Inspection on 06/06/07 for Alder Grange

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alder Grange 28/05/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alder Grange 51 Adamthwaite Drive Blythe Bridge Stoke On Trent Staffordshire ST11 9HL Lead Inspector Pam Grace Unannounced Inspection 6th June 2007 11:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alder Grange Address 51 Adamthwaite Drive Blythe Bridge Stoke On Trent Staffordshire ST11 9HL 01782 393 581 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) sally_appleton@yahoo.co.uk Eungella Care Ltd Anna Marie Carter Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation (without nursing) for service users of both sexes whose primary care needs on admission to the homecare within the following categories: Old age not falling within any other category (OP) 15. The maximum number of service users to be accommodated is 15. 2. Date of last inspection 23/02/07 Brief Description of the Service: Alder Grange is an extended Victorian Villa, which offers residential care accommodation for 15 older ladies or gentlemen. Access to the upper floor is assisted by a stair lift. Within half a mile there are shops, a bank, a public house, and bus stops, whilst the railway station lies two thirds of a mile away. At the time of this inspection the weekly fees charged range from £325-£361, and are subject to annual review. Since the previous inspection, the home is under new ownership by Eungella Care Ltd. The Registered Care Manager is Ms Anna Carter. The home has a philosophy of a `Home for Life’. Alder Grange has recently become a ‘No Smoking’ Home. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was undertaken over approximately 10 hours by one inspector. The home is under new ownership. The new Providers are pro active in supporting the home, and the Registered Manager. The Registered Care Manager Ms Anna Carter and the Provider Ms Shelley Grimshaw assisted the inspector during the inspection. The inspection had been planned with information gathered from the CSCI database and the Annual Quality Assurance Assessment questionnaire that had been completed by the Provider. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, residents and visiting relatives. A tour of the environment was also undertaken. At the end of the inspection, feedback was given to the Registered Care Manager and the Provider. Residents and relatives spoken with were very positive about the care they and their relatives were receiving. There had been no complaints received by CSCI since the previous inspection, and no complaints received by the home. Residents are protected from abuse of all types, by appropriately trained staff. Verbal comments received from residents were generally very positive, and included, comments such as “ staff here know what we want”, “staff are very good to us here”. The home has a philosophy of a `Home for Life’. There was an inspection of the communal areas of the home and a sample of bedrooms. The kitchen, laundry and lower ground floor area were also inspected. Records were inspected, and there were 8 requirements and 7 recommendations made as a result of this inspection, 3 requirements were immediate, they were made in relation to the removal of broken glass from the Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 6 garden greenhouse, the control of hot water temperatures and the strengthening of the home’s Medication procedures. There had been no complaints made to the Commission for Social Care Inspection (CSCI) since the previous inspection, and no complaints had been received by the home. What the service does well: What has improved since the last inspection? The home is under new ownership. The new Providers are pro active in supporting the home, and the Registered Manager – Ms Anna Carter. The acting care manager has been registered by the Commission for Social Care Inspection. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 7 Training provision continues to improve. Staff had attended numerous courses in the last six months. There is evidence that training needs are monitored and courses planned accordingly. Daily Menus have been made available in the dining room, so that residents can more easily see what meals are on offer each day. The home’s care plan format has improved, these are now more uniformly completed, comprehensive and clear, making them easier to read and understand. Care plans are regularly reviewed. General and environmental risk assessments have been completed. What they could do better: Medication systems must be strengthened, and staff responsible for administering medication must be up to date in their knowledge of policy, procedures and training. More evidence of activities, tailored to individual needs and preferences is required. There is also little evidence of residents being able to access the local community. Residents must be consulted in regard to making arrangements for them to engage in local, social and community activities. Care plans should state the arrangements made for a resident in the event of terminal illness. Bathing should be undertaken when the resident chooses to have a bath. Preferences should be taken into account, and documented in the resident’s care plan. The home is in need of redecoration and refurbishment. The laundry floor must be kept clean. A quality assurance system must be put in place, to enable reviewing and improving the quality of the care provided at the home. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 8 The kitchen door should be kept closed, as this is a fire door. It is recommended that after consultation with the Fire authority, magnetic catches, linked to the fire safety system be fitted to those doors that need to be kept open for residents’ access. A Kitchen cleaning schedule should be established and maintained. Fire training for staff must be kept up to date and staff receiving that training should include night staff, and be signed for by individual staff members. Individual training records for staff should be established and maintained. The temperatures of hot water provided to residents for bathing and personal care must be controlled, and must comply with Health and Safety legislation. The downstairs bathroom floor must be repaired or replaced. This currently poses a trip/slip hazard to staff and residents. The broken pane of glass in the garden green house must be removed, and the area made safe. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 and 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are given sufficient information to help them make their choice of home. EVIDENCE: The home’s brochure is on display in the home in the entrance hall. The care manager confirmed that the provider is currently having new brochures printed. These will reflect the new management and staffing structure of the home. The home is now under new ownership. The new Providers are pro active in supporting the home, and the Registered Manager. The inspector examined 4 resident’s care plans. The home’s care plan format has improved. Prospective residents undergo a pre-admission assessment, which is undertaken by the care manager. This forms the basis for the resident’s care plan. Care plans are regularly reviewed, uniformly completed, Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 11 comprehensive and clear, making them easier to read and understand. Prospective residents and their relatives/representatives are welcome to visit and spend time in the home, prior to making a decision to move. During the inspection, the inspector case tracked a newly admitted resident. The care plan was examined, and appropriate risk assessments were in place. However, arrangements in the event of terminal illness were absent. It is a recommendation of this report that those arrangements are included in the care planning process. The Service User Guide had been examined in detail at the home’s previous key inspection. This was seen to be satisfactory. The inspector discussed residents’ risk assessments with the care manager. These were in place in files seen. Other risk assessments in relation to the water system, the environment, domestic staff, health and safety, good hand washing, stair-lift, hoist and portable appliances were also in place. At a ‘themed’ inspection undertaken by CSCI in December 2006, it was established that the costs of living at Alder Grange are fully explained to residents before they move in. Additionally relatives said that the terms and conditions, including fees, had been fully explained to them, that they consider everything to be very clear, and that they are happy with the terms and conditions. No unexpected costs had arisen. The new providers intend to continue this good practice, and to review and update existing contracts and terms and conditions. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The inspector examined four residents’ care plans. These showed that an assessment of needs had been undertaken prior to admission and from this a care plan had been developed. Each file also had a copy of the Social services department assessment. Appropriate risk assessments had been identified, and were documented within care plans seen. An incident in relation to the administration of medication was discussed in detail with the care manager and provider. A notification for this under Regulation 37 was given to the inspector during the inspection, and a review of medication procedures was in the process of being undertaken. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 13 The Medical Administration Recording sheets (MAR) were completed appropriately and all refusals were documented and explained. There were no gaps in the recording of medication administered. Medication was stored appropriately. Records were seen in relation to medication ordered and also for returns to the Pharmacist. Only care staff who have undergone appropriate training are administering medication. There are several care staff who need medication training. Arrangements are in progress for those staff to complete the ‘Safe Handling of Medicines’, distance learning training course. There are also plans for the provider and care manager to develop a system of checking staffs’ on-going competency by running refresher courses. The home’s pharmacist visits approximately twice a year to audit the medication systems. In a later discussion with the provider she confirmed that staff would commence training at the end of July 2007. Meanwhile, she assured me that only trained care staff will be administering medication, and steps are being taken to strengthen the existing medication policy. Staff were observed appropriately addressing and treating the residents with dignity and respect during this visit. Residents requiring assistance with eating and drinking were assisted to eat and drink in a sensitive and private manner. The inspector also observed staff knocking on bedroom and toilet doors prior to entering. Residents spoken with praised the care that they received from care staff at the home, they said “staff here know what we want”, “staff are very good to us here”. There were a number of relatives and visitors to the Home during the inspection, they were observed freely entering and leaving the home without restriction. They were welcomed by staff, and offered a drink. Visitors and relatives can see their residents in private if they wish. Discussions with residents indicated that considerable care is taken by care staff to assist them in maintaining and improving their health. This included daily monitoring of residents’ health and well-being, requests for GP visits if required. Visits made by all health professionals are documented and recorded. Staff spoken with said that the home “is a home for life”, and that if a resident became terminally ill, if at all possible, they would want to care for that resident. Discussions with staff and residents, and scrutiny of care records evidenced that baths are being provided on a rota basis rather than on a more flexible basis. It is a recommendation of this report that bathing is undertaken for residents on a more flexible and needs led basis. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 14 Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service must be able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities must meet individual’s expectations. EVIDENCE: A mobile library visits the home every three weeks, and a reminiscence box is delivered, this contains DVD’s and items of historical interest. These form the basis for `reminiscence’ groups and stimulating discussion. One resident enjoys listening to music in the conservatory, and another creative resident does craft in her own room. A group of residents spoken with confirmed that activities are very dependent upon staffing levels, and that staff were sometimes too busy to run any activities. There is little evidence that residents have a choice or are consulted in relation to activities, and or that activities for residents are being undertaken. Residents’ preferences need to be documented. It is a requirement of this report that “the registered person must, following consultation with the Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 16 residents, provide facilities for recreation including activities”. It is also a requirement of this report that “the registered person must, following consultation with the residents make arrangements for them to engage in local, social and community activities”. The kitchen and preparation areas were inspected. These were found to be clean and tidy. Menus were on display on the wall in the hallway, and had also been placed in the dining room in separate folders, so that residents can easily see what meals are on offer that day. Menus have been devised with residents’ choices and preferences, and more choice is being offered at teatime. Hot and cold food temperatures were documented and recorded. However, hot food temperatures had not been documented whilst the cook had been on leave. This was discussed and highlighted with the care manager at the time, and will be rectified. The food seen during this inspection was of acceptable standard, and was appropriately stored and covered. However, there was little evidence of fresh fruit and a limited choice of fresh vegetables. The inspector discussed this with the care manager and provider, and was informed that the shopping was due to be done that day. Fresh milk was in plentiful supply. The care manager confirmed that menus included fresh vegetables every day. Residents spoken with said that they liked the home baked cakes made by the cook, and said that they had enjoyed their lunch that day. The care manager confirmed that new serving dishes had been ordered for residents use. Jugs of squash were available in the lounges and hot drinks were offered at regular intervals by staff. Residents spoken with confirmed that they had had their hair set, and some had had their nails painted, by the visiting hairdresser. Discussions with staff and residents, and examination of care records evidenced that baths are being provided on a rota basis rather than on a more flexible basis. It is a recommendation of this report that bathing is undertaken for residents on a more flexible and needs led basis. Personal preferences should be established with residents, and documented in their care plan. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: There have been no complaints received by CSCI since February 2007. The area of complaints was examined in detail during a `themed’ inspection undertaken in December 2006 by CSCI. The results of that inspection were that there is an open culture in Alder Grange, with residents feeling comfortable enough to express any concerns to the staff or the management. All of the residents had received a copy of the complaints procedure and numerous compliments had been recorded. The inspector discussed complaints with residents, and with visiting relatives during the inspection. They advised the inspector that they had no cause to complain, as everything had been fine for them and for their relatives. They were aware of whom to complain to if they wished to, and were aware that there is a complaints procedure at the home. Staff recruitment files are undergoing review, and will be updated to reflect the provider’s commitment to a robust recruitment policy and procedure. This will Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 18 be monitored at the next inspection. Recruitment files seen evidenced that Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks are carried out on all potential staff members. There had been no Vulnerable Adults referrals in Alder Grange. The inspector noted from the staff training records, that nine of the sixteen staff employed at Alder Grange had attended training in Protection of Vulnerable Adults. Staff spoken with were very aware of the need to have refresher training and up to date information in relation to the protection of residents at the home. It is a recommendation of this report that all staff should be trained in regard to the above. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 and 26 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment is in need of general redecoration and refurbishment, which should make it easier to keep clean and provide a safer and more pleasant environment for the residents. EVIDENCE: The inspector undertook a tour of the building, the home was generally clean and tidy, and there were no malodours. The provider has stated in the recently completed Annual Quality Assurance Assessment (AQAA) that they have begun an ongoing redecoration and improvement at the home, and that improvements are to be made to both the communal and individual bedroom areas. This will be monitored at the next inspection. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 20 The provider has also stated in the AQAA document that the routine checks/maintenance of equipment have taken place i.e. portable and electrical equipment, lifts and hoists, fire detection, emergency call, heating system and gas appliances. During a tour of the building, the inspector recommended the removal of a standard lamp and extension lead, from the landing, which was a potential trip hazard for residents. This was removed straight away. The gate at the top of the stairs had been repaired and a replacement gate has been ordered. An immediate requirement was made in relation to the garden green house, where there was a broken pane of glass in situ. This was likely to fall out and injure either a resident or member of staff. The care manager was asked to confirm to CSCI in writing when this work was completed. The downstairs bathroom non-slip floor covering needs replacement as the floor covering has started to lift. This was highlighted by the inspector during the inspection and will be rectified. A broken toilet seat in the same bathroom was replaced during the inspection. The laundry was fully operational and generally tidy. However, the floor needed a heavy duty clean, particularly in the corners, and behind the washing machines and dryers. This was highlighted by the inspector during the inspection and was undertaken straight away. The kitchen and preparation areas were clean and tidy, however, a kitchen cleaning schedule was not in place. It is a recommendation of this report that a kitchen cleaning schedule is established by the provider, to ensure that the kitchen and all of the kitchen appliances are kept clean. The staff room had been re-decorated and a new resource room for staff had been established. The home’s water temperatures are reportedly too high, and do not comply with the recommended and acceptable temperature range. This was later discussed with the care manager and will be rectified. It is a requirement of this report that regulators and or thermostats are fitted to the home’s water system to comply with regulations. The inspector discussed the need for the kitchen door to be kept closed, as this is a fire door. It is recommended that magnetic catches, linked to the fire safety system be fitted to those doors that need to be kept open for residents’ access. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 21 Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home must undertake Medication and Fire training. This will ensure a skilled and competent workforce. There are sufficient numbers of staff to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The inspector spoke with residents, relatives and staff, and examined 3 staff recruitment files. The provider and care manager confirmed that they are currently reviewing and updating all staff recruitment files. Staffing levels had been maintained, however at the time of this report the provider confirmed that the home was in the process of recruiting staff. The care manager confirmed that she has completed the Trainer’s course in Moving and Handling, and will be able to train and update care staff at the home. She will also be undertaking the Registered Manager’s Award in September 2007. However, is a recommendation of this report that the care manager still needs to undertake Risk Assessment training. The staff training Matrix provided by the home, shows that staff must undertake Medication and Fire training. It also shows that staff had previously received training in Manual Handling, Protection of Vulnerable Adults, Infection Control, Food Hygiene, Dementia, Funeral awareness and First Aid. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 23 It is a recommendation of this report that individual staff training records should be established for all staff at the home. The provider has stated in the AQAA document that they are committed to ongoing training and development for all staff members, to ensure that staff are knowledgeable and competent in the duties that they undertake. There will be further development of the staff training programme and a review of the skill mix within the staff team. The inspector noted from the staff training records, that nine of the sixteen staff employed at Alder Grange had attended training in Protection of Vulnerable Adults. Staff spoken with were also very aware of the need to have refresher training and up to date information in relation to the protection of residents at the home. It is a recommendation of this report that all staff should be trained in regard to the above. Some staff training in relation to fire safety had been undertaken, however, not all staff had received refresher training for 2007. This was discussed with the care manager during the inspection, and is to be addressed by the provider within the next few months. The inspector discussed the importance of hand washing for staff undertaking care and cooking duties, and also to have a change of uniform to protect food from contamination. The rota indicates when the cook is absent that day, and which member of staff is cooking that day. Breakfasts and teas are prepared by care staff and again, it is recommended that one person is given the specific delegated task of being in the kitchen to avoid cross contamination. Of the sixteen care staff employed at Alder Grange, fourteen have completed food and hygiene training. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 24 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,37and 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new management and administration of the home has made a real improvement. However all policies and procedures need to be reviewed, and a quality assurance system still needs to be developed. Residents’ finances will be monitored at the next inspection. EVIDENCE: The home’s Statement of Purpose/brochure is on display in the home in the entrance hall. The care manager confirmed that the provider is currently having new brochures printed. These will reflect the new management and staffing structure of the home. The home is now under new ownership. There is a new and uniformed format for residents’ care plans, these were clear, comprehensive, and showed attention to detail in relation to assessment. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 25 The inspector examined records in relation to a newly admitted resident. The care plan was examined and appropriate risk assessments were in place. However, care plans should contain information in relation to arrangements to be made in the event of terminal illness. The Registered Care Manager – Ms Anna Carter was registered by CSCI in April 2007. She has been pro active in promoting health and safety within the home, and there have been noticeable improvements since she came into post. Although there are still many improvements to be achieved, some of these are already work in progress. The Registered Care Manager confirmed that she has completed the Trainer’s course in Moving and Handling, and will be able to train and update care staff at the home. She will also be undertaking the Registered Manager’s Award in September 2007. However, the Care Manager still needs to undertake Risk Assessment training. In previous visits to the home, and on this inspection, relatives, staff and residents have said that standards have improved since Ms Carter was employed. The providers of the home have already established an effective relationship with Ms Carter and with staff. The new providers aim to work closely with the Care Manager and staff in relation to the improvement and development of Alder Grange. A sample of environmental risk assessments were seen at this inspection, although it is noted that the care manager stated there are still some outstanding risk assessments to complete. This includes a Fire risk assessment. This is work in progress. The inspector discussed the need for the kitchen door to be kept closed, as this is a fire door. It is recommended that magnetic catches, linked to the fire safety system be fitted to those doors that need to be kept open for residents’ access. The Home has a contract for the safe disposal of waste. All Control of Substances Hazardous to Health items were seen to be stored securely, although the care manager was informed that they must be accessible to staff. An incident in relation to the administration of medication was discussed in detail with the care manager and provider. A Regulation 37 notification was given to the inspector during the inspection in regard to this. Records were seen in relation to medication ordered and also for returns to the Pharmacist. Only care staff who have undergone appropriate training are administering medication. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 26 The inspector discussed the need for staff undertaking care and cooking duties to have a change of uniform to protect food from contamination. The rota indicates when the cook is absent that day, and which member of staff is cooking that day. Breakfasts and teas are prepared by care staff and again, it is recommended that one person is given the specific delegated task of being in the kitchen to avoid cross contamination. Of the sixteen care staff employed at Alder Grange, fourteen have completed food and hygiene training. Protection of Vulnerable Adults and Criminal Records Bureau checks are carried out on all potential staff members. Training for all staff in relation to the Protection of Vulnerable Adults must be undertaken. There had been no complaints received by CSCI since the previous inspection, and no complaints received by the home. An immediate requirement was made in relation to the garden green house, where there was a broken pane of glass in situ. This was likely to fall out and injure either a resident or member of staff. The downstairs bathroom floor needs replacement as the floor covering has started to lift. The laundry was fully operational and generally tidy. However, the floor needed a heavy duty clean, particularly in the corners, and behind the washing machines and dryers. This was highlighted by the inspector during the inspection and will be undertaken straight away. The kitchen was clean and tidy, however, a cleaning schedule is needed to maintain this. The provider has stated in the recently completed Annual Quality Assurance Assessment (AQAA) that they have begun an ongoing redecoration and improvement at the home, and that improvements are to be made to both the communal and individual bedroom areas. This will be monitored at the next inspection. The staff room has been re-decorated and a new resource room for staff has been established. The provider has also stated in the AQAA that the routine checks/maintenance of equipment have taken place i.e. portable and electrical equipment, lifts and hoists, fire detection, emergency call, heating system and gas appliances. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 27 Staff training in relation to fire safety had been undertaken, however, not all staff had received refresher training for 2007. This was discussed with the CM during the inspection, and must be addressed within the next few months. Staffing levels had been maintained, however, at the time of this report the home is undertaking recruitment. The staff training Matrix shows that staff must undertake Medication training, and updates in Fire training. It also shows that staff have previously received training in Manual Handling, Protection of Vulnerable Adults, Infection Control, Food Hygiene, Dementia, Funeral awareness and First Aid. Individual staff training records should be established for all staff at the home. A quality assurance system must be introduced to enable feedback from residents, relatives and stakeholders of the service. Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 28 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 1 X X 2 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Requirement Medication systems must be strengthened. The registered person shall make arrangements for the recording, handling , safekeeping, safe administration and disposal of medicines received into the care home. The registered person must, following consultation with the residents, provide facilities for recreation including activities. The registered person must, following consultation with the residents make arrangements for them to engage in local, social and community activities. Hot water temperatures must be regulated to ensure compliance with health and safety. Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Broken glass in Green house must be removed and made safe Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. DS0000069638.V342047.R01.S.doc Timescale for action 06/06/07 2. OP12 16(2n) 30/09/07 3. OP13 16(2m) 30/09/07 4. OP26 13(c) 06/06/07 5. OP19 13(c) 06/06/07 Alder Grange Version 5.2 Page 30 6. OP19 13(c) 7. OP33 24(1a) 8. OP38 23(4) Non-slip flooring to downstairs 30/09/07 bathroom must be replaced. Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person shall 30/09/07 establish and maintain a system for reviewing and improving the quality of care provided at the home. Fire training must be undertaken 30/09/07 by all staff at the home. The registered person shall after consultation with the fire authority make arrangements for persons working at the care home to receive suitable training in fire prevention. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP7 OP7 OP26 OP30 OP30 OP30 OP38 Good Practice Recommendations Care plans should state the arrangements made for a resident in the event of terminal illness. Bathing should be undertaken when the resident chooses to have a bath. Preferences should be taken into account, and documented in the resident’s care plan. Kitchen schedule should be established and maintained. Individual staff training records should be established and maintained. All staff should receive training in regard to the Protection of Vulnerable Adults. The care manager should undertake Risk Assessment training. The kitchen door should be kept closed, as this is a fire door. It is recommended that after consultation with the Fire authority, magnetic catches, linked to the fire safety system be fitted to those doors that need to be kept open for residents’ access. DS0000069638.V342047.R01.S.doc Version 5.2 Page 31 Alder Grange Alder Grange DS0000069638.V342047.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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