Care Home: The Grange

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What the care home does well The manager/provider is friendly, experienced, well trained and professional. The residents looked well cared for and all commented that they were happy living at The Grange and were pleased with the new management and staffing arrangements. Documentation and recorded information looked at by us was informative and well written. Staff knowledge of individual residents was good and the health safety and welfare of all people is monitored and maintained so that they are protected against harm or abuse. The general environment is a happy relaxed one and residents told us that they have formed good friendships with other people that live there. The manager completed a well thought out and informative AQAA and has worked hard to secure quality of care since taking over as the Provider. What has improved since the last inspection? This is the first Inspection since being registered on 28th July 2009. What the care home could do better: The Manager/Provider need make sure they continue to develop person centred practices and carry out the Quality assurance systems in July 2010, to allow all people to have a say in the support and care they receive from them. Key inspection report Care homes for adults (18-65 years) Name: Address: The Grange 122 Crowstone Road Westcliff-On-Sea Essex SS0 8LQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Axam     Date: 0 6 0 1 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 Adults (18-65 years) Page 2 of 26 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Grange 122 Crowstone Road Westcliff-On-Sea Essex SS0 8LQ 01702432064 01702432064 crowstonecare@live.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Crowstone Care Home Limited Name of registered manager (if applicable) Mrs Patricia Marie Ward Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service Care Home only - Code PC To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Mental Disorder - Code MD The maximum number of service users who can be accommodated is: 18 Date of last inspection Brief description of the care home The grange is a large Victorian House and is a privately run residential care home. They are registered to provide 24 hour care 7 days a week for younger adults, aged between 18-65, with a mental health disorder. They can accommodate up to 18 adults of both sexes. 18 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced site visit took four hours to complete and was carried out as part of the annual inspection programme for this service. This visit was conducted with assistance from the Manager/Provider. As part of the process, a number of records relating to residents, care staff, and the general running of the home were examined. We looked at all the information that we had received, or asked for, or what the service has told us about things that had happened in the service since the last inspection. All 9 residents were spoken with during the site inspection and their care files looked through. Prior to this site visit, CQC (Care Quality Commission) sent out surveys to all interested parties however none were returned to us. (The manager informed us that these were never received) Additionally the manager was sent an (AQAA) Annual Quality Assurance Assessment form by us. This is a self assessment required by law that asked how well the service thinks they are meeting the needs of the people who live at The Grange Care Home. Care Homes for Adults (18-65 years) Page 5 of 26 All information obtained was triangulated and reviewed against the commissions key lines for regulatory activity. This helps us to use the information to make judgements about the outcomes for the people who use this service in a consistent and fair way. Care Homes for Adults (18-65 years) Page 6 of 26 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 Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. A clear and comprehensive assessment process assures people that their needs could be met prior to securing a placement. Evidence: The manager told us that that people who were looking for a placement would have an assessment carried out and would be given suitable information about the care home, staff, facilities and the services offered. When we visited the service we saw that all people who were looking for a placement were initially assessed by a member of staff. (Who have had training and experience in assessment) and then use this to review the support needed by the individual. They also had a process that when a person is referred they ask the local authority or social services to share information with them such as concerns, behavioural issues, physical and mental health and what kind of support would be required by their staff. When we visited the service we saw in peoples records that this was in place and assessments covered areas such as, personal care, medication needs, family or representatives involvement, sight, hearing and communication, mobility, personal safety and risk, religious and cultural needs, health and mental health and included a contract. Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: The statement of purpose and service users guide was up-to-date and we found that it gave good information about the staff structure, their qualifications, the complaint process, support offered by staff, and any additional health services that maybe needed. We were told by the manager that this information can be provided in a number of different formats if need be, depending on their cultural and diverse needs of people. At present, there are 9 resident vacancies. The manager informed us that if there were an enquiry from any new prospective residents, and then a number of visits would be arranged. (After the assessment process and sharing of general information have been completed) Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 using the service can be confident that their identified needs will be met appropriately and that they will be able to live the lifestyle they choose. Evidence: We saw that in all 9 care files provided they included all peoples views. All peoples assessments reduced risks whilst also allowing them to maintain their independence .We saw this in the care plans and when staff recorded daily entries (supporting people in daily tasks) such as, medication, personal care, bathing, washing, shaving, oral hygiene and health needs both physical and mental, behaviour and community support. Looking at peoples guidance notes for staff within the care files, we found these to be informative and written notes and the outcomes of staff practices were recorded clearly, concisely and to a professional standard. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 using the service can be assured that they will have the opportunities for personal development and build upon their daily living skills so that they are able to lead a lifestyle that they choose. Evidence: The manager told us in the Annual Quality Assurance Assessment that all people have equal access to activities that are available locally, such as, the local library, adult education, cinema, shops, pub, restaurants, parks, theatre and trips out. When we spoke to residents they confirmed this and discussed with us the various activities and interests they were involved with. We saw and discussed with the manager how people are involved in some of the domestic tasks. She told us that people were supported to clean and tidy their bedrooms and to carry out some laundry tasks. This was seen by a matrix produced Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: and were told by the residents that they often carried out tasks within the home such as, polishing, laundry, laying the table, stacking up the dish washer and general bits and bobs around the home. Two residents told us that they enjoyed gardening and were encouraged to use these skills alongside staff support. Staff supported residents to eat a healthy and well balanced diet and to monitor weight on a regular basis. The staff at the home cook all meals for people. Information showed us that they held the relevant qualifications needed for this role such as, food hygiene and infection control. Kitchen equipment and regular checks were all in order. There was a four week menu in place that showed us that the likes of residents that were recorded in their information were reflected in the meals provided and that they had a varied and good quality of diet. All 9 residents told us that they thought the food, choice and quality of meals was good and that the fresh fruit that had been recently introduced was a nice new change. Meals that were observed appeared to be appetising, presented nicely and of good nutritional value. All residents told us that they do prepare small snacks and make their own drinks when they wanted. (There is a separate kitchen provided for residents to carry this out.) Care Homes for Adults (18-65 years) Page 13 of 26 Personal and health care support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Peoples assessed needs are followed through in good care plans that give staff the necessary information to provide good care outcomes. Evidence: The manager told us that each person has a full assessment undertaken of their health and personal care needs and a care plan which describes how staff are to support the person. They also told us that staff received training specific to the needs of residents, including training in supporting people who have specific mental health issues. We saw this by some of the assessments of peoples primary mental health needs and the training certificates held by the staff. We saw that each person had a health action plan, which described their needs and how staff were to assist and support them. Looking through daily notes showed us that staff knew individuals well and had the ability to records information effectively. We saw by records that staff supported residents to attend doctors appointments, receive medicines and to monitor their general health and welfare. Looking through information it is apparent that the manager/provider has good relationships and Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: support from other professionals and maintains good link with the local health authority and social services departments, we saw this by complementary e-mails and letters written to the Manager. Evidence of staff medication training and the fact that there have been no incidents reported around medication issues or practice would suggest that the administration of any type of medication is kept to a strict protocol and policy and procedures were good around these issues. There was good information recorded about how medication is managed, for instance, the correct receipt, recording, storage and handling, administration and disposal of medications. When we visited the service the staff confirmed to us that they knew procedures well and were aware of individual need. Staff who administer medication have the required accredited training. Residents who self medicated were supported to do so in a safe responsible manner and good clear risk assessments were in place. Speaking to the residents who self administered felt that staff supported them well i this area. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There are systems in place to ensure that peoples views are listened to acted upon and support people to be protected from abuse. Evidence: The manager told us that staff receive information on how to report poor practices or ill treatment of the people they support and that staff undertook safeguarding training. We saw this in place in the staff training matrix and certificates held in all staff files that were provided to us. The manager had the latest local safeguarding folder in place and had accessed the free training run by the local safeguarding team in order to ensure that staff have the most up-to-date information available. We spoke with the manager around the recording procedures she would implement if a complaint was received. She told us that she would keep a detailed record of any complaints received (none received since being registered) including clear information given to all the people they support on how to contact the services representative or independent external organisation(service users guide and this information also included timescales for action and resolution) When we visited the home we looked at the policies and procedures. We saw that there was detailed information available for residents to assist them in understanding how to complain if they were unhappy. The complaints procedure was also available within the main area of the home, for all visitors to read and use. There was also Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: detailed information made available to staff once they commenced work at the home, which described their roles and responsibilities in reporting bad practice. This included a whistle blowing policy. This helped to assure staff that they would be protected from harassment should they need to raise concerns. We looked at how staff were recruited to work in the home and saw that all of the checks such as employment references, Criminal Records Bureau disclosures were obtained before a person started work at the home. This helped to ensure that only people who were suitable were employed. We saw that all staff had undertaken training in recognising and reporting abuse or bad practices. There have been no complaints raised about the home since the last inspection. Observation showed us that staff treated residents with respect and that residents were very comfortable and open in the company of staff. Care Homes for Adults (18-65 years) Page 17 of 26 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 safe and clean environment. Evidence: Walking around the home we saw that it was clean, with no odours and safe. Some of the fixtures and fittings were tired and in need of replacing and some of the decor needed upgrading. There was a maintenance plan in place. We discussed with the manager the future plans of the up keep of the service as a whole and she told us of the plans they have to gradually address each area and dates to put this into place. This has been discussed with the people who live there that these things will be achieved and completed at some point, including upgrading of their own personal rooms. The Manager/Provider has appointed an estate manager, who is responsible for ensuring the home is well maintained. The manager has a hazard & maintenance system in place for checking each area within the home on a weekly basis to ensure it remains safe and fit for purpose. Any problems are reported to the estates manager who ensures that all maintenance issues are dealt with quickly and recorded. The Manager has contracted a window cleaner and a gardener who provide them with a monthly service. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: We saw by certificates held that all staff have received training in Infection Control measures and that they work within the guidance of the homes Health & Safety policy by the records completed around the monitoring and carrying out of infection control, (cleaning) and health and safety. (weekly and monthly audits of all areas) Care Homes for Adults (18-65 years) Page 19 of 26 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 offered positive relationships by well supported and caring staff and are protected by staff recruitment, induction and training. Evidence: At present there are 14 staff in place 10 female and 4 male. Out of those 14 staff 5 hold the NVQ qualification and for the 5 new staff, funding has already been secured so that they can carry out this qualification sometime in 2010. We looked at the recruitment files for 5 members of staff. We saw that before they commenced work that satisfactory employment references, Criminal Records Bureau disclosures and a full ten year employment history was checked for all people. Staff told us, that their induction covered everything that they needed to know about the job. In addition we saw that staff had detailed job descriptions and information about their roles and the conduct expected of them. Staff matrix held confirmed to us that they have regular supervision and planned meetings. We saw this by the records held (staff meeting and supervision minutes of 8 staff) by the manager/provider. We saw that new staff are inducted, supervised and trained and that they follow the Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: Skills for Care Induction Criteria. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management strategies of the service we looked at overall were stable which ensures the health, safety and welfare of all people. Evidence: The manager has 20 years management experience and has obtained the necessary qualifications to enable to manage the home competently (National Qualification 4 in management and the Registered Managers Award). We saw that she undertakes regular update training courses to ensure she maintains her continued professional development such as, the Mental Capacity Act 2005 and Deprivation of Liberties training. We saw by the evaluation systems that we were provided to us, that there is good opportunity for the people who live in The Grange to improve it and to be generally consulted with about the support they receive such as the recent change of manager provider and staff. Speaking with the residents they confirmed that the manager asked them how they felt about changes and what changes, such as foods, decoration would they like to see. The annual quality system is going to be properly implemented Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: in July 2010, however meanwhile there have been monthly residents meetings that the manager uses to share information with people and to gauge how people are feeling in general about any changes made within the home to gain this feedback and to implement some of these suggestions into the annual development plan of the home. One recent consultation and change made with the residents was the name of the home. There is evidence of regular promoting of best practice among staff through training, staff meetings, and general monitoring of their practice. The service delivers a person centred approach, we saw this through the care plans looked at, recorded daily entries made by the staff and through residents feedback and consultation. (Residents Meetings) This shows us that the people who use this service have a say in how they wish to be supported whilst also being safeguarded against any unnecessary related risks. The manager informed us that she has a commitment to regular staff supervision, induction, appraisals and to encourage the people who use the service to be heard through the residents meetings, 1-1 and then the quality assurance system that will be implemented in July 2010. When we visited the home we saw that there were risk assessments in place to identify where each person may be vulnerable such as in managing money. The manager/provider supported residents to access money from their bank accounts and kept good records where monies were held for safekeeping on residents behalf, although she will be looking at changing this system at some future point to allow people greater independence and better accounting than the system presently does. (This system was inherited from the previous provider). We looked at the arrangements for ensuring that the home was maintained safely. We saw that regular checks were carried out on equipment such as hot water and heating systems, fire alarms and fire fighting equipment, gas and electrical installations and equipment. All equipment was well maintained and repaired as required. Care Homes for Adults (18-65 years) Page 23 of 26 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 Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 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. 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