Inspection on 07/02/07 for Bamford Grange Care Home

This inspection was carried out on 7th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Bamford Grange Care Home 17/12/07

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Thames House

Creative Support

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

CARE HOMES FOR OLDER PEOPLE Bamford Grange Care Home 239 Adswood Road Cheadle Stockport Cheshire SK3 8PA Lead Inspector Tracey Rasmussen Unannounced Inspection 7th February 2007 09:40 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 Bamford Grange Care Home DS0000068318.V329263.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. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bamford Grange Care Home Address 239 Adswood Road Cheadle Stockport Cheshire SK3 8PA 0161 477 8496 0161 477 8269 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) Four Seasons (Bamford) Limited Care Home 79 Category(ies) of Past or present drug dependence over 65 years registration, with number of age (61), Dementia (60), Mental disorder, of places excluding learning disability or dementia (19), Mental Disorder, excluding learning disability or dementia - over 65 years of age (15) Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 79 users to include : *up to 61 service users in the category of DE(E) (Dementia over 65 years of age) * up to 60 service users in the category of DE (Dementia under 65 years of age). * up to 15 service users in the category of MD (E) (Mental disorder excluding learning disability or dementia over 65 years of age). * up to 19 service users in the category of MD (Mental disorder excluding learning disability or dementia under 65 years of age). No more than 19 service users aged 35 and above with mental disorder, may be accommodated. No more than 60 service users aged 55 and above with dementia may be accommodated. 2. 3. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 5 Date of last inspection New Brief Description of the Service: Bamford Grange Nursing Home is a purpose built care home that provides 24 hour nursing care and accommodation to 79 service users. The company Four Seasons (Bamford) Limited recently bought Bamford Grange Nursing Home. The home is split into three separate units. Kensington Unit on the ground floor has 40 beds and provides care for people over 65 years of age suffering from dementia but who are of a lower physical dependency. The first floor has two units; the Windsor Unit which offers high dependency dementia care unit, and the Balmoral Unit which provides a care service to people with a functional mental health disorder and who are generally under the age of 60. Each unit has its own lounge/dining area. Bedrooms are spacious single rooms providing en-suite facilities. A choice of bathroom or shower is available on each floor. The furnishing, carpeting and decoration are of a satisfactory standard. The home has its own hairdressing room, an activity room and Snoezlen room. Smoking is only permitted in one designated area. Bamford Grange has car parking facilities at the main entrance to the home and garden areas are available at the rear of the home. The home is situated in the Adswood area of Stockport and is close to Cheadle and Davenport. Local amenities such as shops, pubs and GP surgeries are close by. Bus services are available and a local train station is approximately a ten minute walk away. The current weekly fees range from £495 to £720 dependent on the package of care required. Further details regarding fees are available from the deputy manager. Additional charges may also be made for hairdressing and other personal requirements. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. One inspector visited the home on the 7th February 2007 to undertake an ‘unannounced’ key inspection. The home was not told beforehand of the inspection visit. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection and this included information received about one abuse allegation and informal information telling the CSCI that the manager had left the home. At this visit the deputy manager was trying to provide management cover in the home. It was noted that the quality of service generally in the home had dropped at this visit and the employment of a new manager is necessary to make sure things get better. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents; talking with visitors; interviewing the deputy manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. A brief explanation of the inspection process was provided to the deputy manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback of the initial findings. What the service does well: Residents living on the Balmoral Unit (younger adults) were positive about living in the home. Residents living on the dementia care units were unable to comment on their care, but most were settled and none were agitated or distressed. Comments from relatives included “The staff are smashing”; “..generally speaking management and staff are very good” and “They are caring for him really well”. There had been no complaints and relatives felt able to discuss any concerns or worries. The complaint procedure did need slight changes so that it was clearer and residents and visitors knew they could complain to the CSCI at any time. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 7 Most staff had had training to make sure residents were safeguarded as far as possible from abuse and they knew what to do if they suspected abuse. Although new staff did need to attend Stockport’s ‘Alerter’ training to develop this further. The proper employment checks are carried out before new staff start work in the home. This means that the home is sure that the staff they employ are suitable to work in this service. The home was clean and generally odour free, some areas particularly lounges would benefit from being made more homely. What has improved since the last inspection? What they could do better: The home has a history of providing a consistent quality standard of care but this site visit identified a dip in the service quality and a number of areas do need improving to ensure the continued wellbeing of residents. The manager of the home had in recent months not been available in the home on a daily basis. The manager had recently been promoted within the Four Seasons’ company and had left the home at very short notice leaving a nurse manager to deal with the management of the home. This lack of management in the home has contributed to fall in the quality of service in the home. Areas that require improvement include: Regular assessment from before admission and throughout the residents stay needed improving so that staff were aware of changing care needs. Care plan documentation needs to be improved and developed so care plans are recorded consistently for all care needs, including dementia or mental health needs and this information needs to be ‘person centred’. This means that information about the resident’s personal wishes and preferences should also be included. Evaluation of the care plans should also be undertaken so that the effectiveness of the care provided to residents is reviewed and changed if necessary. Medication recording practices need to improve so that records are accurate, signed and dated and residents can be confident that the correct medication is given at the right time and mistakes avoided. The meal service needs to improve, more choice at meal times should be provided and residents should be able to sit at dining tables set for a meal. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 8 Staffing levels should be increased so that all residents that need help get their meal in a pleasant and unhurried way. Two different relatives said they came in mealtimes to make sure their loved one got a proper meal. Relatives said, “I visit most days at a meal time to make sure she gets a proper meal.” And, “I think they are understaffed especially at meal times” and “..meal times are rushed, staff are so rushed trying to feed everyone”. Social stimulation and support needs developing. The home had only one activity person who worked two days per week, which was not enough to provide support to all the residents in the home. Records of activities that residents joined in should be recorded and information about whether the resident enjoyed or benefited from these noted. One relative said, “I would say there is not enough going on to stimulate them. There is nothing going on” Staff training both NVQ and training for nurses should be improved and the quality monitoring checks of the service provided done so that areas that need improving are spotted quickly and sorted out. Security in the home needs improving as the front door was not locked at this visit and the inspector and other people just walked into the building without being asked who we were. Fire exits were not linked with the nurse call alarm system and staff did say (unknown to them) that residents did leave the building by the fire exits. This caused the staff concern because they did not always know a resident had left the building. Records of fire drills need to have the names of all who joined in, the person’s signature and the time of the drill so that the home can be sure all it’s staff know what to do if there was a fire. The CSCI needs to be kept informed of any changes or incidents in the home and monitoring checks (Regulation 26 visits) must be done monthly and a copy sent to the CSCI. The home should ensure that the information guide (Service User Guide) is readily available in the home and is up to date in accordance with regulations. Please contact the provider for advice of actions taken in response to this Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 9 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. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 10 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 Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 11 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 and 6 Quality in this outcome area is adequate. Up to date information was not readily available to allow prospective residents to make an informed choice about the suitability of the home. The home’s assessment procedures did not always confirm that they could meet the needs of the resident on admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three resident care files, were looked at to see if information about the care and support needs of each resident had been assessed by the home before the ‘new’ resident moved into the home. Two of the care files provided some information about the care needs of the residents. This information was basic and did not always detail clearly what the need was or how the need was to be met. Information regarding meeting Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 12 mental health needs, personal choices and preferences was not recorded and one resident’s care file did not have a pre-admission assessment available. One staff member spoken with said that the home accepted any ‘new’ residents referred by Stockport hospital without doing a pre-admission assessment first. The deputy manager said that this had occurred previously but she stated she was trying to stop this practice and make sure all residents were assessed before admission into the home. The home’s information guides were not fully reviewed at this visit. The Statement of Purpose was available at reception, however the deputy manager had to search for a copy of the service user guide and when a copy was found it was not up to date. The home does not provide an Intermediate Care Service (Standard 6) Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. Residents receive care and support, on the whole in a respectful manner. Some of the care planning documentation was not sufficient to meet the personal and specialist health care needs of residents. Medication recording practices were not completely safe so residents were potentially at risk from not getting the right medication at the right time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents living on the ground floor Kensington unit and first floor Windsor unit were unable to say if they were happy or not with the care and service they received in the home. Observation of the resident’s did indicate that they were reasonably settled. Residents on Kensington unit were more physically able to walk and move about the home and many were walking about and interacting with each other. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 14 On the whole care and attention had been paid to the appearance of the residents and the hairdresser was working in the home. One relative said ‘generally speaking management and staff are very good’ And another relative said, ‘they are very good’. Residents living on the Windsor unit were very dependent and needed support with all aspects of daily living whilst the residents on the Balmoral unit were more able and supported to make decisions about their daily lives. Residents living on Balmoral were positive about their living in the home. Staff interactions with residents were on the whole pleasant but were for the most part task driven. This means staff were busy making sure resident’s physical care needs were met. It was noted in one lounge that residents were sat at the dining table, after breakfast whilst two care staff were sat in easy chairs watching television. The deputy manager said this poor practice had been addressed with the staff members. Three care plan records were looked at on two of the units in the home. A number of areas for improvement were noted. These included inadequate information recorded upon admission to the home, which affected the quality of the care plans recorded. Health risk assessments such as nutritional assessments were not recorded regularly and did not always have accurate weights measurements that could mean that residents did not receive the level of care and support they needed. One care file indicated that the resident had not been weighed for over two years, monitoring for diabetes in accordance with the care plan was not undertaken, care plan interventions were generalised and did not reflect personal preferences or wishes. The specialist nature of the service provided at the home was not reflected in the care plans and evaluations of the care provided were not good enough. Records of contact with community health services such as GP, tissue viability speech therapy and optical support were available. This visit did identify a number of areas of inadequate medication practice all of which could potentially put the health of residents at risk. The medication administration records contained gaps in the records, which indicated that medicines had not been administered when prescribed or not signed for when administered; handwritten additions had not been consistently signed or dated by the person recording the medication sheet and on one unit the staff had created their medication sheet because they could not get a printed medication record sheet. Bamford Grange Care Home DS0000068318.V329263.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 Social activities and stimulation does not meet the diverse needs of the residents. Some lifestyle preferences were respected, but meals and mealtimes were not relaxed or social events. Visitors were welcome. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations in the home particularly on the dementia care units did indicate that there was little social stimulation being provided and care planning records did not record the social preferences or the types of stimulation residents responded to. The home had only one activity person who worked two full days per week. This was not enough to meet the wide-ranging stimulation needs of the residents living in the home. No activities were observed at this visit on the units providing a dementia care service. Care staff spoken with said the current dependency levels of the residents did not enable them to spend time with residents in a social capacity because they were too busy either feeding or bathing. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 16 Residents living on the Balmoral unit who were generally younger and had more independence were supported to attend various activities in the local community, including keep fit, swimming, literacy and computer literacy at Stockport College. There was an awareness in the home, of the lack of planned activities and stimulation. One unit recently had a relative and resident meeting and relatives had voiced their concerns about the lack of activities. Returned comment cards from relatives also referred to the lack of activities in the home. It was unclear if there were plans to address this shortfall in the home. Visitors confirmed that they were welcomed into the home. Both breakfast and lunchtime meals were observed at this visit on the dementia care units. The mealtime service at this visit was not well planned nor was it provided in a congenial environment. Many residents on the ground floor were still being served breakfast at 09.45am. These residents were assisted back into the dining room at 11.45 am for lunch. It was also noted on Kensington unit that the dining tables were not set at meal times. Residents were sat at a bare table and given their meal with the cutlery they could not use. Residents were given drinks in mugs, with milk or sugar already added and condiments such salt and pepper were not offered. Staff spoken with also said that choices of meals had been reduced and they were concerned about this. Menus indicated that residents with dementia received the choice of the one hot meal or sandwich. At the lunch time meal residents were given the meal that was provided, no alternatives were available or offered and residents were not asked for their preference. One resident was provided with a sandwich. Relatives of two residents had very similar comments about the meal service One relative said ‘I visit most days at a mealtime to make sure she gets a proper meal. The staff are smashing but they have so many to feed and my wife takes so long. At least I know she gets one proper meal per day’. Another resident said, “Meal times are rushed, staff are so rushed trying to feed everyone”. She also said, ‘I come (at lunchtime) to make sure he gets something he will eat. I have brought him a sandwich’. Other comments included, ‘staff don’t seem to assist with meals very well. They mash up the pureed diet and pile it on a spoon. It is not very nice. I don’t think they would eat it served that way’. Staff agreed that they were very busy at meal times and they said there were not enough of them to spend time feeding residents at a normal pace. One Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 17 staff member said, “Meals are rushed because everyone has to be fed or supervised.” Staff also said that when they were assisting residents with their meals they had to keep breaking off to go and check on other residents to make sure they were safe. All of the above practices do not reflect good practice in promoting the health; wellbeing and rights of residents with dementia and action must be taken in the home to improve the quality of the dining experience for residents. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 18 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 good. On the whole residents can be confident that staff are trained to respond appropriately to suspected abuse and that complaints will be treated seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager said, as far as she was aware, that the home had not received any complaints since the last inspection visit. A folder was available to hold complaints but this was empty. The home’s service user guide did contain information about making a complaint but this did need amending so that it reflected the requirements of the Care Home Regulations 2001. Residents and visitors spoken with said they weren’t aware of the specific complaint procedure but said they felt able to speak with both the nurses or staff if they had any concerns. Staff responded appropriately when asked about complaints by indicating they would direct the complainant to a senior person. Most staff reported that they had received training in abuse and the protection of vulnerable adults and were able to discuss the content of their training and relate it to the home environment. It was reported that newer staff that had been employed in the last twelve months had not benefited from the free Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 19 ‘Alerter’ training course provided by Stockport Social Services. Staff who have not had this training should be provided with it. There has been one safeguarding adult protection referral recently at the home in relation to residents allegedly causing injury to each other. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is good. Residents live in a safe, well maintained home that was clean and odour free. . Specialist equipment is available which means the different needs of each resident could be met promptly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and odour free and domestic staff were observed to be thorough in undertaking their duties. Some bedrooms had been made warm and homely with personal possessions, however a number of bedrooms were not made homely and were sparse in appearance. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 21 It was noted that some areas in the homes such as walls and upholstery were showing evidence of wear and tear. The deputy manager did say that some new chairs had been purchased recently and that the kitchen had had a new floor. The kitchen and laundry areas of the home were not seen at this visit. The maintenance man was observed working in the home. His duties included attending to the day to day repairs, general maintenance of the home and monitoring health and safety. Service reports were available which detailed the on going maintenance in the home. A variety of equipment was available in the home to ensure the physical care needs of the residents could be met in a timely manner. Bamford Grange Care Home DS0000068318.V329263.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. Recruitment vetting practices, training and skill mix were on the whole, appropriate to meet residents’ needs and promote their health and safety, however staffing levels did not always ensure residents care needs were met in a timely manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mixed comments were received from staff about working in the home. A common theme from staff was that the level of dependency of the residents had increased which had resulted in them having to rush personal care tasks to make sure all residents got the care they needed. The section on Daily Life and Social Activities includes information about how the quality of care in relation to meals and social stimulation needs to improve because staffing levels are not good enough to meet resident’s needs in a dignified manner. Comments from visitors included; ‘generally speaking management and staff are very good’ and ‘there are nice staff on nights’ Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 23 Three employment files for newer staff to the home were seen and all three had the correct information needed and this included PovaFirst and CRBs. However, the CRB form had been disposed off and the CRB number retained but not the date of receipt. Both the CRB disclosure number and date of disclosure must be retained in the home. Records were available to indicate that the home did train staff from the start of employment with induction training to on-going training and NVQ. However staff did report that since the new company took over they no longer felt supported to undertake training and any training they did wish to do they were expected to do in their own time. Nursing staff said that there was no training available for qualified staff, nor were they given any time to attend training. It was also reported that the home was struggling to train care staff in NVQ because the foreign nationals working in the home were not eligible for training and the systems to assess candidates were inadequate. Bamford Grange Care Home DS0000068318.V329263.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, 32 , 33, 35 and 38 Quality in this outcome area is adequate. The home does not have a full time manager which has had a detrimental effect on quality of care, monitoring of performance and user involvement. Resident’s money is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This visit identified that the management support in Bamford Grange had not been good enough for up to three months. The deputy manager and other staff in the home confirmed that the registered manager for the home had been working in another home for four out of the five days per week. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 25 The registered manager subsequently was promoted within the Four Seasons Company and gave Bamford Grange less than one hour notice that he was leaving. The CSCI were not been formally notified of either of these situations. The deputy manager did confirm that Four Seasons were recruiting for a new manager to the home and she had been left in the interim to ‘get on with it’. Discussion with the deputy identified that she had received very little support from the Four Seasons Company to undertake the management job and that there was expectations on her and other nursing staff to do administrative tasks such as payroll. Evidence from this inspection did identify that the absence of the manager from the home had impacted on the quality of service provided. Security in the home was inadequate in that the Inspector and other visitors walked into the home, easily without challenge. Staff also said that residents on occasion left the home by the fire door, which were not alarmed. This potentially put residents at risk because staff did not know who had left the building or who had come into the home. Quality assurance monitoring systems had not been implemented in recent months, audits of medication and care plans not undertaken since October 2006. Evidence that regulation 26 visits had been undertaken since October 2006 were not available. Service user surveys were available but these had not been dated so it was unclear if they were relevant to the current service provided in the home. Comments from relatives did include concerns about the lack of activities and the lack of staff to feed residents appropriately at meal times. Action to address these concerns was not evident. Staff expressed concerns about the restriction of budgets and the lack of gloves and aprons was reported more than once. It was reported that the home used to support student nurse training but that the university pulled student nurses out of the home out because there were frequently not enough gloves and aprons for the staff to use. The home does hold personal money for residents and computerised records were maintained. The home’s administrator was not available to show the individual accounts for residents, however, records of debits and credits were available as were receipts for expenditure. Health and safety practices in the home were seen to be safe and monitoring records held. Fire safety records were available, however a list of who Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 26 attended the fire drills had not been maintained, staff had not signed their participation nor had the time of the drill been recorded. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 27 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 x 3 x x 1 Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 28 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 OP7 OP8 Regulation 12,13,14, 15 Requirement The registered person must have in place detailed care plans, which reflect the changing needs of service users and the up to date action required. This includes assessments and care plans for mental health and dementia care, nutritional monitoring and social stimulation. The registered person must ensure medication recording and administration practices are safe and this includes recording medication on an appropriate medication sheet and staff signing and dating additions or changes to the medication sheet. Timescale for action 31/03/07 2 OP9 13,17 31/03/07 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 Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 29 1 2 OP1 OP3 3 OP7 4 5 6 7 OP7 OP12 OP12 OP14 8 OP15 9 10 11 12 13 14 15 OP16 OP18 OP19 OP27 OP28 OP29 OP30 The registered person should ensure that the home’s service user guide is readily available and kept up to date. The registered person should ensure that detailed preadmission assessment information is obtained before the arrival of a new resident so that appropriate care plans can be in place to meet the new resident’s assessed needs. The registered person should ensure that residents and their representatives are consulted about their care and care plan interventions are developed further to include more person centred information about each resident’s needs and preferences and explains how these needs are met The registered person should ensure after consultation with residents that care plans are evaluated for their effectiveness and this is recorded. The registered person should ensure that person centred social stimulation is provided to each resident and this is recorded within his or her plan of care. The registered person should ensure that additional activity persons are recruited for the home as soon as possible. The registered person must ensure that management and care practices in the home promote the resident’s right to choose and to be involved in decisions that affect him or her. The registered person must ensure that meal times offer a pleasant social experience where residents receive assistance with dignity; are offered choices and individual preferences are recorded. The registered person should ensure that the home’s complaints information reflects the requirements of Regulation 22 of the Care Home Regulations 2001. To registered person should ensure that all staff attend Stockport’s ‘Alerter’ training. The registered person should ensure the larger lounge on the ground floor is made more homely by the provision of soft furnishings. The registered person should ensure that the service has suitably trained staff in sufficient numbers on duty at all times to support the needs of service users. The registered person should ensure that at least 50 of care staff on duty have a NVQ 2 qualification or equivalent The registered person should ensure that the date of receipt of the CRB disclosure is also recorded with the CRB number, when the CRB certificate is destroyed. The registered person should review the provision of training in the home ensuring all staff are provided and DS0000068318.V329263.R01.S.doc Version 5.2 Page 30 Bamford Grange Care Home 16 17 18 OP31 OP32 OP33 19 OP38 20 21 OP38 OP38 supported to attend training which will promote, health and wellbeing of residents. The registered person should ensure that a new manager is recruited to the managers post as soon as possible. The registered person should ensure that management arrangements in the home are sufficient to promote the safe delivery of service to all users in the home. The registered person must ensure quality assurance and monitoring is undertaken regularly in the home and this includes providing monthly regulation 26 reports to the CSCI. The registered person should ensure that the home is maintained securely at all times and systems are in place so that staff are aware of people entering and leaving the home by all entry and exits in the home. The registered person must ensure that all staff attend fire drill practice, sign alongside their printed name on receipt and the time of the fire drill recorded. The registered person should ensure that notifications in accordance with Regulation 37 are made to the CSCI in a timely manner. Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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. Extracts may not be used or reproduced without the express permission of CSCI Bamford Grange Care Home DS0000068318.V329263.R01.S.doc Version 5.2 Page 32 - 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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