandwiches she had been given and pushed the plate away. In the absence of snack meals or easy access to finger foods the resident may be at risk of not being offered any food until breakfast the following day and depending when the resident gets up they could be without the offer of food for more than 15 hours. This falls below the National Minimum Standard expected that a snack meal in the evening is offered and the interval between this and breakfast the following morning should be no more than 12 hours. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 16 Menus are not displayed in the home and residents are therefore unable to familiarise themselves with the alternatives made available to them on the day. Residents are asked the day before what they would like for their main meal and a record of the meals chosen is used by the kitchen staff and to inform food preparation. Two residents spoken to said they could not remember what they had chosen. The care records of one of the resident’s case tracked identified the need for a liquidised diet. Observations showed staff advising the resident of alternatives and having made a decision on what he would like to eat the meal was presented in a liquidised form. Staff spoken with were also aware of the dietary needs (diabetic) of the second resident being case tracked. Records of planned activities are held by the home. The record for August 2007 included, dominoes, bingo, church service, fitness and fun, canal trip to Atherstone and a trip to Hatton Park. One resident spoken to said she was very satisfied with the service. Comments noted include, staff are very nice and they are always there when I need them.” The resident talked about going on a holiday arranged by staff to Skegness in October. The resident reported that in her view “people here are well cared for” and there are no restrictions placed on their movements and they get up or go to bed when they like. Visiting is flexible and visitors are made to feel welcome. The laundry is generally okay but some items are not always ironed and “a new cardigan hasn’t come back.” Daily entries made by staff showed how one resident spends some of their time this includes visiting the day care unit, playing dominoes having her nails polished and ‘colouring in her bedroom’. Records of daily life activities are also held and show that the resident washes dishes, lays the tables, reads the paper and watches television. Records also include details of family visits. Four residents spoken to said activities are provided on a daily basis (MondayFriday) in the area of the home used for the provision of day-care services and residents could attend any of the activities taking place. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 17 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures in the home ensure that any complaints and any allegations or suspicions of abuse made would be managed appropriately. EVIDENCE: A copy of the complaints procedure was displayed in the reception area of the home. Three residents were asked if they were aware of the procedure for raising any concerns. Two said they would talk to the manager if they were unhappy and one said she would talk to her family. Records of any complaints are held and were seen. The information held includes the date, the name of the complainant, details of the complaint and whether the issues were resolved to the complainant satisfaction. A comments, suggestions and complaints book is available in the home and used by visitors to express their views and opinions of the service. Comments noted include care is wonderful carry on the good work and fantastic what you do. Regular resident meetings are held and provide a forum for residents to discuss any issues and to raise any concerns they might have. Since the last inspection, there have been no complaints made to the commission but there has been one allegation of possible abuse made to the WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 18 home. This was in January 2007 and in the form of a complaint from a resident who expressed concern about the conduct of a care worker. In accordance with the local arrangements for safeguarding adults, the manager informed social services (lead agency responsible for investigating allegations of abuse) of the concerns and was then asked by the agency to carryout an investigation and to inform them of the outcome. A record of the investigation and the outcome showed that the care worker was to attend further safeguarding training “as soon as possible.” Staff training records showed that this training had not yet taken place. The manager reported that all staff attend training in Adult Abuse and are familiar with the homes procedures for reporting any suspicions of possible abuse. Staff spoken with during the inspection confirmed this occurred and were able to give examples of what actions may constitute abuse and of how they would respond. Staff were not all aware of the ‘Whistle blowing’ procedure but would report any issues of concern to the care manager or manager. Safeguarding training is also a feature of National Vocational Qualification (NVQ) training courses that a number of staff had completed and is included in the homes induction programme for any new staff. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 19 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): 19,21,22,23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained home that is clean in most areas. Infection control is well managed. EVIDENCE: There is a door entry system in operation, to enable staff to be aware when people are entering or leaving the building for security reasons. A programme of routine maintenance and renewal is maintained. The home was found to be warm and comfortable, but good levels of light and ventilation. Access to the first-floor is either via a passenger lift or the stairs. Residents are supplied with any equipment assessed as necessary for promoting WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 20 independence and for maintaining their continued health, safety and welfare. There are three mechanical hoists (one of which was out of action awaiting repair) available to support moving and handling activities. There are three bathrooms located on the ground floor and two on the first floor. The first floor also has a separate shower room. The bathroom areas were seen to be well equipped with handrails and specialist equipment to meet the needs of people with disabilities. Specialist beds and mattresses were also supplied where required. There are 30 bedrooms 15 of which have ensuite facilities. At the time of the inspection there were 28 long stay residents and two residents having a short stay. 11 residents were being accommodated on Griff house (specialist dementia care unit located on the first floor). Residents spoken with are happy with the environment and with their individual rooms. Rooms were seen to be personalized to reflect the person’s character and personality. The home has been decorated to a good standard and some areas are colour co-coordinated to assist all people involved with the home with easier orientation. A hairdressing room provides a pleasant environment for residents in which to have their hair done. There are six communal lounges one of which is used for the provision of community day-care services. Each unit has a dining room and kitchenette. Griff house has an orientation board which shows the date and there tactile boards are displayed in the corridor. Each room has the name of the occupant displayed on the door. Systems are in place for separating laundry to maintain suitable hygiene standards. Appropriate arrangements are in place so carrying continence laundry through the home and dissolvable laundry bags are used to avoid unnecessary handling of soiled laundry. The laundry has a washbasin, liquid soap and paper towels staff for staff use. Three staff spoken to said they and other staff had been provided with infection control training to ensure practices were safe. Staff have easy access to disposable gloves and aprons. The manager reported that disposable gloves are always worn by staff when supporting residents with personal care. Observations showed staff wearing protective clothing when entering the kitchen. There is a sluicing facility where commode pots can be disinfected. A number of residents have a key to their room and some have chosen not to. One resident spoken to said “ I like my door left open.” WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 21 The home was well maintained, had good lighting was generally clean tidy fresh and homely. It was noted that a number of carpets particularly those in the corridor on the first floor required cleaning as they were heavily stained in places. Most of the carpets in the home required vacuuming as they looked as if they had not been cleaned recently. During the inspection, a number of residents were asked about their opinions of the environment. All residents expressed satisfaction with their room and with the communal environment. On Griff house where residents requiring specialist dementia care are accommodated rooms seen were also personalised and took into account individual needs of residents. For example, there were fewer or in some instances, no ornaments at all displayed. The manager talked about the routine maintenance and renewal programme and reported that since last inspection, two of the four kitchenettes have been redecorated and redecoration of the remaining two kitchenettes is planned. A number of carpet replacements in communal areas and some bedrooms and further redecoration are also planned. Residents are given the opportunity to choose from a limited number of options the colour of any new carpet and decoration. New bed linen, towels and flannels have been purchased. Future planned purchases are to include new curtains and a number of internal doors are to be replaced. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements are good and suitable and ensure the needs of residents living at the home are met. Residents are protected by the homes recruitment procedures. EVIDENCE: The home has a clear line management structure in place. The staffing structure comprises of the manager, care manager, housekeeper, administrator, senior carer, six lead carers, twenty-five carers (including relief carers), two caterers, and three assistant housekeepers The manager explained the staffing arrangements and advised the inspector that during the day there is normally one staff member (care worker) on duty in each of the three units and three care workers supporting residents on Griff house. In addition, there are domestic staff, caterers and an administrator. At night, there are three carers on duty in the home one on Griff house and two working between the remaining three units. Staff rotas from 19/08/07 - 08/09/07 were seen and showed that although there had been staff shortages which were attributed to staff sickness absence and annual leave entitlements all of the shifts had been covered by either relief WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 23 staff or by permanent staff working additional hours to cover any gaps identified. The manager carries out monthly audits of care support requirements and the outcome is used to determine staff numbers on each of the units. Information supplied by the home before the inspection showed that 63 of the care workers are trained to National Vocational Qualification (NVQ) level two or equivalent. The manager talked about learning and development and reported that a further three staff are to sign up for the award. Staff are actively encouraged to attend NVQ training. In addition, specialist dementia care is provided. Staff training records are held and showed that staff have attended training in health and safety, first aid, manual handling, food hygiene and infection control. The manager reported that regular updates would be carried out throughout the forthcoming year. Two staff members spoken to confirm this occurred and expressed a high satisfaction with the training and were keen to pursue any learning and development opportunities made available to them. Information supplied by the manager showed that future training planned includes ‘Dementia Care’ and ‘Person Centred Care.’ The staff recruitment files belonging to three care workers were looked at. Information held showed that CRBs had been secured but copies of the disclosures were not held at the home and therefore not open to inspection. Application forms showed that none of the new workers had a criminal conviction. Two of the three files held details of full employment history. Gaps in employment history were identified in the recruitment records belonging to one of the workers. Copies of certificates relating to any relevant training and qualifications were held on two of the files looked at. The manager talked about the staff induction procedure, which is under review and is to be revised. New care workers are required to complete a ‘workbook’ to demonstrate their learning and understanding of their role and responsibilities. When completed the information held in the ‘workbook’ is used to support NVQ competencies. New care workers spend time working alongside an experienced staff member until they feel confident and able to work without close supervision. Shadowing usually lasts for a week and is extended if required. Residents spoken with said they had confidence in the staff who they felt were well-trained and competent. Residents generally felt there were sufficient numbers of staff available and talked about the impact of any staff absence. Residents confirmed that only staff employed by the home covered any gaps in the rotas. Residents felt that staff were aware of their needs and they did not have to explain what was required. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 24 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): 31,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attleborough Grange benefits from having a stable consistent manager to provide leadership and to ensure health and safety and quality monitoring systems are fully used. EVIDENCE: The manager has many years experience of working with older people and holds the Registered Managers Award, the Diploma in Welfare Studies and the Advanced Management in Care qualification and is well equipped to manage a care home. Most of the residents spoken to know who the manager is and feel able to approach her with any issues. One resident said, I go to her if I have any problems. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 25 The manager reported that each staff member receives regular supervision and a record of the outcome is held. Two staff spoken to confirmed that they receive formal one-to-one supervision. The inspection showed that staff benefit from a range of health and safetytraining details of which have been included under the ‘Staffing’ outcome group of the report. The good quality assurance systems in place during the last inspection continue to be used to assess the quality of the service. Residents are asked a question from the home’s quality assurance questionnaire each month throughout the year as part of the monthly care reviews and the resulting answers are collated and where necessary extra measures are put in place to make improvements to practices across the organisation. This was verified in the organisations annual report that was seen on display in the main reception area of the home. The manager reported that the next management review of the service is due to take place in November 2007 when residents and their relatives or representatives will be asked about their views and experiences of the service. Meetings are held with the residents and the notes of these meetings demonstrate that residents are being properly consulted and involved in decisions in the home, such as new furniture and planning activities and outings. Monitoring records were seen which demonstrate that the manager regularly monitors and reports on a range of matters in the home, such as staffing, people’s dependency levels, accidents and staff training. Information supplied by the home before the inspection showed that the home’s plans for improvements in the next 12 months are to include: 1. “Consultation with residents to identify what they would like their key worker to do for them. 2. Looking at ways in which residents who suffer from dementia can be made more aware of how to make complaints and feel unable to do so. 3. Set up a volunteer group so there is an independent person holding residents meetings. 4. More staff training in involving residents in daily living tasks. 5. Residents have more access to community events.” The manager does not act as appointee for anyone at the home this role is carried out by relatives or advocates or the residents themselves. The home holds personal cash in safekeeping for residents where required. An expenditure record was seen that is maintained by the administrator together with some receipts for items purchased on behalf of the resident. It is recommended that individual receipts are secured for all services or items purchased on their behalf to include hairdressing and chiropody. This ensures residents are safeguarded. The manager carries out regular audits. Signatures were seen to be in place to verify this. A financial officer employed by the company also carries out periodic checks of the accounts. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 26 We obtain information before inspections. This information includes confirmation that all necessary policies and procedures are in place and are up-to-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Health and safety at the home is generally well managed and there are good operational systems in place. Policies and procedures are regularly reviewed and if necessary revised to reflect any changes. In response to shortfalls identified during the last inspection, the frequency of checks on emergency lighting has been increased and is now carried out weekly and the outcome recorded. Records of fire alarm checks are held and showed that tests are generally carried out weekly apart from on one occasion from 17/08/07 to 05/09/07 when they were tested only once. Records are held of staff attendance at fire drills/practice. Information held showed that one staff member attended fire practice on 10/01/07 and again on the 18/05/07. Records failed to show whether one worker had attended a fire drill/practice at all. The manager demonstrated a commitment to ensuring that staff attend regular fire drills/practice and will carry out an audit to ensure that any staff who have not attended training for some time are up-to-date with procedures. During a tour of the premises, observations in the laundry room showed that detergent and cleaning chemicals were left unsecured and unattended. The risk this may present to residents was discussed with the manager who immediately arranged for the products to be stored safely and securely. The manager intends reminding staff to ensure chemicals are stored safely and securely when left unattended. WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 27 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 X 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP9 Good Practice Recommendations Make sure that regular quality audits are carried out so that the home can be sure medicine is always being administered as prescribed and health care needs are being met. Routine maintenance checks should be carried out to make sure that the curtains hanging in residents rooms can be closed and residents privacy is therefore assured. The recording of any social and therapeutic activities provided on Griff House could be improved to ensure that all residents are provided with opportunities to participate in activities that are within their interests and abilities. Snack meals should be provided in the evenings and finger foods should be made readily available and accessible to residents assessed as requiring specialist dementia care. A record should be held of all food provided including any snack meals so that the home can be sure that nutritional needs are being met. To safeguard residents and to facilitate any request for access to their personal record file individual receipts should be retained for all items or services purchased on the residents behalf. An audit of staff attendance at fire drills/practices held at DS0000004261.V343338.R01.S.doc Version 5.2 Page 30 2. 3. OP10 OP12 4. OP15 5. OP35 6. OP38 WCS - Attleborough Grange the home should take place and the outcome of the audit used to ensue all staff attend regular updates so that residents continued safety is assured. Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 31 © 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 WCS - Attleborough Grange DS0000004261.V343338.R01.S.doc Version 5.2 Page 32 - 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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