CARE HOMES FOR OLDER PEOPLE
Adel Grange Adel Grange Close Leeds LS16 8HX Lead Inspector
Gillian Sangster Unannounced 7 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Adel Grange Address Adel Grange Close Leeds LS16 8HX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2611288 0113 2611288 Parkfield Healthcare Ltd Care home 30 Category(ies) of Dementia - over 65 (30) registration, with number of places Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: On 22 June 2005 the following conditions of registration were imposed to reduce the total number of service users accommodated in the home from 30 to 22 and there shall be no further admissions of service users above the total of 22 without the prior written permission of the Commission for Social Care Inspection. Date of last inspection 24/06/05 Brief Description of the Service: Adel Grange is a converted, detached property situated in a residential area in Adel. There is a small area for car parking directly in front of the home. The home is located close to local bus routes. There are gardens to the rear and side of the property which can be accessed by ramps.The home is registered to provide personal care for thirty older people with dementia. Accommodation is provided on three floors with some service areas located in the basement. A passenger lift links both floors. The accommodation consists of twenty single bedrooms and five doubles, eleven rooms have en suite facilities. There are six communal bathrooms and two communal toilets. There are two lounges and a separate dining room. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors between 9.45am and 1.45pm. The provider was present during the visit and for feedback at the end. This home has been failing to meet many of the standards and regulations over the last two years. Enforcement notices were issued in February 2005 relating to electrical wiring, the provision of door locks on bedroom doors and the call bell system. These requirements have now been met. A further enforcement notice was issued in June 2005 relating to care planning, recruitment procedures, regulation 37 notifications and the management of accidents and incidents. The timescale for these requirements to be met is 31 July 2005. Additional monitoring visits have been made to the home during this time and will continue until compliance with the standards and regulations has been achieved. What the service does well: What has improved since the last inspection?
The atmosphere at the home has improved and communal areas are more homely and comfortable. Some areas of the home have been redecorated and some new carpets have been fitted. Some new equipment has been purchased. The call bell system is now fully operational apart from one call bell in room 26, which is being repaired. The registered manager and deputy manager have left. Staff welcomed the improvements made by the new acting manager. They said that the home was more organised and they felt better supported, communication was better and they knew more about the residents. Hairdressers visiting the home noticed an improvement in staff attitude and said the residents seemed happier. The home is now organised around the needs of the residents. The range of recreational activities has improved. Staff are now spending time with the residents chatting, reading newspapers, playing board games, listening to music and visiting the hairdresser.
Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 6 Residents appeared more relaxed and looked well groomed with clean ironed clothes and careful attention given to their general appearance. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed at this visit. EVIDENCE: Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9. Care planning is very poor with insufficient information recorded to inform and guide staff in meeting individual needs. Health care monitoring needs to improve to make sure that any identified problems are dealt with appropriately. Medication practices are poor leading to some residents not receiving their medication. EVIDENCE: We looked at four residents’ care plans. Three of the care plans contained very poor information. Some of these records had not been updated since 2003 and did not provide sufficient detail for staff to know how to meet the resident’s needs. Risk assessments contained insufficient information and had not been updated for at least a year. Some records were not dated and did not include detailed health care monitoring. For example it was noted that a resident had been losing weight, yet none of the monthly weight checks had been completed or action taken to address this matter. The acting manager is introducing a new format for care plans. A new care plan had been started for one resident. Although this was an improvement on what had been in place previously, it still did not give sufficient information for
Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 10 staff to be able to meet all the resident’s needs. For example there was no reference to the resident’s dementia or epilepsy. Daily records are recorded in a separate day and night book as well as on individual sheets for each resident. This system of recording, combined with the poor quality care plans, makes it difficult to find out how individual residents’ needs are being met by staff and to be able to identify any changes. We recommend that daily reports are written in the individual’s own care file. An enforcement notice has been served on the provider in relation to care planning with a timescale of 31 July 2005 for all the care plans to be completed and updated. We looked at the medication administration charts and found a number of errors. Four residents had refused their medication on several occasions yet there was nothing recorded to show that staff had done anything about this such as informing the GP. Some medicines had not been signed for and therefore it was unclear whether these had been given or not. One resident had not been given important medication for several days and again there was no explanation for this omission. The drugs fridge was inspected. Medication was being stored in the fridge but the fridge was not working. The provider investigated this and found that the fridge had been unplugged so that the visiting hairdressers could use the hairdryers. None of the staff had noticed that this had happened. The provider said that he will contact the GP about the residents who have missed their medication and will arrange for Boots, the chemist who supplies the home, to come in and give training to the staff immediately. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and15. Improvements have been made to the daily lives of the residents with staff spending more quality time with the residents talking and joining in activities. The amount and choice of foods kept in the kitchen has improved. Menus now need to be reviewed to offer a choice of meals for the residents. The kitchen must be cleaned thoroughly. EVIDENCE: We noticed several improvements in residents’ daily lives at this visit. The atmosphere in the home was relaxed and friendly with staff sitting talking with residents. Staff said that they are now encouraged to spend time with the residents and as a result have found out more about their individual interests. This has helped them to form better relationships with the residents. The residents looked well cared for and it was obvious that staff had taken the time to make sure that the residents were well dressed and groomed. Some staff were playing a board game with four residents. Another resident was reading the paper and others were walking freely between the rooms. Music was playing quietly in one of the lounges. Two hairdressers who have been coming to the home for many years said that they had noticed an improvement in the care given to the residents and the staff’s attitude in the last few weeks. They said they were now provided with
Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 12 the towels and equipment they needed to do their job which had not been the case in recent months. The home has employed a new cook since the last inspection. The cook said that he had no formal catering qualifications and had received no induction when he started at the home. It is recommended that suitable support and training is provided for the cook in meeting the nutritional needs of older people with dementia. The cook confirmed that he had completed a basic food hygiene course and fire safety training. The cook said that he had noticed an improvement since the acting manager had arrived. He said that stock levels had improved as he now had control over the ordering. There were plentiful supplies of fresh fruit and vegetables as well as tinned and packet foods. The freezers were well stocked. The cook said that the menus run on a four weekly cycle and he keeps a record of all the meals he serves. He said that he is in the process of reviewing the menus. The kitchen has been fitted with a new extractor fan and the splash backs above the work surfaces are being tiled. The kitchen would benefit from a deep clean particularly areas such as the cooker and overhead extractor fan. The cook said that he is planning to come in with the other kitchen staff and steam clean the kitchen. This must be done within the month. The cook said that none of the residents were on special diets, yet an entry made on one of the medicine sheets stated that a resident was on a low fat diet because of high cholesterol. We had lunch with the residents. This was a sociable occasion and residents seemed to enjoy their meals. Jugs of juice and bowls of fresh fruit were freely available to residents in the communal areas and this is a good improvement. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this visit. EVIDENCE: Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 24, 25 and 26. The home is maintained to a reasonable standard although several repairs were needed during this visit. EVIDENCE: A full tour of the premises was undertaken. The building is maintained to a reasonable standard, however a significant number of repairs were needed. These were listed to the provider at the end of the inspection and are detailed below. Bedroom 25 New wardrobe door handles must be fitted. Bedroom 21 The commode situated next to the door is causing an obstruction and must be moved.
Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 15 Bedroom 20 The en-suite door handle and the toilet must be repaired. Bedroom 19 The window curtain must be replaced and a door lock provided for the ensuite. Bedroom 18 The missing carpet tile must be replaced. Bedroom 16 The wardrobe must be secured. Bedroom 14 The ceiling must repaired following the recent leak. Bedroom 12 The wardrobe must be secured. Bedroom 8 The missing bedside drawer must be replaced. Bedroom 7 The wardrobe must be secured. Bathrooms The door handle on the bathroom next to bedroom 7 must be repaired. A paper towel and soap dispenser must be fitted in the 2nd floor bathroom. The inner lift door was not fully closing. The provider was aware of this and said that he has contacted the lift company. The provider said that he has made sure that staff know that residents must not go in the lift unless they are accompanied by staff. A number of the windows are floor to ceiling. These windows must be fitted with safety glass. A number of lounge chair cushions were missing. Spare cushions must be purchased which can be used while the others are being laundered. The call bell system is fully operational apart from one call bell in room 26 which has been sent for repair. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. Staffing levels are sufficient to meet the needs of the residents but duty rotas must show all the staff on duty and the hours they work. The recruitment checks for the deputy manager had been completed by an agency. EVIDENCE: Duty rotas given to us at the inspection did not reflect the staff on duty that day. The provider said that there were other duty rotas, which were accurate, but these could not be located. There has been a significant turnover of staff since the last inspection. The registered manager and deputy manager have left. A new acting manager has been brought in on a consultancy basis until a suitable permanent manager can be recruited. A new deputy manager has also started in post. Agency staff are being used to maintain sufficient staffing levels to meet the residents’ needs. The home are advertising for more staff to strengthen the team. The recruitment file for the new deputy manager was inspected. This person was recruited through an agency who had completed all the necessary checks. The temporary manager said that he and the provider had interviewed the deputy manager. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31. The current temporary manager provides good leadership and support to the staff team. EVIDENCE: The registered manager resigned in June 2005. Due to the continual failure of the home to meet many of the standards and regulations the provider has employed a temporary manager who is working at the home on a consultancy basis until a suitable permanent replacement can be found. In the short time he has been at the home this manager has provided good leadership and support to the staff team and implemented a number of improvements. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 2 x x x x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x x x x x Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op19 Regulation 15 Requirement The registered person must ensure that the care plans encompass all the assessed needs of the service user and demonstrate how those needs are met, review service user plans monthly and involve the service user and or their relative/representative. The registered person must ensure that the home is conducted so as to make proper provision for the health and welfare of service users. The registered person must ensure that there are arrangements in place for the safekeeping and safe administration of medicines. The registered person must ensure that the kitchen is thoroughly cleaned and maintained to a good standard. The registered person must ensure that the cook is provided with the training and support required to enable him to meet the nutritional needs of the residents. The registered person must complete the maintenance works
J52 S1405 Adel Grange V237497 070705 Stage 4.doc Timescale for action 31/07/05 2. op8 12 31/07/05 3. op9 13 31/07/05 4. op15 23 31/07/05 5. op15 18 30/09/05 6. op19 23 31/08/05
Page 20 Adel Grange Version 1.40 identified in the report. 7. op27 18 The registered person must ensure that the duty rota accurately reflects the number of staff on duty at all times in the home. The registered person must provide an induction, foundation and ongoing training programme for staff that meets the NTO specifications. The registered person must develop and implement a quality assurance system and annual development plan for the home. The registered person must develop and implement a programme of formal supervision for care staff at least six times a year. 31/07/05 8. op30 19 31/10/05 9. op33 24 31/12/05 10. op36 19 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard op15 Good Practice Recommendations The registered person should review the menus and ensure that residents are offered a choice of meals suitable to meet the nutritional needs of older people with dementia. Adel Grange J52 S1405 Adel Grange V237497 070705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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