CARE HOMES FOR OLDER PEOPLE
Caldwell Grange Donnithorne Avenue Nuneaton Warwickshire CV11 4QJ Lead Inspector
Lesley Beadsworth Key Unannounced Inspection 14th September 2007 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 Caldwell Grange DS0000035030.V341002.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. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Caldwell Grange Address Donnithorne Avenue Nuneaton Warwickshire CV11 4QJ 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) 02476 383779 02476 384798 jackywest@warwickshire.gov.uk Warwickshire County Council, Social Services Department Mrs Jacqueline Karen West Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: Caldwell Grange is owned and managed by Warwickshire County Council. The home provides care and accommodation for 35 older people with a wide range of needs. The home is situated in a quiet cul-de-sac on a large housing estate in Attleborough, Nuneaton, with many of the service users coming from the immediate local area. There are local shops, a post office, pub, hairdressers and churches located within half a mile of the home. Caldwell Grange provides accommodation on two floors. All the sitting areas are on the ground floor, where there is a large dining room, incorporating a bar, and four lounge areas including a conservatory. The self-contained day care accommodation is available to residents outside day care hours. The home is set in its own grounds with a well maintained and accessible garden area. There is car parking space available for a number of vehicles. At the time of the inspection visit the fees charged were within the local authority range. Additional fees are charged for newspapers, toiletries, chiropody, hairdressing and individual outings or holidays. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection included a visit to Caldwell Grange. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Some of the information contained within this and in notifications of incidents that have occurred since the last inspection has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 09.45am and 06.40pm. What the service does well:
The home recently suffered the effects of floods when the nearby river broke its banks. Residents were evacuated to other homes belonging to the Local Authority and was managed so well that residents said that they felt as though they had been on holiday. Repairs and any necessary redecoration were virtually complete by the time of the inspection visit. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Risk assessments were in place for moving and handling, falls and nutrition and for specific individual risks including aggressive behaviour and smoking. Daily records had been completed for all residents and related to the care provided. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 6 Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for. Preferred names were recorded and used and when asked residents said that they were treated respectfully. Terms of preferred address are on the residents care plan and heard to be used by staff and residents were cared for in a respectful manner. This ensures that their dignity and self-esteem are maintained. There was ample evidence that residents receive appropriate and sufficient opportunity for stimulation and occupation. The home benefits from a designated activity coordinator, who works with residents on a one to one basis in the morning and carries out group activities for the home and day care in the afternoon. The home has access to an appropriate vehicle and therefore able to arrange regular trips out as chosen by residents, such as shopping and lunches. The registered manager advised that the home was fortunate in being supported by residents, family and friends in their activities and fund raising, and with an emphasis on involving residents throughout. A hairdressing room was provided and used by the visiting hairdresser. This room also has individual personal storage for each resident’s pedicure and manicure equipment, preventing cross infection. Visitors spoken with said that they were made welcome and that visits were unrestricted. Visitors could be entertained in the privacy of the resident’s bedroom or in any of the communal sitting areas. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Residents are also able to bring in their own possessions and to personalise their bedrooms when moving into the home and this was shown by the ornaments, pictures, photographs and small items of furniture seen in bedrooms. The cook and care staff were working with residents in order to improve the choice of food provided. One resident spoke of family members joining them for lunch on occasions and a visitor said that the food was “beautiful”. All residents spoken with said that they enjoyed the food and mealtimes at Caldwell Grange and that they always had a choice of what to eat. A meal taken with the residents was very tasty, nutritious and well presented in attractive surroundings. The mealtime was a pleasant social occasion.
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 7 Residents were protected by the policies related to staff not accepting gifts or benefiting from a resident’s will. The home has appropriate policies and procedures to deal with complaints and to safeguard residents. The home offers the people living there comfortable and pleasant surroundings, which are clean, free of offensive odour, safe and well maintained infection control is maintained. There are sufficient staff available to meet the needs of the residents. The home is on target to achieve 50 of the care staff to have completed National Vocational Qualification Level 2 in Care. This qualification shows that staff have been assessed to be competent in their role. Staff files looked at had records to show that the home is on target for all care staff to have staff supervision six times a year. This gives staff the opportunity to discuss their practice, the philosophy of the home and their individual training needs. A person with the appropriate qualifications and who has previous management experience manages the home. Monitoring and auditing of the service and practices is carried out to ensure that all services operate in the best interests of residents. Records are maintained for any financial transaction involving residents’ monies. Two members of staff now sign if a resident is not able to do so on their own behalf, in order to protect their financial interests. The registered manager said that there is an able senior staff team that has taken on board the changes and the newly designated responsibilities as well as acknowledging that there were further improvements to make. Records showed that there are full health and safety checks carried out at three monthly intervals. A random check was made on maintenance, servicing and in-house fire prevention records and these were up to date and in good order, further showing that the home was a safe to place for residents and staff. What has improved since the last inspection?
The majority of the medication requirements made at the previous inspection had been met. The home had started to collect and photocopy prescriptions from their recently changed pharmacist. This enabled them to check the medications received against what had been ordered by the GP. The home also confirms current medication with any new resident’s GP.
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 8 The registered manager advised that clinical indications, common doses and side effects of commonly used medication were included in current medication training but that there was also a folder available to staff that held the leaflets that are included in the packaging of medication. All staff responsible for medication had undertaken relevant training. There was a ‘PRN’ protocol included in the Medication Administration Record Sheets (MARS) to enable staff to know when these ‘as required’ medicines should be given. Each MARS that recorded a PRN medication included instructions related to when and why this medication should be given. Accurate records of mandatory and of health and safety training were available for inspection with staff undertaking appropriate training to ensure a safe environment for the people who live and work at the home. What they could do better:
Care plans looked at were not signed by the residents or their representatives in order to demonstrate their involvement and to validate the plans should be signed when they are devised. There was no risk assessment or relevant care plan related to the occurrence or prevention of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). This is necessary for all residents in order to minimise this risk. Although the care plans viewed were detailed there were some shortfalls. Due to the floods experienced by the home reviews had not been completed during the month of August although they had been reviewed and revised as necessary for all previous months. As a result two of the care plans looked at did not include information regarding the care that staff needed to provide. Although staff spoken with knew what this care was, relying on staff’s memory creates the risk of needs not being met in a person centred manner. An audit of tablets against the Medication Administration Record Sheets of those residents case tracked, and some chosen at random including controlled drugs, was carried out. Whilst the majority were correct there were some errors. Staff drug audits need to be carried out by the registered manager before and after medicine rounds are undertaken to ensure all senior staff administering medicines accurately administer and record these in accordance with the doctors instructions. This is to ensure that practice is assessed and action is taken when audits indicate that staff fail in their duties. There was no way of ensuring that the temperature of the room used for storing medication was maintained at the required temperature of 25°C or less and was very warm. The plans for installing air conditioning need to be actioned as soon as possible to prevent the instability of medication stored there.
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 9 The medication fridge temperature was being monitored and although a minimum/maximum thermometer was being used only the current temperature was being recorded. To ensure that the temperature remains within the required limits all three temperatures need to be recorded. Some minor concerns were not documented in the home’s complaints records. Although recorded in the residents’ daily records they need to be included in the complaints records held at the home. Apart from the home the registered manager is responsible for day care services in the home and in a centre a short distance from the home. She is also responsible for a project that supports fifty service users in their own home. The Responsible Individual should monitor this responsibility arrangement to ensure that it does not adversely impact on the registered manager or the management of the home. 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. The summary of this inspection report can be made available in other formats on request. Caldwell Grange DS0000035030.V341002.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 Caldwell Grange DS0000035030.V341002.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): 3 Quality in this outcome area is good. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and the AQAA advised that assessments are initially carried out by an allocated social worker prior to a prospective resident being referred to the home. A member of senior staff then visit the service user to assess if the home is able to meet their needs. These assessments were included in each of the three care files looked at and covered all the appropriate headings. The home’s pre-admission assessment process considers strengths alongside needs. The person and/ or their representative is then invited to visit the home prior to making a decision about staying at the home. The procedure for pre admission takes place for all short stay residents as well as permanent residents and evidence of this was seen in the care files ensuring that the home was able to meet the needs of people admitted there.
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. There are some concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were examined as part of the case tracking process, and each one included a care plan that had been devised from the assessments of need. The AQAA and staff spoken with said that when a resident is first admitted to Caldwell Grange they are allocated a ‘attached worker’ who, along with a senior member of staff, spends time over several days with the resident assessing further their specific needs and how the care will be provided by the care staff. However care plans looked at were not signed by the residents or their representatives in order to demonstrate their involvement. The registered manager advised that this was because the residents sign all the monthly
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 13 reviews of the care plans, which was seen in the care plans looked at. However in order to validate it the plan should be signed when it is devised. Risk assessments were in place for moving and handling, falls and nutrition and for specific individual risks including aggressive behaviour and smoking. A risk assessment seen for the use of bedrails was inadequate, as it did not cover all the risks involved in their use, in particular those related to entrapment, and therefore had the potential for action not being taken to prevent them. There was no risk assessment or relevant care plan related to the occurrence or prevention of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). Although the care plans viewed were detailed there were some shortfalls. The registered manager advised that due to the floods experienced by the home reviews had not been completed during the month of August but had been reviewed and revised as necessary for all previous months. A resident’s health had recently deteriorated and at the time of the inspection was very poorly. The care plan for this resident had not been revised to reflect the changes in circumstances in need and the care that staff needed to provide. These included pressure area care and, as in the other care files looked at, there was no risk assessment or relevant care plan related to the occurrence or prevention of pressure sores. Although staff spoken with were aware of the care they needed to provide relying on the spoken word and staff’s memory had the potential for the individual’s needs not being fully met. Preventative measures such as pressure relieving mattresses and cushions were in use for this and other residents. Another resident was assessed as requiring a particular tool for communication and for staff to address in a specific manner. However the tool was not seen throughout the day and staff were observed to be using the manner of address that was advised against in the care plan. The registered manager advised that the equipment was no longer required as staff got to know the person but the care plan needed to be revised to reflect this. Daily records had been completed for all residents and related to the care provided. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for. Preferred names were recorded and used and when asked residents said that they were treated respectfully. The Local Authority were in the process of revising the medication policy and the registered manager advised that she planned to individualise this to meet
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 14 the needs and practice of the home. New medication policies must be provided to reflect practice and be specific to the home. Staff must be trained to adhere to them. The majority of the medication requirements made at the previous inspection had been met. The home had started to collect and photocopy prescriptions from their recently changed pharmacist. This enabled them to check the medications received against what had been ordered by the GP. The home also confirms current medication with any new resident’s GP. There is a designated senior member of staff responsible for the ordering of medication thereby maintaining continuity. The amount of medication received was recorded on the Medication Administration Record Sheets. The home had devised a system to ensure that any medication taken out of the home for residents’ outings was safe and administered at the correct time by providing a lockable case for blister packs accompanied by a photocopy of the Medication Administration Record Sheets. The registered manager advised that clinical indications, common doses and side effects of commonly used medication were included in current medication training but that there was also a folder available to staff that held the leaflets that are included in the packaging of medication. All staff responsible for medication had undertaken relevant training. There was a ‘PRN’ protocol included in the Medication Administration Record Sheets (MARS) to enable staff to know when these ‘as required’ medicines should be given. Each MARS that recorded a PRN medication included instructions related to when and why this medication should be given. MARS also included a photo of the resident to aid in ensuring that medication was given to the correct person, and specific essential information about the administration of medication to that person, e.g. known allergies, that tablets are taken off a spoon or in the case of one resident that medication needed to be given from the left side of that person. The registered manager advised that the competence of staff administering medications was monitored by observing their practice. An audit of tablets against the Medication Administration Record Sheets of those residents case tracked, and some chosen at random, was carried out. Whilst the majority were correct there were some errors. One resident was prescribed Tramadol. Staff had recorded that 84 tablets had been received; there were signatures to show that 59 have been given to the resident; 22 instead of 19 tablets were remaining in the packet, indicating that three tablets had not been given although they had been signed for. A further resident had been prescribed Paracetamol as required. The record showed that there had been 168 tablets at the beginning of the cycle; there were 13 signatures and 146 tablets left.
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 15 This left nine tablets unaccounted for. Staff drug audits need to be carried out by the registered manager before and after medicine rounds are undertaken to ensure all senior staff administering medicines accurately administer and record these in accordance with the doctors instructions. This is to ensure that practice is assessed and action is taken when audits indicate that they fail in their duties. The controlled drug register and cupboard were also audited. Some Temazepam tablets had been returned to the pharmacist and although this could be evidenced in the discharge of medications records this must also be shown in the controlled drug register. The pharmacist had also delivered a bottle of Oramorph in liquid form. The label referred to the manner in which the previous amount had been dispensed, that is 40 vials of 10mg in 5ml, rather than the amount in the bottle. The home needed to have clarified this with the pharmacist. Temazepam 5mg was prescribed for a further resident. 10mg tablets were dispensed with instructions to give half a tablet but this was not clearly identified in the controlled drug register. There was no way of ensuring that the temperature of the room used for storing medication was maintained at the appropriate temperature of 25°C or less and seemed very warm but the registered manager advised that the home has been allocated funding to provide air conditioning in this room. There was a minimum/maximum thermometer in use for the medication fridge but only the current temperature was being recorded. To ensure that the correct temperature was being maintained throughout the day all three temperatures need to be recorded. Terms of preferred address are on the residents care plan and heard to be used by staff and residents were cared for in a respectful manner. This ensures that their dignity and self-esteem are maintained. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the tasty, nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home benefits from a designated activity coordinator and has an area for day care service users on the ground floor where activities also take place and there was ample evidence to show that residents were occupied and stimulated. The activity coordinator was busy with residents on a one to one basis in the morning and carried out group activities for the home and day care in the afternoon. After breakfast one resident was receiving assistance to choose and pick flowers and later on was arranging and pressing these so that pictures could be made at a later date. A further resident was assisting in the garden and appeared to be organising other residents in the work. There was a lively atmosphere throughout the home. The home has access to an appropriate vehicle and therefore able to arrange regular trips out as chosen by residents, such as shopping and lunches. There
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 17 is a charge for these trips but they are also subsidised by the home. Residents spoken with said that they enjoyed these outings. They are also offered the opportunity to go on holiday and following the last one to Blackpool staff had thoughtfully made each person on the holiday a photo album as a souvenir, which were obviously appreciated and enjoyed by the residents spoken with. A hairdressing room was provided and used by the visiting hairdresser. This room has individual personal storage for each resident’s pedicure and manicure equipment, preventing cross infection. The registered manager advised that the home was fortunate in being supported by residents, family and friends in their activities and fund raising, and with an emphasis on involving residents throughout. Visitors spoken with said that they were made welcome and that visits were unrestricted. Visitors could be entertained in the privacy of the resident’s bedroom or in any of the communal sitting areas. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Residents are also able to bring in their own possessions and to personalise their bedrooms when moving into the home and this was shown by the ornaments, pictures, photographs and small items of furniture seen in bedrooms. The registered manager advised that there was currently work being carried out by the cook, and other staff, with residents, on menu planning and meal choices. They are also taking on projects such as celebrating special occasions, international meals and producing a new special diet pudding each month. The registered manager said that a tasting session took place before new menus started and the residents had recently tried curries. This gives residents involvement, interest and choice in what is provided. One resident spoke of family members joining them for lunch on occasions and a visitor said that the food was “beautiful”. Meals are taken in light and cheerful surroundings. Lunch taken with residents was a pleasant occasion and a social event. Food provided was from several choices offered and was exceptionally tasty, well presented, nutritious and served well at appropriate temperatures by catering and care staff. All residents spoken with said that they enjoyed the food and mealtimes at Caldwell Grange and that they always had a choice of what to eat. The kitchen was visited and was clean and in good order apart from minor shortfalls in the storage in the fridge and in the freezer of two items of food, with a low risk of food becoming contaminated or spoiled. Records of food, fridge and freezer temperatures had been monitored and recorded and a
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 18 cleaning schedule was in place to ensure that hygienic standards were maintained. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 19 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): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to deal with complaints and to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Complaints are addressed and records maintained in accordance with the local authority. This procedure requires written communication with the complainant and the Council Customer Services Department and had therefore been viewed as too comprehensive and complicated for minor concerns that can be dealt with straight away. As a result these were not documented in the home’s complaints records. They were however recorded in the residents’ daily records. A complaint recorded described concerns from a short stay service user who had wanted to give staff expensive gifts of gratitude. The action taken as a result and the response to the person demonstrated that the relevant policies, which were in place to protect the financial interests of the people living at and visiting the home, were complied with in a sensitive manner. Residents were protected by the policies related to staff not accepting gifts or benefiting from a resident’s will. Staff had undertaken training related to adult protection to give them the skills and knowledge they required to identify and protect residents from abuse.
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 20 Staff files looked at indicated that the residents are safeguarded from the appointment of inappropriate staff by its robust recruitment policies and practices. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,24,26 Quality in this outcome area is good. The home offers the people living there comfortable and pleasant surroundings, which are clean, free of offensive odour, safe and well maintained. Infection control is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home recently suffered the effects of floods when the nearby river broke its banks. Residents were evacuated to other homes belonging to the Local Authority. Repairs and any necessary redecoration were virtually complete by the time of the inspection visit. Residents said that the evacuation had gone well and that they had felt as though they were going on holiday. The purpose built home had been upgraded to a high and tasteful standard several years ago. Improvements in the surroundings since the last inspection include the upgrading of bathrooms with the installation of new equipment and a cleaning/disinfecting system for the baths; five bedrooms and en suites have
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 22 had replacement floor covering; four bedrooms have been fitted with track hoists to assist transfers from an into bed where the occupant of the room had been assessed as being able to benefit from this equipment. First impressions on arrival at the home were of an attractive gardened frontage and cosy, comfortable and attractive sitting areas in the reception, including a homely area with a fireplace and television. Residents sitting there said that they enjoyed their surroundings. All sitting and dining areas are on the ground floor. All areas inside and outside of the premises are accessible to residents with a passenger lift between the ground and first floors. The reception, corridors and some communal areas had wooden or non-slip man-made wooden effect parquet floors. These were attractive and homely in appearance. Areas visited were clean, free of any offensive odour, attractive, and comfortable. The lounge adjacent to the conservatory did not reach the standard of redecoration seen in other areas of the premises and some of the varnish on the wooden arms of the armchairs in that room were chipped and in need of re-varnishing or replacing. The views from the conservatory were of countryside and residents commented on enjoying watching the antics of the donkeys in the adjacent field. Under the stairs space accommodates a guarded, and clean, fishpond, which did not seem to be attracting much attention from those passing by but some residents spoken with saw it as an attractive feature. The residents all eat in the main dining room and despite the large size of this room and the number of people eating there the layout, decor, furniture, fabric and floor covering provided a comfortable and pleasant eating area. All areas seen had lighting that provided adequate brightness and were domestic in appearance. The bedrooms of those residents case tracked were viewed and were personalised with such possessions as pictures, ornaments and pictures. One resident had an adjustable bed and pressure-relieving mattress and all had ensuite facilities. A lockable space for the occupant to use for the safe keeping of valuables was available in the rooms that were looked at. The home has acquired two new washing machines, with suitable disinfecting programmes, since the last inspection in order to ensure that there are effective measures in place to control infection. The laundry had baskets provided in order to sort laundry and to maintain infection control. All hand Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 23 washing in staff and communal areas had soap dispensers and disposable towels provided to further prevent the risk of cross infection. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 24 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): 27,28,29,30 Quality in this outcome area is good. There are sufficient staff available to meet the needs of the residents. Recruitment practices protect residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are sufficient staff on duty to meet the needs of the people living and staying at the home. The registered manager advised and the rota showed, that there were usually five care staff in the mornings until 12md, three from then to 2.30pm and four in the evening and two during the night. There are also cooks, domestic staff, and at least one senior member of staff on duty each day. The home is on target to achieve 50 of the care staff to have completed National Vocational Qualification Level 2 in Care. This qualification shows that staff have been assessed to be competent in their role. Induction training had been undertaken by the three staff whose files were looked at. Other training undertaken by staff included Moving and handling, Basic Food Hygiene First Aid, Death and Dying, Adult Abuse and Neglect, Food Hazard Analysis, Dementia Awareness and Parkinsons disease. This training gives staff the knowledge an skills they require to carry out their job, Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 25 Examination of staff files showed that recruitment policies and practice are robust and reflect equal opportunities. All files had all the required information including evidence of interviews and selection, two references and appropriate Criminal Records Bureau checks. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 26 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): 31,33,35,38 Quality in this outcome area is good. A person with the appropriate qualifications and who has previous management experience manages the home. Monitoring and auditing of the service and practices is carried out to ensure that all services operate in the best interests of residents. Residents’ financial and health, safety and welfare interests are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager had been at the home for fifteen months having had previous experience of managing similar services. She had the appropriate qualifications for the post and had attended several training sessions in the year to update her knowledge and skills. In addition to managing the home she had responsibility for the day care in the home, a support workers project, made up of a team of care staff who visit fifty individuals in their own home,
Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 27 and an ethnic minority day centre a short distance away from the home. Whilst an organiser has day-to-day responsibility for the running of the day centre the registered manager spends an afternoon there every month and visits a minimum of once every two weeks. There had been some time when the support project had been without an organiser and the registered manager had needed to have day-to-day involvement. The Responsible Individual should monitor this responsibility arrangement to ensure that it does not adversely impact on the registered manager or the management of the home. The registered manager said that there is an able senior staff team who have taken on board the changes and the newly designated responsibilities as well as acknowledging that there were further improvements to make. The home had implemented the Local Authority’s Quality Assurance Programme and there was documented evidence that the service was monitored and appropriate action taken to ensure that the service was run in the best interests of the people using it. The errors found in the medication, and the need for care plans to be updated indicated that the system was not currently working. However these recent shortfalls would appear to be due to the evacuation and the aftermath of the flood experienced by the home. Records are maintained for any financial transaction involving residents’ monies. Two members of staff now sign if a resident is not able to do so on their own behalf, in order to protect their financial interests. Staff files looked at had records to show that the home is on target for all care staff to have staff supervision six times a year. This gives staff the opportunity to discuss their practice, the philosophy of the home and their individual training needs. Accurate records of mandatory and of health and safety training were available for inspection with staff undertaking appropriate training to ensure a safe environment for the people who live and work at the home. Records showed that there are full health and safety checks carried out at three monthly intervals. A random check was made on maintenance, servicing and in-house fire prevention records and these were up to date and in good order, further showing that the home was a safe to place for residents and staff. Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 28 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Caldwell Grange DS0000035030.V341002.R01.S.doc Version 5.2 Page 29 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. Standard OP7 Regulation 15 Requirement Care plans and risk assessments must be revised as an individual’s circumstances change. This will enable their needs to be met in a person centred manner and minimise risk to their health and welfare. All residents must be assessed regarding their risk to the development of pressure sores. This will ensure that residents are protected by the risk of their occurrence being minimised. The temperature in the medication room must be below 25°C at all times. This will ensure the stability of the medicines stored inside and safeguard the residents’ health and welfare. The previous timescale of 05/04/07 was not met. 4. OP9 13(2) New medication policies must be 30/11/07 rewritten to reflect practice and be service specific and staff must be trained to adhere to them.
DS0000035030.V341002.R01.S.doc Version 5.2 Page 30 Timescale for action 15/11/07 2. OP8 13(2)(c) 30/10/07 3. OP9 13(2) 30/11/07 Caldwell Grange This will safeguard the health welfare of the residents. The previous timescale of 05/04/07 was not met. 5. OP9 13 The correct administration and correct dosages of medication must be administered to the correct person at the correct time and correctly recorded. This will ensure that the health and welfare of the residents are protected. Staff drug audits must be undertaken before and after medicine rounds, and the administration of controlled drugs. This will ensure that residents’ health and welfare are protected. A record of all complaints made, including any investigation and any action taken must be kept. This will ensure that residents and visitors know that their concerns are listened to. 22/10/07 6. OP9 13 22/10/07 7. OP16 17 Sch 2 22/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP19 Good Practice Recommendations Where practicable care plans should be signed by the resident or their representative in order to validate the plan and demonstrate the involvement of the person. The décor and furniture in the lounge identified should be addressed as the comfort of the residents is decreased in this area.
DS0000035030.V341002.R01.S.doc Version 5.2 Page 31 Caldwell Grange Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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
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