Care Home: Grange Cottage Residential Home

What the care home does well The recent improvements to the premises offer much better facilities including en suite bathrooms, the installation of a stair lift, ramps, handrails and wider door frames to improve access to people who have mobility difficulties. As Grange Cottage is a small, family run home that currently has no staff vacancies, people who use the service experience a degree of consistency of care. We were able to talk to two sets of relatives on the day of the inspection, both of whom were positive about the care that their relative received. One person said, `I looked at about ten other care homes before I choose this one`, another person said `just look at her.....you can see she is happy.` When we spoke to people who use the service, they to were happy, when we asked do they look after you, the reply was `yes`. It was positive to note that the paperwork in the home was well maintained, up to date and accurate. What has improved since the last inspection? The documentation relating to staff is much improved, there is evidence of checks being undertaken routinely prior to employment; and documentation is maintained in an appropriate manner. With regard to training, the home has initiated a matrix which records courses that have been attended and when refreshers need to be completed. This is a positive as it ensures that well qualified staff are better able to support the needs of people who use the service. What the care home could do better: Grange Cottage must focus on the range of recreational and leisure activities that it offers to people who use the service, particularly those who have limited mobility. Currently, there are table top activities such as bingo, cards and board games, occasional entertainer coming into the home, and some limited outings. The home needs to expand what is on offer so that people can have options, and that activities are inclusive of everyone who lives in the home. Key inspection report Care homes for older people Name: Address: Grange Cottage Residential Home 6 Grange Road Sutton Surrey SM2 6RT     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: Rin Saimbi     Date: 2 4 0 3 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Grange Cottage Residential Home 6 Grange Road Sutton Surrey SM2 6RT 02086422721 02086422721 grangecottage@blueyonder.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Grange Cottage Limited care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 19 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: Dementia of the following age range: 65 years and over - Code DE (E) Dementia - Code DE Date of last inspection Brief description of the care home Grange Cottage is a limited company, Grange Cottage Ltd, owned and run by Mrs and Mrs Halkoree. Mrs Halkoree is also registered as the manager. Grange Cottage is a small residential home registered for nineteen older people with dementia. Its previous registration included people with long-term mental health problems, some of whom still live at the home. The home has been extended and improved so that it better meets the needs of people with dementia, this includes the installation of a stair lift, ramps, handrails and doorways being widened for easier Care Homes for Older People Page 4 of 28 0 7 0 4 2 0 0 9 19 0 Over 65 19 0 Brief description of the care home access for people with mobility problems. The home is situated in a residential part of Sutton, within easy reach of the town centre and transport links. There is very limited parking to the front of the property and a small garden to the rear. The range of weekly fees for the year 2010 is between £420 and £600; purchasers are advised to contact the home directly to get a full menu of the costs. 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: This was an unannounced inspection that started at 9.30 am and finished at 3.40 pm. The inspection took the form of meeting with the majority of people who use the service, and observing staff interaction with people who live at the home. We also had the opportunity to meet with two sets of relatives who were visiting on the day of the inspection. There was a tour of the buildings communal areas and some of the bedrooms, which was only undertaken with permission of people who use the service. We looked through documentation, which related to people who use the service to make sure that they were relevant, accurate and up to date. This case tracking ensured that all documentation relating to three people was checked thoroughly. Care Homes for Older People Page 6 of 28 We also checked documentation coming into the Commission, so that this report reflects the home over the year, rather than a snapshot of findings on the day of inspection. Grange Cottage completed its Annual Quality Assurance Assessment (AQAA) which is self audit tool completed in a timely fashion. We would like to thank the people who use the service and staff for their time and cooperation during the inspection process. 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. The registered provider goes through an appropriate process before admitting any new person into the home. Information is gathered from a variety of sources and consideration is given to people already living within the home. This should ensure that any new person does not feel that they are just being slotted into a vacancy, but that it is the right place for them. Evidence: We case-tracked three people who live in the home, that means that we looked at all the information that relates to them, this included the person who has most recently been admitted to the home. Each set of information showed that the manager had gained information from other professionals. The manager had then completed their own pre-assessment form which included details on the persons communication, sleeping patterns, religious and Care Homes for Older People Page 10 of 28 Evidence: cultural beliefs. This document was then translated into a needs assessment. Once the home has been identified as a suitable place, there was then a process of introductions. The manager stated the introduction period can be as long as is required. However, in reality it tends only to be one visit by the relatives and one visit by the person themselves. Documentation relating to the Service User guide and Statement of Purpose was examined at the previous inspection and therefore was not checked during this inspection. We did however, observe that each set of information that we looked at, had a signed contract between the home and the person using the service. 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. People who use the service should feel that in general that the home can meet all their health and personal care needs. Plans are drawn up between the home and people who use the service which outlines needs and goals, these are reviewed on a regular basis to ensure that services are delivered on an individual basis. Evidence: Each person within the home has a needs assessment which has been generated from the initial comprehensive assessment. The needs assessments were divided into categories which identified the difficulty, strategies for dealing with the issue and what the key worker had agreed to do. The needs assessment is reviewed on annual basis by the home and the placing authority. We were also able to view risk assessments which had been completed in a timely fashion, and reviewed on a regular basis. Care Homes for Older People Page 12 of 28 Evidence: A number of health professionals visit on a regular basis, we were informed by the manager that this includes a dentist, optician and audiologist. On the day of the inspection there was also a visit from the district nurse. We were informed that the most people living at the home were registered with the same GP practice, although not everyone, as people have a choice. With regards to medication, the manager stated that administration of medication is only undertaken by members of staff who are trained to do so; in reality it tends to be the manager or deputy, who are both State Registered Nurses. Medication comes into the home from the pharmacist in a simplified monitored dosage system. We found no error in the recording or administration of the medication. The manager stated that an external audit is carried out on an annual basis to monitor the administration of medication. We talked to staff about issues of privacy and dignity, and all were able to give appropriate answers. We did note that one member of staff was observed knocking at bedroom doors and hastily opening them without waiting for a reply; This meant that on three occasions, people were still in their bedrooms. We discussed this issue with the manager who agreed to remind all staff to be mindful of peoples privacy. A recommendation has been made regarding this issue. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are in general, offered the personal support they need to live ordinary and meaningful lives. The daily routine within the home could be improved to ensure the rights of peoples individuality, dignity and promoting a sense of well being and independence. Evidence: The home was initially registered to provide care for two distinct groups of people, those with dementia and those with mental health problems. The registered providers have recently decided to restrict admissions to a single client group, older people with dementia. This decision has been in conjunction and with the agreement of the Commission. Whilst there are some people still living in the home with mental health problems, variations have been granted for them to remain until such time they wish to move out. The consequences of this is that some people who use the service have differing needs. One person within the home for example, is able to manage their own care, doing their own laundry, being able to cook for themselves and go out when they want to. Care Homes for Older People Page 14 of 28 Evidence: For other people who use the service, the range of activities are somewhat limited. There are table-top games such as bingo, dominoes and cards, exercise DVDs and some staff employ the use of aromatherapy oils. The manager stated that there are usually two summer outings for five people to the seaside; this tends to be the more physically able people. The manager has stated previously that she wishes to employ an activities cocoordinator; this has not been forthcoming. The registered provider must ensure that there are a range of suitable of leisure and recreational facilities available in the home, this does necessarily require an activities co-coordinator, but at the very least more activities being offered by external people. A requirement has been made in this regard to ensure the well-being of people who use the service. The home welcomes visits from relatives and friends; during the inspection process we were able to talk to two sets of relatives. Both sets of people commented on how welcome they were made to feel by staff, and that they were in generally positive about the care that their relatives received. With regard to meals, we spoke to the cook who is employed in the home on a parttime basis. The home works to a four week menu, with the main meal being served at lunchtimes. The menu is compiled in conjunction with people who use the service and can accommodate peoples preferences. On the day of the inspection, there was shop bought chicken pie, potatoes and broccoli; alternatives were being served. In addition there are two roast meals a week on offer, although no cooked breakfasts. In general people were positive about the meals, one person said its really good, a relative commented it always smells good. However, one person who uses the service stated that the food could be better, and when asked said that as they were of Asian origin, they would like a range of Indian food to be offered. Lunch was served in a congenial setting, although it was noted that staff were standing around at lunchtime waiting to serve the lunch with no interaction with people who use the service, this may have as a result of the inspection. One person who uses the service was on the day struggling to have a drink independently, he was provide with a beaker as an alternative; this will assist with maintaining his independence. However, another person who uses the service, who has a visual impairment was struggling to feed himself as there was no plate guard and food was being pushed Care Homes for Older People Page 15 of 28 Evidence: around his plate. A requirement has therefore been made that the registered provider must obtain equipment for people to meet their assessed needs. Care Homes for Older People Page 16 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. There is a policy available to people who use the service, their friends and familys allowing for them to make complaints. This should ensure that people who use the service feel that their views are heard and taken seriously. Evidence: The home has a clear complaints policy, which includes the response time if a complaint is made. There was also evidence around the home of the complaints policy in a pictorial format for those that may find reading difficult. The home does have a complaints log, although none have been recorded within the last year. We talked to people who use the service and two sets of relatives, all of whom commented that if there was a problem that they would feel able to talk to the manager or her deputy. Comments we received included, just ask them anything and hes a nice chap, I just go and talk to him. There has been one safeguarding referral in the last year; procedures were followed and there was a satisfactory outcome. During staff interviews, there was an awareness and understanding of the issues relating to vulnerable adults. We gave a fictional scenario and staff were able to give an appropriate response. Care Homes for Older People Page 17 of 28 Evidence: We note the fact that there is information and understanding about the Mental capacity Act. Care Homes for Older People Page 18 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. After recent refurbishment the environment is much improved so people who use the service can be accommodated in a safe, secure and comfortable setting. Evidence: The premises have been extended to provide more bedrooms; These and several of the existing bedrooms have been modernised and have en suite facilities including toilet and in some rooms as shower as well. All doorways have been widened to 900mm so that it is easier for people who use the service to move about the home. Handrails and ramps are in place and the home also has a stair lift. The home has assisted baths and walk in showers and adapted toilets so facilities for the less mobile are much improved. There are now two lounge areas so people who use the service have some choice about where and with whom they sit during the day. The only outstanding work is in the garden; the home is in the process of building a brick shelter which will be used by the smokers. In addition, the garden needs to be landscaped so that it can be used by everyone. A recommendation is being made in this regard. Care Homes for Older People Page 19 of 28 Evidence: Most bedrooms have a degree of personalisiation with photographs, personal furniture items and ornaments. All bedrooms are lockable, although in reality the manager stated that only a few people who use the service choose to use their keys. There was a strong odour within the home; the manager stated that they are working hard to eliminate the unpleasant smells and that they are considering using vinyl floors in two of the bedrooms. A recommendation is being made that the unpleasant odour is removed. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in sufficient numbers and with the required amount of training to ensure that the welfare of people who use the service is maintained. Evidence: On the day of the inspection with regard to staffing levels, there were two members of staff in the building, an additional member of staff was escorting someone to the hospital for some of the morning, the manager and the cook; The member of domestic staff had telephoned in sick. We were able to confirm by looking at the staff rota on a random basis, that there are three staff on duty during the day plus the manager. There are also two waking night staff. The manager stated that the home is fully staffed and that any vacancies are covered by the existing staff team. Many of the staff team are in the process of completing their National Vocational Qualification (NVQ) with two having done so already and a further five in the process. All staff had undertaken the required amount of training, that is to say, at least three days in the previous year. The manager stated that much of this training is being Care Homes for Older People Page 21 of 28 Evidence: accessed via the London Borough of Sutton. The home is in the process of developing a training matrix which will outline the training that has been undertaken by staff and when it needs to be reviewed. The home is commended to continue this process. We looked at two staff files to check the recruitment process undertaken. We found that there was evidence of identity, completed Criminal Records Beaux checks and two references. The home has previously had a requirement regarding the lack of appropriate checks that they have undertaken. As the home is now ensuring an adequate level of checks, the requirement has been withdrawn. Care Homes for Older People Page 22 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. People who use the service can be assured of the qualities and qualifications of the manager who runs the home in the best interests of the people who live there. Evidence: Mrs Halkoree is the registered manager of this home and has been since 2006; she has considerable experience having qualified as Registered General Nurse and worked in the home since 2003. Mrs Halkoree is the manager and part owner of the home; her husband is the deputy and there is an additional sleeping director. We talked to staff about the impact that this may have upon the service and they reported that there was none. They were clear about the lines of responsibility and accountability particularly with regard to the protection of vulnerable adults. Monthly monitoring visits are currently undertaken by the previous owner of the home, they were available for inspection purposes. Care Homes for Older People Page 23 of 28 Evidence: The manager stated that she supervises staff on a two monthly basis; this was confirmed by staff. Care Homes for Older People Page 24 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 25 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 1 12 12 The registered provider must ensure that a range of varied leisure activities are offered in line with peoples preferences and capacities. This is to ensure the health and welfare of people who use the service. 30/04/2010 2 15 12 The registered provider 30/04/2010 must ensure that equipment is provided to maintain the assessed needs and independence of people who use the service. This is to ensure the dignity of people who use the service 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 10 All staff ensure that privacy and dignity is maintained, this Page 26 of 28 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations includes knocking on peoples doors and waiting for a reply before entering. 2 19 The registered provider should ensure that the garden is landscaped so that it can be accessed by all those who use the service. The registered provider should ensure that the home is free from offensive odours. 3 26 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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