Inspection on 18/04/05 for Astley Grange Nursing Home

This inspection was carried out on 18th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Astley Grange Nursing Home 21/02/08

Astley Grange Nursing Home 08/02/07

Astley Grange Nursing Home 12/10/05

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 288 Blackburn Road Bolton Lancs BL1 8DU Lead Inspector Sue Evans Announced 18th April 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. ASTLEY GRANGE Version 1.10 Page 3 SERVICE INFORMATION Name of service Astley Grange Address 288 Blackburn Road, Bolton, Lancs, BL1 8DU 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) 01204 365435 01204 392687 Ashbourne (Elton) Limited CRH Care Home with Nursing 30 Category(ies) of DE(E) Dementia - Over 65 - 5, OP Old age - 30, registration, with number PD Physical disability - 3, TI Terminally ill - 3. of places ASTLEY GRANGE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Within the maximum registered numbers there can be up to 30 OP, up to 5 DE(E), up to 3 TI and up to 3 PD The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 8th September 2004 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over 2 days (13 hours in total). Most of the first day was spent observing practices and activities in the home and talking to 6 residents, 4 relatives, and 3 staff members. Other inspection methods used included a tour of the building, examination of some key records, sampling the food, and discussions with the General Manager and Care Manager. Completed questionnaires were also received from 9 residents, 9 relatives, and 2 GPs. Since the last inspection, the Registered Manager has left. has not yet been registered with the CSCI. Her replacement What the service does well: What has improved since the last inspection? Catering arrangements had improved since last time. As a result, residents were informed, in advance, of the menu choices open to them. They were also encouraged to give their opinions after each meal in order to assist the manager and cook to monitor quality and preferences, and make changes if necessary. Most residents were satisfied with the standard of food. The home had appointed a new activities co-ordinator who had met with each resident to find out about their interests. She was planning to provide, each ASTLEY GRANGE Version 1.10 Page 6 day, a combination of one-to-one and group activities suited to peoples’ preferences and abilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ASTLEY GRANGE Version 1.10 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 ASTLEY GRANGE Version 1.10 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) 3, 4 and 5 Introductory visits, and a thorough assessment process, enable all parties to reach a decision as to whether the home will be able to meet a person’s needs. EVIDENCE: Records and discussions showed that, before admission, the General Manager or Care Manager visited prospective residents in their own homes or hospital to assess whether the home could meet their needs. The General Manager said that compatibility with the existing resident group was considered. Two visiting relatives confirmed that the home had conducted an assessment before their relative was admitted. Prospective residents and their relatives were welcome to visit the home before making a decision. The two relatives confirmed that they had been able to visit the home to look round and talk to people before deciding whether Astley Grange was suitable. Both felt that Astley Grange had been a good choice. Staff members demonstrated an understanding and awareness of the needs of the residents. Information that they gave about residents’ needs was in line with written records. Staff members were routinely trained in topics such as ASTLEY GRANGE Version 1.10 Page 9 dementia care and tissue viability and they spoke knowledgeably about both topics. ASTLEY GRANGE Version 1.10 Page 10 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 10 Care plans reflect peoples’ changing needs and provide detailed guidance to assist staff in providing the necessary support to residents. Health care needs, and areas of risk, are identified and kept under review so that any changes can be dealt with promptly. Care practices ensure that privacy is upheld. EVIDENCE: Individual care plans were detailed and gave explicit guidance on how needs were to be met. They included references to upholding peoples’ privacy and promoting self-esteem. Residents’ representatives had signed their agreement to the plans of care. Care plans were reviewed monthly and any changes noted. Risk assessments covered areas such as moving and handling, falls, nutrition, and pressure sores. These too were reviewed monthly. Staff members described how they supported people in practice, and the descriptions matched the guidance given in the care plans. The GPs who completed questionnaires felt that staff demonstrated a clear understanding of the care needs of the residents. The residents and relatives who were spoken with during the inspection, and the relatives and GPs who completed questionnaires, all said that they were satisfied with the care provided. Of the 9 service users who completed questionnaires, one person said that they did not feel well cared for. They did not say why. ASTLEY GRANGE Version 1.10 Page 11 Records showed that health needs were kept under review and that specialist services and equipment were obtained as required. Monthly weight records were kept. Care staff understood that they must report any concerns to senior staff. Personal care needs were attended to appropriately, including attention to detail such as ensuring spectacles and dentures were properly cleaned. Residents and relatives confirmed that this was usual practice. Staff members gave examples of how privacy and dignity were promoted in the home, for instance when attending to personal care. Residents said that staff members knocked on their bedroom doors before entering. Eight of the nine residents who completed questionnaires said that their privacy was respected. During the inspection, staff members spoke with residents in a natural, respectful way. Residents said that that staff members treated them well. ASTLEY GRANGE Version 1.10 Page 12 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, 13 and 15 The plans being put into place by the new activities co-ordinator are resulting in the provision of individual and group activities suited to peoples’ preferences and capabilities. The home’s open visiting policy means that residents can continue to see their family and friends as they wish. The improved catering arrangements mean that residents can make choices about what they eat, and they can record their comments on the meals provided. EVIDENCE: Most residents said that they had choice about their daily routines, including what time they got up or went to bed. A new activities co-ordinator had been in post for just 2 weeks. She had met with each resident and found out about their interests. Each resident will have an individual activity programme. There will be a combination of one-to-one and group activities. The co-ordinator gave examples of some of the activities that are planned including memory boards, scrabble, and inviting guest speakers to the home. She is to attend a seminar, run by the Alzheimer’s society, to look at activities provision. Various activities took place during the inspection, including dominoes, cards, and reading newspapers. Residents and relatives had enjoyed a party on the preceding Saturday, when a buffet and entertainer had been provided. Four of the nine residents who completed questionnaires said that the home did not provide suitable activities. However, at the time the questionnaires were completed, the activities co-ordinator’s ASTLEY GRANGE Version 1.10 Page 13 post was vacant. Activities will be looked at again at the next inspection to check that the improvement is continuing. All except one relative said that they were made welcome in the home at any time and could meet with their relative in private. The majority of residents said that they enjoyed the food. For those residents who needed to eat a pureed diet, each element of the meal was pureed separately to preserve appearance and flavour. Menus rotated every 4 weeks and the dishes listed were varied and balanced. Choices were available at each meal. Some improvements had been made since the previous inspection. For example, the home had taken steps to make sure that residents were informed in advance about the choices of food on offer, and after meals they were encouraged to give their opinions on the quality of the meal and whether or not they had enjoyed it. All comments were recorded and the entries were monitored by the manager and the cook, with a view to making improvements and changes if necessary. Most of the comments were complimentary. The lunchtime menu was sampled by the inspector and found to be satisfactory. Two residents said that cuts of meat were sometimes tough. The cook was aware of those opinions and he said that he adjusted cooking times to ensure that meat was tender enough to eat without difficulty. ASTLEY GRANGE Version 1.10 Page 14 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) 16 and 18 The systems in place for responding to complaints, and the regular residents and relatives meetings give people the opportunity to air their views and bring about improvements in standards. Protection policies, 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: The majority of people who completed CSCI questionnaires were aware of the complaints procedure. Records showed that all concerns and complaints, whether verbal or written, were recorded and investigated, and the outcomes reported and acted upon appropriately. Since the previous inspection, the home had looked into four complaints. Three were upheld and one was inconclusive. No complaints had been made to the CSCI. The three-monthly residents and relatives meetings give people an opportunity to informally raise any concerns that they might have. During the inspection, residents were not reticent in stating their opinions to the manager and staff. There were written procedures for adult protection, whistle blowing, acceptance of gifts, and dealing with aggression. However, as an added protection, the whistle blowing policy needs to state that staff members could report concerns direct to the CSCI if they wished. Staff members understood their responsibilities in these areas, all of them having undertaken training in resident’s welfare. This course is updated annually. The Ashbourne Group also has a special phone line whereby staff can report any concerns anonymously if they wish. ASTLEY GRANGE Version 1.10 Page 15 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, 21, 22, 25 and 26 Astley Grange’s ongoing redecoration and refurbishment programme, the employment of key ancillary staff and the implementation of robust safety measures have resulted in a safe, clean, comfortable, well-maintained environment for those that live there. EVIDENCE: Astley Grange is a comfortable well maintained home, situated within reach of bus routes and local amenities. The home employs a maintenance worker, and there is an ongoing programme of redecoration and refurbishment to ensure that standards are maintained. In order to keep up the high standards, it was recommended that attention be given to the base of some of the doors, which had become damaged through wear and tear. A gardener was employed to ensure that the grounds were well kept. The enclosed garden provided an accessible, safe area for residents to sit out. The two lounges were comfortably furnished. Residents had a choice of 2 assisted baths or a walk-in shower. The home was fitted with adaptations and ASTLEY GRANGE Version 1.10 Page 16 equipment suited to the needs of the residents. These included grab rails, ramps, portable hoists, passenger lift, and nurse call. Measures were in place to ensure a safe, pleasant living environment. These included the regulation and regular monitoring of water temperatures, the provision of radiator guards and the fitting and regular checking of window restrictors. Records showed that a number of other safety checks were also routinely done. The home was warm and clean, and odour free. The housekeeper and domestic assistant shared the domestic tasks. There was a written cleaning schedule. Laundry arrangements were satisfactory. Items of clothing were named or marked to ensure items were returned to the correct owner. ASTLEY GRANGE Version 1.10 Page 17 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, 28, 29 and 30 The skill mix of the staff group, and the commitment to ongoing staff training has equipped the team with the knowledge and skills they need to meet the needs of the residents. Recruitment systems are in place but the lack of written references for one staff member could compromise the safety of the residents. EVIDENCE: Staffing numbers met requirements. Rotas showed that a qualified nurse was on duty at all times and that, in addition to care staff, the home employed a number of ancillary staff including an administrative worker and an activities co-ordinator. The catering was done by an external catering company. All nine of the relatives who completed CSCI questionnaires were of the opinion that there were always enough staff members on duty. Records showed that the home had a rolling programme of staff training. Staff members were routinely expected to undertake training in moving and handling, fire safety, health and safety, food hygiene, residents’ welfare, and tissue viability. These were updated at the required intervals. Staff members confirmed that they had attended these courses. Some staff members said that they had also attended a 2-day course on dementia awareness. They talked about what they had learned from some of these courses and it was clear that the training had been beneficial. One of the nursing staff said that Ashbourne was supportive towards training requests for other relevant topics. The induction training for new recruits was in line with requirements. ASTLEY GRANGE Version 1.10 Page 18 The training statistics showed that 62 of the care staff had achieved NVQ level 2 in care, thus exceeding the minimum standard. Staff recruitment records included a checklist to ensure that the necessary recruitment documents, for example CRB (Criminal Records Bureau) disclosures, evidence of identity, and written references, had been obtained. Some staff files contained the required documents. However, in one case, although there was evidence to show that references had been sent for, they were not available for checking. The General Manager was already aware of this and was proposing to undertake a workplace assessment. She was asked to obtain the necessary references without delay. ASTLEY GRANGE Version 1.10 Page 19 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) 33 and 38 The home is clearly committed to seeking ways to improve the service provided to residents but needs to widen its current quality monitoring methods to include the use of anonymous questionnaires. The health and safety of residents and staff are promoted by means of regular maintenance and safety checks, and the commitment to staff training in health and safety topics. EVIDENCE: A number of methods were used to monitor the quality of the service. Records showed that the manager conducted in-depth monthly audits, covering a different topic each month. Action plans for improvement, with timescales were produced. There were also records to show that a senior manager had made monthly monitoring visits to the home, reported on the outcomes, and identified any action required. Residents and relatives were invited to express their views at the three-monthly residents and relatives meetings. Residents were also invited to comment about the food each day. All these methods ASTLEY GRANGE Version 1.10 Page 20 demonstrated the home’s commitment to the ongoing improvement of the service but, in order to fully meet this standard, the home needs to extend its quality monitoring activities to include other means of encouraging comments. This should include the use of anonymous questionnaires. As well as seeking feedback from residents and relatives, the home needs also to seek the views of staff members and professional visitors to the home. The outcomes of any quality monitoring exercise need to be summarised into a report, a copy of which should be supplied to the CSCI. A copy should also be available to residents so that they know that their comments are being noted and acted upon. Records showed that the home took steps to promote the health and safety of residents and staff. Maintenance records were up to date. Those examined included gas soundness, electrical installation, passenger lift servicing, portable electric appliance tests, servicing of portable hoists, and servicing and standard checks of all fire safety equipment, emergency lighting, and nurse call system. Training records showed that regular training was provided in the mandatory health and safety topics. This was confirmed by staff members. ASTLEY GRANGE Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x x x x 3 ASTLEY GRANGE Version 1.10 Page 22 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 18 Regulation 13(6) Requirement The whistle blowing policy needs to clearly state that staff members may report any concerns direct to the CSCI. The home must obtain two written references for the identified staff member. Quality monitoring needs to incorporate the use of anonymous questionnaires, with feedback sought from staff and professional visitors to the home as well as from residents and relatives. Results of satisfaction surveys need to be summarised into a report and made available to residents and to the CSCI. (Previous timescale of 31 December 2004 not met) Timescale for action 30 June 2005 31 May 2005 31 July 2005 2. 3. 29 33 19 21, 24 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 19 Good Practice Recommendations The home is advised to proceed with plans to attend to the base of some of the doors which have become damaged. Version 1.10 Page 23 ASTLEY GRANGE ASTLEY GRANGE Version 1.10 Page 24 Commission for Social Care Inspection 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. 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