Care Home: The Old Grange

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What the care home does well There is a welcoming and relaxing atmosphere within the home. The premises are well maintained and clean. Care plans are `person centred` with comprehensive care packages in place to meet the identified needs of people using the service. The staffing levels meet the needs of those living at The Old Grange and they are knowledgeable and dedicated to ensure the needs of the individuals are met. The company have a good structure in place with good auditing processes in ensuring standards are met in the best interest of those using the service. In relation to equality and diversity, the manager has stated in the AQAA that there is an equal opportunity policy which includes race, gender, disability, sexual orientation, age, religion, that are firmly adhered to and staff receive training to ensure that these policies are followed. What has improved since the last inspection? The home has a registered manager now. New format for the care plans has been devised and implemented. Menu has been changed to meet individual`s preferences. Staff have received refresher training including the safe administration of medication. Staff have also received further training in safeguarding adults. What the care home could do better: The home should ensure that staff adheres to the policies and procedures in relation to the management of medicines and infection control. CARE HOME ADULTS 18-65 The Old Grange College Road Cheshunt Herts EN8 9LT Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 13th June 2008 10:00 The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Grange Address College Road Cheshunt Herts EN8 9LT 01707 646567 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Grange Care Services Limited Annette Clarke Care Home 7 Category(ies) of Learning disability (7), Physical disability (3) registration, with number of places The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th June 2007 Brief Description of the Service: Old Grange is a listed building close to Cheshunt town centre and provides care for people with a learning disability. Up to three of those people may also have a physical disability. Fees for the services are £1,200- £1,500 per week. Additional charges are made for newspapers, toiletries etc. (this is correct as at 13/06/08). The home is provided on three floors, the ground floor is able to accommodate up to three people with a physical disability. The middle floor can only accommodate mobile residents. The top floor consists of two self-contained flats that are provided with 24-hour on-call support and additional support as agreed in their contract. Each bedroom is fitted with a telephone socket and a portable telephone is available for the residents. On the ground floor there is a lounge/diner and a separate seating area. The kitchen has lowered worktops to allow all residents to take an active part in the preparation, cooking and serving of meals. Upstairs there is a sleep-in room that has some storage space for staff, a toilet and a shower. The laundry is situated on the first floor and is equipped with a washing machine that has a sluice cycle. A small office is in the ground floor and does not impinge on the residents’ communal space. There is a secluded and secure rear garden that is fully wheelchair accessible and a small car park. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is *2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was carried out on the 13th June 2008 and took one whole day. It included talking to people using the service and staff, examining care plans, staff files, staff training records, fire safety procedures, maintenance records, all other records and documents and a tour of the premises. The home has not completed an Annual Quality Assurance Assessment (AQAA). Although, feedback received from people using the service was brief yet it was very positive (residents were being taken to the day centres at time of the inspection). They said that they are happy with the support they received. One resident said ‘ I like it here and the staff are good’. What the service does well: There is a welcoming and relaxing atmosphere within the home. The premises are well maintained and clean. Care plans are ‘person centred’ with comprehensive care packages in place to meet the identified needs of people using the service. The staffing levels meet the needs of those living at The Old Grange and they are knowledgeable and dedicated to ensure the needs of the individuals are met. The company have a good structure in place with good auditing processes in ensuring standards are met in the best interest of those using the service. In relation to equality and diversity, the manager has stated in the AQAA that there is an equal opportunity policy which includes race, gender, disability, sexual orientation, age, religion, that are firmly adhered to and staff receive training to ensure that these policies are followed. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to use the service can be assured that information about the home would be available to them so that they could make an informed choice and that their assessed needs would be met. EVIDENCE: Information about the home was available to current and prospective individuals including the ‘Statement of Purpose’ and ‘Service User’s Guide’. Care plans examined and information gained from members of staff indicated that individuals were admitted to the home after an assessment of needs has been carried out. As stated in the AQAA, the manager obtains a community care assessment from the social worker that the home assesses and if appropriate a comprehensive assessment is carried out the service. Staff spoken to confirmed that prospective residents, their relatives/friends are always encouraged to visit and to “test drive” the home. If a placement is offered and accepted, the initial visits to the home is followed by a trial period to allow for staff to carry out a full assessment of needs. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their identified needs would be met appropriately and that they would be enabled to live the lifestyle they chose. EVIDENCE: Unfortunately, the residents were getting ready for their day- care activities at the time of the inspection and their views were not sought fully on this occasion, as there were no residents in the care home during the day. Staff spoken to said that they supported the residents in making choices about their clothes, food and activities they wish to do and participate in. Members of staff were observed to interact well with the residents. Care plans examined showed that these were ‘person centred’ and drawn up from a range of sources including individual’s assessment of needs, reports from Social Workers, input from family representatives, staff’s on going assessment during the trial period and contributions from other professional as The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 10 appropriate. Care plans were detailed and comprehensive which reflected the identified needs of people using the service and how these needs were being met. Regular review of individual’s care needs was also carried out and details of their changing needs were reflected in their care plans. Up to date risk assessments were in place covering a wide range of activities. Records regarding the residents are compiled and stored in accordance with the organisation’s written procedures and the Data Protection Act 1998, and in their best interests. As stated in the AQAA, the manager will continue to ensure that the identified needs of clients are met, reviewed regularly and any changes reflected in their care plans. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that they would have opportunities for personal development and enhanced their daily living skills so that they are able to lead as near normal a life as possible. EVIDENCE: Each resident had a weekly day-service timetable detailing their programme of activities. Details of social history, interest and hobbies were reflected in each person’s care plan. Those who are able were actively encouraged to continue with any activity or hobby they were involved in, prior to their admission to the home. This includes attending college, day centre, gardening and communitybased activities such as bowling, cinemas and other leisure and social activities arranged for them during the evenings and weekends. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 12 The home has a vehicle that is used for transporting people to day centres, outdoor activities and appointments etc. A variety of social and recreational activities are facilitated to people using the service including leisure interests. People using the service are encouraged to develop and maintain social, emotional, communication and independent living skills where appropriate. Information gained from staff and examination of care plans and menus indicates that people using the service and their relatives are consulted regarding residents’ culinary likes and dislikes. As stated in the AQAA, the manager will continue to monitor and update as necessary to meet the needs of people using the service. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their personal and healthcare needs would be met appropriately. EVIDENCE: Two residents spoken to during the inspection said that they were being well looked after and cared for. Members of staff were knowledgeable of the residents’ conditions, their likes and dislikes, and delivered care and support accordingly. Individuals received personal and healthcare support using the ‘person centred’ with support provided based upon identified needs including the rights of dignity, privacy, choices and respect. Care plans examined showed that people using the service are registered with a General Practitioner and they are able to see their doctor at the surgery. Healthcare needs were being met by healthcare professionals and a record of their visits was kept as part of the care plan. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 14 The records for ordering, administration, storage and disposal of medicines are kept in good order. However, no records for the temperature where medicines were stored have been kept. All staff who administer medicines have undergone the safe administration and management of medicines training. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their concerns and complaints would be listened to and acted upon and that they would be safeguarded from abuse, neglect and harm. EVIDENCE: A complaints procedure was available to people using the service and also included in the ‘Service user’s Guide’. Two complaints were received since the last inspection and both were dealt with in accordance with the home’s procedure. The home has a copy of the Hertfordshire procedures on safeguarding adults. Staff spoken to confirmed that they are familiar with the procedures and staff records showed that they have received training on the safeguarding adults. An element of adult protection is also covered in the induction programme for all new staff members and staff who have completed their NVQ assessments. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are cared for in an environment that is homely, comfortable and safe. EVIDENCE: The home was well maintained and furnished in a domestic style to provide a very homely, comfortable and safe environment. All bedrooms viewed were painted in different colours chosen by individual residents and personalised to reflect the tastes of the occupants with pictures and personal belongings displayed in their individual room. However, it was noted that there were loose floor tiles in the shower in bedroom 2 that should be made safe. A good standard of cleanliness was evident throughout those areas viewed. Food items were appropriately stored in fridges and temperatures, recorded daily. The home has an infection control policy and procedures in place and staff encourage residents to follow good hygiene practice. Staff members The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 17 spoken to are conversant with infection control procedures. However, facilities for hand washing and drying was not provided in the laundry room so as to prevent the spread of infection. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service do benefit from the care and support they receive from a competent and qualified staff team and that they feel protected by the home’s recruitment policy and practices. EVIDENCE: Information gained from duty roster and staff members provides evidence that the day and night staffing levels remain adequate to meet the needs of current residents. Staff members have the necessary skills and they receive appropriate training to meet the varying needs of people using the service. Staff spoken with indicated that they have opportunities for relevant training and this gives them greater confidence to do their jobs. Staff were knowledgeable about the needs of individuals whom they were supporting and caring for. Currently, 3 care staff have completed their NVQ Level 2, one Level 3 and 2 Level 4. One staff has completed the Diploma in Social care. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 19 The procedures for the recruitment of staff were found to be robust. The recruitment files for 6 members of staff were examined. These were found to be in good order. All had received the induction programme; the mandatory training and had their CRB checks carried out prior to an offer of employment was made. Staff spoken to confirmed that they received one to one formal supervision on a regular basis. Supervision records were maintained. Staff also confirmed that they received support from the management team and that senior members of staff were approachable and available for advice as and when needed. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their health, safety and welfare are protected by the systems and practices in place and the support they receive from a dedicated staff team. EVIDENCE: The manager is now registered with the Commission. The home is well managed and staff spoken to confirmed that the manager is approachable and they are bale to raise any issues or concerns they may have. The effective implementation of a number of systems including assessment and admission process, care planning and review, consultation and communication, recruitment, induction, training, supervision and appraisal of staff ensures that the home operates in an efficient manner; this clearly The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 21 benefits people using the service and the staff teams. The home has a quality assurance system in place and seek the views of people using the service, relatives, staff and other interested parties. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of people using the service and staff are promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. CSCI has been kept informed of all accidents and admissions to hospital. A valid insurance certificate (expires on 17/07/08) was displayed in the office and this offered cover of no less than £5 million. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. YA30 Refer to Standard YA20 YA24 Good Practice Recommendations A record of the temperature where medicines are stored should be kept. Loose floor tiles in the shower in bedroom 2 should be made safe. Facilities for hand washing and hand paper towels should be provided in the laundry room so as to control the spread of infection. The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Grange DS0000064341.V366461.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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