Inspection on 14/04/05 for Capwell Grange Nursing Home

This inspection was carried out on 14th April 2005.

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 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 11/09/07

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 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 Addington Way Oakley Road Luton LU4 9GR Lead Inspector Sally Snelson Unannounced 14th April 2005 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 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 I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Capwell Grange Address Addington Way Oakley Road Luton LU4 9GR 01582 491874 01582 564225 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Cheryl Ann Edwards Care Home 146 Category(ies) of OP Old Age - 60, registration, with number MD Mental Disorder - 60, of places PD Physical Disability 26 Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 8 of the beds can be used for service users under the age of 65 years with a mental heath condition. Date of last inspection 01/02/05 Brief Description of the Service: Capwell Grange Nursing Home is a modern, purpose built complex comprising of a central two-storey building and five separate Houses. The central building provides accommodation for administration, reception area, and services including laundry and catering, staff room, staff training area and a visitor’s 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 units are all registered for 30 beds. The fifth house Mitre is registerd for 26 service users under the age of 65 years with physical disabilites. Staff providing care are qualified nurses and care assistants supported by ancillary staff. Each unit has a small quiet lounge, open plan lounge, conservatory and dining area. There is access to the well-tended garden. The service users individual accommodation has en suite facilities, comfortable furniture and suitable 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 kitchen for preparation and serving food and drink. Capwell Grange promotes activities and entertainment for service users by employing a designated hobby therapists for each of the houses. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Capwell Grange took place on the 14th April 2005 over a period of 8 hours, commencing at 06.50hrs. The inspector visited two of the units, Milliner and Hatley. Both were registered to care for 30 service users over the age of 65years with a diagnosis of dementia. A case tracking methodology was followed which involved tracking two service users in each of the units visited, talking to staff, visitors and service users and sampling care plans and records. The inspector spent time on each unit observing care, as many of the service users were unable to make meaningful comments because of their condition. Since the weekend prior to the inspection the commissioners of the Local Authority and the Primary Care Trust had put observers into the home, as a number of issues had been raised about the standard of care service users were receiving. This inspection focused on these issues of care and only inspected these standards. Other key standards will be inspected as part of future inspections. What the service does well: What has improved since the last inspection? Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 6 During the last inspection year each of the houses were inspected individually. This year, as all five houses were registered as one registration, there will only be one report to accompany each inspection visit. It has therefore not been possible to assess this statement. There was evidence in Hatley House that dementia care and tissue viability care plans had been put into place. The latest admission to this house had care plans that covered all assessed needs and health problems. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 Pre-admission assessments and details of how decisions for a placement move had been made were not fully completed. There was consequently no assurance that Capwell Grange could meet the assessed needs of a service user. EVIDENCE: During the previous inspection the manager had been made aware that the certificate displayed did not accurately reflect the current and intended service user group. The manager had supplied the CSCI with necessary information to change the certificate to accurately reflect the service users accommodated. Not all the files sampled included information from the pre-inspection assessments. It was therefore difficult to determine how a decision had been reached that a particular house in Capwell Grange could meet the assessed needs of a service user. One of the service users tracked in Milliner House had been moved from another house because of her challenging behaviour. Her care plan did not indicate how staff were supporting this behaviour other than with medication. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 9 Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 10 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 standard(s) 7,8 and 10 Service users health and social needs were not being fully met. EVIDENCE: Care plans sampled were varied and did not always accurately reflect the service users needs. For example one care file indicated that the key worker was a staff member who had left some months earlier. Another file did not accurately reflect the status of a service users wound. A skin tear had been identified and photographed almost eight weeks earlier; no further documentation had been recorded. The inspector noted that this service user had both her ankles bandaged. Staff reported that the bandages were for protection, however when they were removed the skin tear was still visible and paper closures were holding the tear together. The inspector also noted that this service user was lying on three ‘nighttime’ continence pads; a staff member explained that this was due to an allergic reaction to the pads usually used during the day. The inspector did not understand how this allergy necessitated the use of three pads at one time. In one plan where nutritional need had been identified there was evidence that specialist support had been requested and that this had resulted in improvement in the service users condition. Care notes suggested that a service user had been referred by the GP to the psycho-geriatrician who had Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 11 suggested he required terminal care. An end of life care plan had not been written to support this change of condition. There was no evidence that service users had been involved in writing or reviewing care plans. In Hatley House additional care plans had recently been written for tissue viability and dementia care where the condition indicated. In one of the units, wipes and disposable bags had been placed in the lounge in reach of service users with dementia. The inspector noted that one of the service users took a plastic bag as he walked by. A member of staff witnessed this and took the bag from him, but did not move the articles out of his, and other service users, reach. Prior to breakfast a service user was moved from his bedroom to the lounge. The inspector noted that he was dribbling yellow fluid from the side of his mouth. A carer said that this was because he had not swallowed his medication and it was dissolving in his mouth. The nurse in charge gave him a cup of tea but did not speak to him about the importance of swallowing medication or check to ensure that other tablets were not in his mouth or his clothing. The inspector witnessed this incident more than half an hour into the inspection. This was particularly concerning as the early morning medication had been administered prior to her arrival so the medicine had been dissolving for some time. The nurse in charge of Milliner House during the morning shift stated the morning medication during breakfast; she eventually gave the last drug at 11am as care staff requesting her support or advice constantly interrupted her. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 12 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 standard(s) 12,14 and 15 Daily living activities are organised around the routines of the shift and not in line with the needs and wants of the service users. EVIDENCE: The inspection commenced at 06.50hrs. At this time in Milliner House 15 of the 28 service users were up and dressed and either wandering about, sitting in the lounge or dressed and sitting in their bedroom. This situation was discussed with the manager who believed that if the service users were awake it was safer for them to be up and dressed. It was noted that some had gone back to sleep in their chair and others were lying dressed on their bed waiting for the hoist to become available in order that they could be transferred from the bed to a chair. Care plans did not clearly indicate that the service users had made a choice to be up early in the morning and go to bed early at night. Service users who were up were given early morning tea in a teacup that was obviously part of a cup and saucer set without the saucer. The inspector was with service users on Milliner unit from 06.50am -11.30am. The majority of the service users had their breakfast at 8.30am. When the inspector left the unit at 11.30am none had been offered a drink. The inspector asked a carer if this was normal practice and was told that if a service user asked for a drink they could have one otherwise they would wait until Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 13 lunchtime. The inspector heard one service user ask a staff member for a cup of coffee, the carer asked if he would like squash, and, without waiting for a reply gave him a cold drink. The hobby therapist ensured that two service users who were completing craft activities with her were given glasses of milk during the morning. All of the staff took a break and had a drink and something to eat sitting with the service users in the quiet lounge. All of the houses at Capwell Grange employed a hobby therapist who produced a range of activities for the service users. Both of the hobby therapists spoken to by the inspector demonstrated a good knowledge of dementia care and an understanding of care needs. At 11.30am the inspector moved from Milliner House to Hatley House. All of the service users had a cold drink within their reach and jugs of squash were available for staff to refill the service users glasses. At lunchtime service users were asked to choose one of the two meals available. Lunchtime had been bought forward by half an hour in an attempt to space meals out throughout the day. The majority of the service users were sitting at the table. Staff supporting those that required help did so appropriately. At breakfast time in Milliner a service user had been given a bowl of cereal whilst sitting in the lounge. No table was made available and he was balancing the bowl in one hand while trying to eat, consequently much of his breakfast ended up on the floor. It was noted that one of the service users ate most of her lunch but left the meat. She told the inspector that she enjoyed meat but was unable to chew it as she had lost her bottom set of teeth. Her care plan stated that her teeth had not been available when she was assessed prior to admission. This was discussed with a member of staff who stated that the service users did not enjoy pureed food so was encouraged to eat what she could of her meals. There was no evidence that she had been referred to a dentist for a replacement set of teeth. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 18 Poor understanding of all forms of abuse put service users at risk. EVIDENCE: There was photocopied information about adult abuse including the signs and symptoms of the various forms of abuse available in the office for all staff to study. Poor care planning and discrepancies in documentation could result in inappropriate care being provided. There had recently been three unexplained fractures at the home. These were still being investigated as part of the Protection of Vulnerable Adults procedure. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 15 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 standard(s) 19,24 and 26 The internal layout of the home provided a safe comfortable environment. EVIDENCE: The home had been opened for almost 10 years. There was a plan for the refurbishment of the home that had been discussed during previous inspections. Since the last inspection the bathrooms were less cluttered although it was noted that a member of staff was still using the bathroom as a changing room. During the early part of the inspection it was noted that the sluice door and the doors of the cupboards containing pads were open even though some of the service users were wandering. Only one staff member was available to ensure service users safety as others were working in individual service users bedrooms. When the inspector arrived on Milliner House early in the morning there was a slight smell of urine, this soon changed as the domestic staff came on duty. The home was clean and tidy throughout. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 Although staffing levels appeared sufficient staff did fully understand the health and welfare needs of the service users resulting in some poor care practices. EVIDENCE: On Milliner House there were six care staff and a qualified nurse to care for 28 service users. The management had agreed that the sisters in charge of the houses should have their supernumerary hours extended from six hours a week to 18 hours a week to allow them to thoroughly review the care plans and complete any outstanding paperwork. One of the nurses felt that unless they worked away from the unit their time would not be uninterrupted. This time must therefore be managed effectively to ensure that it can be taken when a junior trained nurse is on duty, to ensure that there is at least one trained staff member on duty in each of the houses at all times. The duty rota confirmed that permanent staff and bank staff were able to cover absent colleagues and that the home did not use agency staff. The manager stated that it had not been necessary to use agency staff for more than two years. A group of staff had attended an in-house wound care training session the day before the inspection. On the afternoon of the inspection the manager and the head of care were interviewing qualified nurses for a sister’s post in one of the houses. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The size of the home makes it impossible for one manager to ensure all service users receive consistent care. There were some health and safety and infection control issues that did not safeguard service users. EVIDENCE: The manager had worked at Capwell Grange for a number of years. Initially she had been the sister in charge of one of the houses before being promoted to the post of registered manager. Health and safety Cupboards that were used for the storage of continence pads and the sluice doors were unlocked allowing demented service users free access. Toilet doors had outside door bolts preventing service user entry. The inspector noted that a number of yellow disposal bags were transported to the outside bins in a wheelchair. The cushion of the wheelchair had been placed to the side of the chair. When the wheelchair was returned to the Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 18 storage area there was no attempt to clean it. Staff changed aprons and gloves between caring for one service user and another. In one of the bedrooms in Milliner House where a service user was asleep in bed the inspector noted that a chair had been positioned close to the bed to prevent the service user from getting or falling out of the bed. Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 1 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 2 x x x x x x 2 Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 20 yes 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 3 and 4 Regulation 12,14 Requirement All service users must have a full assessment prior to admission. No service user must be moved into the home if the home is unable to meet their assessed needs. All service users must have care plans that detail the actions that staff need to take to ensure all aspects of care are delivered. Care plans must be reviewed and updated regularly. Professional advice is sought about the promotion of continence and tissue viability. Service users must have access to dental, sight and hearing checks as necessary. Staff must ensure that all medication has been swallowed before the medication chart is signed. All service users must have an end of life care plan that details their wishes and those of their family at this time. The wishes of service users about routines of daily living must be recorded. Drinks must be available for all service users throughout the Timescale for action 15.05.05 2. 7 15 15.05.05 3. 4. 5. 6. 7 8 8 9 15 13 13 13 15.05.05 01.06.05 30.06.05 15.05.05 7. 11 12 30.06.05 8. 9. 12 15 12 16 01.06.05 30.04.05 Page 21 Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 day. 10. 18 12,13 All staff must be aware of the signs and syptoms of possible abuse and follow up any concerns promptly All staff receive training that is appropriate to the needs of the service users. Training is updated and levels of competency assessed. Articles that could be ingested should be stored out of the reach of those service users with a diagnosis of dementia. The registered must ensure that all the houses are given the same information from this report. 15.05.05 11. 30 18 30.05.05 12. 38 12 30.04.05 13. 31 12 30.4.05 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 31 Good Practice Recommendations The organisation to give consideration to providing a registered for each of the houses Capwell Grange I51 S17668 Capwell Grange V221532 140405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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. 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