Inspection on 29/08/06 for Bedale Grange Nursing Home

This inspection was carried out on 29th August 2006.

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

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

Other inspections for this house

Bedale Grange Nursing Home 29/07/08

Bedale Grange Nursing Home 09/08/07

Bedale Grange Nursing Home 15/12/05

Bedale Grange Nursing Home 13/09/05

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 Key Unannounced Inspection 29th August 2006 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.V308577.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. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 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 427535 bedalegrange@fisherpartnership.co.uk 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.V308577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 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. The pre-inspection questionnaire (PIQ) submitted by the home dated 11-07-06 indicated that the fees charged are £400 - £600 per week. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 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 29th August 2006 and the deputy manager Mrs Liz Calvert was available to assist throughout the process. The focus of the inspection was to follow up on matters raised at the last inspection in December 15th last year and talk to the resident’s and staff. The building was previously a private Victorian residence and in consequence there are environmental constraints, which continue to 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 14 residents. What the service does well: What has improved since the last inspection? A new bath has been provided on the ground floor and has been located in the centre of the room. There is a ceiling mounted track system to facilitate the transfer of the residents into and out of the bath. The lighting has also been improved. The external masonry walls and window frames have been painted. New armchairs for the lounge and bedroom furniture for some rooms have been provided. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 6 The six individual rooms, which did not have benefit of thermostatically controlled valves on the sink hot water taps have now been provided with them. 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.V308577.R01.S.doc Version 5.2 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.V308577.R01.S.doc Version 5.2 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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed thereby providing the foundation on which the care plans can be developed. EVIDENCE: Evidence from the case tracked residents records confirmed that pre-admission assessment sheets are completed prior to admission. These contain sufficient detail so that the care plans can be developed from the information provided. Assessments are usually undertaken by the manager or deputy, in hospital or the resident’s place of residence prior to admission. Intermediate Care (Standard 6) is not provided in this home. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s needs are being met in a professional, sensitive and programmed manner. EVIDENCE: There were only fourteen residents in the home on the day of inspection, all of who required nursing care. Individual covered folders which are kept in the drug /clinical room are available for each of the home’s residents into which all information relating to their needs are kept. The care plans are specific to the individual resident and identify all the information needed to help the care staff deliver the care required. The timings of the daily statements are recorded utilising the 24 hr clock in accordance with recommended practices. There is a ‘named nurse and carer system’ whereby particular carers and nurses have responsibility for a small group of residents. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 10 Waterlow assessments are undertaken to determine the risk from pressure sores and there are pressure-relieving mattresses deployed in appropriate circumstances. There was one resident with pressure sores on the day of inspection and she was being nursed on a pressure-relieving mattress. Residents spoken to were most appreciative about their care they receive and the staff that provide it. One lady wished it to be made known that when getting in and out of the new bath that it is uncomfortable and that as there are no grab rails, she lacks confidence. She also said that she “ didn’t think she would like anything not presently provided” and that she had been in the home for three years. 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. There is lockable space provided for only a few of the rooms at present and there is a programme to introduce new furniture with this feature available in the future. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines enable the residents to have control over their own lives. The quality of the meals provided is good with all the residents spoken to confirming this in conversation. 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. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 12 The residents commented favourably upon the quality of the meals, one saying, and “the food is excellent”. There is a choice of the main meal of the day with a four-week cycle of menus to choose from. Being such a small home with only 14 residents at present the individual preferences are easily identified and catererd for. All the staff in the home has completed a food hygiene course. The residents spoken to say that they decide their own daily routines. The home has an activities programme which although there is no identified activities person the care staff endeavour to ‘fill in when and where they can’. A new tray trolley for the meals has been provided. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a relevant complaints procedure and the staff has received abuse awareness training. EVIDENCE: The complaints procedure of the home meets the required standard. Staff are aware of how to respond to any complaints made by either the residents or their representatives. There have been no complaints made about the service either to the home or the CSCI in recent times. There are records to show that there has been recent training of the care staff in abuse issues. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment presents a challenge for the staff that works there. There are avoidable risks to the health and safety of both the residents and staff due the lack of hoisting equipment. EVIDENCE: The home meets the standards for homes registered before 2002. There are eleven single and five shared rooms, representing 48 of the residents sharing a room when full. There are no rooms with en-suite toilet facilities. There is a chair lift providing access from the ground floor to the first floor rooms. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 15 The external masonry walls and window frames have been painted. There are five adjustable height beds, two of which are electrically adjustable profile beds. One resident had purchased her own large electric divan bed and had also installed a ceiling tracking hoist system in her own room. The ground floor bathroom has been provided with a new bath and located in the centre of the room. Unfortunately, there are no grab handles on the bath and a resident who felt less confident in the bath in consequence alluded to this deficit to the inspector. A ceiling mounted track hoist system has been provided which has improved the moving & handling effort in the bathroom. The lighting has also been improved. The toilet in the bathroom was thought by staff to be too small with the front to back distance being rather less than ideal. Toiletries were distributed around in the room and it was suggested that a cupboard is provided for these. The sluice room now has a soap dispenser provided. The Disinfector in the sluice room cannot cope with larger motions and this needs to be brought to the attention of the manufacture and installer as this is not acceptable for a piece of equipment designed for this purpose. New armchairs for the lounge and bedroom furniture for some rooms have been provided. Grab rails are provided in the bathrooms but not in the corridors although some of the corridors are too narrow to accommodate grab rails. A suitable qualified person including an occupational therapist has not assessed the premises. Lockable space for the resident to store money, valuables or medication is only available in five rooms. The six individual rooms, which did not have benefit of thermostatically controlled valves, have now been provided with them and this helps ensure the safety of the residents, as the water does not now exceed 43 degrees centigrade. New furniture in one room included a wardrobe, which was too large to fit in the alcove space where the previous wardrobe fitted. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 16 Two of the home’s mobile hoists have failed servicing inspection, which leaves only one mechanical (Oxford Major) hoist available on the ground floor. As there is no lift to the first floor, there is no hoist available for the residents who reside there. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is not enough staff on occasions to provide sufficient personal care on occasions. The numbers of care staff trained to NVQ Level 2 standard has decreased since the last inspection. EVIDENCE: According to the staff spoken to there are not always enough care staff to provide the basic social and nursing care the highly dependent residents need. Due to high dependency of the residents there is little time for the staff to spend on conversation or in socialising with them. The care staff felt there was sufficient cleaning staff provided with three cleaners employed. Seven of the fifteen care staff have NVQ Level 2 or above qualifications, representing 46 of the total number. This is less than at the inspection held in September 2005 when 50 of the staff was so qualified. Suitable recruitment policies and procedures are in place and all relevant documentation including passport and record that CRB checks are undertaken. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 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 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is well managed by a manager who enjoys the support and confidence of the staff. The issues relating to the inadequacy of moving & handling equipment present possible hazards for the staff and residents alike. EVIDENCE: The manager is a first level nurse who has many years of experience in caring for the elderly. She has completed the NVQ Level 4 in management award, as has the deputy manager. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 19 The staff spoken to were very committed to working in the home and liked working there. There is some uncertainty about the future and the lack of placements to the home in recent times was a matter of concern to some. The staff of the home need to be informed about proposed changes or developments for the home. When staff were asked, what are your hopes for the home? The reply was for the home ”to continue”. The staff felt there was an open atmosphere in the management of the home but that there had been no formal meetings with the manager for a year. They were unaware of any development or business plan for the home. A quality assurance form has been devised and circulated to residents and relatives to gauge their opinion about the standard of care provided in the home. Two of the home’s mobile hoists have failed servicing inspection and there is only one mechanical (Oxford Major) hoist available on the ground floor. As there is no lift to the first floor there is no hoist available for the residents who reside there. The staff felt that there should be power-assisted hoists available not just the mechanical hydraulic ‘pump up’ basic type that is presently provided. The care staff confirmed that they had received training in Health & Safety, Moving & Handling, Fire Safety, Food hygiene, and also some training in Dementia care. There are readily accessible service records relating to servicing of the hoists, gas appliances, lifts etc. Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 2 2 1 X 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 21 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. 2. Standard OP24 Regulation 16, 4 (3) 23(2)(m) Timescale for action Additional adjustable height beds 01/06/07 must be provided for the nursing cases. Lockable storage space must be 01/06/07 provided in each of the resident’s rooms. (Previous timescale of 01/04/06 not met) The sluicing facilities must be 01/02/07 made to operate satisfactorily. A quality assurance system must 01/04/07 be introduced. (Previous Timescale of 01/04/06 not met) Additional power assisted hoists 01/02/07 must be provided. Requirement OP24 3. 4. OP26 OP33 13(3) 16(20(j) 24(1)(a)( b) 13(3) 5 OP38 Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP21 OP22 Good Practice Recommendations A cupboard should be provided in the ground floor bathroom for the storage of toiletries. Suitably qualified persons including an occupational therapist should assess the premises. Grab rails should be provided in corridors, toilets and communal rooms. The provider should endeavour to ensure that 50 of care staff has NVQ Level 2 or equivalent qualifications. The manager should endeavour to have more formal minuted meetings with the staff. 3 4 OP28 OP32 Bedale Grange Nursing Home DS0000064737.V308577.R01.S.doc Version 5.2 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.V308577.R01.S.doc Version 5.2 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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