Care Home: The Grange

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What the care home does well All service users are able to move into the home for a trial period, before making a decision to stay permanently. Staff were observed to interact with service users in a respectful and appropriate manner. Service users were addressed by their preferred name and staff were aware of the need to respect service users privacy and dignity. Service users were complimentary about the food provided. A choice is always offered and service users described the food provided as very good. The housekeeping staff work hard to ensure that the home is clean, pleasant and free from unpleasant odours the home is welcoming, comfortable and has a homely feel. What has improved since the last inspection? Care plans are now more detailed and include information about how service user wants their care provided and when. A full time, experienced activities organiser has been recruited and he/she is due to start working in the home, once all recruitment checks are in place. Two new cooks have been recruited and are due to start work in March 2009. Due to the care home receiving a zero star rating at the last inspection. A safeguarding meeting took place by the Local Authority, which resulted in no referrals being made to the home by Oxfordshire contracts team. This has recently been lifted. Since the last inspection the laundry has been redecorated. A laundry assistant has been recruited to work thirty hours per week. Five care assistants are currently being recruited. This will ensure that an extra member of care staff is on each shift during the day and a third member of staff at night. Additional steps are being taken to ensure that recruitment procedures are more robust, including the updating of job descriptions and risk assessments for the employment of staff under the age of eighteen and the taking up of more recent referees. In January 2009 a new manager was appointed. She is a well qualified and an experienced manager having achieved the Registered Manager`s Award and NVQ level IV as well as being a Registered Nurse. An application for registration has already been submitted. Since the appointment of a new manager, the home is being run in the best interests of service users. A copy of the written report prepared by the responsible individual on the conduct of the home, completed following an unannounced visit now takes place this was confirmed by the person managing the home. The person managing the home is undertaking regular audits and this includes medication, health and safety, accidents/falls and care planning. Service users confirmed that one of the directors of the company, who is also the responsible individual, regularly joins service users for a meal and asks their views about living in the home. Quality assurance systems have been introduced, based on seeking the views, to measure success in meeting the aims, objectives and statement of purpose. Window restrictors have been put on all windows on the first and second floors of the home and safe bathing risk assessments have been completed. What the care home could do better: Following the appointment of a manager and all requirements made at the previous inspection being complied with, the home now needs a period of consolidation and for the home to continue to develop and move forward. CARE HOMES FOR OLDER PEOPLE The Grange Grange Close, Manor Road Goring On Thames Oxfordshire RG8 9DY Lead Inspector Marie Carvell Unannounced Inspection 27th February 2009 10:15 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 DS0000013090.V373922.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 DS0000013090.V373922.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address Grange Close, Manor Road Goring On Thames Oxfordshire RG8 9DY 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) 01491 872853 01491 873397 thegrangegoringltd@tiscali.co.uk The Grange Limited Post Vacant Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition 1 The four rooms for double occupancy must be identified to CSCI by number and used for the purpose of accommodating married couples as stated in the application dated 20 September 2004. 29th August 2008 Date of last inspection Brief Description of the Service: The Grange is a residential home registered for 42 older persons who require personal care and accommodation. The home is not registered to admit service users who require full time nursing care. The home is owned by The Grange Limited and is situated in a quiet residential area in the village of Goring. The accommodation is a large Victorian house that has been altered and adapted for its purpose but also retains many of the features of a family home built over 100 years ago. The home provides people who live there with the opportunity of using the large extensive grounds that lead down to the river and also the convenience of the village close by. The village offers shops, pubs and cafes with transport links to Reading and Oxford. Individual accommodation is provided over 3 floors with 2 lifts available should people wish to use them. Fees range from £650. 00 per week to £750.00 per week. Items not covered within the fees include hairdressing, podiatry, newspapers and magazines, toiletries and contributions to some outings and activities. Continence aids are provided free of charge from the District Nursing Team, following an assessment of need. More information about charges can be obtained by telephoning the home. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’. We arrived at the service at 10:15 and was in the service until 17:25. It was a thorough look at how well the service is doing. It took into account information provided by the deputy manager and administrator, in the form of the Annual Quality Assurance Assessment (AQAA) this is a self-assessment and summary of services questionaire that all registered services must submit to the Commission each year and any information that we have received about the service since the last inspection. The AQAA was received by the commission on the 11th December 2008. We asked the views of the people who use the service and other people seen during the inspection. Seven service users and one member of staff responded to surveys sent out by the Commission. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent with service users, staff on duty and the person appointed to manage the home. A tour of the premises was carried out and a sample of records required to be kept in the home were examined, including case tracking of service user’s files and staff personnel records. In addition we spent time observing how care was being delivered to service users and joined service users for the midday meal in the communal dining room. At the last inspection carried out in September 2008, seven requirements were made. These related to care planning, review of staffing levels, authenticated references being obtained for those staff recruited from abroad, full and satisfactory checks being carried out including Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks being carried out before a member of staff starts work in the home, effective quality assurance systems and methods of continuous monitoring, notifying the commission about the deaths of service users, a monthly report written by a provider representative on the conduct of the home and risk assessments to be carried out for safe bathing, risk of falling from upstairs bedrooms and the risk of falling into the garden pond. These are referred to in the body of the report. Feedback was given to the person managing the home and the deputy manager during and at the end of the inspection. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Care plans are now more detailed and include information about how service user wants their care provided and when. A full time, experienced activities organiser has been recruited and he/she is due to start working in the home, once all recruitment checks are in place. Two new cooks have been recruited and are due to start work in March 2009. Due to the care home receiving a zero star rating at the last inspection. A safeguarding meeting took place by the Local Authority, which resulted in no referrals being made to the home by Oxfordshire contracts team. This has recently been lifted. Since the last inspection the laundry has been redecorated. A laundry assistant has been recruited to work thirty hours per week. Five care assistants are currently being recruited. This will ensure that an extra member of care staff is on each shift during the day and a third member of staff at night. Additional steps are being taken to ensure that recruitment procedures are more robust, including the updating of job descriptions and risk assessments for the employment of staff under the age of eighteen and the taking up of more recent referees. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 7 In January 2009 a new manager was appointed. She is a well qualified and an experienced manager having achieved the Registered Manager’s Award and NVQ level IV as well as being a Registered Nurse. An application for registration has already been submitted. Since the appointment of a new manager, the home is being run in the best interests of service users. A copy of the written report prepared by the responsible individual on the conduct of the home, completed following an unannounced visit now takes place this was confirmed by the person managing the home. The person managing the home is undertaking regular audits and this includes medication, health and safety, accidents/falls and care planning. Service users confirmed that one of the directors of the company, who is also the responsible individual, regularly joins service users for a meal and asks their views about living in the home. Quality assurance systems have been introduced, based on seeking the views, to measure success in meeting the aims, objectives and statement of purpose. Window restrictors have been put on all windows on the first and second floors of the home and safe bathing risk assessments have been completed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 8 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 DS0000013090.V373922.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 DS0000013090.V373922.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): Standard 3. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. Service users are assessed prior to admission to ensure that their needs can be effectively met by the home. All service users are able to move into the home for a trial period, before making a decision to stay permanently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Senior members of staff, either the manager or deputy undertake a pre admission assessment to ensure that the home is able to meet the prospective service users assessed care needs. This includes information regarding the service users social history, hobbies and interests. All prospective service users and their representatives are encouraged to visit the home, stay for a while to The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 11 meet other service users and the staff team, before deciding whether to move in on a trial period. Three surveys completed by service users confirmed that they had received enough information about the home before moving in, two surveys did not confirm whether they had received enough information or not and one survey confirmed they the service user had not received enough information, as their admission was arranged as an emergency. The Grange DS0000013090.V373922.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): Standards 7,8,9, and 10. Standard 7 was subject to requirement at the last inspection. Quality in this outcome area is good. Care plans have been developed and include how the care is to be provided and when. Medication storage, administration and recording were seen to be well maintained. Service users feel that they are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection, a requirement was made that care plans give staff information and instruction about how the care is to be provided to individuals. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 13 From examination of a sample of care plans, discussion with service users, staff on duty and the person managing the home, this has been complied with. Care plans are now more detailed and include information about how service user wants their care provided and when. The person managing the home is developing the care planning documentation further to include emotional, psychological and social care. It is anticipated that the recruitment of a full time activities organiser, will assist with this process. Four of the surveys completed by service users confirmed that they ‘always’ received the care and support needed and two surveys stated that they ‘usually’ received the care and support needed. Comments made on surveys completed by service users included “ The staff at the Grange always go the extra mile in their level of care and support”, “ All the staff at The Grange are kind, caring and supportive. I have never seen them treat their service users with anything less than kindness and respectfulness”. The healthcare needs of service users are met by a local GP practice and a range of healthcare professionals visit the home as required. The person managing the home and staff on duty expressed their satisfaction of the service received and felt that the home has a good working relationship with the GP practice and healthcare professionals, especially the district nursing team. From discussion with service users and examination of records the healthcare needs of service users are fully met. Three surveys completed by service users confirmed that they ‘always’ received the medical support needed and four surveys stated that they ‘usually’ received the medical support needed. Comments made on a survey completed by a service user included “This depends on the person in charge and competence”. Medication administration records, administration and storage are well maintained and no obvious gaps in recordings were observed. The deputy manager has overall responsibility for medication issues in the home, this she does well. All staff who administer medication have received training from a pharmacist, this is evidenced and updated on a regular basis. Some service users take responsibility for the storage and administration of their own medication, this is supported by a risk assessment being completed and action to minimise risks identified. Time was spent with service users in private and communal areas. Most service users spoken to expressed their satisfaction of living in the home and the care received. Several service users expressed the view that they felt well cared for and that staff were helpful and friendly. Comments made by service users who completed surveys included, four service users who confirmed that they ‘always’ received the care and support needed and three service user who confirmed that they ‘usually’ received the care and support needed. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 14 Staff were observed to interact with service users in a respectful and appropriate manner. Service users were addressed by their preferred name and staff were aware of the need to respect service users privacy and dignity. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff team compared with the current service users. From discussion with the person managing the home, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, there are indications that some service users sometimes find that some staff cannot communicate satisfactorily because English is not their first language. Several service users raised this as a concern. The Grange DS0000013090.V373922.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): Standards 12,13,14 and 15. Quality in this outcome area is good. Service users are encouraged to make choices and to remain as independent for as long as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A range of activities are provided to service users and these are displayed in the home. Assistance is given to service users wishing to attend local clubs and societies. Activities undertaken by service users are not reflected in care plans or daily records. The person managing the home has recently recruited a full time, experienced activities organiser and he/she is due to start working in the home, once all recruitment checks are in place. Surveys completed by service users indicated that three service users felt that there were ‘always’ activities arranged by the home that they could take part in, three service user felt ‘usually’ there were activities that they could take part in and one service user felt ‘sometimes’ there were activities that they The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 16 could take part in. Comments made on one survey included “X is always encouraged to take part in the organised activities”. Regular service user meetings take place and the person managing the home, said that once the activity organiser is in place the frequency of the meetings will be increased. Many service users have friends or family who are able to visit on a regular basis. Service users confirmed that friends or family are able to stay for a meal for a nominal charge. Friends and family are made welcome and always offered refreshments. Service users are encouraged to maintain contact, as far as possible, with the local community. Religious ministers visit the home on a regular basis and arrangements can be made for service users to attend a local place of worship, if requested. Service users confirmed that routines in the home are flexible, and they can spend their time as they choose. Service users are encouraged to exercise choice and control over their daily lives. One service user who smokes in his/her bedroom has an appropriate risk assessment in place that identifies and minimises the risks. The completed risk assessment has been agreed and signed by the service user. Service users were complimentary about the food provided. A choice is always offered and service users described the food provided as very good. From discussion it was clear that the cook is familiar with the food preferences of all service users. None of the current service users require a special diet. Menus seen demonstrated that a varied, wholesome and nutritious diet is provided to service users. The person managing the home has recently recruited two new cooks, due to start working in the home, in March 2009. The current cook is to move to the sister home in Goring. Menus seen demonstrated that a varied, wholesome and nutritious diet is provided to service users. We were able to join service users for the midday meal in the communal dining room. The meal was tasty, hot and attractively served. Staff were observed to be attentive and to assist service users in a discreet and dignified manner. Service users were offered extra portions. Surveys completed by service users indicated that five service users ‘ always’ liked the meals at the home, one service user ‘usually’ liked the meals served in the home and one service user ‘sometimes’ liked the meals in the home. Comments made on one survey included “ The quality and presentation of the food leaves much to be desired”. The Grange DS0000013090.V373922.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): Standards 16 and 18. Quality in this outcome area is good. Service users are confident that any concerns or complaints would be taken seriously, listened to and acted upon. Policies and procedures are in place to protect service users from possible abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the recording of complaints has been improved and all complaints are now recorded. The person managing the home is developing the recording of complaints further by introducing a complaints log, which will contain all documentation about any complaint received including action taken and outcomes. The home’s complaints procedure is displayed in the entrance hall of the home. Service users spoken to were aware of how to make a complaint. Comments included “ I would speak to my family to deal with”, “ I tell who ever is on duty”, “ Never needed to make a complaint”, “X (the deputy manager) is very good”. All service users who completed a survey confirmed that they know how to make a complaint. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 18 Since the last inspection, the Commission has not received any information regarding complaints about this service. All staff receive training in the home’s policies and procedures in protecting service users from possible abuse, including whistle blowing procedures. This was confirmed in discuss with staff on duty and evidenced in training records. Due to the care home receiving a zero star rating at the last inspection. A safeguarding meeting took place with the Local Authority, which resulted in no referrals being made to the home by Oxfordshire contracts team. This has recently been lifted. No safeguarding adult referrals or safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. The Grange DS0000013090.V373922.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): Standards 19 and 26. Quality in this outcome area is good. The home is maintained to a reasonable standard and is kept clean, hygienic and pleasant to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is generally well maintained and there is an ongoing programme of redecoration and refurbishment. Service users are encouraged to bring in items of furniture to personalise their rooms, it was not evident that a record of furniture brought in by the service user was kept. It is a recommendation of this report that an inventory of all items brought into the home is kept. Since the last inspection the laundry has been redecorated. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 20 The housekeeping staff work hard to ensure that the home is clean, pleasant and free from unpleasant odours the home is welcoming, comfortable and has a homely feel. Surveys completed by service users indicated that four felt that the home is fresh and clean ‘ always’, two felt that ‘usually’ the home was fresh and clean and one service user felt that ‘never’ was the home fresh and clean and comments included “ The cleaning is absent or very infrequent”. The Grange DS0000013090.V373922.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): Standards 27,28,29, and 30. Standards 27 and 29 were subject to requirement at the last inspection. Quality in this outcome area is good. Since the last inspection the staffing levels have been reviewed and increased, staff recruitment processes are more robust. Training is promoted and staff are competent to do their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made to review all staffing levels in the home to ensure that the needs of the service users are met at all times. This has been complied with and in addition to the appointments already referred to; five care assistants are currently being recruited. This will ensure that an extra member of care staff is on each shift during the day and a third member of staff at night. One of the members of staff on shift is either a team leader or the deputy manager. Since the last inspection the person managing the home is receiving administrative support. From discussion with staff on duty and examination of duty rosters there are adequate staff on duty to meet the needs of the service users. Currently staff are covering additional shifts, until the home is fully staffed. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 22 The person managing the home confirmed that staff are encouraged to undertake national vocational qualification (NVQ) training. The deputy manager has achieved NVQ level II and III and is an NVQ assessor. Eight of the current eighteen care staff have achieved NVQ at level II or III, eight care staff are undertaking the course and two care staff are waiting to commence NVQ level III. At the last inspection a requirement was made that authenticated references, be obtained for staff working in the home, including those recruited from abroad and that full and satisfactory checks including police checks and satisfactory references must be available on file for each member of staff. This is being complied with and following the inspection we received an action plan from the person managing the home, advising us of additional steps being taken including the updating of job descriptions and risk assessments for the employment of staff under the age of eighteen and the taking up of more recent referees. All newly appointed care staff complete an induction programme, which meets Skills for Care guidance. This was well documented and records the date of the induction and an additional date when the member of staff has been able to demonstrate competence. All staff complete induction training, appropriate to their roles once in post, and undertake mandatory training and specialist training as appropriate. This was confirmed by staff on duty and evidenced in training records. Staff meetings are held regularly and are minuted. Handovers take place at the beginning of each shift. One survey was completed by a member of staff comments made included, what the service does well “ We provide a homely, secure atmosphere with excellent, wholesome food”. Comments made regarding what the service could do better included “Ensure that there are adequate staff each day to handle individual requirements such as bathing and dressing without being rushed or hurried”. Other comments made on the staff survey included “ We have recently had a new manager appointed in January 2009. She is professional, kind, thorough and very observant of the service users well being. She is caring and approachable and supportive of the staff. She has brought so much knowledge and new methods. Care plans have been updated and the general work atmosphere is tremendous. It is a pleasure to work for her”. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 23 The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 24 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): Standards 31,32,33,35,37 and 38. Standards 32,33,37 and 38 were subject to requirement at the last inspection. Quality in this outcome area is good. Since the appointment of a new manager, the home being run in the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In January 2009 a new manager was appointed. She is a well qualified and an experienced manager having achieved the Registered Manager’s Award and NVQ level IV as well as being a Registered Nurse. Prior to commencing work at The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 25 The Grange she was registered with us (the commission) as the manager of another care home in Oxfordshire. An application for registration has already been submitted. She is supported by an experienced and well trained deputy manager, an administrator, four team leaders as well as a team of care and ancillary staff. In discussion with staff on duty and service users all expressed the view that the home was being run in the best interests of the service users. Comments made by service users included “ She is making lots of changes for the better and is doing things slowly after consulting with service users and staff”, “ What a difference X has made since coming into post”, “Already lots of improvements made”, “ Delightful, very approachable and professional”, “ Staff seem to be happier and more relaxed, X will has high standards and expects staff to follow her instructions”. At the last inspection a requirement was made that a copy of the written report prepared by the responsible individual on the conduct of the home, completed following an unannounced visit must be sent to us, each month until January 2009. This has been complied with. At the last inspection a requirement was made that a method of continuous monitoring must be implemented to ensure that the care provided to service users is monitored effectively and that effective quality assurance systems are put into place, to measure success in meeting the aims, objectives and statement of purpose. This has been complied with. The person managing the home is undertaking regular audits and this includes medication, health and safety, accidents/falls and care planning. Service users confirmed that one of the directors of the company, who is also the responsible individual, regularly joins service users for a meal and asks their views about the living in the home. At the last inspection a requirement was made that a copy of the home’s business and financial plan was sent to us, to demonstrate the effective and efficient management of the business. This was complied with. Procedures are in place for dealing with service users monies held in safekeeping on their behalf. Records are well maintained. Policies and procedures are in place and are reviewed as necessary. Following the inspection we received an action plan to confirm that all policies and procedures including the home’s statement of purpose and service user guide were to be updated within the next three months. At the last inspection a requirement was made that risk assessments must be carried out to identify and minimise potential risks to service users in relation to safe bathing, falling from windows on the first and second floors of the home and the risk of falling into the garden pond. Window restrictors have been put on all windows on the first and second floors of the home and safe bathing risk assessments have been completed. Although we had previously The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 26 been advised that a risk assessment had been completed and as a result of this a buoy had been placed by the pond. The completed risk assessment was not available for examination. We discussed with the person managing the home, the risks identified and as the pond is shallow, the usefulness of the buoy. We recommended that the Health and Safety officer at the District Council be approached for advice. Following this the person managing the home sent us an action plan to confirm that the pond area is to be fenced in, this will be completed by the end of April. The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 27 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 X 3 3 The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Grange DS0000013090.V373922.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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