Inspection on 27/09/06 for Caldwell Grange

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Caldwell Grange 06/11/08

Caldwell Grange 14/09/07

Caldwell Grange 29/12/05

Caldwell Grange 27/06/05

Caldwell Grange 28/10/04

Caldwell Grange 20/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Caldwell Grange Donnithorne Avenue Nuneaton Warwickshire CV11 4QJ Lead Inspector Patricia Flanaghan Key Unannounced Inspection 27th September 2006 09:30 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.V314289.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.V314289.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 Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th December 2005 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 by the local authority range from £94.45 to £380.24 per week. Additional fees are charged for newspapers, toiletries, chiropody, hairdressing and individual outings or holidays. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection visit took place over two days on Wednesday 27th September between 2.00pm and 6.45pm and Friday 6th October between 9.30am and 1.30pm. The Pharmacist Inspector for the Commission carried out an inspection on 13th September to assess medicine administration practices in the home and her findings are included in this report. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. One completed comment card from a resident had been received at the time of writing this report. The resident indicated they were happy in the home although felt that staff “do not always have the time to look after you.” The registered manager of the home completed and returned a questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. The inspector had the opportunity to meet most of the residents and talked to five of them about their experience of the home. The residents were able to express their opinion of the service they received. General conversation was held with other residents along with observation of working practices and staff interaction with residents. The inspector also spoke with three visitors about their experiences of the home. One visitor said that her relative “is very happy and content here.” She also commented that “staff are very hardworking.” The inspector would like to thank staff and residents for their cooperation and hospitality. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 6 What the service does well: Caldwell Grange has a homely and friendly atmosphere. Overall, the home is clean and comfortable and well equipped to meet the needs of people with disabilities. The home provides good wheelchair access throughout the building, including ramps at the doorways, lift and lifting equipment. Residents were able to personalise their rooms to their choosing. There were good systems in place for assessing the needs of prospective residents to the home so the staff were able to decide if they could meet any identified needs. A visitor spoken with during the inspection said “I was so pleased when a place at this home was offered to my mother, she is happy here, so we (the family) are happy” All residents spoken with were positive about the staff and the care they receive at the home. One resident said that “the girls are brilliant, they can’t do enough for us.” There did not appear to be any rigid rules or routines in the home and residents could spend their time as they chose. Residents had been involved in some activities both inside and outside of the home and more were planned. All residents spoken with were satisfied with the meals they were served and the menus evidenced a varied and nutritious diet with choices available for the residents. Residents were consulted prior to meals about their preferences. One resident said “I always look forward to my meals.” Suitable procedures are in place for dealing with complaints. Regular meetings provide an opportunity for the manager to check that residents are happy and to respond to any concerns. The home is well managed and the views of the residents are routinely sought about everyday matters that affect their lives, for example, a working party of residents has been set up to review the menus for meals in the home. Throughout the inspection staff were observed to be caring and supportive to residents who reacted positively towards the staff. Health and safety systems are in place at the home, fire equipment has been checked and is regularly serviced. Mandatory staff training on health and safety is ongoing. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 8 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.V314289.R01.S.doc Version 5.2 Page 9 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. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to their admission to the home to ensure the home can meet their needs. EVIDENCE: Before moving into the home prospective residents have their initial care needs assessed by a social worker and are encouraged to visit the home before making a decision whether to move in. There is an agreed trial period of usually four weeks and a review date set as soon as the resident moves into the home. In addition, the manager or a senior care officer also visit prospective residents in their own home to assess their care needs and to provide information about the home. A record of the initial care needs assessment is held and used to determine whether the residents care needs can be met. Two residents spoken with said they had visited the home before deciding whether to live there. Another resident said that they had chosen not to visit, Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 10 preferring instead to have family members assess the home’s facilities on their behalf. All three residents spoken with felt they had made the right decision in choosing to live at Caldwell Grange. The home also provides a respite care service and people using this service also have their needs assessed prior to admission to the home. Three initial care needs assessments examined held information about the residents background, personal circumstances and care needs. This initial care needs assessment forms the basis of the resident’s care plan, which is recorded and agreed shortly after admission. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Residents are provided with the support they require to meet their personal and healthcare needs in a manner that respects their privacy and dignity. The management of medicine has improved but not enough to make sure the needs of the service users are fully met. The manager was keen to improve practice further to make sure this happens. EVIDENCE: The care plan files for three residents were examined. The files contain detailed, helpful information explaining people’s needs. The care plans cover a comprehensive range of personal care need and health care needs. Each area of care is risk assessed, for example, risk of falling, skin care and where risks are identified clear directions and guidance are in place for staff to follow. Information in the care review notes also verified that the home seeks to involve residents, relatives and other relevant people in the review process. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 12 During conversation four residents and one relative confirmed that they have been involved in the care reviews. Entries in residents’ health records and comments by staff confirmed that people are supported to gain access to relevant health professionals where required, such as the GP, district nurse, dentist and optician. This was also verified by comments made by a number of residents. Health records contained evidence confirming that where extra care is required it is correctly monitored and recorded, for example, fluid and food intake is recorded in detail to ensure a resident at risk is eating well and they do not become dehydrated. The manager has designated a member of staff specifically responsible for the handling of medicines in the home and this has made an improvement in the medicine management since the last inspection. The system used to check the medicines into the home is poor and must fundamentally change to improve the service. Quantities of medicines were recorded but this did not happen in all instances so audits could not demonstrate that all the medicines had been administered as prescribed by the doctor. Staff do not check all new residents’ medicines with their doctor once bought into the home. Residents are encouraged to take their own medicines but staff do not risk assess them as able or undertake any compliance checks to see whether they actually do take them safely. The home has a designated medication room but the temperature was too hot and reached 29°C at the time of the inspection. Medicines are therefore not correctly stored which may compromise their stability. The staff select the medicines from the pharmacist labelled containers and place in a small medi-pot. This is then taken to the resident. This increases the possible risk of putting the pot of medicines down in the event of an emergency instead of securing it in the lockable trolley. During the inspection the lunchtime tablets were selected against the Medicine Administration Record (MAR) chart but not actually administered to one resident, as she was asleep. Residents are encouraged to go out on trips away from the home but no provision is made to make sure that they do not go without prescribed medication. Records did not support what had actually taken place in all instances. The medication policy was a generic policy written by Warwickshire County Council. This was not specific to the home and was not detailed enough to fully support the care assistants who handle the medicines. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 13 Some residents are prescribed, “when required” medicines which should only be given under specific circumstances. There were no supporting protocols detailing their use. One care assistant that routinely administered the medicines was interviewed. She had a very limited knowledge of the medicines she gave out. Further training is needed. Staff have either completed or nearly completed an accredited training course in the safe handling of medicines. The manager and the new designated lead for medicines were very proactive during the inspection and keen to improve practice. All residents spoken to were positive about the care they receive in the home. Throughout the inspection staff were observed to be caring and supportive towards residents. The people living at the home were seen to be well groomed and dressed in well laundered, age appropriate clothing, indicating that they are supported to maintain a good self-image. Residents’ personal care needs are carried out behind closed doors demonstrating that staff show a suitable regard for people’s privacy and dignity. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in social activities and are given choices in how their care is delivered including choices of meals provided to maintain their quality of life. EVIDENCE: Visitors are welcome at the home and information is available in the home’s brochure of visiting arrangements. An Anglican minister visits monthly and holds a service in the home. Representatives of the Methodist Church, Roman Catholic Church and Salvation Army also visit regularly to meet with residents and offer communion as required. Care plans reviewed showed that the religious and cultural needs of residents are established and considered when planning their care. The programme for activities is displayed on the notice board. Monthly outings are undertaken. The home has access to a mini-bus which has a tail lift and can accommodate 3 wheelchair users and a number of other adults. Three of the staff have received appropriate training and are designated drivers. Seven residents and five carers enjoyed a holiday in Skegness in June 2006. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 15 Photographs of the holiday were on display. Outings planned for the coming months include a trip to a garden centre for lunch and trips for a musical production and the ballet at the local municipal theatre. Residents also regularly visit the local town centre for shopping and fish and chip suppers. Other activities include Music and Movement, board games, reminiscence, quizzes and bingo. The home is also arranging a party to celebrate the 50th anniversary of the home’s opening. All residents spoken with felt there were sufficient activities offered by the home. A sample of menus were examined and these demonstrated that a wholesome and nutritious diet is being provided on an ongoing basis. Staff were aware of residents likes and dislikes and those that required a special diet. Meals are seen as a social occasion where residents chat to each other and staff. The tables are attractively laid with matching cutlery and crockery. Meals observed at lunchtime looked appetising and residents said they had enjoyed their lunch when asked. All meals are freshly prepared and fresh vegetables and fruit are readily available. Residents stated that they were very happy with the food provided and the choices available. One resident commented “I always look forward to my meals,” another resident said “nobody could complain about the food here.” During the inspection, staff made drinks frequently for the residents and also prepared refreshments for the visitors to the home who were made welcome on their arrival. The kitchen was clean and tidy. Cleaning records are kept and were up to date. The refrigerator was well organised and all opened foods had been appropriately covered and labelled with contents and date. Refrigerator and freezer temperatures are taken and records maintained. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures for the protection of residents and complaints are listened to and taken seriously. EVIDENCE: A ‘complaints, concerns and compliments’ box is available in the reception area. A copy of the Warwickshire County Council complaints procedure is in a prominent position on the public notice board. There have been no complaints to the Commission or the home since the last inspection. An examination of the complaints log demonstrates that there are proper systems in place for investigating and recording complaints. Residents spoken to were not all aware of the complaints procedure but it was clear that they felt at ease to raise any concerns with staff if necessary. The home has a procedure for responding to allegations of abuse that provides clear guidance for staff. Three staff spoken with said they would refer any issues of concern about the safety of residents to the senior staff or the manager. All staff members spoken with had knowledge of how to identify any potential abuse and were able to describe the different types of abuse that may occur. One staff member had limited knowledge of the ‘whistle blowing’ policy and procedure operating in the home. The manager was aware of the local arrangements for the Protection of Vulnerable Adults (PoVA). Staff spoken with confirmed they had attended training in adult protection. From records available it was difficult to be clear that all staff had completed this Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 17 training to be sure that they know how to identify abuse and actions they should take. There have been no adult abuse investigations involving the home since the last inspection. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 18 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, 24 and 26 Quality in this outcome is good. This judgment has been made using available evidence including a visit to the home. Residents live in a generally well-maintained and safe environment that is equipped to meet their individual needs. Residents are able to personalise their rooms and benefit from living in a home that is clean and free of offensive odours. EVIDENCE: There are well-maintained gardens for residents to enjoy. The weather was warm during the visit and a resident was seen sitting outside, enjoying the fresh air on both days of the inspection. The gardens are not enclosed and residents can leave the home as they wish. A risk assessment have been undertaken for any residents who like to walk outside of the home’s boundaries, to ensure their individual safety. A tour of the home was undertaken. Since the last inspection the reception area and the dining room has been refurbished. Residents sit on comfortable Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 19 chairs in the large reception area to watch television or read books or newspapers. There is also a main lounge, a smaller quiet lounge and a large conservatory. Some of the individual bedrooms visited were pleasantly decorated and others required some attention. For example, wallpaper was faded and carpets in some rooms were worn thin. Residents are encouraged to bring personal items in with them and can furnish and redecorate their private room to their own taste if they wish. Personal possessions were noted in the bedrooms viewed during the inspection visit. En suite facilities are sufficiently spacious to meet resident’s needs. Four residents spoken with said they were very comfortable in their rooms. Communal bathrooms and toilets are easily accessible and are situated close to the lounge and dining areas. Equipment and aids are provided to assist residents and include toilet seat raisers, assisted baths and hoist. Bathrooms have been redecorated with new assisted bathroom suites installed in all bathrooms ensuring residents can bathe safely and comfortably. There is only one industrial washing machine and a tumble dryer used to manage the laundry service as both the second washer and dryer are broken. The manager advised that a second tumble dryer has been ordered for the home, however, a washing machine will not be available from this year’s budget. The registered provider should consider providing a second washing machine at the earliest opportunity in order to accommodate the changing needs of residents within Caldwell Grange and prevent the spread of infection to residents. Three housekeeping staff work Monday to Friday, 8am – 3.30pm with one staff member being designated to cover laundry duties. In the absence of the laundry person, care staff include the laundry tasks in their daily routines. Before it is returned to residents, clean laundry is placed in baskets with a residents name on or on coat hangers on a clothes rail. Soiled linen is held in red bags and laundered separately at appropriate hot water temperatures to reduce risk of infection. Staff wear disposable gloves when carrying out personal care tasks or when handling soiled linen, and protective clothing when handling or serving food. Liquid soap and paper hand towels is available in the toilets and the laundry room and incontinence pads and clinical waste held and disposed of safely and appropriately. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were sufficient numbers of staff on duty on the day of inspection and residents feel that staff meet their needs. Staff training is ongoing to ensure staff are competent to meet the needs of residents. EVIDENCE: At the time of the inspection there were 28 residents living in the home. The manager was on annual leave the first day of the inspection and the inspection was therefore carried out with the assistance of care officers and care staff on duty. The manager assisted on the second day of the inspection. Sufficient staff were available on both days of the inspection, however, three agency staff were required to ensure the afternoon shift was appropriately staffed on the first day. One agency worker also covered the night shift of the first day. There is a care officer and five care staff on duty in the mornings and a care officer and four care staff on in the afternoon. The manager works supernumerary hours to those of the care staff. At night there are two waking night staff and an emergency on call system in place. In addition to this the home employs domestic, kitchen and laundry staff. The manager said that the home are advertising for two members of care staff to work full time. They have also recently appointed four carers as ‘bank’ staff, that is, staff who will provide cover at short notice. The home are waiting for the outcome of Criminal Record Bureau (CRB) disclosures and Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 21 checks made against the Protection of Vulnerable Adult (PoVA) register to determine the fitness of these four prospective employees before they start to work at the home. Two relatives and four of the five residents spoken to all said there were sufficient numbers of staff available to meet the needs of residents. One resident returned a comments card to the commission stating that staff “do not always have the time to look after you.” The recruitment files of three staff were examined. All files contained information to confirm that the home operate an equal opportunities interview process and staff are properly vetted before starting work. This includes taking up references and a Criminal Record Bureau check to ensure that staff are safe to work at the home. Information provided by the manager on the pre inspection questionnaire demonstrated that 18 of the 28 care staff employed at the home have an National Vocational Qualification (NVQ) level 2, or Level 3 in care. New staff have an induction relevant to their role and responsibilities that includes shadowing an experienced worker and training in health and safety, safe moving and handling techniques and the principles of care. The training manual new staff complete is called ‘Working in Care Settings; Induction and Foundation Standards.’ Staff are supervised until they have satisfactorily completed the training course. Staff training records were not up to date, therefore we cannot be sure that staff have received regular updates in health and safety issues and moving and handling. The manager was able to show how she is in the process of updating records for all staff. Information supplied by the manager, records seen and discussion with staff confirmed that some training linked to resident care had been undertaken by some staff. Further training has been arranged on topics such as equality and diversity, stroke awareness and infection control for all staff. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 22 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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure the home is run in the best interests of the residents and to ensure the health and safety of the residents is protected. EVIDENCE: The manager has worked as a home manager for the local authority for five years and was appointed to Caldwell Grange in June 2006. The manager is experienced, has attained the Registered Managers Award qualification and is suitably qualified to manage the home. She continues to update her learning, for example, undertaking recent training on equality and diversity and managing performance. Age Concern undertakes a formal annual quality system. The annual quality assurance survey is due shortly and the home will assess the results. A formal Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 23 report is then circulated to residents and stakeholders. Feedback from residents, relatives and others is also obtained in a less formal manner during reviews and from thank you letters and cards. Positive comments were seen from appreciative relatives in the comments/complaints book kept in the entrance hall with cards and letters kept in a folder. Regular residents meetings are held. The minutes of the meeting held on 14/09/06 was on display on the notice board. As a result of this meeting a volunteer group of residents was set up to discuss menus and they will take their findings and suggestions back to the next full meeting. The manager confirmed that she does not act as appointee for anyone at the home and that this role is carried out by relatives, advocates or the people themselves. The home holds personal cash in safekeeping for residents where required. An expenditure record was seen that is maintained by the administrator together with receipts. The manager routinely checks the money. Signatures were seen to be in place to verify this. It is recommended that in the absence of the residents signature, two designated staff signatures are obtained for each financial transaction in order to be sure that the home are managing resident’s money properly. Discussions with the manager and a sample examination of staff supervision records indicate that staff are well supported and receive regular supervision from the home manager. This is a management process to monitor care practices delivered by staff ensuring that residents’ health, safety and welfare is maintained at all times. A review of health and safety was undertaken. The home confirmed in a preinspection questionnaire forwarded to the commission that health and safety checks had been completed. Records examined include maintenance, contracts and servicing documentation for electrical equipment. Fire records and electrical tests are up to date. Hot water ‘hand’ tested in the home on the day of inspection was within safe levels to prevent any risks of scalding to the residents. Examination of documentation confirmed the absence of accurate training records and confirmation that staff received regular mandatory training. These issues must be addressed by the Registered Provider so that we can be sure staff receive appropriate health and safety training and any updates necessary to carry out their duties safely and responsibly. Two staff spoken with said they had attended moving and handling training which included the use of a hoist. A care officer also confirmed that she had recently undertaken a four day First Aid course. The manager said that that moving and handling, hoist training and fire safety was due to take place in October and November of this year. Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 24 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 2 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 2 3 3 3 X X 3 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 2 Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement The registered person must ensure that a system is installed to check the prescription prior to dispensing and to check the dispensed medicines and Medicine Administration Record (MAR) chart received into the home. Staff must confirm the current drug for any new service users with the doctor on entry to the home. Liaison with the community pharmacy is required to ensure that the Medicine Administration Record (MAR) chart is printed using the prescriptions and not the pharmacist records. The Medicine Administration Record (MAR) chart must detail exactly what medicines have been received and administered. 2 OP9 13(2) The registered person must ensure that the system used to transport the medicines to the service user is reviewed. All medicines must be able to be secured in the event of an emergency. DS0000035030.V314289.R01.S.doc Timescale for action 30/11/06 30/11/06 Caldwell Grange Version 5.2 Page 26 2 OP9 13(2) The registered person must undertake staff drug audits before and after a drug round to confirm staff competence in administering the medicines and accurately recording what has happened. The registered person must ensure that a system is installed to ensure that service users do not go without their medicines when they leave the home for example, a day trip. Records must reflect practice. The registered person must ensure that the temperature in the medication room is below 25°C at all times to guarantee the stability of the medicines stored inside, in compliance with their product licences. The installation of an air conditioning system must be considered to achieve this. The registered person must ensure that the maximum, minimum and current refrigerator temperature are read on a daily basis and the temperature must lie between 2°C and 8°C at all times. The registered person must ensure that new medication policies are rewritten to reflect practice and be service specific. Staff must be trained to adhere to them. 30/11/06 4 OP9 13(2) 30/11/06 7 OP9 13(2) 31/12/06 8 OP9 13(2) 30/11/06 9 OP9 13(2) 31/12/06 10 OP9 13(2) The registered person must ensure that all staff receive DS0000035030.V314289.R01.S.doc 31/12/06 Version 5.2 Page 27 Caldwell Grange training in the clinical indications, common doses and side effects for all commonly administered medicines routinely administered by them. 11 OP9 13(2) The registered person must ensure that medicines that are administered “when required” are supported by a “prn” protocol detailing their clinical use, dose, and time between doses, maximum daily dose and the outcome recorded following administration. The registered person must arrange, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The Registered Person must ensure accurate training records are maintained and demonstrate that staff receive regular mandatory training. 30/11/06 12 OP18 13(6) 31/12/06 13 OP38 13(4)(5) 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000035030.V314289.R01.S.doc Version 5.2 Page 28 Caldwell Grange 1 Standard OP26 In order to ensure that effective measures are in place to control the risk of infection, the registered provider should consider providing an additional washing machine with a view to accommodating the changing needs of residents within the home. The manager should ensure that the expenditure record is signed by the resident or by two designated staff members every time a financial transaction takes place involving residents’ monies. 2 OP35 Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Caldwell Grange DS0000035030.V314289.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!