Care Home: Grange Court

What the care home does well What has improved since the last inspection? The home continues to operate at a good level with the manager and the staff striving for ways to improve the service. The home is working in conjunction with the community matron and the Primary Care Trust looking at privacy and dignity in care. What the care home could do better: A small number of people at the home said that they were bored and needed more occupation and stimulation. The reforming of the residents` committee might go some way to address this. The care records should be improved to provide good written evidence of care needs and the care provided. CARE HOMES FOR OLDER PEOPLE Grange Court Church Gardens Garforth Leeds LS25 1HG Lead Inspector Catherine Paling Unannounced Inspection 9th October 2007 09:30 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 Court DS0000033226.V352567.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 Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Court Address Church Gardens Garforth Leeds LS25 1HG 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) 0113 2864845 0113 2864845 Leeds City Council Department of Social Services Jane Hawkhead Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2006 Brief Description of the Service: Grange Court is a residential home providing personal care for men and women over pensionable age. There are 30 permanent places with three places available for respite care. The home is on two floors, with a passenger lift providing access to both floors. All bedrooms are single with their own washbasin; there are no en-suite facilities. There is a range of communal toilet and bathing facilities throughout the home. The large communal dining room is on the ground floor, together with a choice of lounge areas, one of which is a designated smoking area. The home is situated off the main shopping street in Garforth town centre, close to local amenities including the library, medical centre, shops and post office. Garforth is a close-knit community, about 10 miles from the centre of Leeds. Information about the service is available in a combined Statement of Purpose and Service User Guide. This document is reviewed annually. The fees range from £94.45 to £ 458.86 per week. There are additional charges for chiropody, dental and optical services, social activities, newspapers, personal items and travel. This information was provided by the manager at the inspection of October 2007. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit by one inspector who was at the home from 09.30 until 15.30 on 9th October 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent talking with the people at the home as well as with the manager and the staff. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent out home before the inspection providing the opportunity for people at the home; visitors and healthcare professionals who visit the home to comment, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A number of surveys were returned and comments are included in the body of the report. What the service does well: Pre-admission practices are thorough and the manager makes good use of the support of other healthcare professionals to make sure that people can be looked after properly. Staff are very knowledgeable about peoples’ care needs. The following comments are representative of how people feel about the home: • • • Very happy with all that is done here When I ask for something it is always done for me Staff are friendly and take an interest in their residents. At this home it is clear that all staff take pride in their work and put the residents needs first. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 6 There is a lively and welcoming atmosphere at the home. Staff have a good rapport with the people living there and visitors are made very welcome. What has improved since the last inspection? 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 Court DS0000033226.V352567.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 Court DS0000033226.V352567.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): 3. Standard 6 does not apply to this service. People who use the service experience good quality outcomes in this area. People are provided with enough information to enable them to make an informed choice about the home. The admission process is good and includes introductory visits. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There is a statement of purpose and service user guide available to give people information about the service provided at the home. This document is reviewed annually. There is also a home brochure available. Up to date pre- admission information is gathered for all people who are admitted to the home. Where people are admitted in emergency situations as much information as possible is gathered before their arrival at the home. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 9 Easy Care documents were seen in records giving staff information about care needs. It is part of the admission process to encourage people to visit and spend time at the home before they make the decision to move in. Grange Court DS0000033226.V352567.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 People who use the service experience good quality outcomes in this area. The home is good at meeting the care needs of the residents but records do not consistently provide evidence of this. Medication practices are safe and healthcare needs are met. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The manager and the care staff team were knowledgeable about the individual care needs of people living at the home. People said that they felt well looked after by the staff and comments made on the day of the visit and received on surveys provide evidence of this. These included: Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 11 • • • Very happy with all that is done here When I ask for something it is always done for me Grange court staff and (district) nurses got her back to full health (after a fall). Should be commended. Some comments reflected the staffing levels, which have meant that staff do sometimes work under pressure and that occasionally people have had to wait when they have asked for assistance: • • They (the staff) kind of half listen. They (the staff) have a habit of saying two minutes and it can be much longer Individual plans of care are in the form of a Lifestyle plan for every person. There continues to be a variable standard of recording with some good personal details about individual care needs documented. However, review and update of care was not always clear, in that entries were not always dated or signed Daily records provide some evidence of the care but can be brief. In the absence of consistently detailed care plans staff need to take care that daily records do provide information of the wellbeing of the person. It was clear from discussion with people at the home that staff do discuss care needs and this was further evidenced in survey information: • X was helped with filling in the lifestyle plan with a member of staff and her wishes were put into this Risk assessments had not always been completed. For example, nutritional risk assessments had not been completed for everyone. Where individuals needed help with transferring and mobilising a full assessment is carried out by an occupational therapist and detail of necessary equipment is included in records. There was evidence in records that healthcare professionals are involved where needed. Surveys returned from healthcare professionals who visit the home contained positive responses about the home, such as: • • • • • • Excellent residential home – always willing to take part in any new initiative Very good communication, always happy to listen to advice Always fight their corner Improves all the time Respect the individual both in needs and lifestyle I can leave instructions knowing they will be followed Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 12 • Staff are friendly and take an interest in their residents. At this home it is clear that all staff take pride in their work and put the residents needs first. The manager and her staff are committed to developing the records to make sure that they reflect people’s needs and the care given. Healthcare needs are met and there is input from other healthcare professionals as necessary. People living at the home are confident and happy with their care and feel well looked after. As part of addressing the shortfalls in the records the manager is developing a more ‘user friendly’ care plan format with the intention of improving the written evidence of care. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 13 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 People who use the service experience good quality outcomes in this area. The social, religious and cultural needs of people living at the home are met. People are able to maintain contact with family and friends and they are encouraged to be part of the decision making at the home. A good, varied and nutritious diet that takes into account individual choice is served. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Observation and discussion with some of the people living at the home made it clear that people were able to exercise choice and control over their daily lives as far as possible. Returned surveys and comments received at the visit provided evidence that people are happy at the home, although for some there is not enough to do in the day; • Finds it hard to sometimes occupy himself because of disabilities….the staff look after him and he seems happy enough. DS0000033226.V352567.R01.S.doc Version 5.2 Page 14 Grange Court • • • • • • • They arrange various ways to try to entertain He has company and says he is happy Great care and understanding. The tables are set up like you do at home, perfect Join in (with activities) if I’m there when (they) take place I’m not getting out unless friends or family take me out I am a bit bored There is no residents’ committee at the moment although the manager is keen to re-convene this but it has not yet been possible due to staffing difficulties. This would be a means of enabling people to be more involved in the arrangements of the entertainment and activities programme. Wherever possible people are supported to continue and pursue their links with the local community and one person is an active member of a spiritualist church, occasionally conducting services. Others go out to the local community centre for bingo and out with friends. The menus provide a balanced and interesting choice and people said that they enjoyed the food. The manager keeps the menus under review and the people at the home are involved in menu planning. They made comments such as: • • Meals – I like them very much. Meals very good Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. A robust adult protection and complaints policy and procedure makes sure that people who live at the home are listened to and are protected from abuse. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There is a comprehensive and clear complaints procedure in place that is readily available to residents and relatives. The people spoken with and completing surveys knew who to talk to if they were unhappy and were confident any concerns would be looked into. No complaints have been received at the home, or by us, since the last inspection. Staff are aware of adult protection and have received training. There are robust procedures in place to protect people living at the home and whistle blowing procedures to protect staff. Training on the Mental Capacity Act 2005 is also now included for staff. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 16 Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 17 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 and 26 People who use the service experience good quality outcomes in this area. People live in a very well maintained and safe environment. Good levels of specialist equipment ensure that peoples’ independence is maintained. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The environment is comfortable and well kept. Although there are no en-suite facilities there are excellent communal sanitary facilities that allow for full assistance from staff. Peoples’ rooms are attractively furnished and the addition of personal items makes the rooms homely. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 18 Comments about the environment taken from surveys included: • • It is spotless. No smell I am happy my room is kept very nice Only personal laundry is carried out on site. The laundry was well organised and everyone has a personalised basket for their laundry. Good hand washing facilities were provided in the laundry and in all the communal areas. Staff receive training in the prevention of cross infection and the greater majority of staff have completed this training. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. Overall, there were enough staff to meet the needs of the people living at the home. People are protected by robust recruitment procedures. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There is a core group of staff providing consistency and continuity for the people at the home. However, there continues to be some vacancies meaning that there is some use of agency staff. The recruitment function is carried out centrally and the home retains copies of documentation to provide evidence of good recruitment practice. Staff do not take up post until all the required checks have been completed. The vast majority of the care staff have a National Vocational Qualification (NVQ) in care at level 2 and a number have NVQ at level 3. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 20 Mandatory training is well established although the manager did say that some of it was not up to date. Training records are kept on individual files and it was not possible to get a view of the training provided without looking at all the files. The manager agreed to look at better ways of providing an overview and evidence of staff training. Besides mandatory training staff have access to a range of other courses to make sure that they have the necessary knowledge to care for people properly. There is a system of staff appraisal and supervision in place, which helps to identify individual training needs. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 21 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 and 38 People who use the service experience good quality outcomes in this area. The home is well managed. The interests of the people living at the home are seen as very important to the manager and staff and are safeguarded at all times. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The registered manager is experienced and provides clear leadership to staff. She has achieved an NVQ in care at level 4 and has also completed a management and leadership development qualification also at level 4. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 22 The manager and the senior staff are very accessible to people living at the home and their relatives. Notes from staff meetings provide clear evidence of an open and inclusive management style with staff encouraged to be involved in the running of the home. The manager and her staff are committed to the development and improvement of the service. There is some work underway at the home in conjunction with the Primary Care Trust (PCT) and the local authority regarding respect and dignity. Feedback is being sought from people living at the home about privacy and dignity as part of the project. People at the home are encouraged and supported wherever possible to manage their own finances. There are good systems in place where the home keeps small amounts of money are kept for people, which are subject to inhouse spot checks and to external audit. The manager makes sure that staff are aware of their health and safety responsibilities. There is a whole range of risk assessments in place for safe work practice and for the building. A member of staff who is a trained fire warden carries out regular fire drills. Records are kept of any accidents occurring at the home and the manager produces a monthly summary. The provider carries out monthly visits to monitor the conduct of the home, as required. Reports are produced and are available at the home. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The manager and her staff should continue to work at developing the care to make sure that the individual records consistently provide detail and evidence of care. Grange Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Court DS0000033226.V352567.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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