Care Home: Charlotte Grange Residential Care Home

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What the care home does well People get good information from the home so that they can make a decision about whether to move here. The home keeps very good care records so that all staff know exactly how to support people in the right way. The home works very well with health services. A visiting health care professional said, "The care is very good here." People who live here said they are are treated with dignity and respect . One visitor said, "They treat people here with such respect and are so supportive to residents and their families." There is a good range of places for people to sit, and everyone has access to the pleasant, sheltered courtyard garden in the centre of the home. All the bedrooms are single and all look out onto garden areas around the home. Residents, relatives and health visitors described the staff as "very nice", "lovely" and "welcoming". One relative said, "The staff here are made of gold. I`m very pleased with the service." Residents and staff get on well together. Many staff have worked here a long time so they know each person`s needs very well. Staff have good training so they know how to support the people in the right way. Overall the home is well run by CIC. What has improved since the last inspection? The storage of medication is much better and there are now individual medication trolleys for each unit. What the care home could do better: The home should give people information about menu choices for each meal in a way that best supports their needs. The Provider must arrange to redecorate bathrooms, and the home staff should remove inappropriate and redundant furniture from these rooms. The home staff must make sure that building is safe from fire hazards. It would be better if bathroom and toilet doors were painted a different colour so that residents could find them easily. It would be better if bedroom doors had names, numbers or familiar pictures to help people find their own bedroom. Other things which would make the home better include: having a copy of information for people in audio format, so it is ready for someone if they have difficulty with reading; having nutritional care plans when people are losing weight; helping people to have more control over their own medication if they are assessed as capable of doing so; keeping a record of all comments of complaints; and offering training in dementia awareness to other staff. Key inspection report Care homes for older people Name: Address: Charlotte Grange Residential Care Home Flaxton Street Hartlepool TS26 9JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrea Goodall     Date: 0 9 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Charlotte Grange Residential Care Home Flaxton Street Hartlepool TS26 9JY 01429860301 01429222472 charlottegrange@c-i-c.co.uk www.c-i-c.co.uk Community Integrated Care care home 46 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 46 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, maximum number of places 24 Dementia Code DE, maximum number of places 12 Physical Disability, Code PD, maximum number of places 10 Date of last inspection Brief description of the care home Charlotte Grange is in a quiet residential area in Hartlepool and is owned by Community Integrated Care (CIC). It is registered to provide care and accommodation for up to 46 people with the categories of dementia (12), Old age not falling within any other category (24) and Physical disability (10). Internally the home is divided into units with a central forum area at the entrance. Each unit has a lounge and additional seating areas as well as a dining area. Residents can choose to eat their meals in the Care Homes for Older People Page 4 of 30 12 0 10 Over 65 0 24 0 Brief description of the care home dining area or in their own rooms. Kitchenettes are provided in each unit where snacks can be made. The home has a central kitchen, which serves all the units. Residents are able to personalise their own rooms and relatives and friends are welcome to visit at any reasonable time. At the time of this visit the weekly fees are £398-415 if local authority funded, or £424-451 if privately funded. The home should be contacted for up-to-date information about fee rates. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit we looked at information we have received since the last visit on 24th July 2007, and the last annual service review on 28th August 2008. We looked at how the service dealt with any complaints or concerns since the last visit. We looked at any changes to how the home is run. We asked the Provider for their view of how well they care for people in their AQAA (an annual quality assurance assessment). We made an unannounced visit to the home on 9th July 2009. During the visit we talked with people who use the service, their relatives, staff, and health care visitors. We joined residents for a meal and looked at how staff support the people who live here. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept by a care service. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure Care Homes for Older People Page 6 of 30 it was clean, safe and comfortable. We checked what improvements had been made since the last visit. We told the senior staff what we found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home should give people information about menu choices for each meal in a way that best supports their needs. The Provider must arrange to redecorate bathrooms, and the home staff should remove inappropriate and redundant furniture from these rooms. The home staff must make sure that building is safe from fire hazards. It would be better if bathroom and toilet doors were painted a different colour so that residents could find them easily. It would be better if bedroom doors had names, numbers or familiar pictures to help people find their own bedroom. Other things which would make the home better include: having a copy of information for people in audio format, so it is ready for someone if they have difficulty with reading; having nutritional care plans when people are losing weight; helping people to Care Homes for Older People Page 8 of 30 have more control over their own medication if they are assessed as capable of doing so; keeping a record of all comments of complaints; and offering training in dementia awareness to other staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed before they make a decision about moving here so that they know the home can meet their needs. Evidence: Charlotte Grange has been open for around 22 years. Many of the people who come to live here are familiar with the surrounding area and some already knew of the home before they moved here. The home provides each prospective resident with an information booklet about the service (called a service users guide) which is easy to read and gives good details about the service. At this time the home does not have the booklet in other formats, for example in audio for people with reading difficulties. However Community Integrated Care (CIC) is able to produce information in a variety of ways if people need this. At the time of this visit there 43 people living at Charlotte Grange. Before people come to live here their needs are assessed by health and social care professionals to see Care Homes for Older People Page 11 of 30 Evidence: what sort of care they need. It was clear that the home has very good working relationships with other care professionals. There was good evidence in care files to show that the home carries out comprehensive assessments of all prospective residents to ensure that the home can provide the right care they need. This clear information is then used to set out an individual plan of care for them when the person moves in. The home is registered to provide up to 12 places for people with dementia care needs and 10 places for people with significant physical disabilities. The home is set out into four different units, and people are generally accommodated in a specific unit according to their care needs. If a residents needs changed over time the home would involve all relevant professionals in assessing whether the home could continue to meet their needs. For example, senior staff were able to describe occasions where peoples needs had changed and they had to move to nursing care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here receive good support so that their personal and health care needs are well met. Evidence: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. For example how to help people with their mobility, emotional well being, and hygiene. The sample of care plans at Charlotte Grange were detailed and provided clear guidance to staff about how to meet each persons needs. For example, a night time care plan includes whether a person likes the light on or off, any night-time needs, their preferred sleeping position, their preferred waking time or whether they like a lie-in, and their preferred morning drink. The care plans are written in a sensitive and respectful way that promotes the individuality and preferences of each person. The care records also show that peoples health care needs are regularly assessed and are well managed with the involvement of health care professionals. The homes Care Homes for Older People Page 13 of 30 Evidence: detailed assessment records include moving & assisting, nutrition, risk of falling, and behavioural needs. In most cases these were linked to the persons care plan so that staff know exactly how to support the person with these areas. However in one case the assessment showed a clear nutritional risk of one person as they are losing weight, but this was not laid out in a care plan. The persons family said that they were very pleased with the care provided by the home and felt that staff do encourage the person to eat sufficiently. However the lack of care plan makes it difficult to tell what action staff are or should be taking, for example increased high calorie foods, and the involvement of dietician and catering staff. Charlotte Grange does not provide nursing care. The care records show that the home supports people to have good access to community health care services such as GPs, dentists, nursing services, opticians and so on. It is good practice that the home is registered with the Gold Standard Framework in Care Homes, which means it works as a team with other professionals to support the best possible care for people when they are nearing the end of their life. It is clear that the home works well with health services. A visiting health care professional said, The care is very good here - its probably the best home that I go to.There are no issues with the way that staff manage peoples needs here. The home states that it would support people to manage their own medication if they chose to and were assessed as capable of doing so. At this time one person manages their own simple painkillers. The assessment shows that the person is capable of this and has secure storage in their bedroom for this. However there are no records of how much medication the person is given or when, and there is no monitoring of this to ensure they have sufficient. The persons family said that the resident often has to ask staff for more when they run out. In this way the person does not have full control over their own medication. For all other people the senior staff manage the medication. Medication is delivered to the home by the pharmacist in individual blister-packs for each person so that it is easy for staff or residents to use. Following a requirement at the last inspection the storage for medication has greatly improved. Medication is now stored securely and safely for each unit, and records of the administration of medication were in good order and up to date. Residents, relatives and other visitors had many positive comments to make about the manner in which people are supported here. One resident said, Ive been here a few Care Homes for Older People Page 14 of 30 Evidence: years now and staff are all lovely. They do anything for me if I ask, but they let me do what I can for myself. One visitor said, They treat people here with such respect and are so supportive to residents and their families. Another relative said, Whenever we visit the staff are very nice. Weve come at different times and seen different staff but they are all very welcoming. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have sufficient information about menu choices, and limited opportunities to go out so they are not fully supported to lead an active lifestyle that meets their individual preferences. Evidence: The home does not employ an activities staff, so it is the responsibility of support staff to arrange and provide activities. In the dementia care unit staff described dancing, karaoke and ball games but mainly one-to-one reminiscence sessions with those who could take part. In other units staff stated that there is weekly bingo and a monthly entertainer. There have been occasional pamper sessions by college students. However most of these activities events were of little interest to several of gentlemen living here, and some residents found them too routine to be stimulating. One resident said, It gets a bit monotonous - there is not much to do. There are volunteer visitors to the home who take two residents out and some people go out with relatives. However other people do not have many chances to go out of the home, even though it is so close to the local town centre.There are occasional trips to a local theatre, but staff stated that that there were very few opportunities for people to go out even into the local community. (In the homes AQAA (annual quality Care Homes for Older People Page 16 of 30 Evidence: assurance assessment) this was an area that the home wants to improve.) There is a very good range of places for people to sit. Each unit has a main lounge/dining area plus a sun room in the corridor. All the unit have access to a very pleasant courtyard garden in the centre of the site. In this way there are plenty of places for residents to receive visitors, and there was a steady stream of visitors on this day. Visitors had many positive comments about the home, for example one person said, Its an excellent place. Ive had two relatives live here and Ive booked a place for myself. Each of the four units has its own small kitchen area within the dining lounge. In this way staff can make people and their visitors drinks or snacks. Main meals are provided by catering staff from the main kitchen. Most people felt that the quality of meals was generally good and they enjoy the home-made, traditional dishes. However there is only one main dish at each lunchtime, or the alternative everyday is a salad. Staff have access to a written menu in the units which show the main dish everyday, but these are not made available to residents as staff said that some people might damage them. In this way residents do not have information in order to make an informed decision about their meals. Also there is very limited choice of main meals. At the teatime meal some people had been able to ask for a change to the menu, for example one person had requested brown bread and a banana instead of the steak pie. However many people might not feel able to ask for something different. People with dementia care needs may not be able to express their choices verbally and are not shown different options from which they could choose. Instead staff who are familiar with their likes and dislikes make their choices for them. It is good practice that staff noticed one person was not eating their meal so offered them a yoghurt, which they enjoyed. (In the homes AQAA, menu choices is an area that it has identified for improvement.) Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have information so they would know how to make a complaint. The staff team have had suitable training so they know how to protect residents from abuse. Evidence: People who come to live at Charlotte Grange are provided with a handbook which outlines the service and the homes complaints procedure. The handbook is available at the front reception area of the home for all visitors to read. In discussions residents or their relatives said that staff were very approachable and that they would feel confident about discussing any concerns with the management staff. The homes complaints records show that there have been no formal complaints received about the service. However the home does not record informal concerns or comments. For example, one visitor commented that they had recently raised concerns about the cleanliness of the home and lack of domestic staff at times. They stated that senior staff had looked into these concerns. However there is no written record of this or the action that the home took. Staff confirmed that they have had training in the protection of vulnerable adults through CIC. It is good practice that all senior staff have also attended a two day training course in Safeguarding Adults with Hartlepool Borough Council. In this way all staff felt confident that they would know how to report any suspected abuse. Care Homes for Older People Page 18 of 30 Evidence: CIC has demonstrated that it responds quickly and takes the right action to deal with suspected abuse. It has worked well with Hartlepool Borough Council and other agencies to look into these. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm and comfortable, but some areas are worn so it is not a fully wellmaintained environment for the people who live here. Evidence: Charlotte Grange is a purpose-built, single storey care home that is designed into four separate units. It provides 46 single bedrooms. Due to the age of the building bedrooms do not have en-suite facilities but there are toilets and bathroom in each unit. Bedrooms are not spacious but most have been highly personalised by the people who live here. All the rooms look out onto garden areas around the side of the home. However the double-glazed windows to some bedrooms have trapped condensation between the panes. This makes the windows look grubby and makes it difficult to look out. The standard of decor and furnishings in lounges and sitting areas is good, and these are comfortable and inviting to use. However as with many buildings of its size and age, the home needs a continuous decoration programme and some bedrooms show signs of wear and tear, such as scuffed paintwork. The home has a part-time maintenance staff to carry out maintenance checks and minor repairs. Bathrooms are in a worn state with scuffed paintwork and tired decor. Redundant furniture, including cupboards and television sets, was being stored in most Care Homes for Older People Page 20 of 30 Evidence: bathrooms which is both inappropriate and a potential hazard. This makes bathrooms appear shabby and uninviting, and detracts from the otherwise homely accommodation. There are no signs on most bathrooms or toilet doors, and no names or numbers on most bedrooms doors. All the doors throughout the home are white which makes it very difficult for people to find their way around. This does not support the needs of people with poor sight or with dementia needs, and is contrary to best environmental design for people with such needs. There is no colour-contrasting in toilets to help people find the light switch, which is white against a white background. In most bathrooms and in some lounges there were boxes of latex gloves on display. There were also continence pads on display in toilets and on bathrooms floors. This compromises residents dignity, and also compromises infection control as people may have touched this equipment. Although toilets and bathrooms were well equipped with soap dispensers and paper towels there were no bins for people to place their paper towels. Light pull cords in some bathrooms were very grubby. Charlotte Grange is a large and busy building. There are two domestic staff on duty in the morning to attend to the 46 rooms and four units. It is evident that the domestic staff work hard to keep the home clean, and odour management was quite good. However from 1pm there is no domestic support available in the home. Some relatives felt that the standard of cleanliness could be improved especially in the dining areas after the teatime meal. For example, there was foodstuff on some dining chairs and the floor even before the meal. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides suitable, competent, trained staff to ensure that the people who live here are protected and that their needs are met. Evidence: The care staff team currently consists of a deputy manager, three senior support staff and about 40 support staff (including some bank staff who cover when needed). The home also employs catering, laundry, domestic staff and a part-time administrative staff. The staffing rota allows for 8 support staff on duty throughout the day and evening, that is two staff on each unit. It is very good practice that the same regular team of staff work in the same units so that residents can get to know them and staff become familiar with the needs of each resident. There are three staff on night time duty. Recently the home has used an outside employment agency to cover gaps (as it is holding vacancies open for another CIC home that is closing).However there are always regular CIC staff on night time duty as well. A core group of support staff have worked at Charlotte Grange for several years, and this supports the continuity of care for the people who live here. One visiting health care professional said, The staff have been here for years, so they can spot any changes in peoples needs and they let us know. Care Homes for Older People Page 22 of 30 Evidence: There is a good mix of age and experience amongst the staff team. At this time there is only one male support staff, and staff agreed that more male staff would benefit the 20 male residents who live here. Community Integrated Care is an equal opportunities employer and uses robust recruitment and selection processes to make sure that only suitable staff are employed here. It was clear from personnel records that no staff starts work here until satisfactory checks, references and police clearance (called a CRB disclosure) have been received. A visiting relative said, The staff here are made of gold. Im very pleased with the service. In discussions all staff confirmed that they have very good training opportunities with CIC. Around 70 of the support staff team have achieved a national care qualification called NVQ level 2, and most other staff are working towards this. All senior staff have achieved the higher care qualification called NVQ level 3. Training records show that staff have also received other relevant training, such as low vision, falls management and continence awareness. A small number of staff, mainly those that work on the dementia care unit, have had some introductory training in dementia awareness and in non-violent crisis management. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is well managed and is run in a way that upholds the best interests of the people who live here. Evidence: Until recently the home was managed by the registered manager. Just prior to this inspection the manager was promoted to another post within the CIC organisation. At this time the home is being managed by the deputy manager, and there are plans for a new manager to be in post in the near future. In the meantime the deputy manager is supported by senior support staff who deputise in her absence. The home also has an administrative staff who provides support with the many administrative tasks involved in running a care home. The Providers quality assurance processes include a number of audits of the home and at least monthly visits by a representative of the organisation to check on its operations and report on its progress. CIC also produce an annual report on its Care Homes for Older People Page 24 of 30 Evidence: service. The homes AQAA indicated that it plans to develop more specific surveys to get residents views about specific elements of the service at Charlotte Grange. Around 16 residents were recently involved in an independent assessment of the service which was arranged by Hartlepool Borough Council, and was largely positive. The home has a copy of the resulting report and recommendations, which will be monitored by the local council. If requested the home will support residents to keep small amounts of their personal monies in individual packets in the home safe. Around half the people living here have asked for some money to be kept for safekeeping. The records of this were found to be up-to-date, in good order and clearly identify any transactions made on behalf of a resident. These records are audited daily by the administrative staff, and on a regular basis by representatives of CIC. It was clear from training records that staff receive training and regular updates in relevant health & safety matters, such as moving & assisting, fire safety and first aid. The maintenance staff carries out and records routine health & safety checks of the building and equipment, for example water temperatures. However there were some potential fire safety hazards in the home at the time of this visit. Several bedrooms doors do not shut properly into their rebate so would not protect people from smoke or fire. The laundry door was being held back by a large box of washing powder, even though it is already fitted with a fire-release device. This means if there was a fire in laundry room, the door would not be able to close and contain it. (This was addressed immediately by senior staff.) A ventilation fan in a toilet has furred up and could cause a fire. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 21 23 The Provider must arrange to redecorate bathrooms, and remove inappropriate and redundant furniture from these rooms. This is to ensure that there is an acceptable standard of decoration and facilities in all areas of the residents accommodation. 01/11/2009 2 38 23 The Provider must address 28/08/2009 the potential fire safety risks. These include poorly fitting bedrooms doors, ensuring fire doors are not held open (except by suitable equipment) and regular cleaning of ventilation fans in toilets and bathrooms. This is to ensure that fire safety is not compromised in this home. Care Homes for Older People Page 27 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It might be helpful if the home had a copy of its service user guide in other formats, such as audio, for any prospective residents who find it difficult to read. The home should ensure that where a nutritional assessment shows a high risk there should be a care plan to show what support is being provided to reduce that risk. People should have greater control over their medication when they have been assessed as capable of doing so. This may be supported by a record of how much medication is given and when it is given so that staff can monitor whether people have sufficient and/or when they require more. There should be more opportuntities for people to go out into their local community or on short trips. People should have access to information about menu choices for each meal in a way that best supports their needs.This is to ensure that resident can make informed choices based on clear information about forthcoming menus. There should be a good range of choices at each mealtime, with varied alternative options. It would be better if all complaints, including informal complaints, were recorded to demonstrate that the home takes such matters seriously and to demonstrate what action was taken to rectify any issues raised. Consideration should be given to how the design of the environment can be improved to support people with dementia care needs to find their way around the home, for instance by use of different coloured doors for toilets and bathrooms, and names, numbers, pictorial signs and familiar objects on doors to denote their use. The condensation in double-glazed windows should be addressed and resealed, so that residents can see out of their bedrooms windows. Boxes of latex gloves and continence equipment should be discreetly stored out of sight in order to protect residents dignity and to uphold infection control. Dirty light pull cords should be replaced and then be included on the cleaning schedule. Page 28 of 30 2 8 3 9 4 5 12 15 6 7 15 16 8 22 9 24 10 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 11 26 Consideration could be given to providing housekeeping support in the early evening, for example after the teatime meal, to ensure that the home is kept clean at these times. It would be useful for more staff to have training in the needs of people with dementia -type illnesses, as there are more residents within other units who also have these needs. 12 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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