Inspection on 26/09/06 for Wing Grange

This inspection was carried out on 26th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wing Grange 01/11/05

Wing Grange 01/11/04

Wing Grange 13/05/04

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Wing Grange Preston Road Oakham Rutland LE15 8SB Lead Inspector Ruth Wood Unannounced Inspection 26th September 2006 10:00 Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 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 Wing Grange DS0000006466.V311804.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 Adults 18-65. 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. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wing Grange Address Preston Road Oakham Rutland LE15 8SB 01572 737246 01572 737510 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) Langley House Trust Mrs Mariane Denise van der Merwe Care Home 12 Category(ies) of Learning disability (12), Mental disorder, registration, with number excluding learning disability or dementia (12) of places Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 1st November 2006 Brief Description of the Service: Wing Grange is a residential home owned by the Langley Trust, which provides care and rehabilitation for men who are ex offenders or at risk of offending. It is situated overlooking open countryside, just outside the village of Wing. The house is surrounded by large grounds, which are used by the residents to grow produce for the community. Residents are involved in training and education programmes to help them develop skills. Residents have access to local transport nearby, and the towns of Oakham and Uppingham are a few miles away. The current weekly fee is £811 Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a weekday between 10am and 4.15pm and staff received no prior notice of the inspection. The registered manager was on annual leave but staff members and the acting deputy project manager discussed how people were supported and the policies and procedures they followed. Documents such as support plans, fire records, staff recruitment records and medication records were examined and the inspector spoke with three residents about the care they received and/or the activities they were involved in. The inspector looked at all the communal areas in the home, one resident’s bedroom (with his permission) and the extensive gardens. Some time was spent looking at a specific project to build a crazy golf course in the grounds and speaking with the residents and staff involved in this. What the service does well: What has improved since the last inspection? What they could do better: It was recommended that the registered manager make a thorough examination of the way medication administration in the home is undertaken Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 6 to ensure that at all times it can be undertaken without the distraction of other activities or excessive tiredness, to ensure the health and safety of residents. Several specific recommendations in relation to medication were also made: • • • The procedure for recording medication received into the home should be clarified to ensure accuracy. Appropriate training for staff administering medication should be arranged to ensure all aspects of the process are carried out correctly. The dispensing pharmacist should be consulted to discuss how the actual time that medication is to be given to a resident can be accurately stated on the Medication Record. A requirement made at the previous inspection that support plans and risk assessments must clearly state the risks and consequences of delayed/missed medication (if this is identified as important) is still to be met. The fire risk assessment for the home was not easily accessible (it had been archived); it is recommended that it be kept in the home’s main fire file. 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. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessment procedures ensure that residents’ needs and aspirations can be met. EVIDENCE: The assessment process was discussed with the acting deputy manager who outlined the comprehensive level of consultation that takes place before a resident comes to live at Wing Grange. Clear guidelines outline the professionals to be consulted, and reports from all relevant parties (such as probation officers, social workers and consultant psychiatrists) are obtained and studied by key staff. The prospective resident’s risk level is assessed; part of this process involves consideration of the protocols in place with the local community as to the nature of offenders that can be considered for placement. A senior staff member will also visit the prospective resident in their current setting to assess their motivation to change. This process was confirmed by discussion with another staff member and a resident. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make informed decisions, to take reasonable risks and to participate in the day to day life of the home. Support plans and other documentation accurately reflects their needs and aspirations. EVIDENCE: Two residents’ care files were examined. These contained detailed support plans with individual risks clearly identified together with the necessary responses. Any restrictions on choice and activities were documented; this is particularly important given the nature of the residents living in the home. There is evidence that residents are actively involved in formulating and reviewing their support plans. The resident as well as a member of staff had signed all documentation and the resident’s contribution is recorded. Plans are reviewed every three months with input from outside agencies/professionals such as the probation and mental health services. Plans contained information about residents’ aspirations and goals and how these could be achieved. The majority of residents manage their own finances; two residents receive some support in this area and clear records were available detailing transactions, which were signed by the resident and a staff member. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 10 Good systems are in place enabling residents to participate in the running of the home and the wider organisation. Weekly ‘men’s meetings’ are held and these are recorded. Issues discussed include trips and activities that people would like to take part in and residents are actively involved in organising these. One of the residents acts as the house representative and attends meetings of the wider organisation on behalf of Wing Grange. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with opportunities to engage in vocational, leisure and community activities, are given support in maintaining links with family and friends and enjoy nutritious, well-cooked food EVIDENCE: Residents are involved in maintaining the home’s garden and selling the produce at the weekly market in Oakham. One staff member is coordinating a project to create a Crazy Golf course in the home’s grounds. The project has involved making visits to other courses and the acquisition of skills such as planning, design and bricklaying. Residents involved were clearly proud of their achievements. This project indicates the high level of creativity and commitment from staff to engage residents in worthwhile and stimulating activities. Residents also have opportunities to extend their education by attending college at one of the nearby market towns. Time is devoted to maintaining the good relationships established with the local community. Some residents attend local churches and the home takes part in the open gardens scheme. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 12 Staff and residents work alongside each other in day-to-day activities and residents’ responsibilities for these tasks are clearly outlined. Residents are also actively involved in menu planning and food preparation. The menu is varied with plenty of fresh fruit and vegetables and residents expressed satisfaction with the food served. Residents are involved in actively choosing their leisure activities and these are often discussed at the weekly men’s meeting. Forthcoming outings include a visit to Stamford to go swimming and a fishing trip. Two vehicles are available should transport be required. Discussion with staff and residents and examination of care files showed that residents were appropriately supported in maintaining links with their family and friends where this was appropriate. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive good support with their personal and health care needs but improvments are needed in the way medication is administered to ensure this process is consistently safe and accurately recorded EVIDENCE: Personal support needs are detailed in residents’ plans and staff encourage residents to achieve a high level of personal care and a healthy lifestyle. Residents have access to general practitioners, dentists, opticians and chiropodists and other medical specialists as required. Seven requirements were made in relation to medication at the last inspection. Although four of these have been addressed there are still some shortfalls in this area of practice. Previous requirements addressed: • Letters are in place from general practitioners detailing changes in medication • Staff were seen to observe that residents had taken their medication before signing the medication record • A consistent method of recording medication refused is being used. None of the current residents are taking ‘as required’ medication so the inspector was unable to check if clear instructions as to this kind of medication Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 14 are in place. It was noted however that such instructions for residents of the supported living project (which forms part of the larger scheme) are in place. There was misunderstanding as to how medication received into the home should be recorded on the Medication Administration Record (MAR); this was clarified and a recommendation made. Staff have not received training on medication administration from a pharmacist or other external provider. It is recommended staff receive such training as this may highlight inconsistencies or errors in internal practice such as the recording issue above. Discussion with staff members and observation of medication being administered indicated that staff can often be interrupted during the process and may be undertaking this duty when distracted or tired (having worked for many hours). The way medication administration in the home is undertaken must be examined to ensure that at all times it can be undertaken without the distraction of other activities or excessive tiredness to ensure the health and safety of residents. Finally requirements were made at the last inspection with regards to medication, which must be given at a specific time; care plans must state the risks of delayed medication and the actual time that medication should be given must be recorded on the MAR. The former has been required again and it is recommended that discussion be held with the dispensing pharmacist as to how the latter can be best achieved. Despite these issues there is evidence that residents are given support and encouragement to take on responsibility for administering their own medication and this is to be commended. Risk assessments for this process are undertaken and recorded during key worker meetings. It is recommended that these be recorded separately to aid clarity. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ concerns are actively listened to and acted upon and effective systems are in place to ensure that they are protected from abuse. EVIDENCE: The complaints procedure is displayed on the residents’ notice board and residents can raise concerns with staff members, the manager or with the probation officer who visits on a weekly basis. Residents’ rights and best interests are therefore protected both by procedures and by having access to people they trust and can confide in both in and outside of the home. The Complaints record details the concern raised together with the response made to resolve it. An enhanced criminal records bureau check is obtained for all staff and their names checked against the protection of vulnerable adults register before they begin working in the home. They also receive training in the appropriate responses to behaviour that may challenge (several staff were attending this specialist training on the day of the inspection). Appropriate policies and multi-agency protocols were in place relating to adult protection. The home also has a clear whistle blowing policy and informs staff where they can gain support should they need to raise any concerns. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, spacious and comfortable making it a pleasant place to live. EVIDENCE: This is a large historic building which invariably requires a great deal of upkeep. A new central heating system is being installed to improve heating and hot water distribution. The home is spread over three floors with bedrooms located on the first and second floors. One resident showed the inspector his bedroom and it was clean, comfortably furnished and spacious. On the ground floor there are two lounges (one designated for smoking) a large conservatory with views over open countryside and a large dining room. On the top floor there is a dedicated games room with a full sized snooker table. These communal areas provide plenty of space for residents to socialise with each other or to spend quiet time alone. Good systems are in place to ensure that all areas are kept clean and hygienic. Residents are actively involved in cleaning all areas of the home and cleaning materials such as mops and buckets are colour coded to ensure that articles used to clean the kitchens are not used in bathrooms. This helps to prevent the risk of cross contamination. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well supported and protected by well-trained staff and effective recruitment practices. EVIDENCE: Staff undertake a formal induction programme and the induction documentation for the most recent member of staff was examined. This is a comprehensive document and records that regular supervision is given throughout this period. There is a comprehensive training programme in place, which includes National Vocational Qualifications and specialist courses such as working with people with mental health needs and specialist risk assessment training. Staff displayed a good understanding of residents’ needs, histories and care plans. Recruitment records for two care staff were examined. These contained a completed application form, two written references and evidence that criminal records bureau checks had been completed before staff started working at the home. Their names had also been checked against the vulnerable adults register. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good management systems and practice promote residents’ health and safety and ensure that their views are actively considered in the running of the home. EVIDENCE: The registered manager has the appropriate qualifications and experience necessary to manage the home. Although she was on annual leave at the time of the inspection other staff members were fully aware of all procedures and how to access required documentation. Some quality assurance systems are in place including a comprehensive residents’ survey detailing their views on many aspects of the service provided. One resident also represents the group at the parent organisation’s residents’ forum. Residents’ views are actively sought in the home and there is a clear sense of partnership between them and staff members. Residents’ meetings are held on a weekly basis and they also have meetings with their key workers on a weekly basis. At present there is no systematic way of ascertaining the views of other stakeholders such as placing social workers or probation officers Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 19 as to the way the home is run. It is recommended that consideration be given to this aspect of quality assurance. Staff have received training in health and safety, first aid and fire safety and regular fire practices and alarm tests are carried out. All fire practices are fully documented. It is recommended that the fire risk assessment be kept in the home’s main fire file so that it is easily accessible rather than in the archive store. Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 3 X Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement Support plans and risk assessments must clearly state the risks and consequences of delayed/missed medication if regular and time specific administration is noted as an important issue for a resident’s care. (Previous timescale of 14/11/05 not met) Timescale for action 20/10/06 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 3 Refer to Standard YA20 YA20 YA20 Good Practice Recommendations The procedure for recording medication received into the home should be clarified to ensure accuracy. Staff members responsible for administering medication should receive appropriate training to ensure all aspects of the process are carried out correctly. The way medication administration in the home is undertaken must be examined to ensure that at all times it can be undertaken without the distraction of other activities or excessive tiredness, to ensure the health and safety of residents. DS0000006466.V311804.R01.S.doc Version 5.2 Page 22 Wing Grange 4 YA20 5 YA42 The dispensing pharmacist should be consulted to discuss how the actual time that medication is to be given to a resident can be accurately stated on the Medication Record. (Required in a different form at the previous inspection) It is recommended that the fire risk assessment be kept in the home’s main fire file rather than in the archive store to ensure that it is easily accessible Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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. Extracts may not be used or reproduced without the express permission of CSCI Wing Grange DS0000006466.V311804.R01.S.doc Version 5.2 Page 24 - 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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