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Inspection on 10/04/06 for Capwell Grange Nursing Home

Also see our care home review for Capwell Grange Nursing Home for more information

This inspection was carried out on 10th April 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All areas visited appeared to be well staffed, and staff were seen to be treating the service users in a courteous manner with dignity and respect. The home was noted to be clean, tidy and well maintained throughout. The units were comfortably furnished with solid dining room furniture and an assortment of comfortable armchairs giving a homely appearance.Care plans viewed had been composed with an individual and descriptive focus, and were being updated at regular / appropriate intervals. Risk assessments were seen for all service users that were tracked. They were being reviewed on a monthly basis, and the outcome scores were being used to generate / review care plans. The accident book was seen on one unit. Incidents/accidents were clearly reported and entries were found in individual service users progress notes to be correctly corresponding. Medication charts were checked in two units. All MAR sheets checked were noted to have been fully completed correctly. There were no missing signatures or administration codes. (This inspection was done on the first day of the fourth week of the present MAR sheet). There is a senior staff meeting held every Monday morning. This ensures all senior staff are kept fully informed as to any changes that maybe required in the day-to-day running of each unit.

What has improved since the last inspection?

Staff morale was much improved since the last inspection. This was indicated by comments from staff to the inspectors. Moving and Handling hoists were seen to be plentiful, and being used in a safe and competent way. Each separate unit had staff supervision plans in place. All service users notes had preference charts in them. These had been completed and signed either by the service users or their relatives, thus ensuring personal likes and dislikes were known and considered in the planning of individual care.

What the care home could do better:

Consent for photograph forms had been completed in the service user files. However one consent form indicated it was for head and shoulders picture, but other areas of the body had been photographed for wound monitoring.Bathrooms were found being used as storage for disused/damaged furniture, mattresses and crates of continence pads. The home needs to be able to evidence clearly that all staff have done training on Protection of Vulnerable Adults. This should be on the unit based training matrix or on the training sheet found in the staff personal files. One of the units was still doing the morning medication round at 11.30 hours. The unit needs to review its daily routines and allocation of workload to ensure service users receive their medication in a way that promotes health and wellbeing. Areas caring for service users suffering from Dementia, need to ensure that meal times are better co-ordinated. They must ensure all service users have the opportunity to choose their meal and enjoy it hot, safely, and with assistance if required. Staff on the Dementia areas, need to improve their knowledge, skills and understanding of this client group in order to improve the outcomes of the care they are providing.

CARE HOMES FOR OLDER PEOPLE Capwell Grange Nursing Home Addington Way Oakley Road Luton Bedfordshire LU4 9GR Lead Inspector Mrs Louise Trainor Unannounced Inspection 10th April 2006 06:30 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 Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 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. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Capwell Grange Nursing Home Address Addington Way Oakley Road Luton Bedfordshire LU4 9GR 01582 491874 01582 564225 edwardscaupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited 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) Cheryl-Ann Edwards Care Home 146 Category(ies) of Dementia - over 65 years of age (60), Mental registration, with number disorder, excluding learning disability or of places dementia (8), Mental Disorder, excluding learning disability or dementia - over 65 years of age (8), Old age, not falling within any other category (120), Physical disability (34) Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate a maximum of 146 service users of either sex. No one falling into the category of mental disorder (MD) or (MD)(E) maybe admitted to the home where there are 8 persons, in the age range of 55 in these categories already accommodated within the home. No one under the age of 65 years can be admitted to the home where there are 34 persons already accommodated in the home. 22nd June 2005 3. Date of last inspection Brief Description of the Service: Capwell Grange Nursing Home is a modern, purpose built complex comprising of a central two-storey building and five houses. The central building provides accommodation for administration, reception, and services including laundry, catering, a staff room, staff training areas and a visitors suite. There is ample parking for staff and visitors. Two of the houses, Milliner and Hatley provide care for elderly service users with a diagnosis of dementia. Two others, Fidora and Bonnetti accommodate frail residents who require both nursing and social care. These four houses are all registered for 30 service users. The fifth house, Mitre, is registered for 26 service users under the age of 65 years with a physical disability. Staff providing care are qualified nurses and care assistants supported by ancillary staff. Each house has a small quiet lounge, an open plan lounge, a conservatory and a dining area. There is access to the well-tended gardens. The service users individual accommodation has en suite facilities and suitable furniture and fittings. All rooms have an emergency call system. There are separate toilet and bathing facilities available with access to aids for assistance. Main meals are prepared centrally and each house has a small kitchen for preparing and serving food and drink. Capwell Grange promotes activities and entertainment for service users by employing a designated Hobby therapist for each of the houses. The fees for this home range from £507.00 per week to £850.00 per week. This is dependent on the funding source, the specific needs of individuals and the level of care required. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first of two Unannounced Key Inspections to be carried out in the home this year. It was carried out by Lead Inspector Louise Trainor and assisted by Mrs Sally Snelson, Regulations Inspector, who has previously been the lead for this service, and had carried out all last years’ inspections and numerous monitoring visits. The Inspection took place between the hours of 06:30 hours and 13:15 hours. During the inspection both Inspectors met with the homes manager, and complaints, recruitment and the general progress of the home was discussed. Two staff personal files were reviewed. Four of the five units, Milliner House, Fidora House, Hatley House and Bonnetti House were visited. A brief tour of each unit was undertaken, and a total of six service users were case tracked. Documentation was viewed on all four units, as were training and supervision records. Staff members of various grades were interviewed informally during the course of the visit. Unfortunately there were no visitors available for consultation during this inspection, and access to the records of service user money was not possible as the administrator was on leave. Overall throughout this inspection there were many very positive improvements noted, and these are clearly evidenced in the body of the report. There was however little evidence of ‘wellbeing’ as defined in ‘Dementia Care Mapping,’ on Milliner House, this indicated that staff had little understanding of the new culture of dementia care. It should also be noted that BUPA are presently recruiting to the Matrons and Deputy Head of Care posts for this home, and the Senior Sisters post on Milliner House. The Inspectors would like to thank everyone concerned for their support and assistance during the inspection. What the service does well: All areas visited appeared to be well staffed, and staff were seen to be treating the service users in a courteous manner with dignity and respect. The home was noted to be clean, tidy and well maintained throughout. The units were comfortably furnished with solid dining room furniture and an assortment of comfortable armchairs giving a homely appearance. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 6 Care plans viewed had been composed with an individual and descriptive focus, and were being updated at regular / appropriate intervals. Risk assessments were seen for all service users that were tracked. They were being reviewed on a monthly basis, and the outcome scores were being used to generate / review care plans. The accident book was seen on one unit. Incidents/accidents were clearly reported and entries were found in individual service users progress notes to be correctly corresponding. Medication charts were checked in two units. All MAR sheets checked were noted to have been fully completed correctly. There were no missing signatures or administration codes. (This inspection was done on the first day of the fourth week of the present MAR sheet). There is a senior staff meeting held every Monday morning. This ensures all senior staff are kept fully informed as to any changes that maybe required in the day-to-day running of each unit. What has improved since the last inspection? What they could do better: Consent for photograph forms had been completed in the service user files. However one consent form indicated it was for head and shoulders picture, but other areas of the body had been photographed for wound monitoring. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 7 Bathrooms were found being used as storage for disused/damaged furniture, mattresses and crates of continence pads. The home needs to be able to evidence clearly that all staff have done training on Protection of Vulnerable Adults. This should be on the unit based training matrix or on the training sheet found in the staff personal files. One of the units was still doing the morning medication round at 11.30 hours. The unit needs to review its daily routines and allocation of workload to ensure service users receive their medication in a way that promotes health and wellbeing. Areas caring for service users suffering from Dementia, need to ensure that meal times are better co-ordinated. They must ensure all service users have the opportunity to choose their meal and enjoy it hot, safely, and with assistance if required. Staff on the Dementia areas, need to improve their knowledge, skills and understanding of this client group in order to improve the outcomes of the care they are providing. 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. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 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 Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Evidence seen relating to the process for pre admission assessment of service users, is insufficient to assure that all service users needs’ will be fully met. EVIDENCE: Only one of the service users that was case tracked during the inspection was a recent admission and had a completed pre admission assessment form in their file. Unfortunately this was not signed or dated, and did not address the problem of wandering, which was a major problem following admission. This gentleman did not settle on the unit he was admitted to, and his management caused some difficulties. Within a week of admission he was found sitting in the garden and had sustained a fractured arm whilst wandering unattended. This resulted in a room move. He was then moved to another unit within a short period of time, where it appeared he settled very quickly. Since this time his care had been managed without problems. The suitability for this Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 10 gentleman’s care should have been assessed more thoroughly initially to avoid the need for second move. Although this gentleman’s needs were primarily physical when his pre assessment was carried out, he did have a diagnosis of dementia and it may have been more appropriate to place him on one of the units more specific to his long-term dementia needs. Five other service users that were tracked had no evidence of pre admission assessments. Information files were found in each service users room. This contained the homes Statement of Purpose, and a detailed account of all the services provided by the home. However one service user was unaware if it s presence. Capwell Grange did not offer intermediate care. The evidence sited in this report relating to the limited interaction at mealtimes on Milliner house, and also the evidence from activity programmes indicates that the needs of some service users with dementia are not being fully met. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The service users health, personal and social care needs are set out in detailed individualised plans of care so that their needs are fully met. However as evidence below indicates, service users in one particular unit were not fully protected by the homes procedures for dealing with medication. EVIDENCE: Most of the care plans were written clearly and in detail. The ‘care required’ was written in a very prescriptive way. This ensures that all staff would know exactly how much assistance was required, for each service user to receive a good standard of care with continuity. They also included personal preferences, and were reviewed and updated on a regular basis. One service users’ care plan identified numerous physical problems. In all cases it was clear that the detail was being followed closely. Blood sugars were being monitored and recorded twice a day, and due to the irregularity of the readings her insulin was being reviewed regularly. The plan for wound care, specified when the dressing should be changed, and what dressings should be Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 12 used, and the service user also confirmed that this did happen. She also had a pressure - relieving mattress in situ as described in her personal care plan. Her nutrition care plan detailed a specific dietary requirement. Her care plan also detailed her preferences for personal hygiene, these she also confirmed to be correct and adhered to. However some care plans were not being adhered to, or were not specific enough: one gentleman who had his arm in a plaster cast, had a plan that instructed this should be kept elevated in a sling, there was no evidence of a sling and this was not being done. His care plan also stated that he walked with a walking stick, however there was no evidence of this either. It is recognised this service user was not always compliant, but there was no reference to managing this problem in his care plan. Another service users plan read, “make use of barrier creams available”, this was not specific enough. Medication charts were checked on two of the units. In both areas charts were fully completed. There were no missing signatures or codes on any charts. There was only one service user on a controlled drug, (Temazepam), and these were counted and reconciled correctly with the record book. The dosset boxes were also checked, and again corresponded with the record sheets. Drug disposal policy was observed and being adhered to, and there was’Destruction of Controlled Drugs’ bottle, used, sealed and awaiting collection. Although documentation and records for medication were good, it was noted in Milliner House that the morning medication round was still in progress at 11.25 hours. This is poor practice, and meant that for some service users whose next dose was due at lunchtime, there might not be a sufficient interval between doses. This was discussed with a staff member at the time. She stated that she was feeling unwell, and so it had been slower than usual. However there were two other qualified nurses on duty at the time who could have done the medication round. Service users were seen being treated with respect and courtesy throughout the inspection. Relationships were informal and friendly. In one unit a service user said “Tip top to all staff, it’ s quite good here”. However on another unit, service user s were not so positive. One lady said “ she s lovely” when a carer came in to take her requests for breakfast. However immediately afterwards another member of the staff came in to assist with another aspect of care and she said “she s horrible, that’s more visits than I usually get most days.” Another service user said, “I’m amazed at the lack of society here.” ‘End of life’ plans were discussed with the manager, however none of the service user files that were inspected had an ‘end of life’ care plan or any indication of service user wishes in the event of death. One service user plan did however have clear instructions to follow in the event of hospitalisation. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, 15, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was a vast contrast noted between the units visited. On Hatley House it was clear that service users were well stimulated socially, and able to exercise choice and control over their life style. However on Milliner House there was very little evidence of this. EVIDENCE: On Hatley House the service users were involved in a session with the hobby therapist, making flower arrangements. They were being asked opinions on what colours to use and some were taking the final products to their rooms. The mealtime on Hatley House was a social occasion, with good staff / service user interaction. Service users were being offered a choice of menu that included: Fish and chips, Chicken in a white wine sauce, Quorn burgers and Ratatouille. Broccoli and new potatoes were also on the menu. Service users appeared to be enjoying most of the meal. Breakfast time on Bonnetti House appeared relaxed. Three service users were up and dressed in the lounge at 06:45 hours, when the inspection began. All of these service users confirmed they were up this early by choice. They were Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 14 offered choice of scrambled eggs, tomatoes, cereal, porridge and toast for their breakfast. Another service user was offered her breakfast choices in her room, and that’s where she preferred to remain. On Milliner House there was limited evidence of activities in progress. A poster in the corridor indicated that the day’s activity was ‘putting up Easter decorations’. Although the hobby therapist was putting up decorations, there appeared to be very little involvement from the service users. And the majority were just sitting in the lounge with little stimulation at all. One service user said, “I’m amazed at the lack of society in this place”. It was noted that during the inspection, a member of staff took a service user from one house to another, where she had a chat with another member of staff, however the service user appeared totally confused. Whilst recognising the intention was to stimulate this service user, it was not beneficial, and appeared to cause more confusion. The activities sheet for Milliner house that has been submitted to CSCI, indicates individual attention in bedrooms every afternoon with a nominated service user. Although the importance of 1:1 interactions is recognised, it is unclear what the remainder of the service users would be doing during this time On Friday morning the programme indicates shopping with a named individual. It is again unclear as to how many of the 30 service users would be involved in this activity. The Commission only received five service user survey replies, and five relative/visitors survey replies. Of the service users responses, three indicated they would like more involvement with decision making in the home, and one indicated that activities are not always suitable. However all relative/visitor responses indicated they are involved in decision-making where their relative/friend is unable to make decisions for themselves. The Mealtime in Milliner House also gave some cause for some concern. Very few service users were seen to be offered a choice of meal. There was a completed menu board by the serving trolley, however being predominantly a Dementia unit, few of the service users could benefit from this. If service users did not respond when asked what they wanted, they just had a meal put in front of them. There was no visual choice offered, either in picture form or by being shown meals presented on plates. Most of the service users were given chicken in sauce, with potatoes, broccoli and ratatouille. None of the service users were seen to be offered fish and chips as an option on Milliner House, as they had been on Hatley House. Condiments were not evident on the tables. One service user had her dinner put in front of her while she was dozing. There was no communication from the staff. Twenty minutes later sponge pudding and custard was brought to the table for this lady, who had just woken up, and Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 15 was tasting a cold potato, she said. “It s horrible, I can t eat that”. After asking if she should reheat this meal, the nurse removed it without offering any alternative. Three service users were given hot plates of dinner whilst sitting in armchairs. There were no trays or small tables to rest on. One service user, who was wandering, was given a bowl of hot sponge and custard to eat whilst he was on the go. Any of these actions could have resulted in incidents /accidents that could have had a detrimental effect on the service users. Another service user, who was rather unsettled and needed a lot of encouragement to sit down for her dinner, she had just focused on her dinner when a member of staff interrupted her with her pudding. She then lost concentration with her dinner and was reluctant to continue with the meal. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Evidence was insufficient to ensure that service users are protected from abuse. . EVIDENCE: The manager stated that all staff in the home had done the Protection of Vulnerable Adults (POVA) training. However the staff personal files that were viewed were not updated to indicate this training had been done, and the training matrix s that were on the units were not indicative of this either Records of one complaint were viewed, but there was no written record of verbal meetings that the manager stated had taken place between herself and the member of staff involved. There is presently one major complaint in the process of investigation, and two staff members remain on suspension. There was no record of progress to date on site, because the investigation was being done by the manager from a different home. . Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the houses were clean, comfortable and well maintained so that service users live in a safe environment. EVIDENCE: All four houses that were visited during the inspection appeared to be clean and well maintained, and free from any offensive odours. The layout of each of the houses was slightly different. This allowed service users quiet areas to meet with relatives and visitors without too much interruption and areas suitable for larger group activities. Some service users’ rooms that were visited during the inspection. They were furnished with personal assets. In some cases these reflected their personal history. One example was, a gentleman who had photographs of the planes he had piloted during the war. All service users rooms are equipped with en suite toilet and washbasin, ensuring adequate washing facilities throughout the home. However one Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 18 service user stated, “I get regular floods from the down pipe in there”, and gestured towards the en suite WC in his room. The communal areas in the houses were clear of clutter and generally homely. Armchairs were varied in height and appearance therefore making the house appear less clinical. Dining area furniture was solid and sturdy in appearance and free from spills and stains. Bathrooms on three of the houses were being used to store old / damaged / unwanted furniture. In one bathroom there was an unused mattress, two broken armchairs and a metal crate full of continence pads. It had previously been agreed that unused WC s on some of the houses could be altered to be used as storerooms, as long as the signs on the doors were changed to reflect this. This had been done, but there was still an overflow of storage in bathrooms. Specialist equipment such as hoists and pressure mattresses were plentiful and being used appropriately and competently. However numerous wheelchairs were noted as being used with missing footplates. Spare footplates along with an old large suitcase were seen being stored in another bathroom. At 07:00 hours the linen cupboards on Bonnetti House were noted to be almost empty Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures for the recruitment of staff within the home were sufficient so that service users are supported and protected. EVIDENCE: All houses that the inspectors visited were well staffed and comments from the staff indicated that morale is much improved. Milliner House had one qualified nurse and three health care assistants on night duty when the inspectors arrived. At 07:45 hours three qualified staff, and four health care assistants came on duty, giving a total of seven for the morning shift. Two staff files were viewed and documents that were present included: Fully completed application forms, interview record sheet, two appropriate references, enhanced CRB checks were present (although one was dated October 2003, and was therefore due for re-newel), caller code NMC registration checks, individual training records, photographic ID, passports and/or Home Office correspondence giving permission to work in the UK and signed terms and conditions sheet. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 20 Each house has its own training records, and each member of staff has a record in their personal file. Milliner House had two training matrix ‘s. One for mandatory training, and one for specialist training. These indicate all the training available, all the training sessions attended by each member of staff and the date, and in some cases the date on which the update is due. Unfortunately Protection of Vulnerable Adult (POVA) training was not included on either matrix. Staff comments were very positive. One nurse said “ It s much better here now, the staff and service users are happier”. Another said she was happy and felt well supported. Service users daily progress reports are completed every day and every night. However there is a column to insert the number of the care plan / problem being reported on. This was not completed in any of the files inspected. Therefore the information written was not always very specific to the individuals needs. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some of the systems in place are insufficient to ensure that the welfare, safety and health of service users and staff are promoted and protected at all times. EVIDENCE: Each house had a plan for staff supervision in the office. However dates showed that many staff had not received supervision since January 2006. One staff member had not had supervision since September 2005. One of the nurses who is listed as a supervisor, told the inspectors how she talks to her supervisees about the things they do wrong at work. This suggests that perhaps the use of Supervision as a neutral tool for discussion between staff and their managers is neither positive nor constructive in effect. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 22 There is a senior staff meeting held every Monday. This allows the manager to keep the senior staff fully informed of any issues arising within the home. There is insufficient evidence around the home, to show that staff are properly supervised on a regular basis. Also training records are not accurately completed. So although the manager stated all staff are fully trained in POVA, there is no evidence to support this, which is ultimately the managers responsibility. The manager was unable to access service users’ financial records due to an unexpected absence of the administrator. In light of this it is unclear how processes in the home would enable service users to access monies held on their behalf. Each house has a certain number of hours each week, which allows a qualified nurse to focus on paperwork. This is in addition to the nursing numbers working with the service users on the house. Milliner has twelve Supernumerary hours each week. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 23 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 1 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 x 1 1 2 2 Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a) (c)(d) Requirement The manager must ensure all prospective service users are fully assessed prior to admission and that all their needs can be fully met. All staff must ensure that documented health care needs are carried out as specified and in a timely fashion. The manager must ensure that prescribed medication is administered in a way that promotes the health and well being of the service users. The manager must ensure that there are meaningful social activities available and ongoing for all service users. The manager must ensure service users are all given a suitable choice at mealtimes. This must include service users who are cognitively impaired. The manager must ensure all actions taken as part of an investigation are clearly recorded and available on request at inspection. The manager must ensure that DS0000017668.V288739.R03.S.doc Timescale for action 30/06/06 2 OP8 12 30/06/06 3. OP9 13(2) 12(1)(a)& (b) 16(2)(m) (n) 16(2)(i) 30/06/06 4. OP12 30/06/06 5. OP15 30/06/06 6. OP16 22(8) 17(2) sch 4(11) & 17(3) 13(6) 30/06/06 7. OP18 31/07/06 Page 25 Capwell Grange Nursing Home Version 5.1 8. OP19 13(4)(c) 9. 10. OP21 OP30 23(l) 18(a) 19(5)(b) 11. OP36 18(2) all staff have attended Protection of Vulnerable Adults training, and that records reflect this. The manager must ensure that all service users are offered meals in a way that will minimise the risks of scalding and burns. The manager must ensure broken and disused furniture is stored appropriately and safely. The manager must ensure all staff working with service users suffering from Dementia, have the appropriate up to date knowledge, skills and understanding to ensure service user needs are fully met, particularly reflecting choice and safety. The manager must ensure all staff understands the process of supervision. There must be records to indicate that all staff are being appropriately supervised. 30/06/06 30/06/06 31/05/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard OP2 OP15 OP30 Good Practice Recommendations Contracts should include the number of the bedroom the service user is using. If a room has to be changed the contract should be altered. The way in which meals are offered should be reviewed to ensure that service users have the opportunity to make a real choice. The home should encourage staff to embark on training such as Dementia Care Mapping to enhance their understanding of the new culture of dementia care. Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Capwell Grange Nursing Home DS0000017668.V288739.R03.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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