Care Home: Grange Care Services Limited

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What the care home does well People living in the home, some of whom have complex needs, receive a very high level of individual care from a committed and well-supported staff team. The home offers a safe and pleasant environment for the people who live and work there. The standard of record keeping is generally good and this helps achieve good care outcomes for people living in the home. The home has successfully integrated a new person into what was a very well settled and established group of people living in the home. What has improved since the last inspection? Staffing at key times has been increased, as recommended in the last inspection, this provides people living in the home with additional help when they most need it. Training for staff in key areas identified during the last inspection report has been provided and provision is now made for regular updates, which increases the skill base of staff and assists them to provide a positive and safe service to people living in the home. There were no issues with the cleanliness of the home during this visit, which suggests that the problems identified previously have been satisfactorily addressed. This will contribute to making the home a pleasant place in which to live and work. What the care home could do better: To avoid potential confusion for staff and those who have responsibility for people living in the home, the roles and responsibilities of the responsible individual, registered manager and deputy manager should be clarified. Some further minor improvements to the medication practice of the home should be introduced to help with the accurate monitoring of some stock medication and to ensure that people living in the home are as fully protected as possible. The process of reviewing and revising the care plan documentation of the home should be accelerated. It is acknowledged that the responsible individual has already picked this up, during their regular monitoring visits to the home. This will better assist staff to provide care taking into account the changing individual needs of people living in the home. CARE HOME ADULTS 18-65 Grange Care Services Limited Grange Care Services Limited 27 Flamstead End Road Cheshunt Hertfordshire EN8 0AJ Lead Inspector Jeffrey Orange Key Unannounced Inspection 1st October 2007 08:15 Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Care Services Limited Address Grange Care Services Limited 27 Flamstead End Road Cheshunt Hertfordshire EN8 0AJ 01707 646567 01707 651010 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) Grange Care Services Limited Mr Andrew Gilbert Fernandes Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are none. Date of last inspection 21st March 2007 Brief Description of the Service: Grange Care Services is registered with the Commission for Social Care Inspection (CSCI) as a care home for six service users with learning and physical disabilities in the Younger Adults category. The home is situated in a residential area in Cheshunt, Hertfordshire, with good public transport links and close to local shops and facilities. The building is a converted eight-bedroom house with a large garden to the back of the building and a parking area in the front. The ground floor has a lounge, laundry room and a large kitchen/dining area. There are five bedrooms on the ground floor, the other bedroom currently in use is situated on the first floor. The administrative office and the storage room for medicines are also on the first floor. The home has no lift. The fee range for the home as at 01/10/2007 is £950 - £1600 per week. Details of what is included in this fee and what is subject to additional charge is set out in individual contracts with each person living in the home and /or the authority responsible for their placement. Further information about the home is contained in the home’s Statement of Purpose and the Service User Guide, which, together with copies of the last inspection report from the CSCI are available in the home. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began early in the morning, which provided an opportunity to observe the routine of the home as people living there were getting ready to attend day care. People living in the home were introduced to the inspector and pictorial information about the CSCI and the inspection process was left with them. During the inspection visit members of the staff team were interviewed and some key records, including those for care planning, staff recruitment and medication were examined. This report also draws on information received by the CSCI about this service since the last inspection in March 2007 as well as information provided to the CSCI by the home in their Annual Quality Assurance Assessment. This is a selfassessment and dataset that is completed once a year by all providers of care and is one of the ways that the CSCI assesses if providers are achieving good care outcomes for people who use their services. Surveys of people associated with the people living in the home have also been sent and where these have not already been received they will be used to determine future regulation and inform the process of continued assessment of this service. What the service does well: What has improved since the last inspection? Staffing at key times has been increased, as recommended in the last inspection, this provides people living in the home with additional help when they most need it. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 6 Training for staff in key areas identified during the last inspection report has been provided and provision is now made for regular updates, which increases the skill base of staff and assists them to provide a positive and safe service to people living in the home. There were no issues with the cleanliness of the home during this visit, which suggests that the problems identified previously have been satisfactorily addressed. This will contribute to making the home a pleasant place in which to live and work. 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. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment process clearly identifies the needs of people considering living in this home and how they will be met. This means that only people whose needs can be met, who will feel at home in this service and will be able to get on with the people already living there are admitted. EVIDENCE: Pre-admission documentation for a recently admitted person was seen to be comprehensive, thorough and very much centred upon them as an individual. Another person who is considering moving into this home is being given an extended period of trial visits of various durations. During these visits they can meet the other people living in the home and choose which bedroom they might like. This also informs the admission process, records of which were seen, and should ensure that the placement, if it goes ahead, will be safe and satisfactory for all concerned. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6 7 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plan documentation clearly identifies the needs of people living in the home and if and how these have changed. People living in the home and those responsible for them are involved in the review and development of their care plans. EVIDENCE: Care plans were seen for several people who live in the home, including someone who only recently moved in. The format varies and includes pictorial versions and one on a CD-Rom for those people living in the home who do not communicate verbally. Care plans are currently at different points in the review process and different details are in several documents, for example “Essential Lifestyle Plans”, “Person Centred Plans” and “Day Care Plans”. Once a settled format is arrived Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 10 at, it would be helpful to staff and beneficial for people living in the home if a consistent pattern could be put in place without delay. There are various risk assessments in place and these included evidence of regular review. An example of a positive approach to risk assessment was one prepared in order to enable a person to go swimming, and set out the requirements on staff to safely achieve this goal. Where risks lead to a degree of restriction for people living in the home, for example the use of bed-rails and also in the case of any specific method of medication administration, there is evidence of the involvement of health and social care professionals in the process and robust documentation to support it. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 16 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are able to build and maintain strong and positive links with their extended families and are able to access local leisure facilities and day time activities. EVIDENCE: The people currently living in the home left during this visit to attend a variety of daytime activities. Different venues and formats were used in line with the assessed needs and personal preferences of the people concerned. Each person has their own “Day Care Plan” which sets out a programme of activities, based on their interests and needs. Evidence was seen of a very successful holiday trip to Lowestoft earlier this year. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 12 Care plans were found to include dietary advice and this is translated into menus for the home and for individual people living in the home where they have specific requirements. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 19 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have access to the community health services they require and where personal care is given, it is done in a way that takes into account their personal preferences and requirements. Medication practice in the home provides adequately for the protection of people living in the home. EVIDENCE: Care plans seen included details of the involvement of a range of healthcare services with people living in the home. This indicates that when people living in the home need treatment or advice, it is available and that their health is protected as a result. Positive comments about the service provided to people living in the home were received from health and social care professionals associated with them. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 14 Medication administration records were checked and were accurate, with each record signed by two members of staff. As totals for some medication were not carried forward it was difficult to reconcile stock from one recording period to another. Start dates were not always recorded when medication was first used which would make it difficult to tell if medication was still in date where it has to be used within a specified time of being opened. Staff have received training in safe medication administration and in the homes’ policies and procedures for the administration of medication. This should ensure that only staff that have been trained to do so assist people living in their home with their medication. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a very open culture that encourages and enables the people living in it to make their views and concerns known through non-verbal communication when that is most appropriate. Staff training and robust policies and procedures in place and followed provide protection for people living in the home from abuse, neglect or self-harm. EVIDENCE: The home has a complaints policy and procedure in place, in an appropriate pictorial format for the people living in the home. During the past three months staff have been provided with additional training in the safeguarding of vulnerable adults and the adult protection procedure is available in pictorial format. Refresher courses are planned throughout the coming year. Each of the people living in the home has substantial contact outside of the home with family, other health and social care professionals and advocacy services and this provides opportunity for any concerns or complaints they may have to be raised in those settings as well. The activities, care planning and routines of the home are all influenced by the views of people living in the home, however expressed. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 16 There are currently no complaints recorded in the home and no complaints have been received about this service by the CSCI since the last inspection. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a safe, clean and comfortable environment for those who live and work in it. EVIDENCE: The cleaning schedule for the home was amended following concerns raised in the last report and there were no issues on the day of this visit, the home was clean and tidy and free from any unpleasant smell. Individual bedrooms are spacious and well furnished and each one is distinctive to the person living there, with substantial evidence of personalisation to reflect their interests and preferences, such as football team soft furnishings for example. A risk assessment has been carried out on the flooring throughout the home and this is considered appropriate and suitable. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32 34 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are cared for by staff that have been subject to a rigorous recruitment process and who are provided with appropriate training and supervision to ensure that they have the skills and support they need. EVIDENCE: Staff training records were seen and members of the staff team on duty confirmed a system of training and supervision is in place that provides them with both the basic and specialist skills they need to help and care for the people living in the home. Recruitment records were seen and were satisfactory, containing evidence that the necessary checks to protect people living in the home had been carried out. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 39 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s management and activity is clearly focussed on achieving good care outcomes for the people who live there including maintaining their health and safety, however lack of clarity about the respective roles of three levels of management involved in the home could potentially be confusing for staff. EVIDENCE: There is a rigorous system of quality assurance and self-assessment in place that includes regular visits by senior management. Evidence is available of a range of health and safety checks and records are also kept for the routine maintenance of equipment in use in the home. All staff have received training in health and safety and infection control. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 20 During the course of this inspection the area manager and responsible individual, the registered manager and the deputy manager were each referred to by one or more of the staff team as being “The manager”. This confusion as to roles has not had any noticeable effect on people living in the home or their care, it could however be confusing for staff who need to have a clear idea as to the relative roles and responsibilities of the management team. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement All medication not supplied in monitored dosage systems must be dated on opening Totals of medication supplied on an as required basis must be carried forward in medication administration records in order to facilitate accurate monitoring of them. Timescale for action 01/10/07 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 YA6 YA34 Good Practice Recommendations The introduction of a consistent format for care plans should be completed as soon as possible. Where any part of the recruitment process is carried out by another agency on behalf of the home, sufficient documentary evidence of the checks made, including those DS0000068014.V347487.R01.S.doc Version 5.2 Page 23 Grange Care Services Limited 3. 4. YA35 YA37 relating to permission to work in the UK and specific references should be provided for the home to retain as evidence, as they retain an overall responsibility for this process. In addition to the training already provided, the home should consider making use of the Learning Disability Qualifications Programme for staff. The respective roles and responsibilities of the management team should be made clear to staff, people living in the home and to other interested parties. Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Grange Care Services Limited DS0000068014.V347487.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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