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Inspection on 13/05/09 for Abbey Grange Nursing Home

Also see our care home review for Abbey Grange Nursing Home for more information

This inspection was carried out on 13th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and provider have stared to work better with the Sheffield Local Authority to make inprovements that will give people better and safer care. Care plans included information such as health care needs, falls and risk assessments. The home recognise they have further improvements to make on care plans. The service has an activities co-ordinator and planned activities throughout the week. People receive support to follow their faith and cultural preferences. People looked comfortable with cusions, footstools and blankets. A person who lives at the home tols us staff were `very gentle` when moving them. There is a good choice of food at Abbey Grange. Abbey Grange had a complaints procedure, which people could use to raise concerns. The home had redecorated and refurbished some areas of Abbey Grange. Most staff had a National Vocational Qualification in care, which means they understand good care practice principles. The manager had good experience and qualifications to manage the home.

What has improved since the last inspection?

Following the concerns which have occurred since the last inspection, the manager and provider have put together an action plan to improve people`s health, welfare and safety. Their action plan includes improvements in the following areas: prevention of falls, pressure care, relationships with visiting professionals, safe guarding procedures, staff supervisions, managers and staff accountability, medication and diet charts. Abbey Grange have also brought more staff up to date in training, so they understand how to care for people and keep them safe. The manager has restructured staff teams to help improve standards at the home.

What the care home could do better:

Improve people`s needs assessments, review them regularly and keep them up to date. Continue to improve the standard of people`s care plans, and include information about people`s privacy, dignity, cultural and mental health needs. Make sure care plans have clear nutritional guidance, so that staff know what people`s nutritional needs are. Improve medication practices so the medication support people receive is safe. Give people better respect and dignity when supporting them to eat their meals, and make sure people are supported to sit in dignified and comfortable places in communal rooms. Monitor staff better and take action when staff act action fail to maintain peoples dignity and respect. Staff need to respond better when someone asks them for a drink. Make sure information is available for managers and staff to follow safeguarding procedures and guidance. Make sure the home is kept hygienic to prevent people getting infections. Make sure offensive odours are eliminated so people can live in pleasant and dignified surroundings. Follow good recruitment practices to help make sure they employ the right staff to care for people. Continue to improve quality assurance checks so people get safe and appropriate care.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey Grange Nursing Home Cammel Road Firth Park Sheffield South Yorkshire S5 6UU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Hall     Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Abbey Grange Nursing Home Cammel Road Firth Park Sheffield South Yorkshire S5 6UU 01142560046 01142617962 abbey.grange@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Larongrove Limited care home 87 Number of places (if applicable): Under 65 Over 65 37 50 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Abbey Grange is a care home providing personal care and nursing care. Accommodation is provided for 88 service users. The home is owned by Larangrove Limited and is situated in the Firvale area near to the Northern General hospital a short walk away from the main bus route to the town centre. The nearest shopping area is situated at Firvale. The home is a converted property with extensions, accommodation is provided on three floors that are accessed by a lift. The original property has been extended to provide 88 beds for nursing and personal care with 66 single and 11 double bedrooms. The grounds are accessible and well laid out, the garden sitting areas are attractive and well maintained. The previous inspection report was made available to service users and their families, Care Homes for Older People Page 4 of 35 Brief description of the care home details of this was on the homes notice board. The manager confirmed that as of April 2009 Abbey Grange fees ranged from £327 to £361 for residential care, £479 for nursing care including nursing care component, and £369 for EMI (Elderly mentally Infirm) care per week. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Care Homes for Older People Page 5 of 35 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: one star adequate 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: We carried out our last key inspection on 17 June 2007. We inspected the home on 13 and 14 May 2009. We called unannounced, two inspectors, one enforcement inspector and a pharmacy inspector carried out this inspection. This was because we had received information about safeguarding referrals; therefore we wanted to check peoples experiences in the home. We spoke to people who live at Abbey Grange, staff, managers, relatives and visiting professionals. We asked them their views about what it was like to live at the home. We also observed peoples care, and how staff interact with people. We looked at the environment and checked some records, so that we could see how Care Homes for Older People Page 6 of 35 safe and well maintained the home was. Before our visit we looked at information we have received about the home since its last inspection. This included the homes annual quality assurance assessment, where the home tells us what has happened over the past 12 months. We also looked at information the home had notified us about, such as complaints, accidents, and safeguarding information. And we looked at what other people, with an interest in the service, told us. We sent out surveys to people who live at the home, staff and professional visitors. We received two surveys back completed by relatives. We talked to the manager about how she was running the home, managing staff and maintaining safety. We gave some feedback about our findings to the manager before we left. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Following the concerns which have occurred since the last inspection, the manager and provider have put together an action plan to improve peoples health, welfare and safety. Their action plan includes improvements in the following areas: prevention of falls, pressure care, relationships with visiting professionals, safe guarding procedures, staff supervisions, managers and staff accountability, medication and diet charts. Abbey Grange have also brought more staff up to date in training, so they understand how to care for people and keep them safe. The manager has restructured staff teams to help improve standards at the home. Care Homes for Older People Page 8 of 35 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 set out 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 Care Homes for Older People Page 9 of 35 7535. Care Homes for Older People Page 10 of 35 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 11 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience poor outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Some people did not have suitable assessments for the home to understand their existing and changing health and social care needs. The home had an action plan in place to start to address this. Evidence: Prior to our inspection visit Sheffield Local Authority had identified that Abbey Grange had not kept up to date with reassessing peoples needs, they were providing support and guidance to the home about this. Sheffield Local Authority had carried out seven needs assessments with individuals. As a result the local authority identified these people needed alternative care placements. Care Homes for Older People Page 12 of 35 Evidence: They planned to carry out a further five assessments. The manager had agreed to do an action plan to improve the way the home manages records; assessments were part of this improvement plan. The manager supplied us with a copy of someones care plan. This did not contain a needs assessment; this means there was insufficient information to make sure staff understand peoples personal and health care needs. The home did not provide intermediate care so we did not assess this standard. Care Homes for Older People Page 13 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area. This judgment has been made using available evidence, including a visit to this service. People have their needs set out in an individual plan, this needs to improve further to meet peoples individual, mental health and diverse needs. People have their health care needs met, this has improved, and the home is following an action plan to improve relationships with health care visitors. The homes medication practices do not protect peoples health, safety and welfare. Evidence: Following a safeguarding investigation and re-assessments of some peoples needs, Sheffield Local Authority had identified that Abbey Grange needs to improve how they record peoples needs and care outcomes, and how staff deliver care. Care Homes for Older People Page 14 of 35 Evidence: The local authority were working with the manager and staff to improve the care plans, record keeping, relationships with visiting professionals, and the standards of care delivered to people. It was part of the homes improvement action plan to make sure documents are complete, updated, reviewed regularly, reflect peoples changing needs, and make reference to health professionals visits and advice. We looked at two care plans; they contained information about health and personal care needs, and risk assessments such as falls and using bedside rails. We could see the home has started to make improvements. There was insufficient evidence about one persons dietary needs. For example the record said the person had a diabetic and normal diet, but it did not explain what this meant or what the persons preferences were. However, a further record contained information instructing staff to encourage someone to eat, this was good practice and there was a clear record of review when the persons needs changed. One plan showed good evidence that the person had access to health care services, and that staff monitor their condition well. For example, it showed records relating to access to tissue viability nurses; and showed consistent recording on fluid intake charts. Most of the care plans were pre-populated suggesting the plan applied to all people at the home. This is not good practice because it does not create a care plan designed to meet someones individual needs and preferences. There was insufficient information relating to peoples privacy, dignity, cultural and mental health needs. This means people may not receive the individual care they need. Sheffield Local Authority raised concerns about the number of falls people had at Abbey Grange. This was part of the safeguarding process and the manager had put an action plan together on falls management and prevention. Relationships between staff at the home and district nursing staff had broken down; this created a dangerous situation for people living at the home. Sheffield Local Authority, District Nursing Services and the manager had agreed an action plan to resolve this, the manager reported that this situation had improved. Some medicines are not stored securely enough and they may not all be stored at the correct temperatures. All medicines must be stored securely at temperatures and conditions recommended by the manufacturer so that staff know they are safe to use Care Homes for Older People Page 15 of 35 Evidence: when needed. Administration gaps on the MAR charts mean it isnt possible to be sure that people living in the home are always given their prescribed medicines correctly. Handwritten entries of medicines seen on MAR charts are not sufficiently clear or detailed enough to be sure that other staff would always follow the prescribers instructions consistently. The quantity of medication brought forward from one monthly cycle to another is not always recorded on the new MAR chart. This means it is not possible to produce a complete record of medication within the home and to check if medication is being given correctly. Monthly prescriptions are currently seen and checked by senior staff before the medicines are supplied. This good practice provides an opportunity to check if any new medicines or dose changes have been added. Individual medication care plans should be developed to reflect the personal preferences and lifestyle choices of people living in the home. For example, daily medication giving times should be adjusted for anyone who prefers not to get up and have breakfast until later in the morning. Clear information should be recorded in each persons care plan to guide staff when giving those medicines labeled when required to ensure the prescribers intentions are carried out correctly. The medication procedures should be revised to reflect current best practice guidance. The Royal Pharmaceutical Society of Great Britain and Care Quality Commission professional advice documents on handling medicines in social care should be made available. Robust procedures and up to date guidance mean that staff working in the home fully understand what is expected of them when handling and giving medication. Care Homes for Older People Page 16 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area. This judgment has been made using available evidence, including a visit to this service. People are able to enjoy some social activities, these needs to improve to better meet peoples expectations and social needs. Not all people living at the home receive care and attention in a dignified and respectful manner. Some people receive support to have meals and drinks in an undignified and disrespectful manner. Evidence: The homes notice board displayed a variety of activities on different days of the week. for example, games, bingo, church service, reminiscence, gentle exercise, quiz, coffee morning and film afternoon. We spoke to the activities coordinator, she told us people preferred activities in the afternoon. The coordinator was not able to give us a clear account of what activities were planned for the day. Care Homes for Older People Page 17 of 35 Evidence: The activities coordinator was responsible for escorting people to hospital, the manager should monitor this to make sure this arrangement does not disrupt peoples planned daily activities. A church visitor completed one of our surveys and said,Every month we are welcomed to lead the church service; it runs very smoothly thanks to the efforts of the day-care coordinator and it is well attended. We spent some time observing how people spent their day and what mealtimes were like. We saw a mixture of good caring practices, and poor practice that did not respect peoples dignity. We saw people walking around the home freely. This demonstrated that people could move around the home as they wished promoting dignity and choice. Abbey Grange offers care to people who have dementia; we noticed some things that would be difficult for people to maintain reality orientation, and they did not promote peoples dignity, for example a very small sign stating the day was Wednesday, blank door boards, and staff instructions about laundry pinned on peoples wardrobes. We observed a lady in an easy chair, rug on her knee, and feet resting on stool, she was sleeping and looked comfortable. One person described staff, when they used the hoist, as very gentle with me; she told us she was not able to get out of bed but that the staff come when she calls. We watched three people return to the lounge in wheelchairs; they sat in these waiting to be transferred into their easy chairs, staff had left them facing the chairs, with their backs to the television. We alerted the manager because she walked past without noticing. We also noticed people sat in the lounge, their chairs with the backs to the wall, a carer sat with them but he faced the television in a dining room chair which had been placed so he had his back and side to people, this prevented any social engagement. The staff flicked through the television programs with the remote control, he looked oblivious to the people sat there and did not include them in what he was doing. One person told us the food was alright but the chips were always hard, however; there was a good choice of food. Another person told us the meals are really lovely with good choice and staff are very good and caring. Care Homes for Older People Page 18 of 35 Evidence: We saw one person ask for a drink from 10:15 am until 11 am. He asked four different staff who were dismissive or said in a minute. He waited 45 minutes until the inspector alerted the manager. One member of staff assisted a person to eat, she was stood over the person him spooning his pudding into his mouth. This is poor practice, it does not help people who need support to eat in a discreet and dignified way. When the staff put on disposable gloves plastic gloves to help clean the persons mouth, this was good hygienic practice, however; the staff then continued to wear while helping the person with the rest of their meal. Again this was undignified and disrespectful toward the person. We noted some good practices in the rest of the home, with regards to giving people food and drinks. Care Homes for Older People Page 19 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area. This judgment has been made using available evidence, including a visit to this service. People have lived in a home which has not safeguarded them from harm and abuse. However the home has demonstrated improvements to better safeguard people. Evidence: The homes AQAA (Annual Quality Assurance Assessment) told us that the home responds to all complaints within 28 days. They have introduced a liaison officer to support people and staff to make a more open and stable environment. They have received two complains and have resolved both of these. They have spoken to people who live at the home, and handed them leaflets about abuse and their rights. One person responded to us in a survey and said they had previously not been happy about staff levels, training, some staff attitudes, and the condition of the homes environment. The said they felt the home only sometimes met their family members needs. However, they said they knew how to complain and had done so on several occasions to the manager. We carried out this inspection because the home had six people in the safeguarding process; the local authority had raised concerns about how well the home was keeping people safe from harm and abuse. Care Homes for Older People Page 20 of 35 Evidence: We wanted to look at peoples safety and welfare. The manager and provider were working with Sheffield local authority to improve adult protection standards at the home. We had concerns about the number and nature of the referrals, and the homes initial response and understanding about these. However, when we visited we saw evidence that the providers and manager had started to improve their systems and the way they safeguard people. For example, the manager put together an action plan and followed disciplinary procedures for some staff. Prior to our inspection Sheffield Local Authority identified a number of safeguarding concerns, this resulted in taking six people through the safeguarding processes in order to protect them. Both the home and Sheffield Local Authority shared information with us about this. The Local Authority moved some incidents into the serious incident process and suspended new placements at Abbey Grange until they could see improvements that made people safer. Sheffield Local Authority required the providers, Laron Grove, to put an action plan together about how they would improve peoples safety at the home. This included improving district nurse relationships, prevention of falls, accountability and record keeping, safeguarding adults, pressure care, staff supervisions, medication and diet charts. Sheffield Local Authority continues to monitor the homes progress with these improvements. As a response to allegations of poor practices that put people at risk, the manager had put in place disciplinary procedures for some staff. This resulted in some staff changes and improvements. This shows the manager took appropriate action to safeguard people. We spoke to a member of staff with senior responsibility; she had no knowledge about her responsibilities toward reporting safeguarding incident. The home did not have a copy of South Yorkshires Joint Adult Protection procedures. Considering the homes involvement at present with safeguarding processes this is poor practice as staff and managers will not be able to check information, contacts and processes. This fails to protect people from harm and abuse. Care Homes for Older People Page 21 of 35 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. People who use the service experience adequate outcomes in this area. This judgment has been made using available evidence, including a visit to this service. In the main people live in safe and comfortable surroundings. However, Abbey Grange need to give better attention to hygiene and unpleasant odours so that people can enjoy a clean, dignified and pleasant environment. Evidence: The homes AQAA (Annual Quality Assurance Assessment) told us they had undertaken a large re-decoration program, and they had consulted with people about the process. One relative told us trays used for food are left dirty with spillages on, and their family members room was not always clean and tidy, with no attention to detail. Another member told us they were not happy about their family members chair because the lever did not work and the person kept slipping down it, they did confirm however, that a new chair was on order. We checked some areas of the premises and found people looked comfortable, with footstools, bedding and bedsides for comfort and safety. People had personalised their Care Homes for Older People Page 22 of 35 Evidence: rooms to their taste. We found a footstool dirty with food stained and debris; these were not fresh spills and stains. Two beds were in poor condition; they had stains and marks on them. Bedroom doors had locks on them which could not be opened from the outside. This means staff could be prevented from accessing someone who needed urgent attention. Toilets had a bad odour with bins supplied by the toilets for used incontinence wear. This contributed to the odour. It was both unpleasant and undignified for people who had to use the rooms. One toilet had a fan fixed to the ceiling but it was out of order. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area. This judgment has been made using available evidence, including a visit to this service. People could be put at risk because the recruitment records are not sufficient to show the home has carried out full staff checks. People have now started to receive safer and better quality, care because the home has taken positive action to improve staff training. Evidence: The homes AQAA (Annual Quality Assurance Assessment) told us that out of 40 permanent care workers 36 had an National Vocational qualification in care at level 2 or above; and all staff had completed an induction in line with Skills for care Standards. Three new staff are in the process of completing this. This is good practice because it enables staff to have basic care skills and knowledge to promote peoples care needs and welfare. We looked at three staff recruitment files to check that the home followed the right procedures to keep people safe by employing the right staff. Care Homes for Older People Page 24 of 35 Evidence: We found that in the main the records contained all the information needed. However, we found two references without dates, this means that we could not be sure they were authentic. Two files did not contain sufficient information to demonstrate the staff had received full Criminal Record Bureau checks. This means the manager could not demonstrate that all staff working at the home had had the right checks to make sure they were suitable. As an outcome of raised concerns from the Sheffield Local Authority, and adult safeguarding processes, the home had worked towards reducing the number of staff that needed update training. When we visited we found most staff had received this, and where they had not we found evidence training was booked in for the near future. The manager had also liaised with Sheffield Local Authority and health Authority to access the most appropriate training. The homes action plan included specific training for staff teams or leaders, such as safeguarding adults, moving and handling, tissue viability, falls and medication. Some of this had already started, however, in order to continue better arrangement for safeguarding people and delivering good care practices the home needs to continue focusing on this area. Care Homes for Older People Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area. This judgment has been made using available evidence, including a visit to this service. Managing the home in the best interests of people who live there has started to improve. However, quality assurance systems need to improve further to enable people to receive safe and consistent care. Evidence: The manager had managed the home for over two years, she told us she was a registered nurse with Registered Managers Award and a national Vocational qualification in management at level 4. This demonstrated the manager had the right experience and qualifications to manage the home. Following the homes action to improve standards of care for people at Abbey Grange; the manager had reviewed the staffing structure and carried out some staff Care Homes for Older People Page 26 of 35 Evidence: disciplinaries. The staffing structure review included clearer lines of responsibility and accountability in order to improve the management of the home. One staff told us, as a result of this, they enjoyed their job better, it was less stressful, and staff received more leadership. Quality assurance systems had started to improve as a result of the manager and providers responding to Sheffield Local Authorities instructions to improve standards and make the home a safer place for people to live. Sheffield Local Authority reported a positive turn-around in attitude from the manager and providers regarding safeguarding people and providing better standards of care. We have found evidence that the home has taken the situation seriously and put some good measures in place to improves peoples lives at Abbey Grange. This includes an action plan, improved record keeping, safer falls and pressure care management, improved staff management and training, and safer responses to safeguarding people. Whilst we acknowledge the home has started to improve some of the systems, there is still a lot of work to do to make standards at the home satisfactory; we have highlighted these throughout this report under the relevant standards. It is important these improvements continue and that the manager receives good support from the providers. We looked at two regulation 26 reports, (these are reports we require registered providers to carry out to demonstrate they are monitoring the service). The reports contained insufficient detail; they did not address the issues raised in recent events and did not contain action about how to improve on their findings. For example, part of one report stated staff files seen x2); however, it did not identify if these were in order or needed to improve. We checked how the home support people who need help with managing their finances. One person did not have access to their finances and therefire could not pay their fees. This could put their accommodation at the home at risk, however, the manager had referred this to Sheffield safeguarding, which was the appropriate action to take in order to safeguard the person. For people who receive support from the home to manage their finances the homes bank statements show a record of their personal allowances. However, their monies are held in the companys business accounts and people do not get accrued interest on their own money. This does not promote peoples rights and best interests. We made some observations on safe working practices such as moving and handling, we found staff followed correct procedures. Care Homes for Older People Page 27 of 35 Evidence: When we visited one person in their bedroom the staff had left the call alarm out of reach, leaving the person without communication if they needed help. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 23 The damaged decoration and 31/12/2007 furniture must be replaced or repaired. Original timescale for action 01/01/07, 27/02/07 Care Homes for Older People Page 29 of 35 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 3 14 The home must ensure people have their needs assessed before being admitted to the home, and must keep the assessments under review. So that people know the service can meet their personal and health care needs. 30/09/2009 2 9 13 Arrangements must be 31/08/2009 made to ensure that medication administration records (MARs) are accurately maintained; that the reasons for nonadministration of medicines are recorded by the timely entry of an appropriate code or entry on the MAR; and that the person who administers each medicine personally completes the MAR at the time of medicine administration. Care Homes for Older People Page 30 of 35 To make staff administer correct medication. 3 9 13 arrangements must be made 31/08/2009 to ensure that all medication is stored securely at the correct temperature recommended by the manufacturer. Staff will then know that medicines are safe to use when needed. 4 14 12 Staff must respond to and provide people with drinks when thay ask for them within a reasonable time. So that people remain comfortable and hydrated. 5 14 12 The home must raise staff awareness on the importance of treating people who live at the home with dignity and respect So that people can enjoy a dignified life at the home. 6 15 12 Staff must be made aware of appropriate and dignified procedures for supporting some one to eat their meal. So that people can eat their meals in comfort and with dignity. 7 18 13 All staff, including those with 30/09/2009 management and leadership responsibility must have an understanding of safeguarding process and what action to take if a 30/09/2009 30/09/2009 30/09/2009 Care Homes for Older People Page 31 of 35 person is suspected of being at risk of harm or abuse. So that people know they can be protected from harm and abuse. 8 19 13 the home must maintain an 30/09/2009 safe environment by making sure staff can access peoples rooms if the rooms are locked from the inside. So that people can receive assistance when they need it. 9 26 13 The home must improve hygiene practices. This must include cleaning food trays, keeping peoples rooms clean and tidy, cleaning footstools, appropriate disposal of used continence wear, and investigations into elimination offensive odours. So people can live in an environment where the risk of contamination and infection is minimized as much as possible 10 33 24 The home must have suitable systems in place to monitor and evaluate the quality of the service people receive To ensure people receive consistent good quality care by identifying and taking action to improve standards when they are not sufficient 30/09/2009 30/09/2009 Care Homes for Older People Page 32 of 35 11 35 12 The home must ensure people receive interest entitlement on their personal monies kept in the companies bank account. So that the home upholds peoples financila rights 30/09/2009 12 38 13 Call alarms must be made accessible to people who need them. So that people can call for help when needed. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 7 7 7 7 7 7 7 9 Care plans should contain information about a persons assessed personal and helath care needs. Care plans should include peoples preferences about their personal and health care needs. The care plans should be individual to a persons needs rather than pre-populated Plans should include peoples privacy, dignity, cultural and mental health needs. The home should continue to improve its prevention of falls strategy. The home should continue to improve its working relationships with external professionals. Individual agreements about how, where, and when to give people their medicines should be put in place which reflect the personal preferences and expressed lifestyle choices of people living in the home. Arrangements should be made to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and is helpful when checking stock levels. 8 9 Care Homes for Older People Page 33 of 35 9 9 Care plans should include detailed information and instructions to staff in respect of the administration of medicines, including the circumstances for the use of medicines prescribedwhen required. The medicine policy & procedures should be updated in line with current professional guidance so that staff understand how to handle and administer medicines safely. Handwritten entries on MAR charts should should be accurately recorded and detailed. They should also be signed, dated and checked by a witness. This makes sure that the correct information is recorded so that all staff understand and follow the changes correctly. The home should have a clearer activities plan and make sure the activities coordinator and staff are aware of what they need to do for peoples activities on each day. The home should make sure routine practices and promote peoples dignity and independence and avoid following institutional practices. 10 9 11 9 12 12 13 14 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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