Care Home: Cantley Grange

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What the care home does well Cantley Grange was well presented, clean and fresh smelling. Staff were knowledgeable about people`s individual needs and personalities. We observed good interaction between the staff and people living at the home. Staff took every opportunity to maintain people`s independence and enable them to exercise choice. People were helped to make use of local amenities. The manager encourages staff to train and extend their knowledge and skills. What has improved since the last inspection? People whose rooms had been redecorated and refurbished were happy with the outcome; they were pleased to have been offered a choice of colour scheme. CARE HOMES FOR OLDER PEOPLE Cantley Grange St. Wilfreds Road Cantley Doncaster South Yorkshire DN4 6AH Lead Inspector Ian Hall Key Unannounced Inspection 3rd September 2008 07:45 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 Cantley Grange DS0000069578.V371769.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. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cantley Grange Address St. Wilfreds Road Cantley Doncaster South Yorkshire DN4 6AH 0845 6037751 01302 532704 cantley.grange@orchardcarehomes.com www.orchardcarehomes.com Orchard Care Homes.Com Limited 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) Mrs Sandra Allen Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 40 10th September 2007 2. Date of last inspection Brief Description of the Service: Cantley Grange was purpose built in 2007 and is owned by Orchard Care Homes. The home and is situated in Cantley, which is near to the town of Doncaster. Cantley Grange is registered to provide personal care for forty older people. The home is on two floors with twenty en-suite bedrooms on each floor. The ground floor has access to a patio and enclosed gardens. Information gained on the 3rd September 2008 indicated the current fees vary from £485.00 to £515.00 per week with additional charges made for hairdressing and chiropody. These fees applied at the time of inspection, more up to date information may be obtained from the manager of the home. There are extra costs for hairdressing, newspapers, chiropody and toiletries. A copy of the home’s statement of purpose, service user guide and complaints procedure was available in the entrance hall. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced site visit undertaken as part of the inspection started at 07:45 and concluded at 15:15 on the 3rd September 2008. The site visit included a tour of the building, reading records, discussions with staff and people who use the service and observation of the meals provided. We also met with the manager and other members of staff. In addition the inspection took account of information received about the service since the last key inspection on 10th September 2007. This included records of telephone conversations with staff, events notified to CSCI and records of management visits to the home. Prior to the site visit the home carried out a self-assessment of the service. This is called the annual quality assurance assessment (AQAA). An AQAA is information the commission ask service’s to provide each year. This shows us how the provider thinks the home is performing. People spoken with were happy to assist with the inspection. Comments were positive when describing the care and motivation of the staff, these included: “I like it at this home, I feel safe,” “they are good to me”, and “its lovely here they are smashing”. At the end of the site visit verbal feedback was given to the manager. What the service does well: What has improved since the last inspection? Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 6 People whose rooms had been redecorated and refurbished were happy with the outcome; they were pleased to have been offered a choice of colour scheme. 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. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. The service provides people with detailed information to enable them to choose whether the home is the one for them. Detailed assessments ensure that people’s needs could be met prior to offering them a place. EVIDENCE: An information pack is available that provides details of the standard of care and services available at Cantley Grange. This includes useful information about staff, their qualifications, visiting the home, choosing meals, the laundry service and how to raise concerns. We checked three case files. Each contained a detailed needs assessment; this included such things as daily living, personal care, health care, social interests and areas of risk when appropriate. Whenever the need for specialist caring Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 9 equipment had been identified this had been obtained prior to the person moving into the home. The assessment formed the basis for the initial care plan. People said they had been able to discuss their wishes and the type of help they needed before they made the decision to live at Cantley Grange. Whenever possible people had been encouraged to visit and spend time at the home so they could meet members of staff and other people living at the home. This was confirmed by written entries in the case files. Copies of contracts, social work referrals and assessments were available and kept in the case file. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Clear information is provided to guide staff meeting people’s needs. Staff ensure that people are able to access health services as they need them. Staff attitude and approach to care is based on respect for the person, this helps to safeguard and promote people’s rights and dignity. Staff work to the home’s policies for the administration of medication, this promotes the wellbeing of people who live at the home. EVIDENCE: Three people’s care records were examined. People’s care needs had been assessed. A range of recognised assessment documents had been used to measure people’s needs. These included mobility, mental ability, state of nutrition, and areas of risk such as falls. These provided a baseline for staff to measure people’s progress or increasing level of need. This enables staff to Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 11 plan the help and support people need. There were care plans to tell staff how to meet these needs. These had been reviewed regularly. Most people we spoke to knew about their care plan. Relatives said they were kept informed and involved whenever possible. Care plans detailed people’s religious and cultural needs and the gender of staff that they wanted to support them with their personal care. Pen portraits of the person, their lives and interests provide staff with background information to improve the care and service provided. Daily entries were made of care provided. This enables staff to review people’s health and wellbeing and change plans of care as necessary. There were records of visits by the GP, community nurse, occupational therapist, dentist, opticians and chiropodist. All people were registered with a family doctor; there were good relationships with the doctors and the district nurses. There were wheelchairs, aids and equipment provided to meet people’s moving and handling needs. We saw that bathing and toilet areas had been provided with aids and adaptations so people can use them independently and safely. People are able to manage their own medication if they wish. No one was currently doing this. People spoken with said that they were happy for staff to manage their medication on their behalf. Medicines were stored safely. We saw people being helped to take medicines according to the doctor’s instructions. Policies and procedures to inform staff and protect people taking medications were current and readily available. Staff had received additional training to assist people to take their medication safely People living at the home and their visitors said that “staff were caring and helpful” and that “nothing was too much trouble, they were always willing and keen to help”, “when dad needs to see the doctor the staff organise things so I don’t have to worry”. People said that the staff promoted their privacy and dignity. We saw staff knocking upon bedroom doors and waiting to be invited to enter. We observed interactions between staff and people living at the home. These were warm relationships with each person showing respect for the other. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Suitable activities were provided at the home to keep people stimulated. Visits from relatives and friends were encouraged so people kept in touch with people who were important to them. There was a good catering service, which met people’s nutritional needs and food preference. People who live at the home were encouraged to eat a healthy and varied diet. EVIDENCE: Three care files and care plans were checked. These show that people were involved in a range of social activities. People were reading, listening to music and watching television. No one currently leaves the home unless accompanied by members of their family or staff. Dedicated staff were employed to organise activities that stimulate people and encourage social interaction. Entertainers visit the home for people’s enjoyment. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 13 People said that they were able to go to bed and rise as they chose. A multi denominational service is held regularly for people who wish to follow their religious faith. Visitors comments included “ the food is excellent”, “Dads needs are well catered for”, “as a visitor I’m always asked if I’d like a drink which is nice and welcoming, mum says the meals are very nice and I think that’s all that matters”, “there’s a good atmosphere when I visit my wife and no limit for visiting, I go at anytime to suit myself”. We saw the cook preparing and baking cakes and buns. She said these were freshly made each day. People said they enjoyed them with their cups of tea and there was always plenty to eat. A list of birthdays had been provided for the cook who said she prepared teas for people’s birthdays. The menu was clearly displayed in each dining room. The meals provided were appealing and smelled appetising. People said they enjoy their meals. They can choose other meals if they don’t like the meal provided. People were seen and heard to make choices at dinnertime. Staff were seen to help and encourage people with their drinks and meals. Mealtimes were unhurried with extra portions provided as required. People’s personal likes and dislikes were documented and known by staff. Special diets were available as needed. Staff said they sought the dietician’s advice when necessary. Drinks and snacks were available through both day and night-time. Adapted cutlery was available to help people to maintain their independence. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. The complaints procedure enables people to raise any concerns. Concerns and complaints received were dealt with promptly and changes made to improve the quality of people’s lives. Staff had been trained in the recognition and reporting of abuse and relevant checks were made prior to them starting work, this reduced the risk of harm to vulnerable people. EVIDENCE: Visiting relatives and some people living at the home were able to describe how they would raise concerns with staff. They said that any matters they raise however trivial were dealt with promptly by staff and they were satisfied with the outcome. The complaints procedure was available for people living at the home, their relatives and staff. Their comments included: “my Mums been here for a year now and I’ve never had any complaints”, “the one minor complaint I had was dealt with very well”, “I’ve no complaints and am always surprised at the willingness of staff to deal with difficult residents”, “anything I ask is sorted out straight away nothing’s too much trouble”. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 15 Doncaster Metropolitan Borough Council (DMBC) Adult Protection Team had been consulted following a situation that arose at Cantley Grange. The home’s manager was found to have dealt with the issue promptly and in accordance with Adult Safeguarding protocols to protect both people involved. Four people had brought their concerns to the manager’s attention, three elements of their concerns were founded, and actions had been taken to deal with the deficits. They had been investigated, recorded within the home’s policy and procedure. People who had no advocate or next of kin have been provided with access to advocacy services provided by Age Concern. Staff had been provided with training in adult protection procedures to ensure people were safe, and to inform staff what to do if an allegation was made. The inspector’s discussions with staff confirmed that they felt confident and able to respond to concerns or complaints effectively. Cantley Grange DS0000069578.V371769.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, 26. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. The home was clean, tidy and well maintained ensuring that people live in pleasant and safe surroundings. The bedrooms were clean and reflected personal choice. Redecoration and refurbishment of the home has maintained the environment. EVIDENCE: We saw that the home was clean and well presented. Soft furnishings, pictures, flowers and ornaments were used throughout the home to provide a homely domestic setting. People said they had a choice of colours for their redecorated bedrooms. The bedrooms had been provided with matching curtains, bedding and soft Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 17 furnishings. They had personalised their rooms with a variety of items of their choice including photographs and other mementoes. Bedrooms were lockable with keys available for those who wished to exercise the choice to lock their own door. We spoke to people who chose to spend their time in their own bedroom. Bedrooms visited had been personalised reflecting the interests and personality of the person who lives there. Many people had brought treasured possessions and memorabilia from their own homes. Visitors’ comments included: “it’s very clean and homely,” “I’m very happy with the standard of hygiene and cleanliness”. There is level access throughout the home with handrails provided to assist people to maintain their independence and mobility. Toilets were easily accessible; they were close to both lounge and dining areas. Toilets had been provided with aids to enable people with physical disabilities to maintain their independence. There was an adequate number of baths, with an assisted bath within each area of the home. Two bathrooms had been fully refurbished and re equipped since the last inspection. People living at the home were able to smoke in a designated smoking area. Appropriate seating has been provided in the enclosed garden area for people wishing to sit outside whenever the weather permitted. There is a proactive infection control policy. Staff work closely with external specialists e.g. the Health Authority, Environmental Health to ensure spread of infection was minimised. Clinical waste was properly managed and stored. Additional shelving in the well-equipped laundry area would ensure staff were able to store items safely and reduce risk of contamination. Staff confirmed that they were provided with protective clothing if they needed it and that equipment was in working order, being serviced as required. Low surface temperature radiators had been provided to reduce risk to people of being burnt. Cantley Grange DS0000069578.V371769.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, 30. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Staffing levels were maintained to meet people’s care and social needs. Staff had received training to meet general and specific needs. Appropriate support and guidance was provided to new staff, enabling them to safely care for people who lived at the home. Staff files included the required information. The home operated a recruitment policy that promoted people’s protection. EVIDENCE: We met with seven members of staff including the manager during the course of this inspection. We saw staff working with people and noted that there was an atmosphere of mutual respect; their conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about their work. They confirmed that they were supported by the manager and encouraged to train and update their skills. A new member of staff we interviewed was able to provide evidence both written and verbal of their induction training and developing knowledge of the care needs of people at Cantley Grange. They confirmed that they had to provide two satisfactory written references and a Criminal Records Bureau Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 19 check before commencing employment. Personnel files sampled confirmed that the home follows the company staff recruitment procedures. Records of staff supervision and their training needs were examined. We saw the staff training and development plan. Training courses completed and planned were seen. These included health and safety, moving and handling, first aid and dementia care training. Many staff had achieved National Vocational Qualifications; the remaining staff were working to achieve the award. Skills for prevention of infection and fire and health and safety were updated each year. This ensures that staff were trained to meet people’s care needs safely Cantley Grange DS0000069578.V371769.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): 31,33,35,38. People who use the service experience good quality outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Staff said the manager was supportive and approachable and there was a wellestablished system of professional supervision. People were involved in making decisions about their care and had control over most issues that affected their lives. Systems were in place to protect people’s financial interests. Checks had been made on the major systems in the home such as fire and gas installations to ensure the home was safe for people. Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 21 EVIDENCE: We saw that there was always a senior member of staff on duty at the home with advice and support readily available. Responsibilities for the day-to- day operation of Cantley Grange were shared between senior members of the team. People said: “I feel the home is very well run, they organise events for residents but these aren’t always well attended by families”, “they have changed my dad’s life, he’s improved since he came here”, “standards are very high”. Staff said the manager was approachable, very professional and they felt confident in her. The manager had a job description that clearly defines her roles and responsibilities and staff were aware of her role. Staff had received management supervision at regular intervals; this is needed to develop staff and monitor care practices. A senior company manager visits the home to monitor care and standards at the home. A written report of their findings was available at the home. Management use a quality assurance system to measure standards of care and service provided. Questionnaires were used annually to seek the views of people and relatives. Regular meetings are held for staff and people who live at the home. These give people living at the home a voice and chance to say how the home should be run. People felt that their views and opinions were taken into account by the staff. The manager handles money on behalf of some people, account sheets were kept with receipts kept. A second person witnessed each transaction. Policies and procedures met the required standards. Records were mainly up to date and well ordered to ensure the best interest of people. No fire exits were obstructed and hazardous substances were securely stored. Statutory servicing and checks of equipment were complete. Risk assessments had been completed and were being reviewed regularly to maintain a safe environment. Service records for the moving and handling equipment, fire safety records and other maintenance records were up to date. The manager had received training in the Mental Capacity Act. This training has not been provided for the staff; it ensures they are aware of the changes needed to fully protect vulnerable people at the home. Cantley Grange DS0000069578.V371769.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 3 X 3 X X N/A 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 X X X X X 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 X x 3 Cantley Grange DS0000069578.V371769.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. 2. Refer to Standard OP26 OP38 Good Practice Recommendations Provision of additional shelving in the laundry area would ensure staff were able to store items safely and reduce risk of contamination. Staff needs extra training so that they know about the Mental Capacity Act 2007 this would make sure that they are able to fully protect vulnerable people. 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