Inspection on 09/03/10 for Abbey Grange Nursing Home

This inspection was carried out on 9th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbey Grange Nursing Home 29/04/10

Abbey Grange Nursing Home 13/05/09

Abbey Grange Nursing Home 17/05/07

Abbey Grange Nursing Home 24/05/06

Abbey Grange Nursing Home 07/03/06

Abbey Grange Nursing Home 19/05/05

Abbey Grange Nursing Home 03/02/05

Abbey Grange Nursing Home 17/08/04

Abbey Grange Nursing Home 28/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

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:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Powell     Date: 0 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 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 None Larongrove Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Tracey Jane Turner Type of registration: Number of places registered: care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 30 Over 65 37 50 0 0 1 4 0 5 2 0 0 9 Brief description of the care home 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, details of this was on the homes notice board. The current fees at Abbey Grange 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 30 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: zero star poor 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: This report follows the visit that took place on Tuesday 9th March 2010. Sarah Powell and Ian Hall Regulatory Inspectors carried out the visit. The visit lasted from 09:00 until 18:00. We have reviewed our practise 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. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include; Care Homes for Older People Page 6 of 30 Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. The manager had completed an annual quality assurance assessment (AQAA), however this lacked detail and comprehensive information. The AQAA focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. We sent out 10 surveys, however none were returned. At the site visit two inspectors spent 9.0 hours at the home. This inspection visit included talking with people living at the home, their relatives, the manager, Deputy, Chef, Activities coordinator and three care staff. We also gained information from visiting professionals, Contracts Officers and safeguarding managers. During the visit we also walked round the building to gain an overview of the facilities. We also checked a number of records. The home is currently in administration and RSM Tenon Recovery are the appointed administrators. Feedback was given to the manager during and at the end of the inspection. We left an immediate requirement form regarding regulation 13 infection control. This was regarding issues identified during the visit that require urgent attention. We have also sent a warning letter to the Administrators who are overseeing the home letting them know of our concerns. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 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 9 of 30 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. Peoples needs were not assessed so peoples needs could not be met. Evidence: We looked at three peoples plans of care, there were not assessment of needs in any of these plans. It was therefore not possible to determine if all peoples needs had been identified. We looked for the placing authoritys assessments and reviews and only one could be found, however it was two years old. The manager also looked and was unable to find up to date reviews, even though she told us they had been completed. Care Homes for Older People Page 10 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and risks were identified, but not followed through so needs were not met. Medication procedures did not protect people. Evidence: We case tracked three people this means we looked at their plans of care in detail. There was a plan of care in place in each file, however they were not generated from a comprehensive assessment of needs, as these were not in plans of care. The plans were well organised and indexed, however not all needs were reviewed or followed through to ensure peoples needs were met. An example was, one person was at risk of poor nutritional intake, this person had not been weighed. It was written in the care plan in December 2009, that the person was poorly so was not weighed. It was written not weighted for January 2010 and February 2010. The person had been put on a food and fluid chart, however this was not fully completed, either ticks were marked next to the meal or sit was written that the person ate half of their meal. Without knowing what the total content of the meal Care Homes for Older People Page 11 of 30 Evidence: was, it is not possible to determine if the person was receiving adequate nutrition. It was also not possible by reviewing the weight record, as this had not been carried out, if the person was receiving enough nutrition. It was therefore not possible to determine if their needs were being met. Other methods of monitoring weight can be used for example upper arm measurements to determine body mass index. This would ensure peoples needs were monitored and measures put in place to meet needs. Another example was a person had developed a pressure ulcer the referral to the tissue viability nurse had been carried out. Information was recorded in the care plan, however it did not detail the size and look of the ulcer. It was also not recorded in the plan if the ulcer was improving or deteriorating. This would have determine if the course of action being taken was appropriate and determine that needs were being met. Another person was identified at risk of falls and as such bed rails were put in place. This risk assessment had not been reviewed since November 2009. This did not show their needs were met. Another person had been assessed as at risk of falls and to be checked every 30 minutes. There was no record seen anywhere in the plan that they were checked every 30 minutes. The same person had also been weighed in February 2010 and had lost weight. It was recorded in their plan oc care to be weighed again on 7/3/10, this was not carried out. Staff were not monitoring conditions and therefore not meeting the persons needs. Another person had a care plan for violence and aggression, the reviews stated there had been episodes of violence and aggression. There was not information as to when these occurred, the time they lasted for and what triggered the episode. This did not ensure any triggers were identified to understand reason why they presented with violence and aggression, which would enable staff to manage the violence and aggression and possibly minimise the incidents. Which would ensure their needs were met. There was evidence that health care professionals were accessed and referrals were seen to the tissue viability nurse. However people identified at risk of poor nutritional intake were not weighed or food and fluid chart monitored correctly. It was therefore not possible to determine when their weight had decreased if they were receiving adequate nutritional intake. No referrals had been made to a dietician and without proper recording of peoples weight it was not possible to determine if a referral to the dietician was required to meet their needs. Care Homes for Older People Page 12 of 30 Evidence: We look at medication for the people we case tracked, we found errors on two of the three people. Medication was signed for but not given as the medication was still in the monthly packs. This did not meet peoples needs as medication was not given as prescribed. We also found that the wrong medication, which was a controlled drug had been dispensed by the pharmacist. The nurse on the unit told us, that she had spoken to the persons GP. She was given instructions and was able to give two patches instead of the one prescribed,. She told us it should be 20 micro grams not 10 micro grams that was on the medication administration chart (MAR). This information she told us was not recorded in the plan of care or on the MAR Chart, therefore if staff gave the higher dose they were giving medication that was not prescribed. The nurse rectified this during our visit and reassured us that the correct dose would be given and instructions from the GP recorded. This would ensure the persons needs were met. We also found one persons prescribed medication, which changed dosage weekly depending on their blood results. The information received from the hospital regarding the dosage to be administered did not tally with the amount of medication that was given to the person, which was detailed on the persons MAR chart. This meant the prescribed medication amount was not always being given to ensure the persons safety. During our visit we looked around the home and we found a number of prescribed medicines in unlocked cupboards in peoples bedrooms, the bedrooms were also unlocked. We also found some medication out of packets on top of one person bed side cabinet in an unlocked room. This does not safeguard people. We observed staff treating people with privacy and dignity, however people were left unattended in lounges for long periods of time, which did not always meet their needs. We have also received a complaint stating people are not always in the correct clothes and wear other peoples. We did not evidence this during our visit and the manager told us this did not happen. Care Homes for Older People Page 13 of 30 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. Not all routines of daily living were flexible or varied to meet peoples needs. Choice and control was not always encouraged, which did not meet everyones needs. Meals provided were satisfactory to meet most peoples needs. Evidence: There was a new activities coordinator in post who was enthusiastic, however the new coordinator was still getting to know what people liked doing and participating in, and was trying to adapt the activities to peoples abilities and choices. This at the time of our visit was not meeting all peoples needs. The coordinator was aware of what she needed to do and intended to put new group activities and 1 to 1 activities in place to meet peoples needs. People Were observed during the day to be sat in lounges with the television on and no other activity, left unattended for long periods of time. Staff were not observed in lounges with people. This did not meet peoples needs. We spoke to two visitors who told us they could visit when they wished and were made welcome. We had received a complaint that stated visitors were not made welcome and on many occasions there was no one on reception and anyone could Care Homes for Older People Page 14 of 30 Evidence: walk in. The manager has responded to this and told us a full time receptionist was located in the entrance area to ensure that no one can just walk in. Some people were able to exercise control over their lives others were not. Many people living at Abbey Grange had limited capacity due to their medical conditions and yet there was limited access to independent advocates, to ensure their best interests were protected. This was evident in regard to peoples finances, people were in debt and they were being allowed to continue to get further into debt, without any reviews being requested or advocates appointed to act on their behalf. We observed a meal in one of the dining rooms it was satisfactory help was given by staff were it was required and drinks were offered. We also spoke to the chef who was knowledgeable on the nutritional needs of the elderly and related medical conditions. He understood nutritional supplements and the use of full fat milk and cream, butter and full fat yogurts. The supply of food in the kitchen store was limited although the chef told us there was a delivery the next day.There had been a recent Environment Health visit and the items identified as requiring attention were being resolved. They received a four star good outcome. This ensured food hygiene standards in the kitchen were good. Care Homes for Older People Page 15 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived in the home were not always listened to or protected. Evidence: There was a complaints procedure available to people and their relatives. The manager told us she had only received on complaint since the last visit, which she had investigated. It was a cardigan that had been shrunk in the wash, this was replaced and the incident resolved. We had received a complaint through Sheffield Council, Contracts Department, the manager has sent a response to this, however this had to be asked for again in a meeting before it was sent. Part of the complaint was substantiated regrading the cleanliness of the home. The manager told us she would improve this to ensure people lived in a clean home. A number of safeguarding referrals were investigated last year, a Case conference had been held. It was concluded that people had been neglected and institutional abuse had occurred. The people had not been protected. We have since received another safeguarding referral. It had been identified to the manager in October 2009, however the manger told us she did not refer it to safeguarding or CQC. She told us she spoke to the person who had allegedly been assaulted and because she said she was OK she didnt take it any further. The person Care Homes for Older People Page 16 of 30 Evidence: had Dementia and had limited capacity so was not able to necessarily make an informed decision. Someone alerted Sheffield safeguarding in March 2010 of the alleged assault, they told the Safeguarding team, they had told the manager but she was doing nothing. A strategy meeting was arranged, at the meeting the manager told us she had started to investigate this alert, which she had been told not to do, which clearly was not following procedures, which she was aware of. She was told again at the meeting not to investigate as it would be refereed to the police, yet Sheffield safeguarding have told us she contacted the persons GP and asked for a Mental Capacity assessment. The manager clearly didnt follow procedures when she was alerted to the alleged assault in October 2009, and again did follow procedures when she was notified of the alert in March 2010. This does not protect people at Abbey Grange. Care Homes for Older People Page 17 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People did not live in a clean, safe or well maintained environment Evidence: We toured the premises as part of our visit. Abbey Grange was not well maintained many item of furniture were old, worn and many were damaged. The cleanliness of the building was extremely poor, due to the infection control risk an immediate requirement was left at the time of our visit. This detailed what we had found and that a thorough clean was required. We found ingrained dirt in carpets and furniture. Floor coverings in bathrooms and toilets were stained and covered in debris, especially in corners and behind piping. Many bedrooms and toilets had a foul odour. Grouting between wall tiles in bathrooms was encrusted in filth and lime scale. Store rooms were dirty, floors littered with debris, items stacked on the floors and access to wash basins restricted due to amount of items stored in the rooms. Many items of equipment were old and rusting. Cleaning equipment used was dirty, mops stored directly on floors and in buckets full of soiled water. Bathrooms were used as store rooms with wheelchairs and commodes stacked in baths, the toilets in these bathrooms were still being used people. This posed a risk to health and safety. Care Homes for Older People Page 18 of 30 Evidence: The immediate requirement identified some issues that posed a risk to people these are listed below. Toilets were dirty, the under sides of the seats were splashed with body fluids. Require a thorough clean. A dirty bed pan was observed in one bathroom. Urine was still present in the pan and the used toilet paper was on the toilet seat. Require a thorough clean. The shower chair was splashed with possible body fluids underneath the seat. This type of equipment must be cleaned after each and every use, including the underneath. Commodes were dirty and splashed with urine and faeces. Require a thorough clean. Male urinal bottles were stored in toilets and bathrooms, some were dirty and contained urine. To be thoroughly cleaned and stored in the sluice. The bath hoist chairs were dirty and marked with possible body fluids. Require a thorough clean. Wheelchairs and commodes stacked in baths. Remove items from baths and store safely. Mop buckets and mop heads were dirty and left in used water. Mops must be stored in racks and inverted. This did not ensure that people lived in a clean well maintained environment and did not maintain infection control. Care Homes for Older People Page 19 of 30 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. Staff were not appropriately trained, this did not ensure people were in safe hands at all times, had their needs met and were protected. Recruitment procedures were robust and protected people. Evidence: We looked at staffing numbers on duty to determine if the numbers could meet peoples needs. The manager told us the numbers allocated to each unit, upstairs the two units in total would have 1 nurse 2 senior carers and 3 carers. Downstairs there would be 1 nurse 2 senior carers and 3 carers again over two units. When we compared this to the duty rota it did not always tally. There was a high incidence of sickness, agency staff were frequently used and the number did not always meet peoples needs. The domestic staffing numbers had also been affected as they had also been covering the laundry. This could be part of the reason the cleanliness was poor. While we were at the home staff were not seen, people were left unattended in lounges and no staff visible for long periods. This did not meet peoples needs. When we spoke to staff they told us it was sometimes difficult when they were the only permanent member of staff on the unit, working with two other agency staff who Care Homes for Older People Page 20 of 30 Evidence: did not always know the residents. The care staff employed by Abbey Grange had completed NVQ training, which ensured the levels with the agency staff included, were always maintained above 50 . This ensured staff could meet peoples needs. However other mandatory training including fire safety, health and safety, infection control, moving and handling and adult safeguarding were not up to date. We were shown a training matrix. This showed most staff were up to date with training, however when we then looked at staff training files the certificates or any evidence of attendance were not available. The manger also looked in a box file, which she told us contained certificates for filing. The certificates we were looking for were not found. It was therefor not evident the training had been carried out. This meant staff were not trained to meet peoples needs. There was a person employed who was responsible for the training. They worked 30 hours supernumerary each week. The files were poorly organised and did not contain any recent certificates. A thorough recruitment procedure was in place, two staff files were seen on the day of the visit and contained all the required information. Protecting people who lived there. Care Homes for Older People Page 21 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration did not always safeguard people. Some good health and safety policies and procedures were in place, however not all staff had received training to ensure the safety of people in the home. Evidence: The home has a registered manager who has been in post over four years. She is a registered nurse and has completed the registered managers award. The home is currently in administration and RSM Tenon Recovery are the appointed administrators overseeing the home until it is sold. Following the key inspection, information obtained from strategy meetings and serious incident meetings, we have serious concerns regrading the competency of the manger and her ability to discharge her responsibilities and meet the homes stated aims and objectives. To ensure peoples needs are met and they are protected. The manger told us regular audits are carried out and questionnaires sent to relatives Care Homes for Older People Page 22 of 30 Evidence: and residents to gain their views. However it was not evident these were reviewed and practises changed as a result. People financial interests were not safeguarded. The company were appointee for 6 people, all but one were in dept, the dept was continuing to increases and no actions being taken. This did not safeguard people. Written records were maintained by the manager of transactions, for the 6 people the home had appointee ship. However no bank statements were available. The manager told us she only had money for these 6 people, other people were invoiced for hairdressers, chiropody etc and their families paid. When we spoke to a Contacts Officer she told us that the manager had told her, at a visit on 4/3/10, that she kept some money in a safe upstairs for people. This is two conflicting stories. We are taking further enforcement action regarding standard 35 regulation 20. Restrictions on acting for a Service User. A maintenance person was employed by the home and he was responsible for the maintenance records, health and safety and environment checks. These were all up to date and safeguarded people. Not all staff were trained in health and safety this did not meet peoples needs. Not all accidents and injuries or alerts have been reported properly putting people at risk of harm. Care Homes for Older People Page 23 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 30 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 1 26 13 To thoroughly clean items of 19/03/2010 equipment, toilets and bathrooms. To prevent the spread of infection at the care home. 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 People must have an 01/05/2010 assessment of needs undertaken prior to admission to Abbey Grange. This includes an assessment provided by the placing authority. The home should also draw up an needs assessment to be able to generate a plan of care from the assessment of needs. To ensure peoples needs are identified and can be met. 2 7 15 People must have a plan of 01/05/2010 care with all needs identified and how these needs will be met, ensuring it is kept under review. Care Homes for Older People Page 25 of 30 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 This will ensure peoples changing needs are identified and met. 3 8 12 Proper provision must be provided for the health, welfare and care of people. This will ensure their needs are met. 4 9 13 Arrangements must be in place for recording, handling, safekeeping, administration and disposal of medicines in the care home. This will ensure medicines are given as prescribed and procedures safeguard people. 5 18 12 People must be protected from abuse by following correct policies and procedures. To ensure people are not subject to abuse. 6 19 23 The premises and equipment 01/08/2010 must be kept in a good state of repair and maintained in good working order. To ensure the People live in a safe well maintained environment. 01/04/2010 01/05/2010 01/05/2010 Care Homes for Older People Page 26 of 30 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 7 26 13 Suitable arrangements must be in place to prevent infection, toxic conditions and the spread of infection at the care home. To protect people from risk of infection. 19/03/2010 8 30 18 Staff must receive training 01/05/2010 appropriate to the work they are to perform. Including; Infection Control, Health and Safety, moving and Handling, fire Safety and Adult Safeguarding. To ensure peoples needs are met. 9 31 10 The registered manager 01/04/2010 must manage the care home with sufficient care, competence and skill. To be able to discharge their responsibilities. 10 35 13 You must request financial 26/03/2010 reviews for the six people you have appointee ship for, to stop the people continuing to get into further dept To be able to demonstrate people are protected and do not suffer from financial abuse Care Homes for Older People Page 27 of 30 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 11 35 20 Peoples financial interests must be safeguarded. The account must be in the name of the person and the account is not to be used in connnection with the carrying on or management of the care home. To ensure people finances are protected. Further enforcement action is being taken. 04/05/2010 12 38 37 Information must be given 10/05/2010 to the commission any event which adversely affects the safety of a person. To ensure people are protected. 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 10 12 13 14 Peoples privacy and dignity should be maintained at all times. The new coordinator should continue to develop the activities to ensure all peoples recreational needs are met. People should be given more opportunity to access the local community. People should be helped to exercise choice and control over their lives and if they lack capacity independent advocates should be considered if required. Care Homes for Older People Page 28 of 30 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 5 6 16 27 All complaints should be responded to within set timescales and full investigations undertaken when requested. Staffing numbers should be able to meet peoples needs taking into account the layout of the home. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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