Inspection on 12/10/05 for Astley Grange Nursing Home

This inspection was carried out on 12th October 2005.

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

Astley Grange Nursing Home 21/02/08

Astley Grange Nursing Home 08/02/07

Astley Grange Nursing Home 18/04/05

Astley Grange Nursing Home 08/09/04

Astley Grange Nursing Home 21/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Astley Grange Nursing Home 288 Blackburn Road Bolton Lancashire BL1 8DU Lead Inspector Sue Evans Unannounced Inspection 12th October 2005 09:20 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 Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Astley Grange Nursing Home Address 288 Blackburn Road Bolton Lancashire BL1 8DU 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) 01204 365435 01204 392687 Ashbourne (Eton) Limited Mrs Barbara Jean Oakes Care Home 30 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (30), of places Physical disability (3), Terminally ill (3) Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 30 service users, to include: up to 30 service users in the category of Older People (OP), up to 5 service users in the category of Dementia over 65 years (DE(E)), up to 3 service users in the category of Terminal Illness under 65 years (TI) and up to 3 service users in the category of Physical Disabilities under 65 years of age (PD) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 18th April 2005 2. Date of last inspection Brief Description of the Service: Astley Grange is owned by Ashbourne Healthcare, a large national company. The home can provide 24 hour care for up to 30 older people, the majority of whom require nursing care. Within that number, it can accommodate a small number of people who are terminally ill, physically disabled or have dementia. A qualified nurse is on duty at all times. Astley Grange is a two-storey property, situated on a main road on the outskirts of Bolton Town Centre. It is within easy reach of bus routes, shops, and other community facilities. The home has 24 single bedrooms and 4 doubles. There is a lounge on each floor, a dining room on the ground floor, and bathrooms and toilets on both floors. The home is fitted with adaptations and equipment suited to the needs of the resident group. Equipment includes passenger lift and ramped access. Outside, there is a small parking area at the front of the home, and an enclosed garden at the side. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 7½ hours. More than half of this time was spent watching what went on in the home, talking to 6 residents, and interviewing 4 staff members. The inspector also examined some key records, and interviewed the Registered Manager. This inspection was the second to take place in the current inspection year. In order to gain a fuller picture of the home, this report needs to be read in conjunction with the report of the previous inspection of April 2005. Since the last inspection, the manager has been registered with the CSCI. What the service does well: What has improved since the last inspection? Since the last inspection, the home has met two requirements that were made in order to promote the welfare and best interests of the residents. These were in respect of written references for one staff member, and amendments to the whistle blowing policy. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 6 The home has also invited residents, relatives and others to complete anonymous questionnaires to try and find out about their opinions of the standards in the home. 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. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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 the following standard(s): None None of the above standards were assessed this time. EVIDENCE: Standards 3, 4 and 5 were assessed in April 2005. Standard 6 is not applicable as this home does not provide intermediate care. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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 the following standard(s): 9, 10 and 11 Medication storage and procedures promote good health and safety. Discreet care practices in the home mean that residents feel that they are treated with respect and that their privacy is upheld. Staff members understand the importance of approaching dying and death in a way that ensures that residents and their families are treated with care, sensitivity and dignity. EVIDENCE: Standards 7, 8 and 10 were assessed in April 2005. Medicines were securely stored. There was separate storage for any controlled drugs. Medicines needing cold storage were kept in a refrigerator that was used solely for that purpose. Fridge temperature records were kept. Some Medication Administration Records (MAR) were checked, and they had been properly completed. In line with good practice, photographs were included with the MAR as an added safeguard in confirming the identity of a resident. All prescriptions were checked against the MAR sheets. Only trained nursing staff were authorised to give medication. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 10 Staff members gave examples of how privacy and dignity were promoted in the home, for instance attending to personal care behind closed doors and not discussing their personal business in front of others. One of the more recent staff recruits said that basic care values were included in staff training. Residents were satisfied that their privacy was respected, for example they said that staff members knocked on their bedroom doors before entering. During the inspection, staff members spoke with residents in a natural, friendly way. They were discreet in the manner in which they assisted residents. Residents said that that staff members were always polite and respectful, and treated them well. One resident said, “Staff are lovely”. From discussions with the manager and staff it was clear that death and dying was handled with dignity and sensitivity. The wishes of residents and their families were respected. Relatives of a resident who was dying could stay with them if they wished. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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 the following standard(s): 12 and 14 Residents are able to have some choice and control over their lives. They have choice about their daily routines, spending their time as they prefer. However, there is a need to improve the frequency and variety of the activities offered so that residents can add more interest and variety to their lives. EVIDENCE: Standards 12, 13 and 15 were assessed in April 2005. Residents were able to make some choices about their daily lives. They said that they got up and went to bed at the time they chose. There were food choices at mealtimes. Throughout the day, residents were able to choose whether they spent time in their rooms or in one of the lounges. Some said that they liked to spend their time reading, doing crosswords or watching television. However, most of the residents who were spoken with said that there wasn’t much to do to pass the time. Since the last inspection, the activities co-ordinator had left and this has clearly meant a reduction in the provision of individual and group activities that had previously been provided. Staff members said that they tried to spend Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 12 some time with residents in the afternoons and evenings but the amount of time available depended upon the other duties they needed to undertake. The manager said that a new activities co-ordinator had been appointed and it was hoped that she would be able to start within the next few weeks. Activities will therefore be looked at again at the next inspection. The manager said that birthdays were always celebrated and that visiting entertainers sometimes came into the home. Representatives of local Churches also visited regularly to offer Communion to residents. Residents were helped to exercise choice about their lives if they had the capacity to do so. The choices they made tended to be in respect of their daily lifestyles within the home. None of the current residents took control of their own finances. Their relatives took responsibility for this, with only small sums being passed to the home to cover day to day sundry expenses. Residents were able to bring some their personal possessions into the home with them. Information about independent advocacy was displayed on the home’s notice board so that residents could, if they wanted to, ask an independent person to act on their behalf. This could help them to have more choice and control over their lives. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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 the following standard(s): 18 Protection policies and procedures, and staff training in adult protection, ensure that the service has the means to be able to respond properly to any suspicion or allegation of abuse. EVIDENCE: Standards 16 and 18 were assessed in April 2005. There were written procedures covering adult protection and whistle blowing. As an added safeguard, the manager had added a sentence to the whistle blowing policy to make it clear to staff that they could report concerns direct to the CSCI if they wished. Staff members understood their responsibilities in protection and whistle blowing. They had either attended a training course on the protection of vulnerable adults (Residents’ Welfare) or had received specific instruction from the manager. Ashbourne also had a freephone line whereby staff could report any concerns anonymously if they wished. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 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 the following standard(s): None None of the above standards were assessed this time. EVIDENCE: Standards 19, 20, 21, 22, 25 and 26 were assessed in April 2005. The environment was not inspected this time. However, it was noted that, as recommended during the April inspection, action was being taken to improve the appearance of the base of some doors that had become damaged due to wear and tear. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The required pre-employment checks are carried out in order to protect residents. EVIDENCE: Standards 27, 28, 29, and 30 were assessed in April 2005. During the last inspection, recruitment records had been satisfactory apart from a need for written references for one specific staff member. Records showed that steps had been taken to rectify this. The file for the most recent recruit showed that the necessary pre-employment checks had been done, for example obtaining employment histories, 2 written references, medical declarations, photographs, CRB (Criminal Records Bureau) disclosures and POVA (Protection of Vulnerable Adults) register checks. The manager was aware that gaps in employment records must been looked into. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Residents benefit from a well managed home. The opinions of residents, and others, have been sought to help the home to review quality. However, the home has yet to produce a written plan that will show residents and others how their views are being used to improve the service. There are no financial irregularities but the home needs to review the way it handles residents’ personal allowances. Staff members are appropriately supported and supervised to help them to develop professionally and provide a good service to residents. The health and safety of residents is promoted by means of regular fire safety checks. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 17 EVIDENCE: Standards 33 and 38 were assessed in April 2005. The manager has the necessary skills and experience to be the manager of a registered Care Home with Nursing. She qualified as an RGN in June 1993 and was previously Registered Manager of Astley Grange from 1999 to 2001. She is a qualified nurse. She also has the D32/D33 NVQ Assessor’s Award. She has also undertaken periodic training in topics such as dementia care, adult protection, and employment law. She is currently undertaking the NVQ level 4 in Management, and intends to follow this by doing the Registered Manager’s Award. Residents and staff spoke highly about the manager’s attitude and commitment. She was described as being approachable and supportive. The home had numerous methods of checking out the quality of the service. Records showed that in-depth monthly audits were carried out, covering a different topic each month. From these audits, action plans were produced. Training was the audit topic for October. Weekly and quarterly performance reviews were also carried out, and a senior manager within Ashbourne carried out monthly monitoring visits. A suggestions box was sited in reception. Residents and relatives were invited to express their views at the three-monthly residents and relatives meetings. There was also a comments book in the dining room for residents to give their opinions about the food. Since the last inspection, residents, relatives, and other visitors to the home had been invited to complete anonymous questionnaires. Not many had been returned. The manager was asked to decide on a cut-off date for the return of questionnaires so that a report could be written, summarising the outcomes of this exercise. The report needs to include an action plan for future improvement. The manager was asked to make sure that a copy of the report was made available to residents, and others, so that they know that their views have been noted and, where applicable, acted upon. A copy also needs to be sent to the CSCI. Discussion took place about the need to include the opinions of staff members when reviewing the quality of the service. Relatives looked after residents’ finances. They passed on small sums to the home to cover day to day sundry items. The cash sums were securely stored in the home’s safe. The systems that the home had in place for safeguarding these finances were complicated. All income and outgoings were recorded on individual sheets and all receipts were kept. There was an individual envelope for each person’s cash. However some of their money was held in a communal bank account Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 18 because the home was only insured to keep a limited amount of cash on the premises. This was not reflected on individual balance sheets. Consequently, although the total of money in the envelopes plus the amount in the bank, added up to the totals on the balance sheets, the cash actually held in individual envelopes did not match with balances on individual finance sheets. The home needs to review the way it handles residents’ personal allowances to make it easier to keep a check on individual finances. Staff members said that they received both informal, and formal support from their line manager. They said that a manager was always available if they needed to speak to them, and they felt well supported. They said that they also had formal 1to1 supervision meetings. Regular staff meetings were also being held. The manager said that care practices in the home were continually observed. Examination of the Fire safety book showed that the necessary checks were being carried out at the required intervals. Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 19 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 3 X 3 Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP12 Regulation 16(2)(m) (n) 21, 24 Timescale for action The registered person needs to 30/11/05 ensure that residents are offered a daily programme of individual and group activities. The results of the satisfaction 31/12/05 surveys need to be summarised into a report and made available to residents and to the CSCI. The registered person needs to 30/11/05 review the systems for handling residents’ personal allowances. Requirement 2 OP33 3 OP35 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Astley Grange Nursing Home DS0000005671.V256638.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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