Care Home: The Grange Care Home

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What the care home does well People were provided with useful information to help them to decide whether the home was suitable for them. Residents were only admitted following a detailed needs assessment to determine whether they could be looked after properly. Resident`s health and well being had been monitored and they had access to a range of health care services; necessary aids and equipment were provided to support and help people to maintain their comfort, health and independence. The care plans included detailed and up to date information about the preferred care and support that was needed to meet residents individual needs. From discussion with residents it was clear they received the care and support they wanted and they said staff listened to and acted on what they said. Each resident had a designated member of staff called a key worker or named nurse who knew them well and would give them special attention; one key worker gave a good account of the individual needs and preferences of a resident in her care. Medication policies and procedures provided staff with safe guidance. Records were accurate and showed that medicines were managed safely. Staff were seen responding to residents and visitors to the home in a positive and friendly way; residents confirmed they were happy with the care they received, were treated with respect and were looked after properly. Residents said they could do what they wanted and were able to make decisions and choices about how they spent their day; comments included `we can suit ourselves`, `there is always something to do, we can get out of the house for a walk or sit in the lounges for a chat` and `Ive made some good friends`. A range of activities and entertainments were available and residents were able to decide whether they wished to participate. Residents knew who to talk to if they were unhappy, knew how to make a complaint and were confident they would be listened to; comments included `I have spoken up and things have been taken care of`, `if things are wrong I will tell staff, they have sorted things out in the past`, `you can tell them if something isn`t right` and `the area manager pops in to check if everything is alright and I would tell her if it wasn`t`. There were clear procedures to help staff protect residents from abuse or neglect. Residents said their requests for attention were answered promptly; comments included `they always come if I press the buzzer` and `they come and help me if I need, I press the buzzer and staff come`. Residents were happy with their rooms; comments included `I have a lovely view`, `I like my room, I have everything I need` and `my room is clean and I have a new bed and new furniture`. Residents were happy with the staff team and said they were looked after; they said `staff are very good`, `there are enough staff`, `I am well looked after` and `all staff are very nice and there are enough to look after us`. Residents also said their requests for attention were answered promptly which was a good indication that there were sufficient staff to meet their needs. A safe, fair and robust recruitment procedure had been followed that would protect residents from unsuitable people. Records and discussion with staff confirmed they were given a range of training that would improve standards of care and help them to meet residents needs. There were a number of audit systems in place to check whether peoples needs were being met and whether staff were following safe policies and procedures. The results of these checks were used to improve the service. Records showed that the home was safe and staff received regular training to keep themselves and others safe from harm. What has improved since the last inspection? Staff said the flexibility of the routines had improved and they were encouraged to respond to residents changing needs, choices and wishes; this was reflected in the care plan and confirmed by residents. Action had been taken to improve the dining experience which was reflected in comments made by residents. Comments included `the cooking has improved`, `the food has improved greatly with a good choice of meals`, `the food is good, there is always a choice or they will make something else`. Residents views and opinions had been considered; one resident said `the food is very good, we told them that we wanted more choices at breakfast and now we can have a choice of cooked breakfast`. Staff said that communication had improved which would help to ensure residents were provided with the right care and support and ensure the smooth running of the home. It was clear that senior management had responded to the concerns raised during the monitoring visits and had taken prompt and appropriate action; evidence supported that the organisation was open and willing to work with external agencies to improve outcomes for residents. Residents said `we are kept up to date with what is going on` and `things are much better`. Staff were happy with the recent changes and one said `things are improving`. What the care home could do better: The care plans should always reflect residents current needs to ensure they received the care and attention they needed. Residents and their relatives should be more involved in the ongoing review of the care plan and involved in decisions regarding their care. Records should reflect residents current needs to ensure they received the care and attention they needed. The home should ensure that activities take place as planned and that interaction or stimulation for residents who were unable to communicate was improved. The provision of suppers and snacks should be improved to ensure residents dietary needs were met at all times. All staff should receive training to help them to recognise and respond to any abuse or neglect. Some areas of the home were in need of attention to ensure residents were provided with a pleasant, safe and comfortable environment that met their needs in an individual and homely way. The training matrix should reflect the skills and competencies of current staff; this would help to identify any gaps in the provision of training. Key inspection report Care homes for older people Name: Address: The Grange Care Home Keighley Road Colne Lancashire BB8 0QG     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: Marie Matthews     Date: 1 7 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: The Grange Care Home Keighley Road Colne Lancashire BB8 0QG 01282866054 01282866054 the.grange.colne@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alliance Care (Dales Homes) Limited (wholly owned subsidiary of Four Seasons Healthcare Limited) Name of registered manager (if applicable) Mrs Carole Patricia Cairns Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Physical disability - Code PD. The maximum number of service users who can be accommodated is: 40. Date of last inspection Brief description of the care home The Grange Care Home is a converted and extended Victorian house, which provides accommodation for up to forty people who require nursing or personal care. The current registration includes thirty-six places for older people and four places for Care Homes for Older People Page 4 of 34 Over 65 40 0 0 40 0 5 1 2 2 0 0 8 Brief description of the care home younger people with a physical disability. The home, which was converted from the original house and has had additional accommodation added, is situated in a quiet residential area on the outskirts of Colne close to shops and on a main road bus route. There is car parking in the grounds of the home. Lawned areas with mature trees surround the home and are easily accessible to those residents who need to use a wheelchair. There is a passenger lift between floors and there are various communal areas. The Grange Care Home is part of the Four Seasons Health Care Group but registered to Alliance Care (Dales Homes) Ltd. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the key inspection the weekly fees ranged from £335.50 to £663.50. Items not covered by the fee are newspapers, toiletries, hairdressing, private chiropody and contributions to some outings and activities. Care Homes for Older People Page 5 of 34 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection, including a visit to the home, took place on 16th and 17th March 2010. The last key inspection visit was completed on 17th April 2007 with a random inspection undertaken on 5th December 2008; annual service reviews had been completed in April 2008 and April 2009. This inspection had been brought forward following a number of serious concerns regarding care of residents, record keeping, communication and the day to day management of the home. The local authority contracts monitoring team had undertaken a number of visits to the home which included a review of records, observation of practices and obtaining peoples views by surveys and face to face discussions. We reviewed this information as part of our inspection process and made reference to it in this report. The inspection process included looking at records, a tour of the home, discussions Care Homes for Older People Page 6 of 34 with the deputy manager, area manager, three members of staff, one visitor and seven residents. Information was also included from surveys completed by five residents, one visitor and three staff. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. The Grange did not have a registered manager at the time of the inspection visit. Care Homes for Older People Page 7 of 34 What the care home does well: People were provided with useful information to help them to decide whether the home was suitable for them. Residents were only admitted following a detailed needs assessment to determine whether they could be looked after properly. Residents health and well being had been monitored and they had access to a range of health care services; necessary aids and equipment were provided to support and help people to maintain their comfort, health and independence. The care plans included detailed and up to date information about the preferred care and support that was needed to meet residents individual needs. From discussion with residents it was clear they received the care and support they wanted and they said staff listened to and acted on what they said. Each resident had a designated member of staff called a key worker or named nurse who knew them well and would give them special attention; one key worker gave a good account of the individual needs and preferences of a resident in her care. Medication policies and procedures provided staff with safe guidance. Records were accurate and showed that medicines were managed safely. Staff were seen responding to residents and visitors to the home in a positive and friendly way; residents confirmed they were happy with the care they received, were treated with respect and were looked after properly. Residents said they could do what they wanted and were able to make decisions and choices about how they spent their day; comments included we can suit ourselves, there is always something to do, we can get out of the house for a walk or sit in the lounges for a chat and Ive made some good friends. A range of activities and entertainments were available and residents were able to decide whether they wished to participate. Residents knew who to talk to if they were unhappy, knew how to make a complaint and were confident they would be listened to; comments included I have spoken up and things have been taken care of, if things are wrong I will tell staff, they have sorted things out in the past, you can tell them if something isnt right and the area manager pops in to check if everything is alright and I would tell her if it wasnt. There were clear procedures to help staff protect residents from abuse or neglect. Residents said their requests for attention were answered promptly; comments included they always come if I press the buzzer and they come and help me if I need, I press the buzzer and staff come. Residents were happy with their rooms; comments included I have a lovely view, I like my room, I have everything I need and my room is clean and I have a new bed and new furniture. Residents were happy with the staff team and said they were looked after; they said staff are very good, there are enough staff, I am well looked after and all staff are very nice and there are enough to look after us. Residents also said their requests for attention were answered promptly which was a good indication that there were sufficient staff to meet their needs. A safe, fair and robust recruitment procedure had been followed that would protect residents from unsuitable people. Records and discussion with staff confirmed they were given a range of training that would improve standards of care and help them to meet residents needs. There were a number of audit systems in place to check whether peoples needs were being met and whether staff were following safe policies and procedures. The results of Care Homes for Older People Page 8 of 34 these checks were used to improve the service. Records showed that the home was safe and staff received regular training to keep themselves and others safe from harm. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with useful information to help them to decide whether the home was suitable for them. Residents were only admitted following a detailed needs assessment to determine whether they could be looked after properly. Evidence: The information about the home was contained in a statement of purpose and service user guides; these were currently being reviewed to reflect the recent changes in the management structure. The service user guide was available to prospective and existing residents and their relatives and included clear and useful information about what to expect if they moved into the home; this would help people to decide whether The Grange was a suitable place for them to live. The information was available in a range of other formats including braille, large print Care Homes for Older People Page 11 of 34 Evidence: and other languages; this would help to ensure everyone had access to and could understand the information. The certificate of registration was on display in the entrance hall with a copy of the last key inspection report which would advise people whether their needs could be met at The Grange. Four residents records were looked at in detail. New residents were not admitted to the home until a full assessment of their needs had been undertaken. The assessments were completed by a senior member of staff and the resident, their relatives and other relevant people had been involved; this would help to ensure that all aspects of the residents needs would be considered. The assessment information was used to develop a care plan and was reviewed on the day of admission to check that the residents needs had not changed. Copies of letters confirming their needs could be met were sent to prospective residents and their families; this would reassure people that The Grange could look after them properly. Resident said they had been encouraged to visit The Grange, before admission, which had allowed them to meet with staff, other residents and to view the facilities. Each resident had access to a key worker who would help them to settle into the home and give them special attention. All residents were issued with a contract or terms and conditions; this would help them to understand their rights and responsibilities during their stay at the home. Residents said they were looked after and were confident that staff had the skills and experience to meet their needs and staff surveys indicated they had the experience and knowledge to meet peoples needs. The training matrix showed that staff had been provided with a range of appropriate training to help them to look after residents properly. However the information was not up to date resulting in a number of gaps in the provision of training; the area manager was aware of this and advised that the training plan was being updated and would be forwarded to Care Quality Commission (CQC) following the inspection (see Staffing outcomes). Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were met although care should be taken to ensure the care plans always reflected residents current needs to ensure they received appropriate care and attention. Evidence: Following a number of serious complaints and allegations the local contracts team had undertaken a number of recent monitoring visits; following the visit concerns had been raised regarding the lack of detail and use of written language in the care plans which could result in residents not receiving the right care. Four residents care plans were looked at in detail and it was clear that action had been taken to improve the standard of the records. The care plans included detailed information about the care and support that was needed to meet residents individual needs. The care plans had been regularly reviewed although, from information seen in the daily report, not always updated at the time when residents needs had changed; records should reflect residents current Care Homes for Older People Page 13 of 34 Evidence: needs to ensure they received the care and attention they needed. Residents and their relatives had been involved in the development of the care plan but were not always involved in the ongoing reviews; involvement would ensure they received the care they both needed and wanted. There was evidence that relatives were kept up to date with any changes to the care plan. Residents health and well being had been monitored and they had access to a range of health care services; necessary aids and equipment were provided to support and help people to maintain their comfort, health and independence. Personal health care needs were clearly recorded in the care plan and appropriate action had been taken to respond to any changes in residents health although as indicated above the records were not always updated at the time when their needs changed; this would result in them not receiving the treatment and support they needed to maintain their health. The home employed registered nurses and a number of care staff had received appropriate health care training; this would help them to recognise and respond appropriately to any changes in residents health care needs. There were records to support that any risks to residents had been assessed and that action had been taken to remove or minimise the risks. Records showed that the risks were kept under review; residents were given appropriate care at appropriate intervals and that any changes to their situation were closely monitored and responded to. The use of bed rails was assessed, clearly recorded, kept under regular review and agreed with the resident or relative; this would help to ensure that the use of this method of restraint was appropriate and safe. The care plans included useful information regarding residents likes, dislikes and preferences which would help staff to provide care in a way that residents preferred. From discussion with residents it was clear they received the care and support they wanted and they said staff listened to and acted on what they said. Each resident had a designated member of staff called a key worker or named nurse who knew them well and would give them special attention; one key worker gave a good account of the individual needs and preferences of a resident in her care. Following recommendations made at the monitoring visit the standard and content of all care plan documentation was being audited and action had been taken to improve any concerns in this area. A number of care staff had received training to help them with care planning and further sessions were planned. The content of care plans had been discussed with staff and from discussion it was clear they were more aware of Care Homes for Older People Page 14 of 34 Evidence: the need for use of appropriate written language and the need for the inclusion of personal details regarding residents likes, dislikes and preferences. Medication policies and procedures provided staff with safe guidance. Records were accurate and showed that residents medicines were managed safely. A concern had previously been raised regarding failure to apply prescribed creams; records were checked and showed that creams had been applied as prescribed. However it was noted that that the administration of creams and lotions was not always signed by the member of staff who completed the task; this could result in errors and omissions being made. The area manager supplied a newly developed procedure that would support staff with this aspect and advised it would be issued to all staff immediately. Risk assessments and procedures were in place for residents who wished to maintain independence and manage their own medicines; however staff should obtain permission from the resident or their representative if they were required to manage residents medicines on their behalf. Regular audits were in place to check whether staff were following safe policies and procedures and staff had been provided with medication training; this would ensure residents medicines were handled properly. Staff were seen responding to residents and visitors to the home in a positive and friendly way. One resident said she had been visited by her GP in the privacy of her room. Residents were dressed appropriately and consideration had been given to maintaining their clothing choices and dignity. Consideration should be given to removing care notices and labels that were displayed in residents bed rooms and on furniture as this does not support that their dignity was respected. Care plans made reference to offering choices, treating residents with respect and maintaining their privacy and dignity; residents confirmed they were happy with the care they received, were treated with respect and were looked after properly. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines were flexible and residents were able to make choices and decisions about their daily lives. The provision of a range of appropriate activities and entertainments had improved although it was not always clear whether everyones social needs and expectations were being met. Residents dietary needs and expectations were being met. Evidence: Residents confirmed they could do what they wanted and were able to make decisions and choices about how they spent their day; comments from residents included we can suit ourselves, there is always something to do, we can get out of the house for a walk or sit in the lounges for a chat and Ive made some good friends. Staff said the flexibility of the routines had improved and they were encouraged to respond to residents changing needs, choices and wishes; this was reflected in the care plan and confirmed by residents. The home employed a member of staff who was responsible for arranging activities and entertainments and ensuring residents diverse social needs were met. Each resident had a detailed assessment of their social needs and expectations which Care Homes for Older People Page 16 of 34 Evidence: included information, provided by the resident or by their relatives, regarding their likes, dislikes, preferences and routines; this would help staff to provide suitable care and support and to plan appropriate activities and entertainments. There was a plan of activities and entertainments for each week that was displayed in areas around the home and given to each resident; this showed that a range of activities were available and residents were able to decide whether they wished to participate. Each resident had a personal activities plan which gave staff some information about the activities they enjoyed and their daily routines. Regular meetings were held with residents; they were consulted about the daily running of the home, kept up to date with any changes and able to plan current and future activities. Information provided for the recent monitoring visits had indicated that activities did not always take place as planned and there was limited interaction or stimulation for residents who were unable to communicate. During this inspection visit it was noted there had been some improvement in the provision of suitable activities however the findings from the monitoring visit continued to be supported by records, observation and comments from residents and staff. The area manager was aware of the shortfalls and action was being taken to ensure that all residents social needs were met. Residents comments included they give me an activity list so there is always something going on but you dont have to join in if you dont want to, the home provides some good activities so we dont become institutionalised, the minister visits now and then and activities are varied and we should be going on more walks when the weather improves. One resident commented they should keep us informed if the activity plan changes, namely going on walks and where to and when they are short of staff. Staff said there is a bit more going on for some residents and not enough activities for residents with dementia. Residents said their friends and families could visit at any reasonable time and could visit in any area of the home. There were a number of quiet seating areas that could also be used. Some residents had started to go out into the local community accompanied by staff on short walks; residents said they enjoyed this. The menu offered a choice of nutritious meal at each sitting with alternatives to the menu also being provided; this would help to ensure residents dietary preferences Care Homes for Older People Page 17 of 34 Evidence: were met. Residents said they were offered drinks and biscuits throughout the day although generally only biscuits were provided for suppers. This was discussed with the area manager who gave reassurances that this would be resolved by the provision of a supper time snack box. The gaps in the records of meals served did not always support that all residents dietary needs were met; it was recommended that the records were maintained in full and also that a record of suppers were recorded. Action had been taken to improve the dining experience which was reflected in comments made by residents. Comments included the cooking has improved, the food has improved greatly with a good choice of meals, the food is good, there is always a choice or they will make something else. Residents views and opinions had been considered; one resident said the food is very good, we told them that we wanted more choices at breakfast and now we can have a choice of cooked breakfast. The lunch time meal was served hot and was attractively presented; one resident said I had a very nice lunch, I really enjoyed it. Staff gave discreet encouragement and assistance to residents who needed additional support and the meal times was unhurried enabling residents to take their time. Meals were served either in the dining room, residents bedroom or on a bed side table in the lounge. Staff commented that there was not enough dining space for all residents who wished to dine at the table; the area manager said this was due to be reviewed as part of the refurbishment plan this year. Dining tables were set with appropriate cutlery, condiments and drinks. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were monitored in the home to ensure dealing with concerns and complaints had improved. People were protected by safe policies and procedures although the provision of safeguarding training for all staff could improve staff awareness and residents safety. Evidence: The complaints procedure was clear and easily accessible and was displayed in the entrance hall and in residents rooms; it was available in other formats which would ensure everyone could read and understand it. There were serious concerns that a number of recent complaints and allegations (2009) had not been responded to in line with the organisations or local safeguarding procedures; these had been referred to the local authority safeguarding team for investigation and monitoring visits were currently underway. Senior management had taken appropriate action to respond to the issues and were currently working with the local authority contracts team to improve outcomes for residents and their relatives. The records showed that previous complaints had been properly responded to. Information from surveys and discussions with residents indicated they knew who to talk to if they were unhappy, knew how to make a complaint and were confident they would be listened to. The area manager said concerns and complaints had been Care Homes for Older People Page 19 of 34 Evidence: discussed at a recent residents meeting; one resident said I feel free to speak up and raise anything either at the meeting or in confidence. Other comments included I have spoken up and things have been taken care of, if things are wrong I will tell staff, they have sorted things out in the past, you can tell them if something isnt right and the area manager pops in to check if everything is alright and I would tell her if it wasnt. Staff said they knew what to do if somebody raised a concern or complaint and a number of them had attended customer care training with further sessions planned; this would help to ensure that residents were listened to and their concerns properly dealt with. The organisation monitored the number and type of complaints and used the information to improve the service. There were clear procedures to help staff protect residents from abuse or neglect. The local authority contact information was available to ensure staff could promptly refer any suspicions of abuse to the right agencies. Following the monitoring visit it was recommended that all staff should have training to help them to recognise and respond appropriately to abuse; from the training matrix it was evident that training had been scheduled but unclear whether this had taken place. Three staff spoken to said they had not received recent safeguarding training although they were able to describe how they would respond to any reports of abuse or neglect. The area manager advised that all staff would receive safeguarding training by the end of April 2010; this will be monitored. The home had clear procedures to support staff with Deprivation Of Liberty Safeguards and the Mental Capacity Act which would help them to understand their role and responsibilities when making choices and decisions for residents. It was not clear whether they had received any training in this aspect although the company employed a Deprivation Of Liberty Safeguards assessor whose details were included in the procedures. There were procedures to support staff with reporting poor practice and staff confirmed they were aware of the procedures. The procedures were clearly displayed in the staff room and staff could access a confidential twenty four hour whistle blowing helpline. Care Homes for Older People Page 20 of 34 Evidence: There were clear procedures to support staff with management of residents finances which would ensure residents best interests were safeguarded. There were clear procedures to support staff with dealing with verbal and physical aggression which would help them to respond appropriately and maintain their own safety and the safety of others. The organisation had a lead person who was available to support and advise staff with caring for residents with difficult and challenging behaviours. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home were in need of attention to ensure residents were provided with a pleasant, safe and comfortable environment that met their needs in an individual and homely way. Evidence: A tour of the home showed that the home was clean and comfortable although some areas of the home were in need of improvement and were described as shabby and dated. Staff said the home is in need of refurbishment as certain areas are very poor and one resident said the home is clean but a bit shabby in places. Some areas noted for attention included a trip hazard to flooring in the lounge, water damage to the main staircase ceiling, cracked walls and ceiling in room 31, dated and damaged decor in some areas including lounges, corridors and bedroom areas. However management were already aware of areas in need of attention and there were plans to improve all communal areas this year; this would ensure residents lived in a safe and pleasant home. Grounds were attractive, safe and accessible to residents and their visitors; appropriate seating was provided to allow residents and their visitors to enjoy the gardens in the warmer weather. Care Homes for Older People Page 22 of 34 Evidence: Communal areas were pleasant, bright and comfortable although were in need of improvement; one staff commented that the lounges could be more coordinated. The dining room was bright and airy but did not provide sufficient space for all residents at meal times; the area manager advised this was under review and residents choices would be improved. A number of rooms had en suite facilities and toilets and bathrooms were suitably equipped, clearly signed and located near to communal areas. A range of aids and equipment were available throughout the home and would support and maintain residents safety, comfort and independence. Call systems were provided in every room and residents said their requests for attention were answered promptly; comments included they always come if I press the buzzer and they come and help me if I need, I press the buzzer and staff come. Bedrooms were bright and clean although some were in need of improvement. Some residents had brought in treasured possessions to make their rooms more homely. Doors were fitted with suitable locks and a lockable storage space was provided for items of value; this support residents rights to privacy. Residents were happy with their rooms; comments included I have a lovely view, I like my room, I have everything I need and my room is clean and I have a new bed and new furniture. Surveys provided for the monitoring visit indicated there were poor standards of cleanliness. The area manager advised that new domestic staff had recently been employed to ensure standards of cleanliness were improved and maintained. Records supported that cleaning requests were responded to although dates for completion should also be recorded; this would help to support prompt action had been taken. Residents surveyed said the home was fresh and clean and there were no offensive odours noted during the inspection. Surveys provided for the monitoring visit indicated that residents clothing was lost or damaged. Laundry areas were clean, organised and suitably equipped. Residents were happy with the service they received and three residents said their clothing was always returned washed, ironed and in good time. Other residents were seen wearing appropriate clothing which supported that residents choices and dignity were respected. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A safe and robust recruitment procedure had been followed that would protect residents from unsuitable people. Staff were sufficient in numbers and provided with the training they needed to meet residents needs. Evidence: The duty rotas showed there were sufficient staff to meet residents needs although it was recommended that the rotas included the full names of staff and their role to make them clearer. Where possible any gaps in the rotas had been covered by existing staff rather than agency staff; this would ensure residents were looked after by staff who knew them. The home employed male and female staff of all ages and experiences; this meant that residents were able to make decisions and choices regarding who cared for them. At the monitoring visit there were variable comments raised regarding staff numbers and attitude. From more recent discussions with a number of residents it was clear they were happy with the staff team and said they were looked after; comments included staff are very good, there are enough staff, I am well looked after and all staff are very nice and there are enough to look after us. Residents also said their requests for attention were answered promptly which was a good indication that there were sufficient staff to meet their needs. Care Homes for Older People Page 24 of 34 Evidence: The opinions in recent staff discussions and surveys were varied as two staff said there were sometimes enough staff and one said never enough staff. One staff said there were enough staff and another said there are enough but we could always do with more on the morning shift. Three staff said that the staff team had recently improved and they worked well together; one commented we look after our clients to the best of our ability. There had been concerns about communication between staff which had impacted on the standards of care that residents received. Staff said that communication had improved which would help to ensure residents were provided with the right care and support and ensure the smooth running of the home. Records and discussion with staff confirmed they were given a range of training that would improve standards of care; however there were some gaps noted in the provision of recent training as the training records were not up to date. The area manager was aware of the gaps and records were being updated and further training sessions were being arranged; this would ensure staff had the skills and experience to meet residents needs. Staff said they were given relevant training and had the experience and knowledge to meet residents needs. A number of staff had a gained a recognised qualification in care whilst others were due to complete their course work; this would help staff to understand and meet the needs of residents in their care. Staff records showed they received regular one to one supervision and support; this would help to identify if any additional training or support was needed. Staff were able to meet regularly as a group; this ensured they were able to air their views, consulted about the running of the home and kept up to date with any changes. New staff had been given a period of induction or introduction to the home; this would ensure they were safe and competent to practice. Staff said the induction covered everything they needed to know. There were clear recruitment procedures and two staff files showed that the home had followed safe and fair processes; this would help to protect residents from unsuitable people. Care Homes for Older People Page 25 of 34 Evidence: All the required checks were in place prior to staff commencing work although it was recommended that any negative information disclosed in employment references was followed up and recorded on file and also a verbal check of employment references should be completed; this would help to improve the recruitment process. It was also recommended that a recent photograph should be provided as part of the recruitment process and attached to staff files as a means of identification. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The organisation had taken appropriate action to respond to serious concerns and ha improved outcomes for people who lived at The Grange. The home was safe and peoples views were obtained and used to develop the service. Evidence: There had been changes to the post of registered manager since the last key inspection. The home currently did not have a registered manager in post although a new manager was due to commence employment. Residents and staff said they had been given the opportunity to meet the new manager; one resident said I have met the new manager she is very nice. At the time of the key inspection visit the deputy manager was responsible for the day to day management of the home; she was supported by the area manager, other registered managers within the group and the larger organisation. Following a number of serious concerns regarding the management of the home the Care Homes for Older People Page 27 of 34 Evidence: contracts monitoring team had undertaken a number of visits to the home; the visits included a review of records, observation of practices, obtaining peoples views by surveys and face to face discussions with residents, staff and visitors. An action plan had been devised with senior management to help improve outcomes for the people who live at The Grange. At this visit it was clear that senior management had responded to the concerns raised and had taken prompt and appropriate action; evidence supported that the organisation was open and willing to work with external agencies to improve outcomes for residents. Senior management visited the home regularly each week to monitor the day to day running and to ensure residents and visitors were happy with the care they received. Residents said we are kept up to date with what is going on and things are much better. Staff were happy with the changes and one said things are improving. Peoples views and opinions had been sought as part of an annual survey. The results had been published, an action plan devised and any concerns followed up by the area manager. The results were sent in the form of a letter to residents and their relatives with an action plan; this supported that peoples views and opinions were used to improve the service. There were a number of audit systems in place to check whether peoples needs were being met and whether staff were following safe policies and procedures. The results were used to improve the service. Staff were provided with polices and procedures to support them with all aspects of their work. Policies and procedures were regularly reviewed to ensure they reflected safe and current practice. Resident meetings were held regularly to allow people to air their views and opinions. Residents said they were kept up to date and were able to influence how the home was run. The home sent us their annual quality assurance assessment (AQAA) before the key inspection; this gave us a good picture of what had changed in the last twelve months and where further improvements were needed. The home kept us up to date with any changes that may affect residents well being; this helped us to monitor the day to day management of the home. Residents finances were managed appropriately; clear and accurate records were maintained. Senior management completed regular audits to ensure residents monies Care Homes for Older People Page 28 of 34 Evidence: were safeguarded. Records were secure, up to date and accurate; residents could access their records if they wished. Any shortfalls in record keeping had been referred to under the relevant outcome area of the report. Records showed that systems were serviced regularly and staff received regular training to keep themselves and others safe from harm. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 Care records must reflect 03/05/2010 residents current needs and be updated at the time when their needs had changed. This will ensure they receive the care and attention they need. 2 18 13 All staff must receive training to help them to recognise and respond to abuse and neglect. This will help them to protect residents from abuse and neglect. 30/04/2010 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 7 Residents and their relatives should be involved in the ongoing review of the care plan; this will ensure they are involved in decisions about care and receive the care they both need and want. Care Homes for Older People Page 31 of 34 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 2 9 Staff should obtain permission from the resident or their representative if they are required to manage residents medicines on their behalf. The administration of creams and lotions should be signed by the member of staff who completes the task; this could reduce the risk of errors and omissions being made. Consideration should be given to removing care notices and labels that were displayed in residents bed rooms and on furniture as this does not support that their dignity was respected. Action should be taken to ensure that activities take place as planned and that all residents are involved in suitable activities; this will ensure all residents social needs and expectations are met. The records of meals served should be completed in full; this will support that all residents dietary needs are met. Residents should be offered a choice of snacks at supper time and a record of their choice maintained; this will help to ensure residents dietary needs are met. Areas in need of repair and refurbishment should be improved to ensure residents live in a safe, comfortable and pleasant home. The provision of dining space should be improved to provide sufficient space for all residents at meal times; this will enhance the dining experience and improve residents choices. The cleaning request book should be dated on completion of the task; this will support that requests were responded to promptly. The staff rota should include the full names and role of staff; this will help to make them clearer. There should be at least 50 care staff with a recognised qualification (NVQ or equivalent); this will help staff to understand and meet residents needs. A recent photograph should be provided as part of the recruitment process and attached to staff files as a means of identification. Any negative information disclosed in employment Page 32 of 34 3 9 4 10 5 12 6 7 15 15 8 19 9 20 10 26 11 12 27 28 13 29 14 29 Care Homes for Older People 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 references should be followed up and recorded on file; this would support that the applicant was suitable to care for vulnerable adults. 15 29 References should be followed up verbally to help to determine the authenticity of the information; this would help to improve the recruitment process. The training matrix and individual training plans should be kept up to date and reflect any gaps in the provision of training and the skills and experience of current staff. There should be a manager who is responsible for the day to day management of the home and who is registered by the Care Quality Commission. 16 30 17 32 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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