Care Home: Christopher Grange

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What the care home does well People who are thinking about moving in are given up to date information about the home and their needs are properly assessed so that they can be sure that it is the right place for them to live. Each of the residents had a care plan, which are kept up to date and clearly set out how staff need to meet their health, personal, and social care needs. Staff showed good knowledge and understanding of the needs of the residents, during the inspection visit they were observed talking to residents in a polite manner and treating them with respect. There was an excellent range of activities for residents to choose from and they are offered well balanced and nutirious meals. The home had in place appropriate procedures for responding to concerns complaints and for ensuring that residents are safe from abuse, harm or neglect. Everybody spoken with during the inspection said that they had been given information about how to make a complaint if they needed to. People were confident that their complaints would be listened to and dealt with in the correct way. The home was comfortable and well maintained and there were no hazards found during the inspection visit. More than half of the staff team have achieved or are working towards a National Vocational Qualification in Care level 2 or above and they have all completed or are planning to complete training linked to the aims and objectives of the home and the needs of the residents. The home is well managed to the benefit of the residents and staff. What has improved since the last inspection? Parts of the home have been re - furbished and re - decorated and there are plans in place for further improvements making the home more comfortable for the people that live there. Since the last inspection staff have completed a lot of training so that they have the right skills to meet the needs of the residents and up to date knowledge about good practice and changes in the law. What the care home could do better: Residents relatives/representatives should be invited to take part in reviewing residents care plans so that they know how the residents needs are to be met. Meals, which have to be specailly prepared for residents should be presented so that they look and taste better. Key inspection report Care homes for older people Name: Address: Christopher Grange Youens Way East Prescot Road Liverpool Merseyside L14 2EW     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: Janet Marshall     Date: 1 2 1 2 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 28 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 28 Information about the care home Name of care home: Address: Christopher Grange Youens Way East Prescot Road Liverpool Merseyside L14 2EW 01512202525 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: theresemcgrath@christophergrange.org The Trustees Catholic Blind Institute care home 78 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category sensory impairment Additional conditions: 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 Sensory Impairment - Code SI The maximum number of service users who can be accommodated is: 78 Date of last inspection Brief description of the care home Christopher Grange is registered with CSCI as a care home for 78 older people. Christopher Grange provides accommodation in single bedrooms on four separate units all of which have an en-suite WC and wash hand-basin. Bedrooms are located on the first floor and can be accessed by stairs or two passenger lifts. The home is situated in Liverpool 14 and is in close proximity to local shops and public transport routes. The home is owned by the Catholic Blind Institute and has its own chapel in which a daily Care Homes for Older People Page 4 of 28 Over 65 78 0 0 78 Brief description of the care home mass is held. However, residents are accepted from any faith and local ministers of other religions visit to provide pastoral support. Care Homes for Older People Page 5 of 28 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: The Quality rating for this service is 2 star. This means the people living at the home experience good outcomes. This was a key inspection. We consider 22 out of the 38 National Minimum Standards for this type of service, Care Homes for Older People as the key standards, which have to be inspected during a key inspection. The key standards are highlighted in bold in the different outcome sections of this report. A key inspection is a planned inspection and the report is put together using information gathered in a number of different ways, which helps us decide the overall rating of the service. We keep all information we receive about the home in a file, we looked at all the information we have received since the key last inspection, which took place in November 2008. We sent out a form to the home called an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 28 (AQAA). The AQAA has to be filled in and returned to us by a set date usually before the site visit takes place. The AQAA was filled in by the manager and returned to us on time, it provided us with all the information we asked for about the service. We carried out an unannounced visit to the home, this is when we visit the home with out any body knowing and is called the site visit. People at the home were very helpful with the inspection, including residents, their family and friends, the manager and staff who were on duty at the time. Also during the visit a selection of records and certificates, which have to be kept in the home by law were looked at and checked to make sure they were up to date and accurate. a number of residents were case tracked. This is a process we use to find out whether the people that live at the home are receiving good quality care that meets their individual needs. It is done by talking to people, looking at results of surveys and reading the records of a sample of people that live at the home to give us a good idea of what it is like for them. Before the site visit took place we sent out Have Your Say surveys to people asking them about what it is like to live and work there. No surveys were returned at the time of writing the report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 28 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 9 of 28 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. Residents are given good information about the home and their needs are assessed before they decide to live there. Evidence: The Homes Statement of Purpose and Service User Guide have been updated since the last inspection. They included good information about the services and facilities, which are available at the home as well as information about how a person can complain. Details provided in the AQAA and discussion with the manager showed that the documents are given to prospective residents and their relatives before they decide to move in. The manager said that a new brochure design has been agreed and will soon be available to give out to residents already living at the home and those who are thinking about living there. The AQAA showed that a number of residents have been admitted to the home in the last twelve months. The manager confirmed that pre admission assessments were carried out for all newly admitted residents. Care Homes for Older People Page 10 of 28 Evidence: Pre admission assessments were looked at for three people who have recently moved into the home. All assessments, which were carried out by a unit manager were detailed and covered things such as, sight, hearing social contacts, medical history, mobility, personal care and safety. Assessments carried out by social workers and other professionals were also available in residents care files. Care Homes for Older People Page 11 of 28 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. Residents personal and healthcare is well monitored and supported ensuring they stay well and they are treated with dignity and and respect. Evidence: Each of the residents had an individual care plan, which was kept securely at the home. Since the last inspection the management team have introduced a new care planning format, which is now being used to set out the residents care need requirements and the action that staff need to take to ensure they are met. A selection of care plans were looked during the inspection visit as part of the case tracking process. The plans included detailed information about the persons health, personal and social care needs. The plans were well organised and easy to read. Staff spoken with showed a good understanding of care plans and explained why they are important. They made the following comments to support this, They tell us how a persons needs should be met. They are important way of getting to know the person. They help us understand the person and tell us how to support them in the right way. Contained within the care files looked at were review records, the records showed that Care Homes for Older People Page 12 of 28 Evidence: each section of the persons care plan has been reviewed and updated each month with the involvement of the resident and or their representative. Although one family member said they had not been invited to take part in reviewing their relatives care plan but they did say their care was regularly discussed with them. Residents relatives/representatives should be invited to take part in reviewing residents care plans so that they know how the residents needs are to be met. Records of medical appointments were kept in good detail and showed that residents have regular access to specialist medical, nursing, dental, chiropody and doctors services. Visits to the home by healthcare professionals are arranged when needed. Residents spoken with confirmed that they could see their doctor when they choose. During the inspection visit a resident received a visit from their doctor and a number of others were visited by a nurse. They were all seen in the privacy of their own bedrooms. The manager confirmed the arrangements that are in place at the home to enable residents to access other specialist services such as speech therapists and dietitians. Discussion took place with an incontinence nurse who was visiting several residents at the home at the time of the inspection visit. The nurse said, Staff have always been very good at following advice and instructions following my visits and I have no concerns about incontinence care of the residents whom I attend to at the home. She also said, They always make sure that there is a good supply of incontinence aids and as far as I am concerned they use them in the correct way. The AQAA provided details of a number of policies and procedures, which relate to the health care of residents. They include infection control, administration, recording, safe keeping, handling and disposal of medication. Medication was stored safely at the home and records, which were looked at, were well maintained. The AQAA told us that staff who give out medication have completed medication training. Discussion with staff and records, which were looked at showed that all staff who give out medication to residents have completed the relevant training. Certificates for some staff were seen displayed in the medical rooms on each of the units. During this inspection visit staff were seen, knocking on doors before entering rooms, assisting residents with personal care in private, talking to them in a polite manner and treating them with respect. Residents spoken with said staff always treat them well and respect their privacy and dignity. They made the following comments to support this, All the staff are lovely, the are good to me. Staff are kind and polite. The staff treat me well. Yes, they always knock on my bedroom door before coming in to my room. Comments made by staff, which supported their understanding of, care values such as privacy, dignity and respect included, I always close doors when helping residents with personal care. I knock on doors before entering a room, talk to the person Care Homes for Older People Page 13 of 28 Evidence: about what I am going to do. I always give residents choices and encourage them to do things for themselves. I shut doors and blinds when helping a person to wash and dress and I always ask them if them want me to help them. A healthcare professional said, The staff are always pleasant, helpful and polite. I have only ever seen them treating residents with respect. Discussion took place with a number of residents relatives and friends who said, The staff are caring. The staff are always polite. They treat my dad very well. I have no concerns about the staff at all they work very hard. Care Homes for Older People Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy with the variety of activities available at the home and they enjoy meal and mealtimes. Evidence: Pre admission assessments and care plans detailed residents social preferences and lifestyles. Information about their likes and dislikes, past lives, social interests and hobbies were recorded to enable staff to appropriately support these needs. The AQAA showed that residents routines and daily lives are varied and flexible to suit their individual needs. The home has an activities coordinator who works 30 hours a week. The activities coordinator, who was previously a care assistant at the home showed good knowledge of residents social needs. She said she works on each unit providing both group and one to one activities as well as arranging activities and entertainment for everybody in the Market Place. There was a singer performing in the Market Place during the afternoon of the inspection visit. The event was well attended by residents and some of their visitors. A weekly activities programme was displayed on a wall in the Market Place. The programme included a variety of activities and services for residents to choose from including hairdressing and manicures, film shows, quizzes, bingo, singing and dancing. The manager reported that church services and holy communion are Care Homes for Older People Page 15 of 28 Evidence: regularly held in the chapel at the home for those residents who choose to take part. Information detailing religious services was also on display at the home. Residents care plans included information about their religion. During the inspection visit residents said, There is lots of things for us to do if we want to. I enjoy the sing a longs. A residents relative said, Residents are given a lot of opportunities and there is a variety of activities, which have improved lately. A visitors book was kept at the reception area and has to be filled in by people when they enter and leave the home. This showed that residents receive regular visits from friends and family members. Visitors were seen coming and going at intervals throughout the inspection visit. They were welcomed by the manager and staff and offered refreshments. Residents spent time with their visitors in the privacy of their own rooms, the lounge areas and in the Market Place. Discussion took place with a number of visitors, all of them said that they are always made to feel welcome at the home by both the manager and staff. One relative said, There are no visiting restrictions, I can come and see dad at any time. During the inspection visit residents were seen making choices for themselves, others were seen being encouraged by staff to make choices. Residents spoken with confirmed that they choose what clothes they were each day and decide what time they get up and go to bed. All residents spoken with said they go to bed and get up when they choose and staff spoken with said, Residents can lie in bed if they want to, we never get them up if they ask to stay in bed. Care plans detailed daily tasks and activities, which residents are able to do independently and those, which they need help with. Each unit has its own dining area, which overlook gardens. They were furnished with dining sets, which seat four people. All main meals are prepared in the main kitchen, which is close to all units. The kitchen is managed by a head chef who has a team of cooks and domestic staff. Hot trolleys are used to transport meals to each of the units. A four week menu was on display at the home. The chef said he devises the menus to suit the time of year and the dietary needs of the residents. Held in the kitchen were details of any special dietary requirements that residents have as well as information about their likes and dislikes, preferred portion size and nutritional needs. Menus were varied and included nutritious and well balanced meals. The main meal is at lunch time, each day there are three choices of hot meals and residents are asked to choose their meal the day before. The lunchtime meal was spent with residents and the food was sampled. Staff served residents individually with their meal. The meal began with staff offering residents a bowl of hot soup followed by a roast dinner. Residents were offered a choice of desserts following their meal. The meals were nicely presented and generous in Care Homes for Older People Page 16 of 28 Evidence: portions. Staff assisted residents in a sensitive way and they gave them time to eat their meal at a pace that suited them. Hot and cold drinks were served and residents were offered seconds. One resident, who needs their food pureed was served with the lunch of the day all mixed together in a bowl. This looked unattractive and takes away from the resident the experience of different food tastes. This was discussed with the staff and the chef who said, they would ensure that the food is prepared and presented in a more appropriate way. The chef said, he has ordered special molds to help with the presentation of pureed foods. Meals, which have to be specailly prepared for residents should be presented so that they look and taste better. Each of the units has their own kitchen, which were equipped with a microwave and fridge so that staff can prepare snacks and drinks for residents in between main meals. Residents and their visitors are discouraged from using the kitchen because of health and safety reasons. Residents spoken with said they like the food served at the home. They made the following comments, The food lovely. We get plenty of nice food to eat. We are always asked what we ant to eat. I have no complaints about the food, it is lovely. Care Homes for Older People Page 17 of 28 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. Residents are fully protected by procedures, which are in place at the home and they are confident about complaining if they need to. Evidence: The Commission have received several anonymous complaints about the home since the last inspection. Our records show that they have been appropriately investigated. The AQAA told us that 11 complaints have been made directly to the home. The compalints book, which was looked at during the inspection visit showed that all the complaints have been recorded and dealt with in the right way, up to date 7 of them have been resolved and the others are ongoing. Residents and their visitors spoken with were asked if they knew about the homes complaints procedure and if they were confident about complaining if they needed to. They gave the following responses. Yes I would complain if I needed to. I know how to complain. I have complained and the manager dealt with it promptly and in the right way. Yes I have been given information about how to complain. Available at the home were a number of other policies and procedures, which aim to ensure the protection of both residents and staff. They included, whistle blowing and protection of vulnerable adults procedures (POVA). The AQAA showed that all these policies and procedures have been reviewed and updated since the last inspection. Staff spoken with were familiar with all of procedures and said they were confident about using them if they needed to. Care Homes for Older People Page 18 of 28 Evidence: The AQAA told us that all staff are provided with POVA training. This was also confirmed by a number of staff that were spoken with during the inspection visit when they said, they were confident about what they would do if they saw or thought somebody was being abused. A member of staff said, I would definitley report abuse. Another staff member said, I would report it right away. Our records showed that 9 safeguarding referrals have been made promptly and for the right reasons. The manager of the home works well with ourselves and other agencies to ensure they are properly investigated and resolved. Care Homes for Older People Page 19 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a comfortable and safe place for residents to live. Evidence: Christopher Grange is located in a residential area of Dovecot Liverpool. There is a main reception area as you enter the home, which is staffed during the day Monday to Friday. There is a large Chapel in the building that is open for residents and their visitors to use whenever they want. Corridors linked to the reception area lead to a large communal area commonly known as The Market Place. One end of the The Market Place is furnished with leather sofas and there is a piano for residents use. At the other end is a hairdressing salon and a coffee shop that is run by voluntees. Residents accommodation is spread over four units. Each unit has a kitchen, lounge, sitting room, dining room, toilets and bathrooms. All residents bedrooms are located on the first floor of the home. A tour of the home was carried out as part of the inspection visit. There was a warm and friendly atmosphere throughout and residents were seen moving freely about the home independently or if needed with the help of staff. Specialist equipment was in place to assist residents with mobility, including a lift, which operates from the ground floor up to the first floor, lifting hoists, handrails and ramps. The home has a maintenance department with a manager and a small team of workmen. The department was visited during the inspection when the maintenance manager explained what their responsibilities are. They include every day general repairs and general maintenance of the building. The department also Care Homes for Older People Page 20 of 28 Evidence: carry out the required checks on systems and equipement used at the home, such as fire alarms and extinquishers, water temperatures and gas and electricity appliances. Records for these were kept and those looked at were accurate and up to date. The maintenance manager spoke with great enthsusiasm about his work and showed good knowledge and understanding about issues of health and saftey. The AQAA detailed a number of improvements carried out at the home since the last inspection, they included some decoration to all four units and the installment of new kitchens in each of them. It also told us about plans for further improvements, which included further decoration on all units. Most parts of the home were clean, peasant and hygienic and there were no hazards identified at the time of the inspection. A random selection of residents bedrooms were looked at during the inspection visit. Most of them were nicely decorated and furnished to a good standard although there were a couple of rooms with broken pieces of furniture and tatty decor. The maintenance manager provided records to show that these had been reported and there are plans in place to repair or replace broken furniture and to redecorate those room that need it. One residents bedroom had a very strong and unplesant smell of urine. On close inspection it was noted that a large patch of the carpet was wet with urine. This was pointed out to the manager of the home and immediate action was taken to resolve this. The resident was provided with another room and plans were put in place to redecorate and replace the carpet and furniture. Residents spoken with said their rooms and other parts of the home are always clean and tidy. They made the following comments, My room is always kept clean. The cleaners keep my room nice for me. Detailed in AQAA and available at the home were a number of policies and procedures, which aim to ensure a clean and safe environment, they include infection control and disposal of soiled waste. Staff spoken with said they have completed health and safety training and they said there are always enough dispoable gloves and aprons for their use. Domestic staff said they always have enough cleaning products, which they keep locked away for health and safety reasons. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported and cared for by right amount of staff that are qualified and experienced. Evidence: Each unit has its own team of staff. The manager explained that there are occasions when staff are moved from one unit to another usually to cover absences or to ensure that units are covered by staff with the right skills and experience. At the time of the inspection there was at least 3 care staff on each unit. A member of staff spoken with said, I think there is always enough staff on duty to meet the needs of the residents and there is always a senior member of staff on each shift. The staff member said, There are usually 3 or 4 care staff on each unit during the day and evening and 1 member of staff throughout the night with a sleep in staff member who is called upon when needed. The staffing rotas, which were examined as part of the inspection showed the staffing levels as described by staff spoken with. The manager said she is on duty at least five days a week. Discussion with the manager and information provided in the AQAA showed that the turn over of staff has been low since the last inspection. Three members of staff were interviewed on a one to one basis during this inspection. General discussion also took place with a number of other staff at intervals throughout the visit. Care Homes for Older People Page 22 of 28 Evidence: Staff interviewed showed a good understanding of their roles and responsibilities, they were very knowledgeable about the needs of the residents and showed a real commitment to ensuring that they are well cared for and have a good quality of life. Residents and their relatives spoken with during the inspection visit made many positive comments about the staff, including, I like all the staff and they are very good. The staff are very kind, caring and polite. The staff do a good job. They are well trained. The staff work very hard. An equal opportunities policy and procedure was available at the home. The AQAA told us that the home employs people of various ages, gender and of different backgrounds. It also told us that strict recruitment and selection procedures are followed when taking on new staff. This was also evidenced upon examination of records for two staff that have been recruited since the last inspection. The records showed the required checks were carried out before the people were allowed to start work at the home. Staff files were well organised and contained all the information, which needs to kept by law. The AQAA told us that all new staff complete induction training based on The National Minimum Standards for this type of service. Records, which were viewed for new staff showed that they received induction training when they started work at the home. The AQAA told us that staff have received a good amount of training since the last inspection visit, which is relevant to the jobs that they do. It also showed that training is high on the agenda and there is further training planned for the future in both mandatory and specialist subjects. Each member of staff has a training and development plan, which is used to assess and identify their individual training needs. A training programme which, was looked at showed details of up to date training completed by all staff, it included mandatory and specialist training such as Moving and Handling, Dementia Awareness, Medication, Infection Control and Fire Awareness. Staff spoken with said that they have completed a lot of training since the last inspection and gave the following examples, Fire Safety Health and Safety, POVA, Medication Awareness and First Aid. Staff said, We get a lot more training now. The training is really good. I enjoy the training and have learnt a lot from it. We can request training if we think we need it. I feel well trained. The AQAA and staff training records held at the home showed that more than half the staff team have achieved a National Vocational Qualification (NVQ) in Care Level 2 or above. NVQ training was also included in training planned for the future. Care Homes for Older People Page 23 of 28 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. The home is well managed in the best interests of the residents and staff. Evidence: Therese McGrath is the Registered Manager of the home. Therese is a Registered Nurse and has many years experience of working in Health and Social Care as well as a number of other qualifications, which are relevant to her job as manager. Therese has the support of a Director of Care who also is a Registered Nurse with many years experience. As a charitable organisation Christopher Grange is governed by a board of Trustees who were described by the manager as being very supportive. Each unit has an appointed manager although Therese has overall responsibility of the day to day running of the home. The AQAA told us that all of the unit managers have got an NVQ L4 Managers award. Residents and staff spoken with during the inspection were complimentary of the managers and the way the home is run, the following comments made during the inspection supported this, There is always a manager to talk to. You can talk to any one of them. I have no problem talking to the manager. The manager is very good Care Homes for Older People Page 24 of 28 Evidence: to the residents and always talks to them. Yes I feel well supported. I get on well with the managers. Therese is very supportive. Therese is approachable, caring and a good listener. Comments made by relatives included, I think the home is well managed. The home is managed better now. Therese is very good she has made a difference. Discussion with the manager and records, which were examined, showed that the home has in place a number of quality monitoring systems, which aim to ensure that the home is run in the best interests of the residents. Satisfaction questionnaires are given out to residents and their representatives as a way of seeking peoples views about the home and the results of them are used to plan make the necessary improvements and to plan for the future. The health safety and welfare of residents are well protected, this was supported by a set of policies and procedures, which were detailed in the AQAA and available at the home. Most of the homes policies and procedures have been reviewed and updated since the last inspection. Information provided in the AQAA and examination of a selection of health and safety records showed that the required health and safety checks have been carried out on the environment at the required intervals, for example fire system checks, gas and electricity checks and environmental risk assessments. Staff and residents spoken with confirmed that they hear the fire alarm system regularly being tested. Discussion with the manager and staff and examination of training records showed that all staff have completed Fire training. Care Homes for Older People Page 25 of 28 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 28 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 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 7 Residents relatives/representatives should be invited to take part in reviewing residents care plans so that they know how the residents needs are to be met. Meals, which have to be specailly prepared for residents should be presented so that they look and taste better. 2 15 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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