Inspection on 13/09/05 for Bedale Grange Nursing Home

This inspection was carried out on 13th September 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

Bedale Grange Nursing Home 29/07/08

Bedale Grange Nursing Home 09/08/07

Bedale Grange Nursing Home 29/08/06

Bedale Grange Nursing Home 15/12/05

Similar services:

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Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Bedale Grange Nursing Home 28 Firby Road Bedale North Yorkshire DL8 1AS Lead Inspector John McGarva Unannounced Inspection 13 September 2005 10:00 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 Bedale Grange Nursing Home DS0000064737.V249229.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. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bedale Grange Nursing Home Address 28 Firby Road Bedale North Yorkshire DL8 1AS 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) 01677 422980 01677 422980 Bedale Grange (TFP) Ltd Mrs Julie Atkins Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30/9/04 Brief Description of the Service: Bedale Grange is a care home registered to provide Nursing and Social care for up to 21 residents. It is located just west of the small market town of Bedale and was first registered as a Nursing home in September 1985. The home is a large detached pebble-dashed building with three floors including ground and single storey extensions have been added. There is an electric chair lift from the ground to the first floor and the residents are accommodated on the ground and first floors only. The front elevation facing south overlooks a large garden area that has a pergola with lawn, mature trees and shrubbery extending beyond. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Tuesday 13th September 2005 and the manager Mrs Julie Atkins was available to assist throughout the process. The focus of the inspection was on all the key standards as well as the Requirements and Recommendations from the last inspection. The building was previously a private Victorian residence and in consequence there are environmental constraints, which make providing care a challenge for the staff. With 21 residents when full it is one of the few small care homes providing nursing care in North Yorkshire and on the day of inspection there were 18 residents. Ownership of the home changed on July 2005 and there has been a significant programme of decoration and refurbishment since this time. What the service does well: What has improved since the last inspection? There has been a significant programme of improvement to the physical environment since the last inspection: All the residents’ rooms have been decorated and provided with new carpeting, curtains and matching duvet covers. The main stairway, lounge and corridors have also been decorated and recarpeted. There has been a sluice bedpan disinfector installed in the sluice room. Five new divan type beds are now available and permit the deployment of lifting hoists. Two electric variable height and adjustable beds have been provided. A new ceiling mounted hoist tracking system has been provided for the main bathroom. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 6 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. Bedale Grange Nursing Home DS0000064737.V249229.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 Bedale Grange Nursing Home DS0000064737.V249229.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): 3 & 4. Further detail of the resident’s social history and personal likes and dislikes would help to make the assessments and care plans more complete. The nursing and care staff have the required training and skills to meet identified needs. EVIDENCE: Each individual resident has a ring folder located in the clinical room where all information relating to their care is kept. The documentation includes admission details, medical history, medications, general assessment, nutrition and risk assessments, moving & handling, weight charts, care plans and daily statements on their general care and well being. In general, the assessment and care plan records were of a good standard so that the resident’s assessed needs can be met. However, more information on the resident’s preferences in relation to food, drink, social care, time of getting up and going to bed as well as biographical details is required so that all their needs/problems are addressed. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 9 The nursing and care staff are well motivated to providing good quality care and the evidence for this is found in the well-cared-for look of the residents together with their positive comments they made about the staff and manager. Intermediate care is not provided in this home. (Standard 6.) Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 and 10. The physical and health care needs are identified and appropriate care plans designed to meet them. The storage and management of the medications is in accordance with good practice. EVIDENCE: An inspection of case files indicated that the appropriate assessments of need including weight, nutrition, risk, moving and handling were undertaken and the care plans designed to address these developed. There is a place for the residents or their relatives to sign to indicate their involvement and consultation in the development of the plans produced. The plans are reviewed on a monthly basis in accordance with recommended practice. Waterlow assessments are undertaken to determine the risk from pressure sores and there are pressure-relieving mattresses deployed in appropriate circumstances. There were two residents with pressure sores and both had them before admission to the home. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 11 Although there are weight charts, which indicate monthly recordings are made, more recent records were in composite form where the weights of several residents had been recorded at the time of weighing. These records should be transferred as soon as possible to the individual records and the composite record destroyed. The medications are located in a clinical room together with the care plans and other documentation. The Nomad seven-day blister pack system is in use and appears to be working satisfactorily. The controlled drug record of one resident was inspected and found to correspond with the stock. The nurses and care staff receive training on maintaining the dignity of the residents. The residents preferred mode of address is recorded in the admission details and the staff knock before being invited into the resident’s own room. There is no longer a resident’s pay phone as it was little used and they can now access the homes own mobile phone when required. The dependency of the residents is very high and all require assistance with the activities of daily life. There is lockable space provided for only five of the rooms at present and there is a programme to introduce new furniture with this feature available in a rolling programme of refurbishment. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 and 15. The resident’s wishes are respected within the constraints of their abilities and contact with friends and relatives are encouraged. The dietary needs of the residents are met with variable choice being offered in a programmed way. EVIDENCE: The daily routines of the residents are made as flexible as possible and they can stay in bed longer, or for the whole day should this be their wish. Visitors are welcome at any time of the day or night and there were several present during the inspection. Drinks and also meals are provided for them where indicated as many of them are old and frail themselves. The residents or their relatives deal with all their financial affairs and in consequence the home have no responsibilities in this regard. The residents can bring in personal items of furniture or objets d’art as is evidenced by their presence in the rooms. The residents commented favourably upon the quality of the meals and there is a choice of the main meal of the day with a four-week cycle of menus to choose from. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 13 The timings of the meals can be flexible with breakfast being from 9am and the last cooked meal at 5.30pm. Six of the service users require assistance with their meals and this was observed to be done with in an unhurried and sensitive manner. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18. The production and dissemination of complaints and adult protection policies and procedures safeguard the residents from abuse. EVIDENCE: Appropriate adult protection procedures are in place and the signatures of staff are obtained to evidence that they have seen and understood them. There have been no complaints received by the home or the Commission (CSCI) about this home during the past year. Criminal Records Bureau (CRB) checks are made on all staff who work in the home and the home has a record that these were undertaken and this further helps to ensure the residents’ safety . Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 23, 24, 25 and 26. The physical environment is not entirely ideal, but improvements have been made by the new owner to address some of the issues identified at the last inspection. EVIDENCE: The home meets the standards for pre-existing homes registered before 2002. The number of beds registered has been reduced to from 25 to 21 acknowledging that three of the rooms previously registered for three residents can only take two. There are eleven single and five shared rooms, representing 48 of the residents sharing a room when full and there are no rooms with en-suite toilet facilities. On the day of inspection there were eighteen residents in the home. There is a chair lift providing access from the ground floor to the first floor rooms. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 16 Some of the matters identified at the last inspection have been acted upon and include: • • • • • • All individual rooms have been decorated and provided with new carpeting, curtains and matching duvet covers. Stairway, lounge and corridors decorated. New carpeting provided throughout the home. Five new divan type beds to enable the deployment of hoists have been provided as well as two electric variable height beds. A bedpan disinfector has been installed in the sluice room. A new ceiling fixed tracking system has been provided for the downstairs bathroom. Matters, which have yet to be addressed, include: • • • • • • None of the three bathrooms has an island bath from where the care staff can access the resident from both sides. These have ‘rising chair’ type hoists one of which is not usable as the ‘lifting chair’ is broken. A suitable qualified person including an occupational therapist has not assessed the premises. Grab rails are provided in the bathrooms but not in the corridors although some of the corridors are too narrow to accommodate grab rails. Lockable space for the resident to store money, valuables or medication is only available in five of the newly refurnished rooms. Six individual rooms do not have benefit of thermostatically controlled valves to ensure the water does not exceed 43 degrees centigrade. A liquid soap dispenser is required in the downstairs sluice room. The new provider has made a good start in improving the physical environment and discussions have already taken place with the manager in relation to installing an assisted shower instead of a bath in one of the rather restricted bathrooms. Other improvements within the constraints of the space available in the home are to be discussed. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 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 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): 27,28 29 and 30. The residents receive a good standard of nursing care from well-motivated staff who are supported in what they do. The staff personal files did not contain all the required information. EVIDENCE: The home staffing levels correspond to the requirements of the previous regulatory authority and the well cared for look of the residents testifies to the care that is taken to ensure they are well clothed, clean and turned out. The numbers of care staff trained to NVQ Level two or above has increased to eight, which represents 50 of the total thereby meeting the required standard for such provision. Six of the eight care staff have trained to NVQ Level 3 Standard and another has commenced with this training. An additional three are about to commence Level 2 training. Suitable recruitment policies and procedures are in place, however there was no passport or photograph of employee in the file of a recently appointed person inspected. The passport had been scanned into a computer, but copies of these documents need to be available in hard copy for the inspector to see. Criminal Records Bureau (CRB) checks have been scanned onto a computer. A record that they have been done, and the outcome, is the only record that needs to be kept. The CRB record should be destroyed after a short period. All staff receive induction training at the start of their employment and further training is provided at sequenced intervals in accordance with good practice. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 18 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 and 38. The home is well managed and staff are informed and consulted about any changes that are to take place. Health & Safety issues are attended to appropriately. A quality assurance system needs to be introduced. EVIDENCE: The manager is a first level nurse with many years of experience in caring for the elderly. She completed the NVQ Level 4 in management award last year, as has the deputy manager. There is as yet no quality assurance system in place and this is a matter that the manager will consider with the new provider in the future. None of the resident’s money’s are managed by the home and they, or their relatives or representatives attend this to. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 19 Proper regard is paid to the promotion and safeguarding of the resident’s health and safety and there are records to show that servicing of boilers, hoists and fire equipment takes place at predetermined intervals. First aid training is provided on a regular basis. There is a training officer employed by the new provider who ensures that all statutory training in Health & Safety issues takes place at the recommended intervals Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 20 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 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 1 2 3 1 1 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 x x 3 Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 2 3 4 Standard OP21 OP24 OP25 OP29 Regulation 21.2 (n) 23(2)(m) 13(4)(c) 17, (2) Sched 4 Requirement All bathrooms must be brought into usable condition. Lockable storage space must be provided in each of the resident’s rooms. Hot water outlets in each of the resident’s rooms must not exceed 43 degrees centigrade. A copy of the employee’s passport must be available in their file. If no passport available, a photograph of the employee must be obtained. The provisions of the data protection act must be adhered to in relation to computer records. A quality assurance system must be introduced. Timescale for action 01/04/06 01/04/06 01/04/06 01/10/05 5 OP33 24(1)(a) (b) 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 22 No. 1 2 3 Refer to Standard OP3 OP8 OP22 Good Practice Recommendations More information on the resident’s biography, social care, likes & dislikes should be recorded to help ensure that all their needs are being met. Current records of weight should be available in the resident’s own records. Suitably qualified persons including an occupational therapist should assess the premises. Grab rails should be provided in corridors, toilets, communal rooms and where necessary, in the resident’s own rooms. Liquid soap dispenser should be provided in the sluice room. 4 OP26 Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Bedale Grange Nursing Home DS0000064737.V249229.R01.S.doc Version 5.0 Page 24 - 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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