Care Home: Grimsby Grange and Manor

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What the care home does well People looking to move to the home are given all the information they need. People`s needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. The care planning system is very good, people have their health care needs fully met and are treated with respect and dignity. A person centred ethos is promoted within the home. People living in the home are consulted about what they want to do with their time. Staff were observed interacting and communicating with people in an open, friendly and non-judgemental way. People living in the home enjoy a range of recreational activities and contact with the local community is encouraged. The home provides a high standard of accommodation and facilities. The atmosphere is friendly and relaxed. People told us they were very comfortable and happy at the home. Everyone spoken to said that the meals provided are very good. People commented during the visit `The meals here are excellent` and `The cooked breakfasts are lovely`. People can choose where they have their meals, the dining facilities are pleasant and tables are nicely laid. The home`s complaint procedure ensures that all complaints are dealt with in a fair and thorough way. People are supported by staff that have been recruited appropriately and receive induction and foundation training that meets the required standard. The home is well managed and the quality assurance systems in place give people the opportunity to affect the way in which the home operates. There are effective health and safety measures in place that protect people who use the service and others from harm. Feedback from people who use the service and their relatives were extremely positive about the service. Comments included: `They look after us very well`, `You would have to go a long way to find a home as good as this` and `The staff are always willing to help, everyone is so kind`. What has improved since the last inspection? This was the homes first inspection. What the care home could do better: The home should action the requirement made by the Environmental Health Officer to provide staff training in the safe management of bed rails. This will protect people`s safety. The home should utilise The Residential Staffing Forum which will support effective staff rostering. Key inspection report Care homes for older people Name: Address: Grimsby Grange and Manor Grimsby Grange and Manor Second Avenue Grimsby North East Lincolnshire DN33 1NU     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: Jane Lyons     Date: 2 1 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Grimsby Grange and Manor Grimsby Grange and Manor Second Avenue Grimsby North East Lincolnshire DN33 1NU 08456044971 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Orchard Care Homes.Com Ltd Name of registered manager (if applicable) Mrs Sonia Lesley Little Mrs Sonia Lesley Little Type of registration: Number of places registered: care home 94 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 94 The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia (Code DE); Old Age, not falling within any other category (CodeOP) Date of last inspection Brief description of the care home Grimsby Grange and Manor is a large purpose built home in a residential area of Grimsby. It is owned and managed by Orchard Care Ltd and is registered to offer care and support to ninety four people aged over 65 years of age, some of whom may have dementia. The home is divided into two separate buildings, each building provides Care Homes for Older People Page 4 of 32 0 0 Over 65 0 0 Brief description of the care home accommodation and facilities over three floors, for forty seven people. There is lift and stair access to all floors. Private accommodation comprises of single en- suite bedrooms throughout, some ground floor rooms have patio access onto the gardens. There are a good variety of lounge and dining rooms on each floor. Assisted bath and shower facilities are also provided on each floor. Attractive garden areas have been developed around both buildings, parts of the gardens have been made secure. Ample parking is provided to the rear of the home. The whole feel of the home is one of comfort with pleasant, clean and homely surroundings. The home is situated approximately two miles from Grimsby town centre and is well served by the local bus service. There are a number of shops and local amenities close by including the local district general hospital. Weekly fees are 525 pounds - 565 pounds. Additional charges are made for the following: toiletries, newspapers, magazines, hairdressing and chiropody. Information on the service is made available to prospective and current persons via the statement of purpose and service user guide. Documents are made available prior to and following admission, copies are always held in the reception area. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons and Mrs Kate Emmerson on the 21st May 2009. This inspection report is based on information received by the Care Quality Commission (CQC) from the last six months including information gathered during a site visit to the home which took approximately six and a half hours. The home opened in November 2008 and this was the first inspection visit following registration therefore all the National Minimum Standards have been assessed. As part of this inspection process surveys were sent out to fifteen people using the Care Homes for Older People Page 6 of 32 service and fifteen staff who work there. Surveys were received from eight staff members and three individuals. Comments were positive such as The staff are very kind and always willing to help and The home is lovely. Anonymised comments from surveys and from discussions on the day of the site visit will be included throughout the report. Throughout the day we spoke to people staying in the home to gain a picture of what life is like at Grimsby Grange and Manor. We also had discussions with the manager, support manager, deputy manager, care staff, the cook, community nursing staff and relatives. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were to be met while they were staying there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, staff training, how the home monitors the quality of service provided and how the home is managed overall. We also checked with people to make sure that privacy and dignity is maintained, that people can make choices about aspects of their lives and that the home ensures they are protected in a safe, clean environment. We observed the way staff spoke to people and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people who were staying at Grimsby Grange and Manor, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. This was a very positive and enjoyable visit. We have reviewed our practice when making requirements, to improve national consistency. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The home should action the requirement made by the Environmental Health Officer to provide staff training in the safe management of bed rails. This will protect peoples safety. The home should utilise The Residential Staffing Forum which will support effective Care Homes for Older People Page 8 of 32 staff rostering. 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 9 of 32 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 10 of 32 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 home provides detailed information to enable people to make an informed choice about the services they provide. Proper pre- admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Evidence: The home has a detailed statement of purpose and service user guide in place which ensures that people considering using the service have helpful, accurate and up to date information. These documents are made available in the home or could be sent to prospective persons. Pre - admission procedures are in place to make sure that only suitable people are admitted into the home. Information about the persons care needs is collected from all available sources such as a community care assessment from the persons social worker, to support the home in their decision making about whether they have the Care Homes for Older People Page 11 of 32 Evidence: skills and resources to meet the persons needs. The manager said she would then visit the person in their own home or in hospital to carry out an assessment of the persons needs before deciding on their suitability to live at the home. People who are considering moving into the home and their relatives are invited for a visit before any decision is made about whether they move into the home on a permanent basis. The home formally writes to individuals following the assessment visit to confirm if the home can meet their needs, copies of these letters were seen in peoples care files. We spoke with one person who had recently moved in for a temporary stay, they said that they were given plenty of information about the home, they had visited beforehand and had chosen the home as it was close to their relatives and they liked the facilities and staff. The various assessments and care plans indicate that individuals and their relatives are being fully involved in the assessment, review and care planning process. At times, the home accepts people through emergency admissions and records and discussions with staff evidenced that as much information was obtained prior to admission as possible, to ensure peoples needs could be met. The returned surveys show people are very happy with the services provided and were given enough information prior to their admission. Copies of peoples contracts and statements of terms and conditions are held in their care files. There is a comprehensive and ongoing programme of training for staff which is tailored to the care and support needs of this client group. Discussions with staff and training records indicate that the home has the requisite range of skills and abilities with which to meet the needs of the people residing at the home. People are able to make a choice of staff gender when deciding whom they would like to deliver their care, the home currently employs both male and female staff. The home does not provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs, so standard six is not applicable. Care Homes for Older People Page 12 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans are very detailed and outline the level of support and care each person requires in ensuring their health and welfare needs will be met. People are being well protected by the homes medication policies and procedures. People are treated with respect and dignity in all aspects of their daily living. Evidence: During this visit we looked at the care plans for five people living in the home. These evidenced the full involvement of the individuals and their nearest relatives in identifying their needs, wishes and preferences in drawing up their care plans. We found that the home has very good care plans for people who live in the home, the plans are comprehensive and person centred, focussing on the individuals physical, cultural, mental, emotional and spiritual needs and wishes and how the home aims to meet these. We saw that the care plans had been regularly reviewed and updated where necessary, evaluation records are detailed and staff are thorough in updating all relevant records to ensure the current care support required is well documented. The care plans include clear and achievable goals to make sure that people maintain their Care Homes for Older People Page 13 of 32 Evidence: independence as much as possible. We also saw that each of the care plan files include risk assessments for manual handling, pressure care, nutrition and other potential risks. The risk assessments have been well completed and include guidance for staff on how identified risks should be minimised. We saw that peoples care plans include a good record of all health care appointments. These records are evidence that people have access to the primary healthcare and remedial services they need, the records detail outcomes from visits by external professionals and attendance at appointments. The records are well maintained, this helps in making sure that everyone is aware of the persons health needs and how these are to be met. Those people spoken with during this visit said that the home always arranges the doctor when needed and relatives spoken with said that the staff always let them know if there have been any changes. During the visit we spoke with two district nurses who visit the home regularly, comments include The care here is very good, staff communicate well and support our visits, our patients are very happy here. People looked clean, well dressed and had received a good level of personal care. Views were elicited from a number of people who use the service, very favourable views were expressed regarding the home and the care and support provided by staff. Some of the comments include They all do a fantastic job. and Couldnt wish for anything better, staff are all wonderful. I love everything here, I shall be here to the end. A key worker system is in place to enable people to receive one to one support. A staff survey detailed, we always do our best to provide high standards of care. People said that they receive support in a way that respects their privacy and dignity and this could be observed during the visit. Observation of the service showed there is good interaction between the staff and people, with polite, friendly and supportive care practices being used to assist people in their daily lives. Care plans clearly detail individual wishes and preferences in regard to their daily living and routines. During the visit we checked the way that staff in the home managed peoples prescribed medication. The way medicines are handled and stored in the home keeps people safe. The staff make sure that the correct medication has been brought in with the individual on admission and any omissions are quickly followed up. The home had recently notified us about two medication errors and the action they had taken , which has ensured the administration practices are more robust, which was evidenced at the visit. Records showed that each person got the medication they needed at the right Care Homes for Older People Page 14 of 32 Evidence: time and staff made sure that accurate records were kept. Each house has its own secure storage cabinets for peoples prescribed medication and these were kept well organised by staff. The home is in the process of changing the pharmacy providers, staff are scheduled to access training on the new administration systems. People are encouraged to be as independent as possible in controlling their own medication, risk assessments and monitoring systems are in place for those who can self medicate. The home has very detailed policies and procedures in place to support all aspects of the system, we consider the range of p.r.n.(as needed) guidance to be very positive in providing staff with detailed guidance in this area. All the staff who administer medication have received training, some have completed the safe handling of medications course and the remainder have completed an internal course. The manager told us that she had recently gained funding to enable the remainder of staff to access the safe handling of medications course which she considers more comprehensive and better equips the staff. End of life wishes had been discussed with people who live in the home and were documented sensitively. Some of the staff have accessed training in bereavement and loss which enables them to develop insights and skills to assist in supporting people when a death in the home or a family bereavement occurs. Care Homes for Older People Page 15 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a choice of activities in the home and are encouraged to pursue their own interests. Meals served at the home are of a good quality and offer choice to ensure people receive a varied and nutritious diet. Evidence: People spoke of how they are able to make their own choices in how they spend their time. People said that there were activities arranged each day and that they enjoyed taking part. The home has a weekly activities plan displayed in the front entrance of the home so visitors can see the type of activities available to people on a daily basis. A monthly events calendar has also been developed for the year, which includes events such as Grandparents day and a Strawberry and Cream afternoon. During the visit we observed people participating in a range of activities from knitting, playing Scrabble, enjoying a sing a long and in the afternoon a reminiscence therapist visited the home. Although there isnt an activities organiser, activities are planned in advance and provided by staff each day. Typical activities that take place range from Bingo, dominoes, bean bag games, watching DVDs, reminiscence, sing a longs, crafts, Care Homes for Older People Page 16 of 32 Evidence: manicures, baking and gentle exercise programmes. Views from people during the day and from comments in surveys were very positive about the activities and entertainment provided, some of these included Theres always lots for us to do, sometimes we do baking and I always like a game of Bingo. The home has made efforts to develop closer links with the local community, representatives from the local Methodist Chapel now visit the home and some of the residents from the local sheltered housing have visited the home for Sunday lunch. The home is also working with the local Trust, with the older persons collaborative, which involves support workers visiting the home to work with people and opportunities for people from the home to attend lunch clubs and a trip out to Bridlington has been arranged in June. Cultural and religious needs are responded to with services for different faith groups held at the home. There was evidence in the care documentation of personal profiles, social needs assessments and plans which identify peoples hobbies and leisure pastimes before they entered the home and what they enjoy doing now. Grimsby Grange and Manor has a welcoming and friendly atmosphere. Although few relatives visited during the inspection, there was good evidence from records and discussion with staff and people who use the service that many peoples relatives and friends regularly visit the home. People who use the service clearly enjoy and value the contact from their families and friends. We spoke with one relative who told us how lovely and friendly all the staff are and how she often has lunch there with her husband which is always very nice. The home offers a high standard of meals, people who use the service are consulted on admission regarding their dietary needs. Menus are planned over a four week period with input from individuals, and knowledge of needs and preference. Lunch is the main meal, which includes a choice of three courses. There is good evidence from residents meeting minutes that the manager has consulted very regularly with people about the menus and the meal choices they would like, for instance some of the continental choices have been changed recently. When we spoke with the people who live at the home about the meals they told us that they were very good and there is plenty of choice. We observed breakfast and lunch meals, the dining rooms are pleasant and tables are very attractively laid. The meals are well presented and look wholesome and nutritious, some of the comments received include the food is excellent, there is always a good choice and lovely menu, you cant fault any of the meals. Staff encourage independence and aids are provided, staff were seen to offer assistance to people in a sensitive and discreet manner. The cook told us that she had Care Homes for Older People Page 17 of 32 Evidence: recently attended a course on nutrition and the specialised diets currently provided were diabetic and fortified. Entries in the care files detail where individuals have specific nutritional needs and also note their likes and dislikes. Care records show that people are weighed regularly, nutritional needs are monitored, intake levels recorded and specialist advice is sought where necessary. The kitchen areas had been inspected by the Environmental Health Officer in March and the home was awarded a four star rating. Care Homes for Older People Page 18 of 32 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. If people have concerns with their care, they or people close to them know how to complain. The complaints procedures are good and ensure that all complaints are dealt with in a fair and though way. There are suitable policies and practices within the home to ensure people are safeguarding from harm and abuse. Evidence: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. The procedure provides people with clear information. Surveys returned by people living at the home and discussions with people during the day confirmed that they knew who to speak to if they were unhappy about something and knew how to make a complaint. The home has received four complaints since it opened, records show that the complaints were dealt with in accordance with the homes procedures with details of the investigation and any actions taken, held on file. Information about advocacy services is displayed in the reception area, the manager told us that representatives from the local advocacy service had visited the home to discuss how they could support people living in the home. Senior staff have accessed training on the Mental Capacity Act and the new Deprivation of Liberty legislation, this is being rolled out to the remaining staff in this years staff development programme. Care Homes for Older People Page 19 of 32 Evidence: When we spoke with the staff they were able to tell us what they would do if they witnessed any abuse within the home or if anyone made any allegation to them. To protect people receiving a service, staff training records show they have all attended safeguarding training. There have been two safeguarding issues since the home opened, both of which were acted upon quickly by the manager and referrals made to the appropriate Social Services Team. One resulted in staff members being dismissed following disciplinary hearings and the second is currently being investigated. The action taken by the manager prevented people living in the home being placed at risk and these two situations were managed well. Staff were observed throughout the visit listening to what people said and treating them with dignity and responding to their wishes. Care Homes for Older People Page 20 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home is high, providing people with a very safe, comfortable and attractive place to live. Evidence: Grimsby Grange and Manor is a purpose built home which opened in November 2008.The home is divided into two buildings, Grimsby Grange has accommodation for forty seven people and provides residential support for people with dementia, Grimsby Manor also has accommodation for forty seven people and provides general residential care support. Facilities for people in both buildings are provided over three floors with lift and stair access. The decor and furnishings throughout the building are of good quality and reflect a contemporary style, providing very comfortable and pleasant accommodation. Carpeting throughout the home has been carefully selected and walls painted plain colours to ensure suitability for meeting needs of people with dementia. All areas of the home are well lit the lighting is domestic in style. All bedrooms are for single occupancy offering en suite facilities, which includes a wet shower room. People are able to bring personal items with them on admission and can install a private telephone if they wish. Those people who spoke with us were very Care Homes for Older People Page 21 of 32 Evidence: happy with their rooms, comments included my room is lovely, I couldnt wish for better and the facilities here are excellent, all the rooms are very pleasant and Im very happy and comfortable here. There are safe facilities and small fridge freezers in every bedroom and people can lock their rooms if they wish. All the bedroom doors have been provided with small frames where people can put in photographs, pictures or their names, to help them recognise their room. There is colour signage on room doors in Grimsby Grange to help people recognise where the bathroom and toilet facilities are. Many of the rooms on the ground floor have patio doors with direct access into the garden area. There are a variety of bathrooms and shower facilities on each floor, the baths have hoist facilities, the rooms are spacious, well ventilated and decorated pleasantly. There are a range of lounge and dining areas on each floor where people can choose to sit and spend their time this was observed during the visit. The furniture in these areas is of good quality and specially designed for older persons. Each communal lounge has a large digital television making easy viewing for those people who may have sight problems. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home. Many of the beds are the profile style which are electric and better enable staff to adjust the height and position to suit the individuals needs and makes life more comfortable for people who have to spend a long time in bed. Pressure relieving mattresses and cushions are provided by the community services, where people are deemed at risk of developing pressure sores. A walk around the home found it to be exceptionally clean and tidy and smelling fresh. Comments from surveys and people during the day include ensures very high standards of hygiene and the home is always kept very clean and tidy, the staff work really hard. The home has a good infection control policy and the manager explained that she would seek advice from external specialists, eg. Health Protection Agency if and when required. All staff have received training in this area and this ensures that disease and illness are managed in a safe way and people receive the support they require without being placed at risk of contracting infectious diseases. To ensure the safety of the people who use the service a key coded access facility to both buildings ensures people cant leave the home unsupervised, although there is free access to the enclosed sensory garden. There are lovely garden areas adjacent to both buildings, they have been well thought out with attractive planting of flowers and Care Homes for Older People Page 22 of 32 Evidence: shrubs, small lawn areas and plenty of seating and shade. The garden area for Grimsby Grange is secure and is being further developed to provide a greenhouse and vegetable plot for people to enjoy some gardening. There is ample parking space provided at the rear of the home. Overall the facilities provided at the home are very good. From surveys received and from speaking with people during the visit it was evident that they enjoy living in the home and feel that the standard of accommodation is excellent. Care Homes for Older People Page 23 of 32 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 employed in sufficient numbers to ensure people have their needs fully met. People can be confident that they are cared for by a skilled and competent staff group and the robust recruitment procedures provide protection. Evidence: The management at the home started recruiting the homes staff two months prior to the home opening, there has been some staff turnover during the last six months, occupancy has steadily increased with thirty people residing in the home at the time of the visit. The staff rotas show there are enough staff planned to be on duty to meet peoples needs. On the day of the visit enough staff, were observed, to be available to meet peoples needs in a relaxed and unhurried manner. The care staff work 12 hour shifts which they said worked well, although discussions with the manager evidenced that she would consider more flexible rostering of staff as the homes occupancy increases, to provide more staff at the busier times of day. Currently one floor is occupied in Grimsby Manor and two floors occupied in Grimsby Grange two care staff are rostered to each floor and there is a deputy manager in both buildings, for the day shift. Staff and people at the home said that the staffing levels were good. Everyone that completed a survey said that there was always enough staff to assist them. The home does not currently utilise the Residential Staffing Forum, this Care Homes for Older People Page 24 of 32 Evidence: is a dependency tool devised by the department of health, which care homes are obliged to use to support their staffing levels. As occupancy increases the home should use this dependency tool to ensure that the staffing levels are appropriate. We discussed the number of falls in Grimsby Grange in recent weeks, records showed a number had taken place in peoples bedroom accomodation; peoples risk of falls and their overall dependency should be factored in to the staff rostering to ensure people are monitored and supported effectively. All people spoken to during the day and comments on surveys were extremely complimentary about the staff at the home. Many people said how lovely and kind the staff are. One person wrote The staff are all very caring and are willing to help us at anytime. The home also employs a team of ancillary staff who are highly motivated ensuring that the standards relating to food, cleanliness, laundry and administration are fully met. Given the current occupancy, the home is utilising the kitchen facilities in Grimsby Grange to provide all meals for people, there are no kitchen assistants currently employed at the home however the manager confirmed that this would be reviewed as occupancy increased. People who use the service are protected through robust recruitment procedures. Staff records sampled during the visit show that face- to- face interviews take place and formal questions and responses are noted. Recruitment records are well maintained and up to date. Safe vetting procedures are followed, these include taking up written references and carrying out checks through the Criminal Records Bureau before appointment. All staff files contain a photograph, proof of identification, a contract and terms and conditions of employment. Information provided prior to the visit evidences that 50 of staff have achieved the NVQ level 2 or above in care and further staff are working towards this qualification. This helps to ensure that people are receiving care from staff with the right skills and knowledge. Records show that new staff follow an eight day induction programme, staff complete an induction and foundation training package that meets the specification of the Skills for Care targets. Comments in surveys from staff include the induction programme was thorough, I hadnt done this work before and I felt well supported. The majority of staff attended a range of training courses following their recruitment and prior to the admission of people to the home. The home provides a programme Care Homes for Older People Page 25 of 32 Evidence: which includes: mandatory, general and some service specific training. The management maintain a training matrix on the computer and we also looked at some staff training files, which contained the relevant certificates. Records show that staff are up to date with mandatory courses in fire safety, moving/ handling, first aid and basic food hygiene. Other courses they have accessed are medication, safeguarding adults, health and safety, infection control, nutrition, bereavement, communication and dementia. Views expressed by staff on this inspection indicated staff are feeling well supported, that they are receiving good training, supervision and encouragement to develop their skills and potential. Care Homes for Older People Page 26 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the management at the home. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The manager is registered with the CQC and has many years experience in managing a range of care services. She has completed the Registered Managers Award. From information received before the site visit and from speaking to people living in the home and relatives, it is clear that the manager operates an open door policy and is very approachable. From observation throughout the visit, the manager communicated very well with people living in the home and has a very good understanding of the needs of older people. She is committed to ensuring the service provides excellent standards of care for people and has cultivated a very positive Care Homes for Older People Page 27 of 32 Evidence: ethos amongst her staff, a number of staff told us that the manager insists on high standards at all times. There are clear lines of accountability within the home and with external management. Some of the comments from people include the home is well run, you only have to mention something and its sorted out and we see the manager every day, she always has time for a chat and I cant think of anything they could do better. The manager provided us with information about the home in their Annual Quality Assurance Assessment AQQA. This information let us know about the service and what they are doing to improve the outcomes for people who use this service and about improvements they intend to make to continue with this. A system of monitoring the quality of the care provided at the home has been fully implemented. The management complete regular audits of key areas such as the facilities, care records, peoples weights, medication records and accidents. There was good evidence that the management review the findings from the audits and take action to address any issues arising. There was evidence of involvement in the quality monitoring process from people who live in the home in surveys and residents and relatives meetings. Surveys are sent to people who use the service and their relatives every six months, these are analysed by staff at head office and a report is provided to the home, we saw evidence that action plans are drawn up where deficiencies and issues have been identified. Minutes of the most recent meetings in January were looked at, these showed that the meetings are well attended and discussions about all aspects of the service are discussed, there was evidence that any issues raised had been acted upon. The returned service and CQC surveys show that people are more than happy with the service. The manager explained that she would be completing the annual development plan, which supports the quality programme, later in the year given the recent opening of the home. The support manager carries out monthly visits to the home in line with Regulation 26 and reports generated from these visits are held at the home. The homes business and financial plan and insurance arrangements are in place and were submitted to support the homes registration in November 2008. People are protected by the way their finances are dealt with as two peoples records were checked and found to be correct, safe and good records kept. There are detailed, up to date policies and procedures in place for all areas of practice. Information provided in the AQQA detailed that the manager has requested from her head office that staff are provided with a handbook which will contain all the homes Care Homes for Older People Page 28 of 32 Evidence: key policies for easy reference purposes. All staff spoken with said that they receive regular supervision and regularly meet up with their manager to discuss ways of working and training, checks of records confirmed this. The records showed that where issues had arisen with staff practice they had been followed up appropriately in the supervision meetings. To keep people safe, the information provided before the visit shows there are regular health and safety checks carried out throughout the home, including fire and emergency equipment. The fire safety records and discussion with the manager confirmed this. Staff undertake all health and safety courses within the first six months of employment ensuring that the staff are knowledgeable and have the necessary skills to deal with emergencies. All accident and incidents are reported and recorded appropriately. The home had undergone a full health and safety inspection from the environmental health team in March, the findings had been very positive with one requirement made around providing staff with training on the safe use of bed rails, due to the incorrect fitting of a set found at their inspection. The manager confirmed that this had not yet taken place. There were no bed rails in use at the time of this site visit. Care Homes for Older People Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 27 38 The management should utilise the Residential Staffing Forum to support effective staff rostering. The home should action the requirement made by the Environmental Health Officer to provide staff training in the safe management of bed rails. This will protect peoples safety. Care Homes for Older People Page 31 of 32 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 32 of 32 - 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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