Care Home: The Grange

Similar services:

• Sunny Bank (P.R.S.) Ltd
• Ashwood Court Unit 1
• Thornton Lodge
• Alfred House Residential Care Home
• Barkerhouse Road (123)
• Fernhaven
• Thames House
• Creative Support

What the care home does well Before people are admitted to the home their needs were assessed. They were consulted about the level and type of care they required. Important information needed to support them in every day living was recorded and used to decide if The Grange could provide the right care, staff expertise and facilities they needed. Contracts given to residents outlined the terms and conditions of residence, and protected their legal rights. Residents were allocated a named carer/key worker to support them with individual needs. This was particularly beneficial for residents with dementia care needs, as they were cared for by people they knew and trusted. Relatives who sent written comments considered their relatives well cared for. Comments included, `From my experience I am very happy with the level of care.` And `I think they all do a marvellous job`. During the inspection, visitorssaid `excellent and supportive, very good` and `all residents were well cared for`. Health professionals were confident in how the home responded to residents healthcare needs and said the home always met individual needs, respecting residents privacy and dignity. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Activities were varied and personalised. Observations during inspection showed people being given one to one attention. Relatives who provided written comments were pleased with the provision made. Comments included `Every afternoon they have a lady going in to keep the residents brains active with quizzes, games and craft work`. Visiting times were flexible so friends and relatives could call at different times, and residents could see people in private. Relatives visiting said they were always made to feel welcome at the home. Catering arrangements were to the resident`s satisfaction. They were provided with good quality, variety and choice of home cooked meals. All residents who could communicate, spoke well of, and enjoy the food. Residents requiring support and supervision during meals were given special attention by staff. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. The home was exceptionally clean and furnished to a good standard. Comments from relatives received at the commission considered, `The home is always clean, warm and tidy`. And `The Grange has a homely atmosphere`. The staffing levels in the home were very good, and sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering. Relatives were of the opinion, `Staff very efficient and all pleasant with a great sense of humour`. `Very happy with the level of care and the caring attitude of all the staff.` And, `This is a lovely place with very caring concientous staff and management`. Observations of the staff on duty, showed caring people who worked together as a team for the benefit of the residents. Staff said they were happy in their work. They considered they were supported in their role. Written comments from staff included, `The management try particularly hard with training courses, NVQ`s etc. to ensure all staff are given equal opportunity to gain qualifications relating to their role as care assistants`.The GrangeDS0000005918.V367078.R01.S.docVersion 5.2Page 7There was a warm and friendly atmosphere in the home. Team work amongst staff and management was good and residents appeared to be very happy. Positive written comments from staff confirmed this. Comments such as `Provides a first class care to all clients`. `The service gives dedicated 24hour care to its residents, and gives staff every opportunity on training courses`. And, `At the Grange we have a responsibility to give the best care to each individual as an equal.` What has improved since the last inspection? The decision to offer a place in the home following a persons` assessment of need, is confirmed in writing to the person concerned. Advice from a Continence Advisor meant individual needs was considered and managed properly. To make sure staff know their responsibility in Protection Of Vulnerable Adults, formal training is provided. New floor coverings in bedrooms were matched with individual resident needs. High cleaning tasks are carried out safely. In addition to the required improvements further improvements were made and included, new carpets in rooms that required attention. New carpet cleaner purchased. Co-ordinated curtains and bedding purchased. New furniture throughout the home, and some rooms decorated. Staff had been given dementia training. Rotas have been optimised to give a better mix of trained staff on each shift. CARE HOMES FOR OLDER PEOPLE The Grange Stump Lane Chorley Lancashire PR6 0AL Lead Inspector Mrs Marie Dickinson Unannounced Inspection 21st August 2008 10:00 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 The Grange DS0000005918.V367078.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. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address Stump Lane Chorley Lancashire PR6 0AL 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) 01257 241133 Mrs Sharon Louise Atherfold Mrs Diane Michelle Jolly, Mr Stephen William Sams, Mr John Paul Atherfold Mrs Sharon Louise Atherfold Care Home 26 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number disorder, excluding learning disability or of places dementia (2) The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to accommodate 24 Elderly People suffering from dementia (Category DE(E)) Two adult persons who have a mental disorder (Category MD); Date of last inspection 22nd August 2006 Brief Description of the Service: The Grange is a residential care home for older people who have dementia and mental health care needs. The home accommodates male and female residents with varying needs on a long or short-term basis. The home is located near to Chorley town centre, and within close proximity for community resources such as banks, shops, health centre, doctors and, library. Accommodation is provided in single rooms and two twin-bedded rooms on two floors. The upper floor of the home can be reached via a passenger lift. There are a number of communal areas for residents to choose to use and resident’s benefit from a safe garden area at the back. Car parking facilities are at the front and a ramped pathway to the entrance provide easy access for wheelchair users. Information about the service is available from the home. Weekly charges for personal care and accommodation are set at a standard rate of £394 per week. The Grange DS0000005918.V367078.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 Star. This means the people who use this service experience good quality outcomes. A key unannounced inspection was conducted in respect of The Grange on 21st August 2008. The inspection involved getting information from an Annual Quality Assurance Assessment completed by the provider, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the provider, and an inspection of the premises including residents’ bedrooms. Relatives, and staff provided written comments direct to the Commission giving their view of the services provided. Other information was considered such as the homes Annual Service Review carried out in November 2007, which identified the service had continued to provide good outcomes for people living and working at the home. Areas that needed to improve from the previous key inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well: Before people are admitted to the home their needs were assessed. They were consulted about the level and type of care they required. Important information needed to support them in every day living was recorded and used to decide if The Grange could provide the right care, staff expertise and facilities they needed. Contracts given to residents outlined the terms and conditions of residence, and protected their legal rights. Residents were allocated a named carer/key worker to support them with individual needs. This was particularly beneficial for residents with dementia care needs, as they were cared for by people they knew and trusted. Relatives who sent written comments considered their relatives well cared for. Comments included, ‘From my experience I am very happy with the level of care.’ And ‘I think they all do a marvellous job’. During the inspection, visitors The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 6 said ‘excellent and supportive, very good’ and ‘all residents were well cared for’. Health professionals were confident in how the home responded to residents healthcare needs and said the home always met individual needs, respecting residents privacy and dignity. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Activities were varied and personalised. Observations during inspection showed people being given one to one attention. Relatives who provided written comments were pleased with the provision made. Comments included ‘Every afternoon they have a lady going in to keep the residents brains active with quizzes, games and craft work’. Visiting times were flexible so friends and relatives could call at different times, and residents could see people in private. Relatives visiting said they were always made to feel welcome at the home. Catering arrangements were to the resident’s satisfaction. They were provided with good quality, variety and choice of home cooked meals. All residents who could communicate, spoke well of, and enjoy the food. Residents requiring support and supervision during meals were given special attention by staff. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. The home was exceptionally clean and furnished to a good standard. Comments from relatives received at the commission considered, ‘The home is always clean, warm and tidy’. And ‘The Grange has a homely atmosphere’. The staffing levels in the home were very good, and sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering. Relatives were of the opinion, ‘Staff very efficient and all pleasant with a great sense of humour’. ‘Very happy with the level of care and the caring attitude of all the staff.’ And, ‘This is a lovely place with very caring concientous staff and management’. Observations of the staff on duty, showed caring people who worked together as a team for the benefit of the residents. Staff said they were happy in their work. They considered they were supported in their role. Written comments from staff included, ‘The management try particularly hard with training courses, NVQ’s etc. to ensure all staff are given equal opportunity to gain qualifications relating to their role as care assistants’. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 7 There was a warm and friendly atmosphere in the home. Team work amongst staff and management was good and residents appeared to be very happy. Positive written comments from staff confirmed this. Comments such as ‘Provides a first class care to all clients’. ‘The service gives dedicated 24hour care to its residents, and gives staff every opportunity on training courses’. And, ‘At the Grange we have a responsibility to give the best care to each individual as an equal.’ What has improved since the last inspection? What they could do better: Care plans should be better detailed as to the type and level of support residents require. This will prevent care being given in a generalised manner. Resident’s should be asked how they want their medication to be managed and a formal consent to medication administration by staff should be obtained. This will show that they have been consulted as to the best option for them. Medication prescribed to be administered when necessary should be detailed better as to the circumstances it would be given. This will support residents unable to communicate this need. Two people should check handwritten additions to medication administration records to help ensure no error is made. Staff should have clear instructions in the homes procedure in the use of restraint. This will help them deal with any difficult situation. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 8 It is essential that the outcome of a Criminal Record Bureaux police check be considered and risk assessed to support any decision made to employ a person. Two valid references for staff and a complete work history must be obtained prior to any appointment being made. Internal quality assessment questionnaire results should be published. This will show interested parties how well the home is doing and what is being planned to improve services as a result of what they say. Staff meetings and staff supervision should be increased in frequency to support staff to develop professionally. The office communication book should be tamper proof and comply with data protection. Sensitive information should be recorded on individual files to protect residents’ rights to confidentiality. 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. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 9 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 The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 10 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): 2,3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission processes ensured the residents’ were properly assessed, and their needs and wishes known and planned for, prior to moving into the home. People were given individual contracts/terms of conditions of residence that protected their legal rights. EVIDENCE: Information received from the home informed the Commission they did well as, ‘all service users are assessed prior to admission by the home as well as with social workers’. Written comments from relatives showed most people considered they had enough information to help them make a choice. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 11 Several people had been admitted since the last inspection. Records seen showed they had a completed assessment of their needs that helped make a decision to admit, by considering if the home had the right facilities, and staff expertise to meet those needs. The assessment record had identified personal, health, and social care needs and provided information about the person’s circumstances and level of support required to enable them to have the right care. A summary of an assessment undertaken through care management arrangements, were in place and input from health professionals as needed. There was evidence individuals were involved in their assessment. Information recorded on the Annual Quality Assessment completed by the manager showed all residents had been issued with a contract that protected their legal rights. Copies of contracts were kept on resident files. Residents placed in the home by the local authority were given a contract for financial arrangements for payment. The contracts gave clear information and were signed by both parties. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents had care plans, risk assessments, and a named key worker, which supported them to ensure their health and personal care needs being met in a consistent way. Medication was managed safely. EVIDENCE: Information received at the Commission indicated ‘every resident has an individual plan of care which states preferences in regard to daily living assistance each person requires with personal care, risk assessments, moving and handling assessments’. Three care plans were looked at in detail and one in part. A brief record was made of residents past history. Needs identified such as personal care, mobility, communication, personal safety, medication, medical, and social were The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 13 listed. How identified needs are to be supported was generally clear. For example, ‘Is able to wash, dress, and shave, slowly but independently. To offer assistance only if needed’. And ‘needs assistance in choosing appropriate clothing. Staff to ensure she is dressed appropriately’. More consideration is needed to avoid vague statements written such as ‘not sleeping much day or night. Staff to promote sleep pattern’. This gave no indication as to how this would be achieved. This meant care provided was sometimes generalised, rather than being person centred. Care plans were reviewed regularly. Pressure care was promoted and pressure-relieving aids were used where need was identified. Risk assessments had been completed for moving and handling and were used as guidance for staff to help care for residents safely. Observations were made of equipment being used safely with residents. There was no restraint procedure in place, with individual risk assessments for residents written, to inform staff of how they are expected to manage difficult situations. Residents were allocated a named carer/key worker to provide personalised care. This meant residents benefitted a conituation of their care support, by people they knew and trusted. This was particularly beneficial for residents with dementia care needs. Relatives visiting were familiar with the key workers and were happy with the standard of care given. Relatives who provided written comments considered the home always kept them up to date with important issues affecting their relative/friend. Comment: ‘We are contacted whenever my mother is ill. Even late at night when she was admitted to hospital.’ They also considered the home always gave the support and care their relative/friend expected and agreed. Residents had access to health care services both within the home and in the local community. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included visits from the district nursing team. Written comments received from health professionals showed they considered the home always met individual care needs and the service respected individual’s privacy and dignity. They said the service responded appropriately if they or the person using the service raised concerns about their care. Visitors and residents interviewed thought some of the staff did a good job, and were pleased with the standards. Staff were described as ‘excellent and supportive, very good’ and ‘all residents were well cared for’. The home operated a monitored dosage system for the administration of medication, which was dispensed into blister packs by the supplying pharmacist. An appropriate recording system was in place to record the receipt, administration and disposal of medication. Consent to medication was not always clear in assessment. A random selection of individual medication The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 14 checked showed handwritten entries onto records were not all doubly signed. Medication given as when necessary required more detail as to when this would be given, particularly where it involves administering medication, for example to residents unable to verbally tell someone if they were not well. A clear audit of medication received was kept. The record of medication adminstration was signed and storage of medication was secure. Staff had been trained. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The homes routines are flexible and provide an environment where individual social, cultural, and recreational needs can be met. EVIDENCE: Information received at the Commission told us the home did well as, ‘entertainment is organised regularly. Birthdays and special occasions are celebrated. These include festive celebrations. Outings are arranged. Flexible routines to suit residents’. and ‘All religions are catered for by visiting clergy’. Routines in the home appeared flexible, and there was no expectation residents had to conform to set routines. Residents said they could get up and go to bed when they wished. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 16 An activity coordinator was employed to support residents in pursuing their interests, and despite being on special leave staff had continued to provide residents with one to one attention and support in activity leisure time. There was evidence residents enjoyed entertainment in the home and went on outings that was arranged periodically. Visitors in the home said they do try to motivate residents, and there was usually something going on. One written comment from a relative said ‘‘Every afternoon they have a lady going in to keep the residents brains active with quizzes, games and craft work’. Residents’ care plans included details of their social and recreational needs and interests. Records were kept of what people did and when family visited. Comments from residents and relatives showed visiting arrangements to be very good. They could visit when they wanted and were offered refreshments. Privacy was respected during visits. Visitors were invited to events in the home and a newsletter kept people informed of forthcoming events. Information received at the Commission told us some ways the home promoted equality and diversity. For example, ‘Dependency of residents is managed very well. All residents are included in activity programme, and given one to one. There are visits by clergy of different religions’. All the residents spoken with said they were happy with the meals provided. If they didn’t like what was on the menu, the cook said an alternative would be provided. The cook also said she knew all the residents likes and dislikes, and took this into account when writing the menus. Menus seen were varied and nutritionally balanced. Residents requiring support and assistance were given one to one attention. Special diets were catered for. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a complaints procedure, and relatives and residents were confident that their concerns are listened to, taken seriously, and acted upon. The homes vulnerable adults policies and procedures, generally supported people living at the home being protected from abuse. EVIDENCE: A copy of the complaints procedure was displayed and was included in the information given to current and prospective residents. The procedure gave clear directions on whom to make a complaint to, and the timescales for the process. Relatives who provided written comments for this inspection knew how to make a complaint and considered the home to respond appropriately. Comment included ‘everyone is happy to help and listen’. There were policies and procedures in place to ensure a proper response to any suspicion or allegation of abuse. Staff were familiar with this and had received training. Staff interviewed knew their duty and obligation to report poor practice. Staff sign disclaimer for not accepting gifts when they are employed. Training records showed that training for managing aggression or The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 18 use of restraint had not been given to all staff. There was no restraint policy in the home for staff to follow in promoting best practice. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 19 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): 19,20,23,24,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents were provided with a warm, comfortable, clean, safe, environment that suited their needs. EVIDENCE: The home is a large adapted property situated in a residential area of Chorley. The process of refurbishing the home as identified in the last inspection had continued. Information for this inspection received at the Commission listed some improvements made. These included, new carpets in rooms that required attention, and a new carpet cleaner purchased. Bedrooms had been decorated and co-ordinated curtains and bedding had been purchased. New furniture provided throughout the home. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 20 Residents said they liked their accommodation. It was a homely environment. Lounges were comfortable and visitors on the day said the home was always clean whenever they came. Comments from relatives received at the commission considered, ‘The home is always clean, warm and tidy’. And ‘The Grange has a homely atmosphere’. ‘A lovely environment’. When people are admitted to the home, they can bring with them items of furniture and personal effects that can be reasonably accommodated in their bedroom. Bedrooms seen were personalised, clean, and comfortable, with aids provided where needed. The home was exceptionally clean and furnished to a good standard. Laundry facilities were good and had been relocated to improve efficiency and order. Staff were provided with disposable gloves, and aprons. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The level of staffing, training given, and skill mix of staff was satisfactory to meet the needs of residents. Recruitment practices were not entirley thorough in ensuring the right staff were employed. EVIDENCE: Relatives considered staff had the necessary skills to do their job. Written comments included, ‘Staff very efficient and all pleasant with a great sense of humour’. ‘Very happy with the level of care and the caring attitude of all the staff.’ And, ‘This is a lovely place with very caring concientous staff and management’. Rotas completed showed the compliment of staff was sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, and senior staff were on duty at all times. Those staff who sent written comments to the Commission considered they were recruited properly, given induction and training right for the work they do. They said, ‘The management are very strict in their policy on checks re The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 22 POVA/CRB.’ Staff files showed recruitment checks to be complete and met with legislative requirements for Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check, being applied for, prior to employment. However there was no evidence that information disclosed had been considered and more care is required to ensure two references have been received. All employees must have two references to support their application. On appointment members of staff were issued with a contract of terms and conditions of employment. Staff induction had been given. Comments received at the Commission in relation to induction said, ‘There is so much information and details to relate, but every effort is taken plus ongoing new details are given if and when available’. Records showed training covered some essential mandatory training such as moving and handling, but showed some gaps in training. However staff who provided written comments said, ‘We regularly have training courses and do NVQ’s to make sure we are up to date with all regulations.’ ‘The management try particularly hard with training courses, NVQ’s etc. to ensure all staff are given equal opportunity to gain qualifications relating to their role as care assistants’. Staff considered they were supported in their work and said, ‘‘Life is a learning process and I try to keep up with ever changing care demands.’ ‘I have regular appraisals with my manager and discuss any training that I would like to do.’ ‘I have received training re different cultures.’ Observations of the staff on duty, showed caring people who worked together as a team for the benefit of the residents. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home was run in the best interests of residents, which meant their health, safety and welfare was promoted. EVIDENCE: Relatives who provided written comments on the performance of the home considered the service did well. Comments included, ‘I think they all do a marvellous job’. And ‘I am very happy with this care home and compared to the other care homes my mother has been in and the ones I have visited, this is a lovely place.’ ‘From my experience I am very happy with the level of care.’ The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 24 Many positive comments from staff were received. These included, ‘Provides a first class care to all clients’. ‘This is the first care home I have worked in and it’s excellent care and food given to the clients.’ And ‘The service gives dedicated 24hour care to its residents, and gives staff every opportunity on training courses’. They also said, ‘At the Grange we have a responsibility to give the best care to each individual as an equal. We provide a warm, caring, relaxed environment and have all the correct equipment to ensure all staff and residents have the best safety whilst moving and handling.’ ‘As a carer at the Grange, I feel very welcome as a guest as well as being part of the team. When I walk in at the beginning of each shift, I am a different person. It is our responsibility for the residents well being.’ The owner/manager has many years experience working in a care home. She works with the care staff and is supported by a number of senior carers. Her professional development includes having the Registered Managers Award, and is working towards National Vocational Qualification in care level four. Quality assurance audits carried out show people are generally satisfied with the care in the home. Comments and acknowledgements included, ‘You are truly exceptional people with exceptional sense of caring’. And, ‘I have always found you and your staff helpful and caring.’ Professional people gave their views and said, ‘staff are pleasant, helpful and communicate all my clients needs well’. And ‘they show a great compassion to him in his needs.’ Information received at the Commission stated, residents meetings were held with the activity coordinator. Staff had formal meetings, however the frequency of these needs to improve. Staff confirmed they meet together daily and have ‘shift meetings’ to discuss residents and other issues relevant to their work for the day and night. The home does not manage residents finances. However a small amount of money for some residents may be held at the home. Formal supervision was being given to staff, some at regular periods, although this needs to be sustained for all staff. Supervision included policies and their understanding and work performance. Record keeping was generally satisfactory. However the recording of sensitive information relating to individuals in a general communication book is not good practice. The office communication book should be a tamper proof recording tool. Information received at the Commission showed maintenance of essential services such as gas and electric had been completed. The health, safety, and welfare of residents and staff were considered. The home had a good range of policies and procedures and practice aimed at keeping everyone safe. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 25 Information received at the Commission showed regular maintenance of the homes fixtures, fitting and equipment. Staff training records showed essential mandatory training was given to staff. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 X 4 STAFFING Standard No Score 27 4 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement Two valid references for staff and a complete work history must be obtained prior to any appointment being made. It is essential that the outcome of a Criminal Record Bureaux police check be considered and risk assessed to show the person is fit to work at the care home. Timescale for action 30/09/08 2 OP29 19(1)(a) 30/09/08 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 3 4 Refer to Standard OP7 OP9 OP9 OP9 Good Practice Recommendations Care plans should be better detailed as to the type and level of support residents require. Formal consent to administration of medication should be sought. It is recommended medication prescribed to be administered when necessary be detailed better as to the circumstances it would be given. Two people should check handwritten additions to medication administration records. DS0000005918.V367078.R01.S.doc Version 5.2 Page 28 The Grange 4 5 6 7 8 9 OP18 OP33 OP33 OP36 OP37 OP37 Staff should have clear instructions in the homes procedure in the use of restraint. It is recommended that quality assessment questionnaire results are published and made available for all interested parties including the Commission. It is recommended staff meetings increase in frequency. Staff supervision should be at least every two months. The office communication book should be tamper proof and comply with data protection. Sensitive information should be recorded on individual files to protect residents right to confidentiality. The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North West Region 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 The Grange DS0000005918.V367078.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!