Care Home: Hall Grange

What the care home does well "I`m very satisfied", "on the whole a very good place", "the people make it, we have lovely times together", "the care I get is excellent" and "the staff are unfailingly courteous and friendly" were all comments from the people who live at the home. A relative or friend of an individual told us that the home was "a very caring place" and the person they visited was "very happy". Individuals can take part in a variety of activities and there are a large number of volunteers who regularly contribute to the life of the home. There is a new manager in post. The service is clearly benefiting from her leadership and staffs are positive about the changes being made to the service. What has improved since the last inspection? There have been significant improvements in the areas of care planning, staff training and medication. The systems for making sure medication is administered safely to individuals are now working well. Staff have received training in this important area and records are audited regularly by the responsible manager. Care plans are fully completed and regularly reviewed. This makes sure that staff are up to date with the needs of each person living there.Health and Safety checks now take place as required. Cleaning materials are stored securely. What the care home could do better: The challenge for the home is to continue to make progress and build on the good work completed in recent months. The service should continue to make the care and support provided even more person centred. Care plans for example could be made even better by containing more detailed information about people`s individual needs. Staffing levels need to be reviewed to make sure there are always enough staff on duty to effectively support people in all areas of their lives. Occupation, engagement and ensuring well being should be seen as equally important to the support given with physical care. It is strongly recommended that the organisation buy a suitable vehicle to be used for trips out for the people who live there. CARE HOMES FOR OLDER PEOPLE Hall Grange 17 Shirley Church Road Shirley Croydon Surrey CR9 5AL Lead Inspector Jon Fry Key Unannounced Inspection 10:00 19 & 27th February 2008 th 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 Hall Grange DS0000025787.V358548.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. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hall Grange Address 17 Shirley Church Road Shirley Croydon Surrey CR9 5AL 020 8654 1708 020 8654 4982 home.shi@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged 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) Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who may be accommodated is 36. Date of last inspection Brief Description of the Service: Hall Grange provides care for up to 36 older people. It is run by Methodist Homes for the Aged (MHA). The home is situated in a pleasant residential area of Shirley close to local shops and transport links. Accommodation is provided over two floors with lift access. Rooms are single and some have the added attraction of overlooking the extensive garden and grounds. A copy of the service’s Statement of Purpose and User Guide can be obtained on request. Fees for the home at the time of writing range between £509.00 and £567.00 per week. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We spent thirteen hours in the home over two separate visits. We spoke to fourteen people who live at the home, one relative or friend of an individual, the manager and four staff members. We looked at records and documents kept at the service including three people’s care plans. Completed surveys were received from seven people who live at the home. What the service does well: What has improved since the last inspection? There have been significant improvements in the areas of care planning, staff training and medication. The systems for making sure medication is administered safely to individuals are now working well. Staff have received training in this important area and records are audited regularly by the responsible manager. Care plans are fully completed and regularly reviewed. This makes sure that staff are up to date with the needs of each person living there. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 6 Health and Safety checks now take place as required. Cleaning materials are stored securely. 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. Hall Grange DS0000025787.V358548.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 Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to people about the service. Assessments are completed before people move in and these are kept up to date. EVIDENCE: “I found it through relatives”, “I knew the home through friends”, “my family found it for me – they visited on my behalf” and “I used to volunteer here” were comments from individuals about how they came to live at the home. 85 of people who returned surveys said that they had received enough information to make a decision about moving in. 15 said ‘no’ to this question. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 9 We saw that the User Guide for the home has been updated since our last inspection visit in September 2007. This document is now available in large print and we have recommended that the service continue to look at other formats to make it as user friendly as possible. Assessments are completed before someone moves into the home. We saw that improvements have been made to the assessment process to make sure that documents are fully completed and then kept up to date. The assessments capture some good information about individuals that includes their background, history and current daily living skills. Family members had also contributed information in two of the three files we looked at. Hall Grange DS0000025787.V358548.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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are now well maintained and clearly address individual needs. People’s health needs are met well. Arrangements for the handling, storage and administration of medication are excellent. EVIDENCE: We think that the service has made significant improvements in this outcome area since the last inspection took place. 50 of people who completed surveys said ‘always’ when asked if they received the care and support they needed. 50 said ‘usually’. Comments included “excellent”, “it runs very well” and “I’d rather be here than the last place”. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 11 We looked at care plans for three people. These were all fully completed and regularly reviewed to make sure they are up to date. Areas of care looked at include personal hygiene, health, social needs and spirituality. The plans seen for personal care included some good information around the help the individuals required each morning. We have recommended that the staff continue to look at how care plans can be even more detailed and person centred. For example we saw a care plan that said ‘please promote my independence as I can do a lot myself’. This could be developed to say in more detail exactly what the person can do themselves and how the staff can help them to be independent. Risk assessments we looked at were fully completed or had been kept under review. This makes sure that areas such as risk of falls, developing pressure sores and nutritional intake are looked at regularly. Daily notes kept by staff should be discussed within the team. We saw that some of these contain very repetitive and occasionally negative statements. Notes kept by staff need to contain good quality information which can then be used to evaluate and review the care being provided. It is recommended that the home look at developing life story books with the people living there and these could then be shared with others in the home. This may also help staff to relate to people as individuals and encourage more interaction. Staff may also wish to develop their own life story books as part of this process. We saw that health needs of individuals are being met. “They go and get the GP at once”, “I see my own Doctor either at the surgery or he comes to the home” and “the Doctor visits weekly” were comments from people living at the home. One person raised some issues around their dental care during our visit. We found that the home had been supporting the individual to see a dentist to try and solve the problem they were having. Records of appointments with the GP and other healthcare professionals are kept well. 67 of people who completed a survey said that they ‘always’ received the medical support they needed. 33 of people said ‘usually’. The home has made significant improvements in the way it manages medication. We looked at medication records on both days of this inspection and audited quantities of tablets against these records. The manager responsible has introduced a very good system to make sure that medication is administered as prescribed and that quantities are regularly audited. This is clearly working well and all the records we looked at were accurate and up to date. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 offers a good range of activities. People living at the home generally enjoy the food provided to them. EVIDENCE: 33 of people who completed a survey said that there were ‘always’ activities they could take part in. 33 of people said ‘usually’ and 33 said ‘sometimes’. “It’s not a dull place”, “quite a few things going on”, “enough to do” and “the activities person is amazing” were some comments from individuals. Two people said they would like more trips out commenting “more fresh air” and “I’d like to get to the local shops more”. One person said that they would like “more intellectual amusement”. A weekly schedule of activities is displayed for the people who live there and this includes cake making, quizzes, an art group and religious services. We Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 13 attended the monthly meeting for the people who live there and this included discussion around activities. Some of the many volunteers who regularly come to the home were about to conduct an audit of activities on behalf of the manager. This information is to be used to look at the activities schedule to tailor it to people’s preferences. We have strongly recommended that the organisation look at providing a minibus for the home. This will more easily enable trips outside the home and allow for spontaneity when the weather allows. Care staff we spoke to said that they did would like more time to be involved in providing activities and just to be able to spend more social time with the people who live there. As at the previous inspection, we have recommended that the service look at how care staff could be more actively involved in social and emotional care. This is important in continuing to develop a service that is person centred rather than task based. Life story work could also help with changing culture within the service. In completed surveys, 72 of people said they ‘usually’ liked the meals served. 14 said ‘always’ and 14 replied ‘sometimes’. Comments from individuals included “the food is good”, “it varies”, “the breakfast is good”, “always very well cooked” and “satisfactory”. The manager told us that they had just completed a review of the menus and this had involved the Residents Committee as well as input from relatives, friends and a dietician. The changes were being announced at the meeting for everybody living at the home and each person was to get a copy of the new menus. Other issues being discussed at the meeting were for a starter to be available at each meal and making sure that people knew that suitable desserts were always provided for diabetics. We saw lunch being served on both days we visited. Some of the people we spoke to just before lunch did not know the meal they were about to be served. We have recommended that the home develop the menus for display in the dining room using photographs of each dish. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are protected from abuse. Concerns about the care provided are listened to and acted on. EVIDENCE: 85 of the people who completed surveys said that they knew how to make a complaint. 15 of individuals said ‘no’ to this question. Comments included “I don’t feel we have anything to complain about”, “I can speak to my key worker or write to the manager”, “I would speak to the assistant manager” and “the manager is very approachable”. Improvements have been made to make sure that full and accurate records are now kept of any concerns or complaints. We saw that these recorded the timescales for replying to the individual, the outcome and any actions required. One person who lives there told us that they had made a complaint recently and were able to show us the written response from the manager. The person concerned felt confident that the home was addressing the issues they had raised. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 15 We saw that care staff have training that teaches them how to recognise and report abuse. Each staff members training has recently been audited and refresher training has or is being arranged where required. The organisation has a procedure for staff to follow in the event of any allegations being made. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 16 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, 21 and 26. People using the 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 living at the home enjoy a comfortable and safe living environment. The home is generally kept clean and well maintained. EVIDENCE: The organisation is continuing to seek planning permission for a new building within the existing grounds of the home. We saw that funds are still being made available to make sure the existing environment is maintained well for the people living there. Recent improvements include better kitchen areas and new carpeting. Future plans include additional adapted baths and improvements to the decoration of the communal bathrooms. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 17 People we spoke to were happy with the environment. Comments from individuals included “fine”, “comfortable” and “very welcoming”. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 18 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are generally happy with the care they receive. Staff recruitment practices and training have been improved. Staffing levels need to be kept under review to make sure they meet the needs of people using the service. EVIDENCE: Feedback about the staff was generally very positive. Comments included “very good”, “they treat you well”, “they don’t push themselves on you”, “all very polite”, “the staff are lovely” and “we are altogether looked after very well”. Comments about numbers of staff included “more staff would be better”, “staff are very busy” and “there is an unnecessary delay in answering call bells”. One person spoke about the domestic staff employed at the home saying that they felt they sometimes talked to you like ‘you were old’. This was discussed with the manager at the time of inspection. 83 of people who filled in surveys said that staff were ‘usually’ available when needed. 17 of individuals said ‘sometimes’. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 19 Three of the four care staff we spoke with said that they thought staffing levels needed to be looked at as the needs of some people living there were increasing. The manager has raised staffing levels since November 2007 and told us that they were continuing to look at this issue. We have made a Requirement for the service to review the staffing levels to make they are meeting the needs of the people who live there. This is important to continue to move the service forward and ensure person centred rather than task based care. We have recommended that the home look at the wearing of uniforms by care staff to see if they are really necessary and if they perhaps take away from the homely feel of the service. This may be an interesting discussion for both the Residents Committee and the staff team to have. Staff now have better access to training and recent courses attended include manual handling, medication and Fire Safety. The home has audited the training needs of all staff and a training plan for 2008 has been drawn up. This includes further training for staff in dementia care and person centred planning. Computer E-learning is available for staff in areas such as Food Hygiene and Health and Safety. New staff receive induction training to Skills for Care standards and all staff either have, or are studying for, the NVQ Level 2 Award. We looked at the recruitment checks for three staff and found that good records are now kept of these. This is an improvement from the September 2007 inspection. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 20 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, 32, 33, 35, 36 and 38. People using the 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 live in a home that is well run. There are good arrangements to make sure that the health and welfare of people using the service is protected. EVIDENCE: A new manager has been in post since November 2007. Staff spoken to were very positive about the changes in the service since the new manager started work. Their comments included “the manager is very professional”, “standards are going up” and “there have been a lot of changes – necessary changes”. We think that the home is clearly benefiting from her leadership. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 21 People who live there are consulted about the running of the service. A Residents Committee meets regularly and looks at issues around things like menus and activities. A monthly meeting takes place for everybody who lives there and there is opportunity for further discussion at the weekly coffee morning open to all. A system for regular individual staff supervision is in place and this is being developed to make sure that all full time staff receive this at least six times per year. Staff training around supervision is being provided. Improved Health and Safety checks take place to make sure people are kept safe and good records are now kept of these. Issues found at the last inspection around fridge temperature checks, a missing fire blanket and hoist safety checks have been addressed. Cleaning materials are now locked away when not in use. Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 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 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 (1) (a) Requirement Care staffing levels on each shift must be reviewed. This is to ensure there are always suitable numbers of staff to meet the needs of the people living at the home. The manager must apply for registration with the CSCI. Timescale for action 01/05/08 2. OP31 CSA 2000 11 (1) 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The user guide to the home should be made available in other formats such as audiotape or pictures. The home should continue to look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should always direct the care to be person orientated and not DS0000025787.V358548.R01.S.doc Version 5.2 Page 24 Hall Grange task based. Care plans need to give specific information about how the person likes the care and support to be delivered. 3. 4. OP7 OP7 The content of daily notes should be discussed to make sure that good quality and useful information is being recorded. Life story books could be developed with individuals and their family or friends. These books could then be used to help communication and engagement. Staff may wish to develop their own life story books to share. The home should continue to look at how care staff could be more involved in the provision of social and emotional care. It is strongly recommended that a suitable vehicle be purchased for use by the service. Picture menus should be displayed in the dining room to help people know what is being served that day. It is recommended that the wearing of uniforms by care staff should be discussed. 5. OP12 6. 7. 8. OP12 OP15 OP27 Hall Grange DS0000025787.V358548.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Hall Grange DS0000025787.V358548.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. 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