Inspection on 11/09/07 for Capwell Grange Nursing Home

This inspection was carried out on 11th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Capwell Grange Nursing Home 24/01/08

Capwell Grange Nursing Home 08/01/07

Capwell Grange Nursing Home 05/09/06

Capwell Grange Nursing Home 10/04/06

Capwell Grange Nursing Home 22/06/05

Capwell Grange Nursing Home 14/04/05

Capwell Grange Nursing Home 01/02/05

Capwell Grange Nursing Home 01/02/05

Capwell Grange Nursing Home 30/11/04

Capwell Grange Nursing Home 30/11/04

Capwell Grange Nursing Home 05/10/04

Capwell Grange Nursing Home 28/04/04

Capwell Grange Nursing Home 23/04/04

Capwell Grange Nursing Home 23/04/04

Capwell Grange Nursing Home 22/04/04

Capwell Grange Nursing Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Capwell Grange Nursing Home Addington Way Oakley Road Luton Bedfordshire LU4 9GR Lead Inspector Leonorah Milton Unannounced Inspection 11th September 2007 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 Capwell Grange Nursing Home DS0000017668.V346416.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. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Capwell Grange Nursing Home Address Addington Way Oakley Road Luton Bedfordshire LU4 9GR 01582 491874 01582 564225 tolladam@bupa.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) Mary Tolladay 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.V346416.R01.S.doc Version 5.2 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) may be admitted to the home where there are 8 persons, in the age range of 55 in these categories already accommodated within the home. No person under the age of 55 years can be accommodated in the category of MD. No one under the age of 65 years can be admitted to the home where there are 34 persons already accommodated in the home. Service users who are over the age of 60 years and who have dementia (DE) can be admitted to Hatley Unit. 8th January 2007 3. 4. 5. 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 single-storey 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, which in some houses is used as a service user smoking area, 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. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 5 The fees for this home range from £507.00 per week to £905.00 per week. This is dependent on the funding source and the specific needs of individuals. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care Inspection since the last visit to and public report on, the home’s service provision in January 2007. Reports from the home including its annual self assessment document (AQAA), other statutory agencies, and information gathered at the site visit to the home, which was carried out on 11th September 2007 between 09.30 and 18.00 by two inspectors were taken into account. The Commission had received thirteen responses, completed by people living in the home or their representative, to a questionnaire circulated prior to this inspection and Twenty-four responses from staff working in the home. These have been taken into account and reflected in this report. The site visit took place in Mitre House, which accommodates adults with physical disabilities. The visit included a review of the case files for two people living in the home, conversations with seven people, two visitors, four members of staff, the acting manager of the unit and also the manager and deputy of the entire home. The majority of the time was spent in the communal areas of the building with people living in the home, where the daily lifestyle and practice of personnel was observed. A partial tour of the building was carried out and other records were reviewed. What the service does well: This purpose built home provided spacious and comfortable accommodation. Despite the size of the home, the arrangement of separate units had enabled the home to care for people with diverse needs. Arrangements to maintain a safe place to live and work in were good. Corporate systems were in place for the provision of safety checks on equipment and suchlike by qualified contractors. The lifestyle seen at the inspection took place at a leisurely pace. Cordial exchanges were observed between the people living in the home and those caring for them. It was evident that visitors were welcomed into the home. People’s representatives had been able to advocate for them at meetings held in the unit. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Despite the ongoing emphasis on raising staff awareness about safeguarding procedures there had been delay to report a recent incident. Staff will need guidance about reporting procedures. Pre-assessments of need, had not in all cases, led to sufficient preparation to ensure that needs were met once admitted to the home. Special consideration must be given to the dressings and similar that will be required for wound care. People should be given sufficient time and support to eat their meals. Staff must ensure that people have eaten enough before meals are taken away. People should not be left to sit in isolation for prolonged periods. Staff on duty must engage with people unless it is their wish to be left alone. There was little evidence to show that people, after the initial assessment of need, were consulted about their preferences for their day-to-day lifestyle. Preferences listed in care plans bore little resemblance to the lifestyle observed at the visit to the home. Action must be taken to ensure that people receiving the service have a real influence on the conduct of the daily lifestyle so that it meets their assessed needs and personal expectations. Staffing arrangements were inadequate. There were shortfalls in the care team through ongoing vacancies and also the post of unit manager at Mitre House. The team had been also reduced by staff sickness. Issues of poor practice in one unit were also undergoing an internal investigation that meant an assessment of the performance of the whole team. The organisation must notify the Commission about the outcomes of this investigation. Training must be provided in specialist areas such as multiple sclerosis, diabetes, and epilepsy so that staff can work effectively with people who have these conditions. Where assessments of need have identified that someone’s condition causes them to experience pain when assisted to move, there must be a corresponding plan to show how this pain is to be managed. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 8 Risk assessments must document accurately the level of ability, need and risk. Written information about people’s personal needs and progress must be accessible only to authorised persons. Action must be taken with regard to a requirement outstanding from the previous inspection to improve the environment. This must include the replacement of chairs that pose a risk of the spread of fire where the upholstery has split and foam is exposed. The organisation should consider the management structure in the home and the registered status of the same. Whilst it was evident that the overall manager was qualified and experienced to manage a care home, given the size and complexity of this home and its the history of inadequate practice, it might be better managed with each head of unit being registered to manage. The manager must be supported by a competent senior team. 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. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 9 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.V346416.R01.S.doc Version 5.2 Page 10 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): Standards 1,2,3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There had been insufficient preparation before a resident was admitted to the home to ensure their care needs were met in full. EVIDENCE: Two case files were assessed. Each showed that comprehensive assessments of the person using the service had been carried out prior to admission to the home and were regularly reviewed. A new assessment tool was in use in the home, which led the worker through the process of assessment, indicating where service user plans needed to be written. An investigation carried out under Procedures for the Protection of Vulnerable Adults in relation to someone who had been recently admitted to the home had included an assessment by a representative of the Primary Care Trust. Their report showed that the home had been unable to dress wounds, that were significant and which caused the person much pain, with appropriate dressings Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 11 because they had not arranged for a sufficient supply of the same before admission. The representative had witnessed a member of staff applying an inappropriate dressing and had asked the member of staff to cease the procedure. The results from the survey showed: Have you received a contract? Responses:38 Yes, 46 No Did you receive enough information about this home before you moved in? Responses:77 Yes, 23 No Comments included: “We received a brochure from Hemel Hampstead Hospital outlining care services. We visited several homes and were very impressed with Fidora House due to apparent order and organisation present during our visit. We chose Fidora House even thought there was a BUPA care home closer to us. We have never regretted our choice. Yes, but this was only meant to be on a temporary basis until a BUPA home nearer Welwyn Garden City became available. After 19 months I’ve still heard nothing. The information I was given when I was shown around Mitre House has not been followed through. We did not receive the information pack to until several weeks after my relative had moved in. Capwell Grange was not our choice of nursing home.” Capwell Grange Nursing Home DS0000017668.V346416.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): Standards 7,8,9,10,11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor preparation for the admission of resident had meant that the home had failed to meet their healthcare needs. EVIDENCE: Two care plans were assessed. These followed a new format that was comprehensive in the assessments of need and corresponding plan to meet them. Plans covered people’s personal, physical, health, recreational, social and emotional needs. A lifestyle profile had been completed. This contained details of people’s preferred lifestyle in relation to recreational activities, diet, and daily routines. Details on assessments for health care needs were thorough but conflicting in some areas: The moving and handling risk assessment showed that the person was in pain when moving “because of her disease”. It also mentioned that the person Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 13 suffered from involuntary movements due to the disease. However, there was no direction in the care plan about how this pain was to be managed or how best to manage the involuntary movement when assisting the person to move. The person had a bedrail fitted to their bed. The documentation package led the person completing the paperwork to complete a falls risk assessment. However, this had not been completed appropriately and led to confusing information about the person’s mobility; the care plan stated that the person was immobile, but the falls risk assessment stated “gait – unsteady” and “mobility – restricted.” One plan identified that the person required specialist medical intervention in the form of a PEG feed. A risk assessment had been appropriately completed The care plan was clear about how to manage this, but did not detail, whether this intervention required the care of a nurse or an unqualified worker. There was evidence to show that people had been supported to access healthcare appointments for routine treatments such as chiropody, optical tests and had been referred to their doctors and other specialists in relation to their individual conditions as need be. As detailed previously, there been a failure to properly manage the wound care of a person admitted recently. The representative from the Primary Healthcare Trust reported that they had observed a nurse applying a plastic barrier sheet to an open wound and was told that the home did not have the appropriate dressings yet. There had also been a delay in registering the person with a local doctor and a corresponding delay to obtain a review of medication for pain relief, which was described as “excruciating”. It was explained that the home was not in control of the local allocation of Doctors for newcomers to the home and it was not unusual for there to be such difficulties. Given this knowledge and the knowledge about the needs of this person before admission, the home should have made sufficient arrangements prior to admission to ensure that everything was in place to meet this person’s needs at admission. Medicines were stored in a purpose built, lockable trolley that was secured in a locked room when not in use. Other spare medicines were secured in locked cupboards in this room. Controlled drugs were stored appropriately. Medicines were only administered by qualified staff. Records inspected showed that medicines had been administered as prescribed. Entries on records also indicated that proper balances of stocks had been maintained when new stocks had been delivered to the home, so that it was possible to audit the stock of medicines. Appropriate records had been maintained of medicines for disposal. Aspects of people’s rights to privacy had been compromised because records for fluid intake and output, which detailed continence issues, were kept outside Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 14 bedrooms on rails in the communal corridors where they were accessible to any passer-by. People who contributed to the inspection at Mitre House were mostly satisfied with their care. Comments included, “I am happy with the care here. I am well treated,” “I do not have to wait for assistance”, “ Its ok here”. Results of the survey showed: Do you receive the care and support you need? Responses: 54 always, usually 31 , sometimes 15 , never 0 Comments included: “xxxx has had excellent care with adjustments being made to the manner in which xxxx’s food is presented to her. xxxx has no bed sores after lengthy times in bed. Nursing care is excellent., support and constructive advice are given immediately. xxxx is very well cared for and is happy and settled in the home. The staff keep the family up to date on a regular basis, they are all very helpful and approachable. Can usually find someone to answer my questions. Could do with more hygiene. Eg more showers , hair-washes. Nails are always dirty!! Face and hands could be wiped after food times more often than they are at the moment. There does not seem to be a back-up plan if staff are sick or attending hospital with another resident. They remainder are left to cope. The staff in the house that I am in are very friendly and do their job very well. I feel very happy and safe there. It is very disappointing and sad that the best nurse on the unit is being moved to another unit though. Shortage of staff causes problems. “ Do staff listen and act on what you say? Responses: 85 yes, 0 no Comments included : “The staff on this ward I can only say they are first! On occasions they are unable to because of shortage of staff. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 15 If xxxxis struggling to swallow of if xxx needs suction or adjustments to xxx diet or consistent turning or help, staff have always responded within a reasonable time. We have a listening staff who are ready to action solutions. The staff do act, then it lapses and we’re back to square one. “ Do you always receive the medical support you need? Responses: 69 always, 23 usually, 5 sometimes and 0 never. Comments included: “xxx has had several visits from the doctor when there have been cause for concern regarding xxx well-being and the family have been informed of this either by phone or at visits. Most of the time my relative’s medical needs are looked after. We just have to ask for xxxx to be placed on the list to see the doctors who frequently visit Fidora House. Doctors are available and willing to offer support and advice. Either there have been times when they had to call on staff from other units because there is nobody on my husband’s unit that can sort the problem out. Staff shortages again.” Capwell Grange Nursing Home DS0000017668.V346416.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): Standards 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. The daily routine seen at the visit to the home did not meet people’s assessed needs or their documented wishes for their preferred lifestyle EVIDENCE: Details from a care plan seen at the visit included a map of the person’s life and their preferences about how they like to spend their time. However, care notes for the previous four weeks did not contain any evidence to show that the person had been enabled to pursue any of their interests during that time or that they had left the house at anytime for recreational purposes during that time. There was little evidence of this person’s involvement in their assessment or care plan even though the person was said to have capacity. There was evidence that their family had been spoken with, but their recorded aims for the person (to get better) were unrealistic. There was no evidence that the home were addressing this with them. Another lifestyle plan focused only on eating, sleeping and watching television. This house had two activity co-ordinators. They work thirty hours per week and split their time between group activities and 1:1 work. 1:1 work included Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 17 shopping, pub and reading. One of these stated that said she discusses with people what they like to do and was knowledgeable about people’s preferences. Despite this input, the daily lifestyle was not meeting the needs of some people living in the home. Some people appeared to be isolated because members of staff did not engage with them. The lifestyle for one person was observed in the communal lounge/diner. This person did not have any members of staff interact with them between 13:30 and 16:15 and appeared to be unoccupied throughout this time. A worker eventually approached them, and following a brief address, moved the person in their wheelchair from one table to another and left them there alone to wait for the evening meal. Two members of staff did address the other service user who had been sitting at the same table throughout the afternoon. One service user who has been on five weeks respite care said that during that time they has seen the range of activities improving and was very complimentary about what was offered. A book group had been started. Also observed at this visit was a person was sitting in a recliner chair at a right angle to the dining table where their meal was placed. A member of staff had been helping them with the meal. The person reached out and picked up some food with their fingers and ate it. Shortly after this another member of staff took the plate of food away without asking the person if they had finished (or saying anything else), although the staff member did speak with another person sitting at the table. The plate was still half full of food. Another member of staff then helped the person to eat their pudding. This member of staff did tell the person what was for pudding and asked them if they liked it. Minutes of recent meetings showed that people were dissatisfied with the choice of menu and had raised concerns that food was not always hot enough. The manager acknowledged these issues and said that the recently appointed chef had met with people and was planning the introduction of new menus. The manager also acknowledged complaints received about activities and that plans were in hand to improve this situation. Results of the survey showed: Are there activities arranged by the home that you can take part in? Responses: 8 always, 23 usually, 54 sometimes. 15 never Comments included: “This past Christmas, xxxx enjoyed the party sitting in the chair, tapping xxx foot to the music. Since then (March) xxx has been unable to join in activities due to failing health. However, xxx listens to music and is content with this. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 18 I have had meetings with senior staff to try and get activities sorted out. Since my relative has been in Mitre House xxxx has been involved in about a dozen activities. There is only one person on the unit who does activities. Staff shortages again. Also in the time my relative has been in Mitre House they have had one trip out. We were told they held exercise classes in Mitre House, but this has not happened. When xxx is well enough he can sometimes join in with games of dominoes. Haven’t found out yet (been in respite for 2 weeks) Taking up painting with first class painter. In their brochure Capwell Grange lists their daily activates as painting, sing-along, movement to music, bingo and reminiscence, local entertainers visit the home on a regular basis and they arrange trips to the Arndale centre and local garden centres. But I am afraid these are all very few and far between.” Do you like the meals in the home? Responses:31 always, 62 usually Capwell Grange Nursing Home DS0000017668.V346416.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): Standards 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had detailed complaints and safeguarding procedures. However reporting of issues raised under these procedures to senior management had been tardy so that there was some risk that any action required to remedy situations would be delayed. EVIDENCE: Previous inspections had established that the home had satisfactory written complaints and protection procedures. People confirmed that they felt able to raise concerns. “ I can talk to staff if I’m worried”, “ I’ll tell the nurses”. There were also regular meetings in which people or their representatives could comment on aspects of the service such as meals and activities. Minutes of frequent meetings were seen. Five records of complaints were seen. These indicated that the complaints raised had been investigated and responded to within the procedures’ timescales. However, one complaint in relation to the risks of contractor’s equipment had not included sight of their risk assessment to ensure that safeguards had been properly assessed. Another complaint referred to the poor moving and handling practice of a lead nurse and a worker on duty. This included use of wrong size sling. The inappropriate sling resulted in ‘jack-knifing’ of the person being “imminent”. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 20 As a result the staff were re-trained. However, there was no evidence that the worker’s practice had been monitored. Personnel files were assessed. Each contained records to show that robust recruitment practice had been followed that included the checking of employment history through references and checks via the Criminal Records Bureau and the Protection of Vulnerable Adults Register. Records indicated that staff had received training in safeguarding procedures. Staff spoken to demonstrated their understanding of protection procedures and their individual responsibility. However a recent referral under these procedures showed that staff had not reported an injury sustained by a person whilst they had been assisted by staff. Another carer subsequently reported the injury to a nurse who in turn reported to the person in charge. This issue, which could have been dealt with as an accident notification then came under safeguarding procedures because of the failure to take immediate action. Results of the survey showed: Do you know who to speak to if you are not happy? Responses :77 yes, 15 no Comments included: “Sister xxxx is always attentive, focused and ready to action and adjust appropriately according to the need. I have made complaints, but don’t get much feedback.” Capwell Grange Nursing Home DS0000017668.V346416.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): Standard 19, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The unit seen at the site visit was showing signs of wear and tear, which detracted from the overall atmosphere. EVIDENCE: This unit had been purpose built and provided sufficient private and communal space for the equipment required to meet the needs of those with physical disabilities. Homely touches were seen in communal areas and in people’s private accommodation. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 22 Areas of the building were clean and orderly and in most instances well decorated. The communal lounge diner was showing signs of wear and tear to the décor and furnishings: The curtain rail was down above both sets of double doors and the paintwork had not been repaired. The dresser in the dining area had one cupboard door missing and a broken drawer. Plasterwork in the area where the trolley stands was very marked and indented. There were no blinds in the conservatory area. The inspectors were unclear whether this area required blinds during hot weather. The two armchairs were worn and foam was showing through where the material had worn. The atmosphere in the lounge was uncomfortable. The radio and the television in the lounge/diner were playing simultaneously. The inspector stood beside one person who was seated who between the television and the radio. The conflict of noise was an unpleasant experience that prevented concentration on one or the other. The previous report had made requirements about the home’s décor. Whilst action had been taken in some areas it had evidently not extended to this unit. Sluicing areas were clean and orderly. Safe hygiene notices were posted. Bedrooms, bathrooms and toilets were filled with soap dispensers and disposable towel holders to aid hygienic hand washing procedures. Results of the survey showed: Is the home fresh and clean? Responses:69 always, 15 usually, Comments included: “The home is very well ventilated and always clean and tidy. This is a very pleasant environment. High standards prevail in Fidora House. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 23 The staff work very hard to make the home clean and tidy but I feel that it would benefit from some new carpets and furniture as there is a must smell about the place! (Hatley House) Mitre House is in need of an update in several areas, decoration, new carpets, decor and general cleaning.. Mitre Unit is supposed to be a young persons unit. Staff shortages again. The facilities need attention such as carpets, furniture and such. The home is very well looked after but sometimes if a resident needs changing and is left for sometime it can be most unpleasant.” Capwell Grange Nursing Home DS0000017668.V346416.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): Standards 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Inadequate staffing arrangements had compromised the level of care given to people living in the home. EVIDENCE: The manager explained that there were significant staff vacancies but a recent recruitment drive had been successful and several personnel were scheduled to commence in the near future. The unit manager’s post for Mitre House had been vacant since January, the current holder having been appointed recently as a temporary measure. The staffing numbers in Mitre house was assessed as requiring three qualified staff and five carers for morning shifts, two qualified and four carers for afternoon shifts and two qualified and two carers for night shift. Recent rotas showed that actual staffing arrangements had fallen short of these numbers: on 1st September 2007 the rota showed there were only four staff including nurses on duty all day. Much of the written feedback to the Commission from users of the service and staff working in the home was in relation to inadequate staffing arrangements in the home as has been shown previously in this report. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 25 Information provided by the AQAA showed that 15 of 110 care staff had achieved and National Vocational Qualification in Care and a further 15 were working towards this award. Records and conversations with staff indicated that they had received basic statutory training. There was an evident need for training in specialist areas to understand the needs of those in Mitre House such as multiple sclerosis, epilepsy and similar. There was also a need for further guidance in relation to basic communication skills and the need to converse with people living in the home. Recruitment procedures as previously reported were satisfactory to ensure people of the right calibre were employed to care for vulnerable people. Staff morale was most concerning. The Commission received several responses to staff questionnaires. Whilst the majority of these were positive about the care practice in the home and the level of support staff received, a few were extremely negative in their opinions. Given that the manager was appointed at a time when the performance of the home was low and that since then she has introduced significant and much needed change to address problems, it is inevitable that some personnel may be unsettled by such changes. The questionnaires showed that some staff had unrealistic expectations of the manager and that much of the responsibility for day-to day management of staff fell to unit managers. It is recommended that the organisation review the status of the registered manager against the devolved responsibilities of unit managers and clarify for personnel where responsibilities lie. On the day of the inspection people passed positive comments about staff on duty. Staff were described, as “OK and some are better than others”, “ They treat me well enough”, “Staff are nice and kind, there is no waiting for assistance”. “They look after me very well here.” A visitor stated that staff were, “Wonderful” and said that they were, “really grateful for the care their relative received and the kindness shown to me.” A couple were celebrating a wedding anniversary on the day of the inspection. Staff had arranged a cake and gift for the person living in the home and their spouse. Both people were visibly moved by this kind attention. Results of the survey showed: Comments included: “I would like to make a respectful, polite suggestion which would help to alleviate rare emergency situations and this is to have a sound contingency plan in place for they unexpected moments such as having someone on an emergency retainer status. This would eradicate the need to phone present employees an contacting lists of present staff who often die to commitments may feel they have to decline to work more hours. xxxx is very happy and Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 26 secure here because the staff take the time to build relationships and trust with those she meets often because they attend to her needs. Due to staff shortages the staff find it difficult to get to clients on time. Also they do not have time to send just to have a chat. My relative has had to wait a long time in several occasions for his call buzzer to be answered. It would be remiss of me not to take this opportunity to thank the unit manager, for her fine leadership and for the example she sets to her staff who provide us with high standards of care, support, expertise and constant unselfish giving of service. Almost all problems stem from shortage of staff. 99.9 of staff are lovely caring people and deserve medals. In recent months a policy of exchange of staff between houses appears to have been introduced, I am wondering what effect this has on patients. xxxx clothes are very untidy, need to be sorted and folded then put away neatly. The staff we feel are very good, friendly and always seen to speak to the resident. Sometimes it is hard for us visitors to understand some of the staff. So we feel the resident must struggle with this also. More staff needed when others are off sick. The staff cope very well, but it is hard work for them if they are short on their shift. The staff in Mitre House find it difficult to give clients the time and professional care they deserve because of staff shortages. We think that the majority of the staff do the best they can under difficult circumstances. Staff: Are you being given training which is relevant to your role and helps you meet the individual needs of residents? Responses:79 yes, 4 no Comments included: We are given just the basic training. Every training is given to us all and we are doing well. I haven’t been given training relevant to me. I have been transferred to a dementia unit with no explanation, unaware of how to understand and cope with people with dementia. I was very depressed and thought about leaving. More training on: • skin integrity • first aid • communication skills! • How to take a blood specimen Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 27 • • • . NVQ x2 Dementia care Training to help deal with those who are more difficult that the others.” What are the usual staffing levels on each shift? Do the staffing levels give you enough time to meet the assessed needs of the residents? Responses: 21 yes, 63 no Comments included: “Yes, staffing levels give us enough time to meet the assessed needs. Yes there is enough time to meet the assessed needs Our staff levels are good. But one thing is that the number of staff is not enough to get the residents washed and dressed. Staffing levels are done by 4 carers for 30 residents- cannot meet the needs of the residents. Nurses and unit manager are always in the office all day and will not help the carers even though the carers asked for help from the office. staff, carers always have to help the nurses with dressing, sometimes residents even have 11am, tea, lunch is given late 2pm. Trained staff will see what’s happened but will not help, not even answer the call bell. Trained staff only help with inspectors are around and to let then see that they are working and being busy. Staffing level is a big problem at the moment, and nothing is being done about it. Carers are working overtime and are tired and stressed. Staffing levels should be 7 in the morning and 6 in the afternoon, but I can assure you that its not like that most days. Management doesn’t care because she wants no agency, so at times we are short staff, 5 in the morning, 4 in the afternoon with 30 residents. We have to kill ourselves to get all 30 residents up before 10:30 or you’ll be in trouble. No we are very often short staffed. I don’t understand why we cannot have agency staff instead of working with a double load. I find this particularly straining. No, no, no. We are always short staff and overworked. We are expected to get all residents out of bed for a certain time, if that is not done you are called to the office and penalised. Staff are so pushed that they hardly ever get time to have a proper break. Residents are being treated like it is a production line, being made to rush out of bed like if they are animals. They are taking on residents with so much needs to be met and having the same amount of staff or even less. Varies but mostly we need more carers.” Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 28 Not enough time to do things with residents No, more often than not the units are seriously understaffed which then puts too much pressure on those on duty, as the manager still expects the same results as when there is full staff. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 29 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): Standards 31,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has proven abilities and strategies to manage a care home. She had been appointed at a time when the home required a skilled and experienced manager to introduce change for the better. Previous reports have recognised the interventions she has successfully introduced to improve practice. It must be acknowledged however that this change has been very gradual and the rate of progress has been hindered by the lack of senior team support within the home for the manager. The deputy has only recently been appointed. One unit had been without a manager for several months. As detailed in the previous section some staff have been unsettled by change and Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 30 staff shortages. They had unrealistic expectations of the manager despite there being evidence of regular meetings with them. The organisation must take action to support the manager and assess the level of competency required of unit managers and empower them to manage staff effectively. The overall quality assurance systems were not assessed at this inspection but evidence of consultation with people using the service was assessed from minutes of meetings. Records of these were poor in some instances and did not show actions taken in response to issues raised previously. It was also noted that people’s representatives had always been present at these meetings. Whilst it is commendable for people to be represented in this way, they should also be given opportunities to voice their opinions without the presence of families and others. Record keeping in general was of a good standard but there were some issues with records maintained in Mitre house. The rotas did not meet required standards, these noting only staff first names. The training matrix on Mitre Unit was incomplete. Supervision in Mitre house was not meeting required standards. Supervision had not been offered to staff on a regular basis. Three records were seen and showed that one person had been supervised on 8th August 2006, 13th June 2007 and 2007 with no other date against the entry. Two other members of staff had only received supervision on one occasion. Records of supervision showed that issues of performance, conduct and development needs were not being discussed: The content of supervision often showed that guidance notes for use of equipment or practice had been given. These included operating eclectic bed, proper position for feeding client and hand washing technique. These were photocopied with the person’s name and date of meeting written in. There was no evidence of discussion or individual issues having been raised on those occasions. One person did have a performance review. However this was totally inadequate. The front page had a space for ‘objectives’ but this had not been completed and there were no actions completed. The one record that was specific to the person showed a list of actions rather than evidence of discussion. The overall health and safety of the operation appeared to be well managed. Visual checks on equipment showed that qualified contractors had regularly serviced these. The AQAA showed that safety issues were monitored by “Regular Health & Safety meetings with a standardised agenda giving staff the opportunity to communicate on Health and Safety issues. The minutes from these meetings go to the Regional Manager. There are regional and national experts available within the company for advice and guidance if required. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 31 There are dedicated Health & Safety staff within the Quality and Compliance directorate.” Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 32 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x 1 3 2 Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 33 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 OP3 Regulation 12(1)(a), 14(1), Requirement Timescale for action 14/10/07 2. OP12 16(2)(n) 3. OP10 12(1) (4)(a) 4. OP15 12(1)(a) 16(2)(i) The registered person must ensure that pre-admission assessments of need have resulted in preparations for admission to include the obtaining of sufficient stocks of suitable dressings so that treatment of existing wounds is managed from admission and thereafter. The registered person must 30/11/07 arrange for people living in the home to be provided with activities for stimulation and recreation that meets their assessed needs and preferences. The registered person must 14/10/07 ensure that people’s rights to be treated with respect are upheld. In this instance this means that members of staff must actively engage with people and include them in general conversations that take place in the lounge. The registered person must 14/10/07 ensure that people are given sufficient time and support to eat their meals. Staff must ensure that people have eaten enough DS0000017668.V346416.R01.S.doc Version 5.2 Capwell Grange Nursing Home Page 34 5. OP16 22(1) 6. OP19 23(2) before meals are taken away. All staff must record and report concerns raised with them about service users care. (Previous timescale of 28/02/07 had not been met) The company must ensure that all areas of the home are well decorated and fit for purpose. (Previous timescale of 01/04/07 had not been met) The registered person must ensure that sufficient staff are available on each shift to properly care for people. The registered person must provide training for staff in relation to people’s special needs such as multiple sclerosis, epilepsy and similar to ensure that they have sufficient knowledge about these conditions to properly care for people. The registered person must ensure that the manager is properly supported by a competent senior team. The manager must ensure all staff understands the process of supervision. There must be records to indicate that all staff are being appropriately supervised. Previous timescales of 01.04.97 had not been met) The registered person must ensure that all furniture meets fire retardant standards to ensure that people living in the home are not put at risk of the spread of fire. 14/10/07 31/12/07 7 OP27 18(1)(a) 14/10/07 8 OP30 18(1)(c) (i) 31/03/08 9 OP31 12(1)(a) 18(1)(a) 18(2) 31/12/07 10 OP36 30/11/07 11 OP38 13(4)(c) 23(2)(4) (c)(i) 30/11/07 Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 35 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. Refer to Standard OP33 Good Practice Recommendations An effective quality assurance programme should inform the annual development plan for the home. Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Capwell Grange Nursing Home DS0000017668.V346416.R01.S.doc Version 5.2 Page 37 - 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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