We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The Grange Care Home 22 Cornwallis Avenue, Folkestone, CT19 5JB Tel: Date of Inspection: 23 January 2014 Date of Publication: February 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Meeting nutritional needs Staffing Complaints Inspection Report The Grange Care Home February

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Ashwood Court Health Care Limited Mrs. Carol Weeks The Grange Care Home provides accommodation and personal care for up to 28 older people. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report The Grange Care Home February

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Meeting nutritional needs 10 Staffing 12 Complaints 14 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report The Grange Care Home February

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 23 January 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. What people told us and what we found At the time of our inspection, there were 27 people who lived at the home. We spoke with five people who lived there, seven visiting relatives, three staff and the manager. People we spoke with who lived at the home told us that they were happy with the care and support they received. One person said "I would recommend this place to anybody". Another person said "I have been ever so happy here". A visitor commented "I am happy with the care, definitely". People told us that they were supported to make their own day-to-day decisions and were involved in how their care and support was provided. We found that care plans contained details about people's daily routines, their care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who lived in the home. We found that people enjoyed the food and were able to make choices about the meals they received. Staff were aware of people's dietary needs and helped to ensure people were protected from the risks of inadequate nutrition and dehydration. One person told us "the food is lovely" and a visitor told us "the food is really good". We found that there were enough suitably trained staff to support people's needs. One person we spoke with who lived in the home told us "the staff are good to you; nothing's too much trouble, they're wonderful". The home had a complaints policy and a procedure that was followed to enable the manager to respond and address complaints in a timely way. In this report, the name of the registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name Inspection Report The Grange Care Home February

5 appears because they were still registered with us at the time of our inspection. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report The Grange Care Home February

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement People expressed their views and were involved in making decisions about their care, treatment and support. We spoke with people who lived in the home and they told us that they made choices about their daily routines and were asked by the staff about their preferences. For example, what they wanted to wear, what they would like to eat and what time they got up and went to bed. One person told us "I am an early riser, but I could have a lay-in if I wanted to; I please myself about when I go to bed". We saw care records that identified people's individual preferences about their daily routines. For example, records showed that one person liked to be assisted to the communal lounge every morning after getting ready for the day, as they enjoyed socialising with others. We observed that staff ensured this happened on the day of our inspection and the person's daily records confirmed this happened most days. We spoke with a visitor, who told us that they were involved in, and consulted about their relative's care and support needs. They told us that the manager had visited prior to their relative moving into the home and "went through everything" with them and that they were given information about the home. Another relative we spoke with told us that "staff do appear to involve people in things whenever they can". Records showed that the staff communicated regularly with people's families and/or their representatives. For example, we saw that conversations had been recorded with a person's relative about their reduced appetite and actions agreed with them about how to encourage the person to eat more at mealtimes. We saw that there was a choice of menu at mealtimes and people told us that they were asked what they wanted to eat each day. One person said "the food is lovely; they know what I like". We saw that the lunch time meal was served in the dining room, where people sat together in small sociable groups, choosing their own company. For example, one person told us that they enjoyed socialising at the lunch table with the same group of Inspection Report The Grange Care Home February

7 people, where they often had a glass of wine together. We saw that staff served their lunch and offered them wine or beer to enjoy with their food. We saw that other people chose to eat in their rooms if they wished to. People told us that they were able to choose how to spend their time. For example, we saw that some people were socialising together in the shared lounge areas, whilst others were spending time in their rooms. Some people told us that they preferred to stay in their rooms enjoying their own interests, such as reading the newspaper, watching television, or enjoying visits from family and friends. Other people told us that they enjoyed a range of interests and frequently joined in the entertainment available in the home, including bingo, keep fit exercises and visits from musical entertainers and singers. People told us that regular parties also took place in the home, where families and friends were invited to celebrate special occasions, such as birthday parties and Christmas celebrations. We saw that people's rooms were personalised, containing photos, pictures and many soft furnishings and possessions that people liked to have around them. We saw that some people had brought in some of their own furniture when they had moved into the home. People were supported in promoting their independence. For example, we saw that care records identified where people were able to undertake aspects of their own personal care and were supported to do things for themselves wherever possible. Some people told us that they were able to undertake some aspects of their own personal care, with the staff providing support only where it was needed. For example, one person said "I wash myself and make my own bed each day; I have help where needed, when I have a bath". We spoke with staff, who knew the needs and preferences of the people they supported. One member of staff told us "I encourage people to do what they can themselves". People's diversity, values and human rights were respected. We saw that staff knocked on people's bedroom doors before entering and were respectful in how they addressed and spoke with them. People told us that staff spoke to them in a respectful way and we saw that where people required help and support, staff assisted them in a sensitive and dignified manner. Inspection Report The Grange Care Home February

8 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at three people's care records and saw that their needs were assessed prior to their admission to the home. Assessment visits were undertaken by senior staff to ensure that people's needs could be met. This information was used to develop individual care plans that included details about people's specific needs. The manager told us that new care plan documents were being introduced that would provide a more personalised approach and we saw one person's care plan that had been developed using the new template, although we saw that the information had not been recently reviewed to ensure the person's needs were accurately reflected. We also saw that there were gaps in some people's monthly weight monitoring charts during 2013, which meant that any changes or fluctuations in people's weight had not been identified. However, senior staff told us that a new system had been introduced to ensure that this was addressed and we saw that a procedure had been implemented, and that weight charts had been completed in people's care plans during January We spoke with staff who told us that they followed people's care plans to help them meet the needs of the people they supported. This meant that staff knew how to provide the care and support that each person required. We saw that daily records were used by the staff to monitor and comment on people's day-to-day experiences and their wellbeing. For example, they included details about people's personal care, their dietary intake, and daily routines and activities that they had participated in. We saw that care records contained details of visits from health care professionals, such as doctors, community nurses, dentists and opticians. Records showed that staff reported and responded when people required health care support. For example, one person's records showed that they had become unwell with a raised temperature. Staff had requested a visit from the doctor, who had prescribed medicines to treat a chest infection. We spoke with a visiting relative who told us that the staff were "very good at getting the doctor or nurse in when needed". Some people had specific health care needs that required regular input from community health care professionals such as dieticians, clinical nurses, and speech and language therapists, where a separate clinical care plan was kept by the clinicians involved with their care. However, the provider may find it useful to note Inspection Report The Grange Care Home February

9 that it was not always apparent that separate clinical records were in place. This meant that some people's care records that were maintained by the home appeared incomplete, as no reference was made to the records that were being kept for clinical purposes. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that care plans contained individual risk assessments where specific risks had been identified and guidance recorded for staff to follow. For example, this included people's mobility and the prevention of falls. We observed that some people were accompanied and escorted by staff when moving about the home using their walking aids, and we saw that this was reflected in their mobility risk assessments as the required procedure for staff to follow. Records showed that people were able to undertake activities that met their emotional and social needs. We saw that activities, entertainment and events were arranged for people to participate in if they wished and the dates and information were displayed on the lounge noticeboard. This included visiting entertainers, regular visits from an exercise therapist as well as a reminiscence therapy group, although on the day of our inspection, we did not observe any pre-arranged activities being undertaken in the home. During our inspection, we met the vicar from the local church who attended regularly at the home to conduct religious observance for people who wished to participate. Records showed that many people enjoyed the company of visitors and that some people regularly went out with their relatives and friends. During our inspection we saw many visitors in the home. The manager told us that people liked to use the garden and outside space in warmer weather and we saw that the garden was easily accessible and provided safe and secluded areas for people to enjoy. There were arrangements in place to deal with foreseeable emergencies. We saw that oncall emergency contact details were available, which meant that staff could contact management or senior staff, should an emergency arise where they required additional support. The staff we spoke with had an understanding of their responsibilities under the requirements of the Mental Capacity Act 2005 and had undertaken relevant training. Records showed that people were supported to make their own decisions on a day-to-day basis. The manager told us that advocacy support would be made available if people required independent support with decision making, for example, where significant decisions might need to be made. Meetings would be arranged to include the person's care manager and family representatives, to ensure their best interests were considered and their rights protected. Inspection Report The Grange Care Home February

10 Meeting nutritional needs Food and drink should meet people's individual dietary needs Our judgement The provider was meeting this standard. People were protected from the risks of inadequate nutrition and dehydration. Reasons for our judgement People were provided with a choice of suitable and nutritious food and drink. People told us that they enjoyed the food, that there were menu choices available and an alternative would be provided if requested. People's comments included "the food is wonderful" and "they know what I like" and "they do a good job; nice steak and kidney yesterday". Records showed that there were two hot meal choices available at lunch-times and that people had been consulted about their menu choices. We spoke with the catering staff and they told us that they were aware of people's likes and dislikes and we saw that the lunch-time meal had been prepared according to people's choices. They were also aware of the various dietary needs of people in the home and they told us how special diets were accommodated. For example, soft or pureed diets and low sugar diets for people with diabetes. They told us about one person who was a vegetarian and we saw that they had adapted the lunch-time meal to accommodate their requirements. People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed the lunch-time meal in the dining room and saw that staff were attentive, continually checking to see if anyone required assistance and to make sure people were enjoying their meals. Staff asked people if they wanted more to eat and drink and we saw that a variety of cold drinks were being offered throughout the meal to accommodate people's preferences, such as orange squash, blackcurrant and water. We saw that people were given plenty of time to eat independently and staff were available to encourage, supervise and assist if required. Some people required encouragement and supervision throughout their meals as they had swallowing difficulties, which meant that they needed to take their time when eating. We saw that staff were patient, did not rush and ensured that only small quantities of food were eaten at a time. We saw that some people were provided with deeper plates or plate guards, whilst others required their food to be cut up by the staff to assist them to eat independently. We saw that people remained in the dining room until they were ready to leave, as many were enjoying their meal as a social occasion. During our inspection we saw that people were provided with hot and cold drinks regularly throughout the day, accompanied by light snacks such as biscuits and fruit between their main meals. Inspection Report The Grange Care Home February

11 We looked at care records and saw that nutritional assessments had been undertaken where people had specific nutritional needs, for example, risks associated with poor appetite, concerns about people's weight, or any food allergies. One person's care records showed that their assessment had identified risks associated with swallowing difficulties and concerns about their poor appetite and weight loss. Their weight had been regularly monitored, and staff had discussed their concerns with the community nurse. A nutritional care plan had been put in place for staff to follow and a referral made to the speech and language therapist, who had reviewed the care plan and prescribed food supplements and thickening agents to be put in their drinks. We saw that records included details about people's dietary likes and dislikes so that staff became aware of people's preferences. Records also showed where people required assistance or encouragement from staff at meal times and the staff we spoke with were aware of how to support people's nutritional needs. For example, they explained that some people who had reduced appetites preferred smaller portions on their plates, as they were sometimes put off eating their meal if they felt unable to cope with larger quantities of food. Inspection Report The Grange Care Home February

12 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement At the time of our inspection, there were enough qualified, skilled and experienced staff to meet people's needs. We were told by the manager that the home employed permanent staff and that gaps in the staffing rota, due to unplanned absence, were covered by staff employed by the home. This meant that people were supported by staff they knew and who were familiar with their needs. The home employed care staff, domestic cleaning and catering staff, and a maintenance person. There was a manager and deputy manager, who were both 'acting' in their roles, pending recruitment by the provider. We looked at the staffing rota and saw that there were four care staff on duty in the morning and three care staff on duty in the afternoon, as well as the manager and deputy manager who were both available during the day time. At night time there were two care staff on duty and on-call telephone contact arrangements were in place, should the manager or provider be required for additional support. The manager told us that staffing was allocated according to the needs of the people who used the service. For example, if people were unwell and their needs increased, additional staff would be called in to assist. At the time of our inspection, we saw that an additional member of staff had been allocated to the rota to cover additional duties. We spoke with people who used the service, as well as some visitors, who told us that they felt there were enough staff on duty. People said that staff responded promptly when they called for assistance. One person told us "the staff are good, great; they are there when needed". Another person said "the staff come when called; I use my buzzer". During our inspection, we observed that staff spent time with people and were available when people required assistance. We saw that when staff were assisting people, they were not rushed and people were able to take their time, and to do things at their own pace. Staff we spoke with said that they felt there were enough staff on each shift and that they had sufficient time to support people according to their needs. One member of staff told us that they had rarely been short staffed and said "staffing levels are fine; very few staff go sick". Another member of staff said they felt that the provider would increase staffing levels if needed and that the staffing rota "takes account of people's needs". A senior member of staff told us that the provider responded to any concerns raised about staffing Inspection Report The Grange Care Home February

13 levels and that the rota had been increased when people's needs had changed. Staff told us that they had received essential training and were supported to achieve formal qualifications in care. They said that they felt they had the skills required to support people appropriately. Inspection Report The Grange Care Home February

14 Complaints People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Reasons for our judgement The home had a written complaints policy and we saw that the complaints procedure was very clear, containing details of who to contact and the timescales for responding to complaints and what to do if the complainant remained dissatisfied. The procedure was included in the home's brochure and 'statement of purpose' document that was shared with people on admission to the home. The people we spoke with who used the service told us that they had no complaints but knew who to speak to if they wanted to complain. One person told us they would go to the staff and felt "they would sort it out". A relative told us they would be comfortable talking to the manager or any of the staff as they were "approachable". Another person told us that on one occasion they had needed to speak to the manager about some clothing that had been damaged in the laundry and that it had been addressed appropriately. The manager told us that people and their relatives were given opportunities to raise concerns or issues. We saw that quality assurance questionnaires were used to gather comments that could be fed-back to the provider. We saw that the questionnaires were readily available for people to complete. The manager told us that annual surveys were also conducted, although the latest survey results were unavailable at the time of our inspection. We saw information and details of an advocacy service displayed on the noticeboard in the lounge and the manager told us that people would be supported to make a complaint if this was required. People had their comments and complaints listened to and these would be fully investigated and resolved where possible, to people's satisfaction. We looked at the home's complaints folder and saw that a complaints form had been recently introduced to record all complaints received, the actions taken and the outcomes. At the time of our inspection, we saw that there had been one formal complaint received and that it had been addressed in accordance with the home's complaints procedure and concluded to the complainant's satisfaction. The staff we spoke with told us that they knew how to respond to complaints that people raised with them and would know how and who to report concerns, comments or Inspection Report The Grange Care Home February

15 complaints to. Inspection Report The Grange Care Home February

16 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report The Grange Care Home February

17 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report The Grange Care Home February

18 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report The Grange Care Home February

19 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report The Grange Care Home February

20 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report The Grange Care Home February

21 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report The Grange Care Home February

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