Care Home: The Grange

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What the care home does well The Grange offers a comfortable environment for up to 4 people with learning disabilities all with single bedrooms and a good range of communal space. The facilities in the home are suitable for the individual and collective needs of the service users. The home have developed good pre-admission assessment processes for prospective service users. Two individual service user files were examined that had been developed in good detail providing clear guidance to enable staff to the assessed needs. Residents have the opportunity to engage in a good variety of activities promoting independence where possible. Service users are encouraged to take an active part in the day-to-day running of the home and were observed taking part in activities of their own choosing. One service user said `I like it here, I like my room and the food is nice`. All of the staff have achieved National Vocational Qualifications in care at level 2 or above and the deputy manager has gained the Registered Managers Award. The home has robust recruitment processes and all staff have attended courses covering mandatory topics and other related subjects. What has improved since the last inspection? The home have continued to develop the care planning and risk assessment processes that have a person-centred focus. On-going maintenance in the service has been carried out with areas of the home having been refurbished and redecorated since the last inspection. The staff have worked positively with service users to enable greater levels of independence and review of medication regimes improving outcomes for the residents. What the care home could do better: No requirements and four recommendations have been made as a result of this inspection process. The home is advised to develop specific areas of the care plan and risk assessment for one individual with regard to past and present risk factors. Additionally it is recommended that the manager develops lone working processes in concurrence with this. Quality assurance systems are in place, but there is scope for developing these further to include feedback from health and social care professionals. The manager is also advised to ensure that the fire safety risk assessment shows evidence of annual review and updating as required. Key inspection report Care homes for adults (18-65 years) Name: Address: The Grange 75 Reculver Road Herne Bay Kent CT6 6LQ     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: Joseph Harris     Date: 2 2 0 5 2 0 0 9 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 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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 25 Information about the care home Name of care home: Address: The Grange 75 Reculver Road Herne Bay Kent CT6 6LQ 01227741357 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: lifetimecare@tiscali.co.uk Lifetime Care Development Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. 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: Learning disability (LD). Date of last inspection Brief description of the care home The Grange is a small care home for four people with learning disabilities. It is within the village of Beltinge which has some local amenities, and a short distance from Herne Bay, a nearby town with more facilities. A bus route is close by and there is a mainline rail station at Herne Bay. Parking is not restricted in the roads around the home. The statement of purpose relating to the home, as well as business cards and information leaflets are made available to prospective residents and their representatives on request, as is a copy of the latest Commission for Social Care Inspection (CSCI) inspection report. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 4 Brief description of the care home Mr Fisher confirmed the fees start from 650 pounds per week. Personal toiletries, newspapers and magazines are not included in the fees. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection process culminated in a site visit to The Grange on the 22nd May 2009. The visit commenced at 09:30 and lasted for approximately 5 hours. Prior to the site visit a range of information was examined and reviewed including the Annual Quality Assurance Assessment completed by the service, information received from other sources, any notifications, complaints and concerns and past inspection reports. During the site visit a tour of the premises was undertaken and discussions held with all of the service users and staff on duty. A range of documentation was examined including individual service user files, staff personnel files, health and safety information and other records relating to operation and running of the home. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare 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 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, 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. Prospective service users and their representatives are able to make an informed choice about moving into the home. Evidence: The home has a statement of purpose and service user guide in place that are provided to all prospective service users and their representatives. Copies of the latest inspection report are available on request. A pre-admission assessment process has been developed. There has been one new service user admitted to the home since the last inspection. Individual service user plans were examined for two residents both of which provided evidence of assessment prior to admission to the home. The manager stated that in all cases information is received from the referrer including care management care plans, risk assessments and other information. A senior member of staff aims to visit the prospective resident in their current accommodation once the referral documentation is received and the home completes their own pre-admission assessment format that covers all aspects of need, risk and personal preferences and history. In both examples examined these records had been completed in good detail. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: Prospective residents are offered trial visits to the service ranging from day visits to overnight stays. Staff underlined the importance of spending time with people before they decide to move in enabling a full assessment process and the chance for the individual to get to know the other residents and staff. Care Homes for Adults (18-65 years) Page 10 of 25 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. The individual needs and choices of service users are planned for and their decisions respected. Evidence: Two individual service user plans were examined during the course of the site visit. In both cases the plans of care had been developed in good detail based on assessed needs. The plans demonstrated a person-centred approach and provided clear guidance for staff to enable needs to be met. Individual preferences, likes and dislikes were documented and the information set out in an orderly manner. The plans showed evidence of regular review and updating in response to changing needs. Following discussion with the manager and the deputy manager regarding one service users needs it was advised that information relating to specific behaviours and activities could be further expanded upon. The manager agreed to update the plan of care and risk assessments accordingly. Refer to recommendation 1. Risk assessments have been developed for each service user addressing the perceived areas of risk. The risk management plans have been developed promoting positive Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: outcomes and responsible risk taking. The risk assessments are reviewed on a regular basis. Through examination of records, discussion with service users and staff and observation of daily activities it was evident that residents are able to make decisions regarding their day-to-day lives. People are able to choose how they spend their time and, within flexible boundaries, their daily routines. Service users are supported to engage in chosen activities where staff input is required and sufficient staff are on duty to enable this. Care Homes for Adults (18-65 years) Page 12 of 25 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. Service users have an active lifestyle that suits their individual needs. Evidence: The home ensures that all of the service users have an active and varied lifestyle providing opportunities for both organised and spontaneous activities. A record of activities and an activity plan for each resident is maintained. These demonstrate that service users engage in a variety of pastimes such as bowling, walks, bus trips and shopping amongst other things. One person has been supported in efforts to find employment and has completed a number of college courses. All of the people who use the service were observed relaxing in the home, interacting with staff and taking part in activities of their choice. An annual holiday is provided and the home has access to a vehicle for transportation, although residents are encouraged to use public transport where possible. No visitors were present at the time of the site visit, but it was reported that friends Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: and family are welcomed into the home at all reasonable times. There is sufficient space for people to meet in relative privacy should they wish to do so. Residents spoke about family visits and when they return to their family homes. Service users are supported and encouraged to take an active part in the day-to-day running of the home. This includes completing household tasks, cleaning their bedrooms, shopping and assisting in the kitchen where possible. Residents can choose the times when they get up and go to bed within flexible and reasonable boundaries. The home maintains menu records which demonstrate that a healthy and balanced diet is provided based on individual choices. There is a guide menu, but this is altered and changes documented depending on the wishes of each person. One resident said, I like the food. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare 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. The personal and healthcare needs of the service users are met. Evidence: Service users require varying levels of support with their personal care needs from prompting and encouragement to assistance with aspects of personal hygiene. The plans of care suitably detail the levels of support required and individual preferences to enable staff to consistently meet these needs. Staff were observed interacting positively with service users respecting their choices. The home maintains a record of healthcare information including visits to health professionals and the outcomes of appointments. All of the residents are registered with local GPs and there is evidence of annual health check ups. The home reported that they receive support from Local Community Learning Disability teams and regular reviews of care are completed. Records are kept of complimentary health care needs such as chiropody and dentistry. Issues relating to specific health needs for each service user are recorded and suitable guidance is in place. There is evidence that concerns are appropriately referred to relevant professionals in this regard. The home has appropriate measures in place relating to medication systems. Medication administration records were complete and up to date and records are kept Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: of returned medication. The storage facilities are adequate for the needs of the home and medications seen were suitably stored. All staff have received necessary medication training. None of the service users self-medicate. There is also evidence that the home have worked with medical practitioners to review and reduce medications were appropriate. Care Homes for Adults (18-65 years) Page 16 of 25 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. Service users concerns and complaints are listened to and acted upon. residents are protected from forms of abuse. Evidence: There is a clear complaints process in place and this is on display within the home. Systems are in place to records any concerns and complaints including the outcome of any investigations. It was reported that one complaint had been received since the last inspection and there was evidence that the home liaised with the care manager in this instance. The complaint involved an allegation made by a service user and was investigated by the police. The service user subsequently withdrew the complaint. The home was advised to develop guidance to protect staff and service users from similar unsubstantiated allegations in the future. Refer to recommendation 2. Information and correspondence relating to the complaint had been retained on file. Policies and procedures relating to adult protection and abuse awareness are in place and staff have completed the requisite training covering these topics. Two staff were attending a training day about the Mental Capacity Act 2005 on the day of the site visit. In discussion staff demonstrated a good knowledge of their roles and responsibilities in relation to adult protection issues. No adult protection alerts have been raised in connection with the service since the last inspection. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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. The premises are suitable for the needs of the service users. Evidence: The Grange is located in a residential area in the village of Beltinge close to Herne Bay. There are local amenities nearby and public transport links connecting to larger towns in the area. Parking is available at the front of the house and there is a relatively small, functional garden to the rear. The home is generally well cared for and in a good state of repair with sufficient communal space for the needs of the residents including a large L-shaped lounge/dining room. There are toilets and bathing facilities on both the ground and first floors. Two service users bedrooms were seen, both of whom were particularly proud of their own spaces. The rooms had suitable furnishings and fittings and were decorated according personal taste. The kitchen and laundry facilities are domestic in size and it was reported that all equipment is in good working order and meets relevant regulations. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, 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. There is a competent staff team in sufficient numbers to support the service users. The home follows suitable recruitment procedures. Evidence: All of the staff working in the service have achieved at least a National Vocational Qualification in care at level 2 or above. It was evident through discussion with the staff on duty that there is a good understanding of the individual and collective needs of the service users. Staff were observed interacting positively with service users responding appropriately to their requests. The home operates with 2-3 staff on duty each day and a sleep-in member of staff at night. This level of staffing ensures that service users individual needs can be met and enables flexibility to support people in the community when required. A discussion was held with the manager regarding lone working especially at night time for female staff and consideration should be given to implementing systems to ensure safety. This is relevant due to the fact that one individual has, in the past, made allegations against female staff. Refer to recommendation 2. Two staff personnel files were examined. In both cases all required information had been gathered prior to appointment. Relevant CRB and POVAfirst checks were on file alongside two written references, proof of identity and completed application forms. There was evidence staff had completed the induction programme and mandatory Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: training to enable them to fulfill their roles. The manager acknowledged that some staff require training updates and plans are in place to book staff on the relevant courses. Additional training is also provided including adult protection, medication, learning disability awareness and the Mental Capacity Act 2005 amongst other things. Care Homes for Adults (18-65 years) Page 20 of 25 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 home is well managed in the best interests of the service users. The health, safety and welfare of the service users is promoted. Evidence: The registered manager has completed all required training and has been in this role for approximately 4 years, having owned the home for around 10 years. He is supported by a deputy manager who has also completed her NVQ level 4 and Registered Managers Award. Tasks in the home are delegated according to individual skills and interests with the deputy manager concentrating more on the issues of care whilst the manager oversees the organisational aspects of the service to a greater extent. There are quality assurance processes in place. The owner/manager is in day-to-day charge of the service and, therefore, ensures on-going monitoring. Service users and their relatives have the opportunity to complete and annual questionnaire and feedback from this exercise and through more informal means are taken on board. It is advised that annual surveys are also sent out to health and social care professionals involved in the service to broaden the level of feedback received. Refer to Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: recommendation 3. Health and safety issues are monitored and addressed. Fire safety and accident records are in place and kept up to date. A fire safety risk assessment has been completed, although the manager should ensure that this is reviewed annually. Refer to recommendation 4. The home has completed environmental risk assessments and safe working practices are followed. Service safety checks have been completed. It was noted to the electrical wiring certificate is due for renewal, which the manager stated he was in the process of arranging. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 6 22 39 42 To develop guidance within the service user plans addressing identified needs. To develop guidance relating to lone working. To expand annual surveys including relevant health and social care professionals. To ensure that the fire safety risk assessment is reviewed annually and updated as required. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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