Care Home: The Grange

What the care home does well Staff in the home are caring and dedicated to the welfare of the residents in the home. Health care needs are well met, but may not be well documented. Residents say they like living in the home and that the food is of good quality and that they have a choice of menus. Families are encouraged to maintain contact with their relatives and are made welcomed when they visit. Full assessments are undertaken prior to admission to ensure assessed needs can be met by the home. It was previously reported that a visitor said that `staff go the extra mile for her relative and that she can leave them there knowing they are safe and well cared for`. What has improved since the last inspection? The requirements made in the last report have been met. Staff training has been ongoing. The home was a clean and fresh at this inspection. What the care home could do better: All appropriate risk assessments need to be completed in order to promote the health and safety of residents and staff. Regular reviews of the care plan need to be undertaken as required by regulation. Infection control practices within the home need to be improved to ensure that residents and staff are not put at risk. The home needs a qualified and experienced manager to support staff and to be in day to day control of the home. Key inspection report Care homes for older people Name: Address: The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ     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: Sandra Crosby     Date: 0 1 0 2 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ 01634270674 01634270674 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Henry Alfred James Holloway Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home The Grange is located in a rural area with few local amenities. To the front of the property there is a circular drive and a paved area, offering ample parking. To the rear there is a large garden mostly laid to lawn, with a raised patio area. The home occupies detached premises with accommodation on two floors. There is a single person lift between the two floors. There are 8 single rooms and 1 double bedroom. 2 of the single rooms and the double room have en-suite facilities. There are call bells in bedrooms, bathrooms and toilets. The staff provide 24-hour cover working a rota, Care Homes for Older People Page 4 of 27 Over 65 0 0 Brief description of the care home there are two waking night staff on duty. The current fees for the service at the time of the visit range from £450 to £500 per week. Information on the Homes services and the CQC reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is no current e-mail address for the home. Care Homes for Older People Page 5 of 27 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 this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of the 20 July 2009, and a visit to the home. The key inspection visit was unannounced and carried out on Monday 01 February 2010 between 10.00 and 14.00. During the time at the home the inspector spoke with the carer in charge, care staff, the cook and people who use the service. Various records were seen, together with an accompanied tour of some areas of the premises being made. The manager who had not registered with the Commission and was present at the last Care Homes for Older People Page 6 of 27 inspection visit retired in November 2009. The registered provider in a telephone conversation after the inspection visit confirmed that a new qualified and experienced manager was due to start at the home, and that he was currently completing the recruitment process. As the planned inspection was carried out at short notice, no service user or staff surveys were requested. The Annual Quality Assurance Assessment (AQAA) had not been requested for this year at the time of the inspection visit, and the information contained in the last completed AQAA by the previous manager was taken into consideration when completing this report. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The findings of this inspection were discussed with the carer in charge at the time of the visit and later in a telephone conversation with the registered provider. Care Homes for Older People Page 7 of 27 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. 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 8 of 27 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 9 of 27 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. People are provided with the information they need to make an informed choice about moving into the home. Pre-admission assessments ensure that the home can meet the persons needs. Intermediate care is not provided. Evidence: We looked at the information provided to people who use the service to find out whether it was detailed and answered all their questions, and to find out how the service passed on the information. The last inspection report dated 20 July 2009 confirmed that the Statement of Purpose and Service User Guide have been updated and now reflect what the service has to offer. We viewed two individual care planning files for people who use the service, and spoke Care Homes for Older People Page 10 of 27 Evidence: with the staff to determine how the home assesses people. The documentation seen showed that a person from the home carries out a visit to the person and completes pre-assessment documentation to ensure that the home is able to meet the persons needs. There was also assessment information seen, provided by the local Social Services. Prospective clients would be invited to visit the home for a day or an overnight stay. This home caters for residents with dementia and the majority of staff have undertaken training in caring for people who have dementia. It was previously reported that all people are provided with a contract/ statement of terms and conditions. This home does not offer an intermediate care service. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not currently benefit from having clear and in-depth care plans that contain all appropriate risk assessments and the care plans are not reviewed regularly. People can be confident that their health care needs are met and benefit from having full access to all professional health care services as required. People can feel confident that they will be treated with respect and their right to privacy is upheld. Evidence: We wanted to look at peoples care plans to ensure that their health, personal and social care needs were set out in a way that would enable staff to deliver good care. We looked at two plans to evidence this. We found that all information regarding each individual was now held in one file, although it was seen that there were two care planning systems in operation. The care plans had not been regularly reviewed, and not all appropriate risk assessments had been undertaken. The carer in charge at the time of the visit said that a new care planning system was waiting to be implemented when a new manager took up post. Care Homes for Older People Page 12 of 27 Evidence: Any incidents of pressure areas were reported to the district nurses who would give advice, treatment, and provide necessary equipment. Advice was also sought from the district nurses for continence problems. A doctor had been requested for two people on the morning of the inspection visit. We viewed the administration of medication at this inspection. It was reported at the last inspection visit that the then manager had written a new policy that reflected good practice. The administration records were viewed and were on the whole appropriately signed and dated. Gaps in recording that were seen were discussed with the carer in charge. Residents in the home were treated with dignity and their right to privacy was respected. Some good examples of interaction were seen between staff and residents especially at dinnertime. Staff confirmed at the previous inspection visit that the higher staffing levels had improved the amount of time that could be spent with each person and this had greatly enhanced their lives. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the flexible routines in the home. Social and recreational interests and needs are well provided for with a wide range of activities organised. People are supported to maintain contact with family and friends. People enjoy a good, balanced and wholesome diet with special diets being catered for. Evidence: We wanted to look at the type of lifestyle experienced in the home and if people were happy with the level of social interaction and level of activities. We also wanted to look at if choices were given to the people and what control they had over their lives. To do this we spoke with people. The home cares for people with varying degrees of dementia and lifestyles can be very challenging for some. With the levels of dementia within the home it was not always easy to ensure full choices were given at all times, however staff were seen to offer choices where possible and where not possible gave full support and consideration. The home organises a range of activities for the people to keep them stimulated and motivated. When the home is fully staffed more activities and 1:1s are undertaken. Care Homes for Older People Page 14 of 27 Evidence: Activities ranged from for example painting sessions, with the artwork displayed in the hallway, bingo, bean bag games. Connect 4, quizzes, skittles, films and TV shows. Monthly motivational sessions and other outside entertainers are also used. A carer was observed assisting people to play dominoes during the morning of the visit. Staff previously confirmed that the extra time spent on 1:1s has really helped. Staff confirmed that the food continues to be ordered on line by the provider. Staff are able to buy extra items from the petty cash. The provider is advised to give the new manager a food budget, as they will be more aware of the everyday needs of the home. The meal seen on the day of the visit was well presented and looked appetizing. Mealtimes were seen to be relaxed and at a comfortable pace. It was seen that staff assist with feeding in an appropriate manner for those persons that require help. Good staff interaction was observed together with interaction between residents over the mealtime. Care Homes for Older People Page 15 of 27 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 confident that their opinions and concerns are taken seriously and responded to appropriately. People are protected from abuse and feel safe living in the home. Evidence: We wanted to ensure that all people concerned with the home were aware of the complaints procedure and felt confident their concerns would be listened to and acted upon. We also wanted to ensure all people were protected from any form of abuse. The home had a clear complaints policy, and a copy was on display in the hallway. The documentation needs to be updated and this was discussed with the carer in charge. It was reported at the last inspection that the home has policies on Adult Abuse and Whistle Blowing. The majority of the staff have now attended training on Adult Abuse. A one day First aid course has also been undertaken by the majority of staff. All current staff had an enhanced disclosure undertaken by the Criminal Records Bureau (CRB). Good recruitment procedures, has ensured the safety of the people in the home. Care Homes for Older People Page 16 of 27 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 benefit from living in a pleasant, homely environment that is well maintained. Infection control practices observed in the home means that people may not always be safeguarded. Evidence: We wanted to ensure that people lived in a well maintained environment and had safe access to comfortable indoor and outdoor communal facilities. We also wanted to ensure that bedrooms were clean and comfortable and met good environmental standards. The home was warm, clean and well maintained at the time of the inspection visit. Bedrooms were seen to be personalized to meet individual needs. A requirement was made in the last report in relation to the registered provider ensuring that residents remain safe should the lift breakdown and/or be declared obsolete. It was seen that action has been taken and a stairlift has been installed. The carer in charge said that the stairlift also has battery power in case of electrical failure. The requirement has now been met. A requirement was made for suitable door closures to be fitted especially for one person who liked to have their door open. It was seen that to date two door closures Care Homes for Older People Page 17 of 27 Evidence: have been fitted. One of these has been fitted to the bedroom door of a person who likes to sit in their room with the door open as reported in the last report. The requirement has now been met. A requirement was made in the last report in relation to the provision of correct moving and handling equipment. The carer in charge said following the last inspection action has been taken and the home now has an additional hoist to meet the needs of residents. The requirement has now been met. Action is required to be taken in relation to the practice seen of staff carrying laundry for washing in open topped laundry baskets through part of the kitchen to access the laundry. It may be possible for a doorway to be made through the wall in the hallway allowing access to the laundry room without staff needing to enter through the kitchen. It was also noted that there was no liquid soap and paper towels in bedrooms, but these were available in the bathrooms. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well-trained, enthusiastic and supportive staff team. People are protected by the homes recruitment procedures. Evidence: We wanted to ensure that sufficient staff were employed, who were suitably trained and had a good understanding of the needs of older people. We wanted to ensure they had been appropriately recruited to ensure the safety of the people in the home. At the time of the inspection visit, the home was without a manager, there were three care staff and the cook on duty. It is indicated that when the home is fully staffed there would be sufficient staff to meet the needs of the current residents. It was stated by the carer in charge and later in a telephone conversation with the registered person that a new manager is due to start in the next couple of weeks. A copy of the staff training matrix for the home was provided and indicates that staff training has been ongoing throughout 2009. Seven of the twelve care staff have NVQ Level 2 or above. The majority of staff have undertaken an ASET 2 course in relation to dementia. Staff files were viewed at the last inspection visit, and all information required by regulation was in place. One new staff file was viewed at this visit and it was found Care Homes for Older People Page 19 of 27 Evidence: that a thorough recruitment process with all appropriate checks being undertaken. Care Homes for Older People Page 20 of 27 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 registered provider is not managing the home in a proper manner and this has the potential to impact on the quality of the service. Peoples health, safety and welfare may not always be promoted due to poor infection practices. Evidence: We wanted to look at the skills of the management team and if the service benefited from the ethos, leadership and management of the home. We also wanted to see if the home was run in the best interests of the people who lived there. We also needed to ensure their health and safety was protected and promoted. The registered provider continues not to be involved in the day to day running of the home, but continues to manage the budget. The registered provider does not visit the home regularly and seriously needs to consider his position as registered provider. He relied heavily on the manager, who had made good progress in running the home Care Homes for Older People Page 21 of 27 Evidence: effectively and in the best interests of the people who live there. Unfortunately the manager left in November 2009. The registered provider has stated in a telephone conversation that a new manager is due to start at the home in the next couple of weeks. The carer in charge was unable to provide information in relation to the quality assurance systems used at the home. The last report stated that the then manager was in the process of assessing the returned questionnaires and was intending to compile a report and take any necessary action that had been identified. It was commented that mostly all the returned questionnaires gave positive feedback. Evidence was also seen at that visit that regular residents meeting are held and that actions are taken following these meetings. The then manager also confirmed that supervision with staff was happening on a regular basis and that staff and records confirmed this is in place. It was reported that the home has robust procedures in place for dealing with the clients monies. Receipts were kept and all transactions were documented and double signed by staff. The records were not viewed at this visit. A new fire risk assessment had been completed in May 2009 and the fire equipment was regularly tested. The staff training matrix indicates that all staff have undertaken fire training during 2009 and the requirement made at the last inspection visit has been met. Care Homes for Older People Page 22 of 27 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 27 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 13 The registered person shall 31/03/2010 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. It is a legal requirement for the care home to minimise risks as far as is practicable. Risk assessments must be comprehensive and recorded in response to incidents and changes in service users welfare. Comprehensive risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 2 7 17 The registered person shall maintain records as specified in Schedule 3 It is a legal requirement for the registered person to keep the service users plan 31/03/2010 Care Homes for Older People Page 24 of 27 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 under review. Service users individual plans and records must be up to date, consistent and specific in detail of information required. All service users must have an accurate care plan by the given timescale, if not sooner, which is maintained thereafter. 3 26 13 The registered person shall 31/03/2010 make suitable arrangements to prevent infrection, toxic conditions and the spread of infection at the care home. The registered person has a legal responsibility to prevent infection, toxic conditions and the spread of infection at the care home. Laundry practice and procedures need to be reviewed in order to promote good infection control practice. 4 31 8 The registered provider shall 31/03/2010 appoint an individual to manage the care home. The registered person must ensure that an application for registration is made in respect of the appointed manager of the home. This is to ensure that residents benefit from a home that is run by a Care Homes for Older People Page 25 of 27 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 manager registered as fit to manage the home. 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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