Care Home: Priory Grange Care Home Limited

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What the care home does well Before someone comes to live at the home there is a full assessment done by the placing local authority and the home. This makes sure that the service offered by the home can meet the person`s needs and that staff have enough information to make sure that people are looked after properly. The home make sure there are plenty of activities for the people to take part in and the food continues to be of a good standard. The home is well maintained and clean and bedrooms are decorated on an as and when required basis. When staff are recruited to work at the home, all the proper checks are done before they start working. This makes sure that people are not exposed to staff who should not be working with vulnerable adults. What has improved since the last inspection? A full time activities coordinator is now employed at the home so that people can take part in a range of activities o a daily basis. Staff now receive the proper training about how to give out medication safely. What the care home could do better: People must be protected by the risk assessments in place and these must be more personal to the person. This will ensure staff have good information and enable them to ensure the person`s safety when caring for them. People with dementia should be provided with activities which are specifically for them and meet their needs. The outcome of complaints received by the home should be recorded as should the satisfaction of the complainant. This will provide a good audit trail and ensure that compliant are dealt with to the satisfaction of the complainant. Staff should have all of their training both mandatory and about the specific needs of older people, up dated as required. This will ensure that people are cared for by a well trained knowledgeable staff group. The acting manager should submit an application for registration as soon as is practicable. This will ensure the people who live at the home are protected and the acting manager is assessed as being fit to manage. This will ensure the acting manager is working within the law and people are protected. Key inspection report Care homes for older people Name: Address: Priory Grange Care Home Limited Hessle High Road Hull East Yorkshire HU4 7BA     The quality rating for this care home is:   one star adequate 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: George Skinn     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Priory Grange Care Home Limited Hessle High Road Hull East Yorkshire HU4 7BA 01482504222 01482573966 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Priory Grange Care Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Priory Grange is owned by Priory Grange Care Home Limited, a family company that have the one home. It is registered to provide personal care and accommodation for up to 41 people of either gender, over the age of 65, some of who may suffer from dementia. Priory Grange is located in the Hessle area of Hull to the west of the city centre. The home is purpose built with a rear garden and some car parking space. It is a short drive from the centre of Hessle where there is a wide range of shops, pubs and churches. The home provides accommodation in single rooms all with en-suite on two floors. There was a passenger lift connecting the floors. Downstairs there was a large Care Homes for Older People Page 4 of 25 Over 65 41 41 0 0 2 1 0 5 2 0 0 9 Brief description of the care home conservatory and dining room, there was also a lounge and dining room on the first floor and a smaller lounge. People who live at the home that smoke must go outside. Care Homes for Older People Page 5 of 25 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: one star adequate 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 the service is 1 star. This means that the people who use this service experience adequate quality outcomes. We were at the home for seven (7) hours and we looked at records which told us about the way people are cared for, staff recruitment files and other records about the general running of the home. We spoke with some of the people who live at the home, we interviewed staff and spoke with the acting manager. Before we went to the home we asked the acting manager to complete an Annual Quality Assurance Assessment (AQAA), this told about how the home is run, what the home had improved on since the last inspection, and areas of improvement for comming year. Care Homes for Older People Page 6 of 25 We sent out some surveys for people who live at the home and staff to complete and send back to us. We got back eight (8) surveys from the people who live at the home and three (3) from the staff. The people who live at the home told us that they thought the home was very good, the staff were always helpful and kind, one relative told us that they thought there could be more staff on duty as they always looked busy. The staff told us that they generally felt well supported and the new acting manager was very hands on which they liked. They felt the home had been through a lot of changes in the last year and hoped that would now settle and there would now be more consistent management of the home. We spent some time looking at what goes on the in the home and watching the way staff cared for people. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. The home was last inspected 21st May 2009. The current weekly charges are 359.50 GBP to 390 GBP which includes a top up of 25 GBP. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 25 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 25 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 25 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. Peoples needs are assessed before they come to live at the home. Evidence: We looked at a sample of files which belonged to the people who live at the home and we saw that these contained copies of assessments undertaken by the placing authority and the home. This assessment information is then used to write a care or support plan describing what staff need to do to look after each person. The home does not provide intermediate care, which is a specialist service aimed at maximising peoples independence and return home after a hospital admission. Care Homes for Older People Page 11 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the people who live at the home have a plan of care, however they are not protected by the risk assessments in place. They are protected by the way the staff handle their medication and staff have a good understanding of their needs and how to meet these. Evidence: We looked at six (6) files which belonged to the people who live at the home. We saw that these contained basic information about the persons GP and next of kin and a brief medical history. The files contained information about what the persons wishes were when they died. We saw that there was a brief life history recorded in the files and the person preferences and wishes were recorded. This included information about food and daily routines like when they liked to get up and go to bed. Peoples religious practices and observance was recorded and whether this was important to them. The files contained risk assessment and a care plan. The care plan detailed what the Care Homes for Older People Page 12 of 25 Evidence: staff needed to do for the person so their needs would be met, these had been completed with the person or their relatives. The risk assessments were generic and did not detail what the risk was to each person. For example the risk assessment about how to help someone walk safely detailed staff training, use and maintenance of equipment but nothing about how the person was to be helped, or what their specific needs were. These were the same for everyone who needed help with walking just the names had been changed. We saw that the medication is handled safely. The amount of medication delivered into the building was recorded and any medication left in the monitored dosage system was sent back to the pharmacist. The staff accurately record the medication given to the person and record when and why medication was not given. We looked at the record of controlled drugs and this was accurate. Medication is stored safely in locked cabinets. The acting manager is assessing the medication systems at the present time. This is to establish if the service provided by the pharmacist is flexible enough to make sure there is always the right medication available for the people whole live the home, as there is no out of hours service for medication which maybe needed like anti biotics which are prescribed following a GPs visit. When we spoke with the staff they were able to describe what the needs of the people were, they were aware of their roles and responsibilities toward the people who live at the home. Care Homes for Older People Page 13 of 25 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 are able to participate in age appropriate activities, however further development is needs to provide specific activities for those people with dementia. The food continues to be of a good standard and people are provided with a wholesome and varied diet. Evidence: The acting manager has employed a full time activities coordinator. She has not been post for long and is currently formulating an activities calendar based on what people like to do. During the site visit people were watching videos about past times and were knitting scarves for the planned summer faire. We did not see any activities specifically developed for those people with dementia, however we saw that staff were patient and sensitive when helping those people who had dementia, and were aware of peoples preferences when eating. For example one person was eating their meal in their own chosen way and would not accept any help form staff, but staff were monitoring what they had eaten and whether they wanted any more. People told us that activities had improved recently and they felt much more involved Care Homes for Older People Page 14 of 25 Evidence: with the running of the home. The people who live at the home had started a good neighbour scheme whereby those people who had been at the home for a while befriended those people who had just move in to make them feel welcome. People told us that the food continues to be good and there is always a choice at meal times. Care Homes for Older People Page 15 of 25 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. People are protected by the way the home handles complaints and are kept safe by the procedures in place for safeguarding. Staff have received training about how keep people safe. Evidence: There continues to be a complaint procedure displayed around the home. A record is kept of all complaints received by the home; we saw that there have been two (2) complaints recorded since the last inspection. The record did not show what the outcome of the complaint was or if the complainant was satisfied with this and the way in which the compliant had been handled. The CQC have received no concerns about the home since the last inspection. There have been five (5) safeguarding investigations involving the local authority safeguarding team. Three (3) were about staff using abusive language towards the people who live at the home. One (1) was about a person being left in an unkempt condition and not having their needs met by the staff and one (1) was about a staff member being rough and verbally abusive towards someone who lives at the home. All of the investigations have been resolved, none of the staff who were accused of being verbally abusive continue to work at the home. The staff who left the person uncared for have been disciplined and their practice is being closely monitored by the acting manager. Much the investigative work had been done by the acting manager. Care Homes for Older People Page 16 of 25 Evidence: We asked the manager why she had undertaken her own investigation and not followed the agreed safeguarding procedures, she told us she was acting on instructions from the safeguarding team. This satisfactory and is safeguarding the wellbeing of the people who live at the home. We saw that staff had received training on how to identify abuse and how to report this to the proper authorities. Staff told us that they were confident that the acting manager would take any allegations seriously and felt well supported. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is well maintained and clean Evidence: The home continues to be hygienic and clean, all areas seen were well maintained and the handyman was seen redecorating the one of the bedrooms. This is done when the room becomes vacant and before the next person moves in. We looked at peoples rooms and the communal areas of the home. Peoples rooms were clean and there were no offensive smells. The rooms are all en-suite and are large enough for peoples personal belongings and many have their own TV and music equipment. People told us they spend time in their room but can use the communal areas if they want to. The acting manager has removed chairs from the entrance as this was a request made at the last residents meeting. People felt intimidated by one person who seemed to monopolise this area and had on occasions made it difficult for their relatives to visit due to their behaviour. The acting manager had identified this area as a potential flash point due to the behaviour of one of the people who lives at the home and how this often erupted into violence. People told us that this was now much better and there was no confrontation. Care Homes for Older People Page 18 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are provided in enough numbers to meet their needs, however the staff lack the training needed to care for older people and to keep them safe. Evidence: We looked at the files of those staff who had been recruited since the last inspection. We saw that these contained references from previous employers, criminal records Bureau (CRB) checks and a completed application form covering any gaps in employment history. Some of the surveys sent back to us commented on a lack of staff. We checked the staffing levels and found these to comply with the minimum recommended guidance. However this will have to be reviewed as the number of people living at the home increases. We looked at staff training. We saw that some staff had attended training about dementia but not all had done this. We found that on the whole staff had not had much opportunity for training since the last inspection and staff told us that their training needed up dated, not only mandatory training like health safety, basic food hygiene etc but also more specific training about the needs older people. Care Homes for Older People Page 19 of 25 Evidence: The deputy manager had undertaken an audit into staff training and we saw that training had been identified for staff to undertake and areas of lack of knowledge were being addressed. Care Homes for Older People Page 20 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run in the best interests of the people who live there and their welfare is safeguarded as far as is practicable. The acting manager is not registered with the CQC. Health and safety of staff is ensured. Evidence: The acting manager has been in post for about a month. She has the appropriate qualifications and the experience to undertake the managers role. She is not yet registered with the CQC and no application has been made for this. Staff we spoke with hoped that this would be a more settled time and were hopeful the acting manager would stay. They told us that they found the acting manager approachable and a very hands on worker which they liked. They told us they felt well supported and could see the benefit of the changes the acting manager had implemented. People who live at the home told us that they liked the acting manager and also found Care Homes for Older People Page 21 of 25 Evidence: her approachable. They told us they felt more involved with the running of the home and had attended residents meetings following which their views and wishes had been acted upon. We saw that the health and welfare of the people who live at the home and the staff was protected as far as practicable, and policies and procedures were up dated as required. We saw that the equipment used at the home was regularly maintained as per manufactures recommendations. There continues to be a QA system in place at the home, the acting manager told us that this is to expended to include the opinions of all other stakeholders like doctors, nurses, relatives and other visiting health care professionals. She has held meetings with the people who live at home and this had been positive. Care Homes for Older People Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People must be protected by 30/07/2010 the risk assessments in place and these must be more personal to the person. This will ensure the persons safety and wellbeing. 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 3 12 16 30 Those people who have dementia should be provided with specific activities which meet their needs. The outcome of all complaints received by the home should be recorded as should the satisfaction of the complainant. Staff should have all of their training both mandatory and about the specific needs of older people, up dated as required. The acting manager should submit an application for registration as soon as is practicable. This will ensure the people who live at the home are protected and the acting manager is assessed to be fit to manage. 4 31 Care Homes for Older People Page 24 of 25 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. 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