Care Home: Grange Cottage Home For Elderly Persons

What the care home does well What has improved since the last inspection? A number of environmental improvements have taken place over the last year. These include redecoration of two bedrooms. The dining room had been decorated and had new chairs and carpet provided. The hall carpet had been replaced. An old bath had been replaced with a large shower cubicle. A new oven had been purchased. The registered provider had carried out some staff supervision and had sent out satisfaction surveys to people and their relatives, to gain their feedback on the quality of the service provided. What the care home could do better: We found some medicines were being stored in an unlocked drawer. All medicines must be securely stored and a requirement is made on this. Staff training in food hygiene and infection control took place a number of years ago, and it is recommended that training updates be provided. CARE HOMES FOR OLDER PEOPLE Grange Cottage Home For Elderly Persons Albert Road Grange-over-Sands Cumbria LA11 7EZ Lead Inspector Jenny Donnelly Key Unannounced Inspection 22nd May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Cottage Home For Elderly Persons Address Albert Road Grange-over-Sands Cumbria LA11 7EZ 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) 015395 33122 Mr Michael Frois Mr Michael Frois Care Home 9 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (9) of places Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 9 service users to include: up to 9 service users in the category of OP (Older People) up to 2 service users in the category of DE(E) (Dementia over 65 years of age) 5th June 2006 Date of last inspection Brief Description of the Service: Grange Cottage is registered to provide residential services for nine older people two of who may have dementia. The registered owner/manager is Mr Michael Frois. The home is situated in a residential area of the town of Grange-over-Sands, Cumbria. The home is a large Victorian semi-detached property with a purpose built bungalow within the grounds adjacent to the home. The home is well situated for the local amenities in the centre of Grange. There is wheelchair access to the front of the home, where there is a well-kept garden with seated areas. There is also pedestrian access to the rear of the home, which leads to the town. The previous Inspection report is displayed in the entrance hall in the home, and a Grange Cottage information pack is available. Current fees range from £386 to £395 per week. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the main or ‘key’ inspection of the service. Jenny Donnelly inspector, made an unannounced visit to the service on 22nd May 2008. During the visit we (the commission) toured the building, spoke with residents, staff and the management. We looked at care, medication, staffing and management records. We saw how people were spending their day, and observed lunch and the day’s activities. Prior to this inspection the manager had completed and returned an Annual Quality Assessment Audit (AQAA) that we had requested. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys out to some of the people who live in the home and their relatives. The findings of the surveys are included in this report. What the service does well: What has improved since the last inspection? A number of environmental improvements have taken place over the last year. These include redecoration of two bedrooms. The dining room had been decorated and had new chairs and carpet provided. The hall carpet had been Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 6 replaced. An old bath had been replaced with a large shower cubicle. A new oven had been purchased. The registered provider had carried out some staff supervision and had sent out satisfaction surveys to people and their relatives, to gain their feedback on the quality of the service provided. 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 Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good written information about the type of service offered at Grange Cottage, and peoples care needs are fully assessed, so people know the home will suit them, before they decide to move in. EVIDENCE: The registered provider had produced a statement of purpose and service user guide, which provides good information about the services available at Grange Cottage. We viewed the file of a person who had moved into Grange Cottage quite recently. This showed that a full assessment of the person’s health, personal and social care needs had been conducted prior to him or her being offered a place. Assessments included information from the person themselves, their supporters and any professionals involved with them. The assessment process ensured that this placement would suit the person and Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 9 staff would be able to meet their care needs. Some of the people we spoke with had visited the home to look around before choosing to move in. The registered provider operates the philosophy that Grange Cottage is a ‘house’ not a care home. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were very happy with the personal and health care they received and felt well looked after. EVIDENCE: Each person had an individual plan of care in place, which detailed their personal, health and social care needs. We thoroughly examined the records of two people, and looked at a further two in less detail. The care records were complete, had been kept up to date through monthly reviews and reflected any changes in the person’s needs or wishes. Care plans showed that staff worked individually with people to support them in a way they found acceptable, and met their particular needs and wishes. People told us they received the level of personal care and support they needed, and had good access to healthcare services. There was evidence of close liaison between the care home and visiting health professionals such as doctors, community nurses and the mental health team. Staff were pro-active is seeking health advice for Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 11 people when needed, and took account of their wishes about suggested treatment and care. People told us: • • “Grange Cottage is very small and (my relative) benefits from the individual attention that she receives” “They treat residents as individuals, give them as much as possible to themselves, and tolerate difficult and eccentric behaviour sympathetically”. One person felt more care could be taken with maintaining personal hygiene. We found that staff tried to respect people’s wishes in this whilst working positively with people to encourage regular grooming. The management of medicines was generally good, with people receiving the right medicines at the right time, and with little use of ‘as required’ sedating drugs. There was a homely remedies policy, which enabled people to have simple remedies such as mild painkillers without the need to wait and consult a doctor. The storage of medicines needs to be improved as some medicines were kept in an unlocked drawer, rather than in the locked medicine cabinet. A requirement is made of the registered provider to ensure the safe keeping of all medicines. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were able to choose how to live their life, and were supported to do the things they wanted. EVIDENCE: Grange Cottage runs activities and occupation on a very individual basis. Two people attend the local day centre for two mornings a week, with staff walking them there and back. Other people go into town independently as they wish, and use the local bus service. One person said they go out for a walk every afternoon if the weather is nice, another said they went out often with friends. The registered provider often takes people out individually to destinations of their choice, often for coffee or to the library. One of the care staff runs a more structured craft activity session once a week, which people enjoy, and they plan to hold some film afternoons. People said they were able to express their choice, and felt they were given the independence and the support they wanted to lead a fulfilling life. The provision of meals was praised. People said they always enjoyed the food, and there was plenty of it. The main meal is served at lunchtime and is a set Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 13 meal, based on peoples known likes and dislikes. We saw that although everyone had the same lamb casserole, and enjoyed it, people were given different vegetables according to their own individual preference. One person was confident that staff would not serve her carrots as she did not like them, and another person knew he would always get his favourite mushy peas. The evening meal was a free choice from a wide variety of options. Nutritional assessments had been completed and peoples weight was monitored. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People knew how to make a complaint and felt confident that their concerns would be listened to and addressed. EVIDENCE: There was a complaints procedure on display and people we spoke with told us they knew how to make a complaint if they needed to. Some people said they had friends and relatives who would help them to complain, but didn’t feel it would ever be necessary. One person told us: • “I would deal directly with Grange Cottage if there were a problem”. One person told us they “didn’t know how to complain” but supposed they would speak with the registered provider if there were a problem. The registered provider had recently attended a ‘training the trainer’ event on safeguarding vulnerable adults and two of the staff had attended training on the Mental Capacity Act. There had been one safeguarding referral during the last year, which the provider had correctly reported to adult social care in line with local procedures. Staff had copies of the local multi-agency guide for safeguarding and were aware of the referral process. People told us they felt safe and happy at Grange Cottage. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, comfortable and very homely environment. EVIDENCE: Grange Cottage is situated in a residential area in the town of Grange-overSands. The home is a large Victorian semi-detached property with an adjacent modern bungalow. The main house has six single bedrooms, two on the ground floor and four on the first floor. There is a chair lift on the stairs. Livein staff occupy the second floor of the house. The main house also has a dining room, lounge, conservatory, two shower rooms and the kitchen and laundry. The bungalow comprises three single ensuite bedrooms, a dining lounge and a bathroom. Since the last inspection improvements have been made around the home. One old bath has been replaced with a large shower unit, a new oven has been Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 16 provided, some bedrooms have been redecorated, the dining room has been redecorated, and had new a carpet and dining chairs provided. There is a new hall carpet. General maintenance was ongoing and safety checks on the premises and equipment were up to date. People had personalised their bedrooms and made them very homely. People said staff dusted and vacuumed the rooms regularly. The home was clean, tidy and comfortable throughout. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a competent and caring staff team. EVIDENCE: Staffing levels comprised of two staff throughout the day, and one waking and one sleep-in staff at night. This was satisfactory to meet the needs of people currently living in the home. Two out of the six staff had a National Vocational Qualification in care, and two were working towards this. An external trainer provided mandatory training on moving and handling, two staff members were qualified to provide training in fire safety and the registered provider was a safeguarding trainer. All staff had received infection control and food hygiene training in the past, although consideration should be given to updating this. Three new staff had been employed since the last inspection and their files showed that correct recruitment procedures had been adhered to, including satisfactory references and criminal records bureau checks. Staff said they felt well supported by the registered provider and said this was a happy place to work. Staff clearly worked in the best interests of people living in the home and structured the days around peoples wishes, not their own. People living in the home spoke fondly of the care staff and said they enjoyed their company. One person said: • “All the care staff are well trained and very caring”. DS0000022643.V360955.R01.S.doc Version 5.2 Page 18 Grange Cottage Home For Elderly Persons Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Grange Cottage has a stable and ‘hands on’ management, which listens to people and takes account of their views. EVIDENCE: Mr Frois is the registered provider and registered manager of Grange Cottage. He is an experienced owner/manager and has completed a National Vocational Qualification in management at level 4. Mr Frois spends a lot of time working in the home, supporting the people who live there, and the staff. There is regular consultation with people, both informally and through an annual satisfaction survey. We saw the results of the last survey, conducted in February 2008, and these were very positive. Where a shortfall had been highlighted there was evidence that this had been attended to. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 19 Staff received periodic supervision sessions, which we saw were recorded in their files. Mr Frois did not have any dealings with people’s finances. We saw that the fire log was up to date showing regular alarm tests and fire drills. The hot water temperatures were monitored monthly and environmental risk assessments had been updated this year. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement All medicines must be securely stored under lock and key. Timescale for action 01/07/08 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. Refer to Standard OP30 Good Practice Recommendations It is recommended that staff receive update training in infection control and food hygiene. Grange Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Cottage Home For Elderly Persons DS0000022643.V360955.R01.S.doc Version 5.2 Page 23 - 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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