Inspection on 14/06/07 for Collingwood Grange Nursing Home

This inspection was carried out on 14th June 2007.

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

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

Other inspections for this house

Collingwood Grange Nursing Home 02/06/08

Collingwood Grange Nursing Home 31/05/06

Collingwood Grange Nursing Home 26/01/06

Collingwood Grange Nursing Home 12/07/05

Collingwood Grange Nursing Home 03/08/04

Collingwood Grange Nursing Home 21/04/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Collingwood Grange Nursing Home Collingwood Grange Close Camberley Surrey GU15 1LD Lead Inspector Pat Collins Unannounced Inspection 09:15 14th June 2007 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 Collingwood Grange Nursing Home DS0000017599.V339236.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. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collingwood Grange Nursing Home Address Collingwood Grange Close Camberley Surrey GU15 1LD 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) 01276 670700 01276 670017 brunskij@bupa.com BUPA Care Homes (AKW) Ltd Mrs Judith Margaret Brunskill Care Home 90 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability (0) Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical Disability (PD) 2. Dementia - over 65 years of age (DE (E)) The maximum number of service users to be accommodated is 90. 31st May 2006 (Full Inspection) 18th December 2006 (Random Inspection) Date of last inspection Brief Description of the Service: Collingwood Grange Care Centre is a care home with nursing operated by the BUPA Care Homes Company Ltd. Service provision is for older people of either gender, also older people with dementia and young adults with physical disabilities. Placements may be for long - term, respite or convalescent care. The property is a very large, detached, three - story house with basement laundry and kitchen facilities, situated in three acres of landscaped gardens. It has been converted and extended, affording modern, spacious facilities that tastefully blend with the building’s original period features. The home has a large car park and is located near to Camberley town centre and all community amenities, including medical centres, churches and a hospital. Bedrooms all have en suite facilities and are mostly single occupancy. They are arranged on three floors and accessible by passenger lift. Communal lounges, dining rooms, assisted bathrooms and wheelchair accessible toilets are also provided on all floors. The home has a hairdressing salon. Wheelchair accessible transport is available providing access to the community as part of the home’s varied activities programme. Fee charges range between £850 and £1200 per week Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit forms part of the key inspection process using the new ‘Inspecting for Better Lives’ (IBL) methodology. Judgements about the home’s conduct and standards of care are based on the cumulative assessment, knowledge and experience of service provision at the home since its last full inspection in July 2006. This includes information supplied to the Commission for Social Care Inspection (CSCI) by the home manager. Additionally, findings at the time of an unannounced random inspection carried out in December 2006 by Ms Denise Debieux, Regulation Inspector. The report of that inspection is available to the public on request to the CSCI. Ms Pat Collins, Regulation Inspector, undertook the latest inspection visit commencing at 09:15 hrs and concluding the same day at 19:45 hrs. In the manager’s absence the deputy manager and the manager’s personal assistant facilitated the inspection process. The manager attended the feedback session at the end of the visit. The inspector has looked at how well the home is meeting the national minumum standards set by the Government, forming judgements about the home’s standard of service provision which are detailed in this report. A partial tour of the building took place and records were sampled. The views of people using the home’s services have been sought through discussions with individuals’ during the inspection visit and from the content of questionnaires received from four people living at the home. Communication with some people using services was limited due to communication difficulties, however observations of their body language, appearance and records, also feedback from staff mostly indicated a sense of their well - being. Information obtained during discussions with individual staff members and from questionnaires received from two relatives and a General Practitioner also informed the inspection process. The term ‘residents’ is used hereafter in this report when referring to people using the home’s services. This is in accordance with the expressed preferences of individual residents’ consulted in this matter by the inspector; also to afford continuity and familiarity by using the term featuring in the home’s information materials and used by staff, residents and their relatives and friends. The inspector would like to thank all who contributed to the inspection process; also the residents at Collingwood Grange Care Centre and staff for their time, hospitality and assistance throughout the inspection visit. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There has been compliance with outstanding requirements brought forward from the last full inspection. The manager is now registered by CSCI and a staff supervision structure is in place affording staff a combination of individual and group support arrangements. Staff consulted demonstrated familiarity with Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 7 local multi-agency safeguarding vulnerable adults procedures and would respond appropriately to allegations or suspicions of abuse. The staff-training programme now provides staff with the necessary skills and knowledge to enable assessment and provision of appropriate care for residents who have dementia or sensory impairment. The needs of all residents have been reassessed using a recently implemented assessment tool and adopting a person centred approach. Care plans generated from assessments are in a new format that is easily navigated and clear. Training for staff responsible for assessments and care planning preceded implementation of the use of new assessment tools and new care plans. The assessments and care plans sampled were observed to provide a comprehensive, holistic view of residents’ needs and aspirations. Systems and practices ensure continuous assessment of needs and regular evaluation of care plans. Staff had signed and dated all entries in the care records inspected. Areas of the home had been redecorated and carpets replaced on first floor corridors, providing a pleasing environment for all. The dementia unit is a recent initiative and this environment is gradually being developed, adopting research based principles and model of care and ensuring an holistic approach to care planning. Visual cues are being introduced into the physical environment intended to stimulate awareness of surroundings, aid communication and prompt memory recall. A small lounge on this floor has been refurbished using furniture, artefacts, ornaments and pictures from decades past. This room is used as a quiet area for residents to sit also for one to one and small group activities organised by the senior activities coordinator. This staff member informed the inspector of the beneficial impact of this setting on social interaction between residents and between staff and residents, invoking memories and provided interesting new topics of conversation. Staff deployed in the dementia unit use various communication techniques, including reminiscence materials for initiating conversations with residents. This enhances understanding of residents’ subjective experiences, fears, behaviours and emotional reactions. It was good to note life history information collated by staff in consultation with residents and their relatives. This is used to aid communication, providing staff with the necessary insight into what is important to each resident in their lives and raising staff’s awareness of residents’ likes and dislikes and their personal interests. A programme of dementia training for staff was on - going. What they could do better: It is recommended that management review arrangements for ensuring accessibility of the complaint procedure for all residents. The manager has acknowledged a shortfall in making provision of review meetings for all residents in accordance with the organisation’s own policy. This will afford residents’ and as appropriate, their relatives, ongoing opportunity to be Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 8 involved in care planning and provide a non-threatening forum in which to raise any concerns. Further training is necessary for individual care staff to ensure continence aids are fitted appropriately and staff awareness increased in respect of diversity issues specific to meeting residents needs. It is acknowledged that some training has taken place in this area and related good practice also noted. Feedback from individual residents confirmed a perception that staffing levels are inadequate. Indicators included comments about delays in response to call bells and staff not having time to talk with residents, also nurses being unable to leave their duties to attend planned individual supervision sessions. Comments received from residents include “ When staff are in short supply I sometimes have to wait unacceptably long for the commode” “ Staff appear untrained and staff turnover is high”. “ Carers are individually attentive and dedicated but they are overstretched. There are too few of them.” A relative said the home could improve by staff spending more time with residents. This feedback has been discussed with the manager and recommendation made for review of staffing levels, staff routines and of staff deployment. It is acknowledged that staffing levels are enhanced in the mornings and evenings, achieved through flexible working arrangements. Also that call bell response times are monitored regularly by the manager. The information received from a resident however was that though call bells may receive a prompt response and then turned off, at times, unless the situation is considered an emergency, there can be a significant delay before needs receive attention. Of the two relatives who returned questionnaires to the CSCI, one was satisfied with communication systems at the home and reported always being kept up to date with important issues affecting their relative living at the home. The other relative reported sometimes being kept up to date in this matter, referring to not being aware of a recent significant event. The inspector followed this up with the manager who confirmed staff had notified the residents’ named representative and this information had not been passed on to this relative as expected. The home has since reviewed and improved communication lines with the relatives of this resident. Care Managers giving feedback to the inspector also referred to occasional oversight in notifying them of significant incidents affecting residents they were responsible for, citing hospital admissions as an example. They confirmed this matter had been raised directly with the manager. 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. Collingwood Grange Nursing Home DS0000017599.V339236.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 Collingwood Grange Nursing Home DS0000017599.V339236.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, 3, 4. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have access to information that enables an informed decision about the home’s suitability to meet needs and expectations. Admissions do not take place until after a comprehensive needs assessment has been undertaken to be assured that needs can be met. There has been substantial improvement in needs assessment and care planning since the last full inspection. Intermediate care is not provided. EVIDENCE: The management of the home understands the importance of having sufficient information when choosing a care home to meet prospective residents needs, expectations and preferences. A clear information pack is given to all enquirers. This contains a colour brochure with photographs, detailing whom the home is intended for, the care philosophy and objectives and describing the home’s services and facilities. The pack includes examples of menus and of available activities also information regarding additional charges not included in fees. Comments received from a resident were “ The manager answered all my questions about the home before moving in, giving me all the time I Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 11 needed to think about questions I needed to ask, given with care and concern for my needs” Quoting the manager this resident stated “ I was told this will be your home and we do all we can to make it your home and try to make all your wishes and comforts work out for you “ Another resident commented “We were courteously received when we visited without an appointment to view the home. We felt welcome and comfortable”. One resident was less satisfied with the pre-admission information expressing the view that prospective residents needed written information about staffing ratios to enable an informed choice about the home’s suitability to meet expectations and needs. The home has an individualised fee structure determined by the level of nursing needs and type of accommodation. A comprehensive ‘service users guide’ is available at the reception. The inspector was informed that a copy of this document is placed in every bedroom and prospective residents’ and/or their representatives may see the home’s statement of purpose document, by request. The manager accepted the need for minor amendments to the ‘service users guide’ for accuracy and agreed to refer to the home’s non-smoking policy in this document. A new, improved assessment tool has been implemented since the last inspection. This is being used for pre-admission and post-admission assessments and staff have been trained in its use. Assessments and preadmission assessments were sampled, including risk assessments. These were comprehensive and holistic. Information is gathered from a range of sources as necessary and a summary of care management (health and social services) assessments obtained for people placed through care management arrangements. Prospective residents and/or their representatives are encouraged to be involved in the assessment process. Admissions are agreed on the basis that needs can be met and admissions were observed to be within the home’s registration conditions. Discussions with a nurse confirmed that prior to admission of a new resident that all assessment information is accessible to the nurse in charge of the floor where the person is to be accommmodated. This enables preparation of any special equipment in advance of admission or additional arrangements for meeting religious and diversity needs. An equal opportunities policy underpins admissions to the home and observations confirmed that services offered to residents are demonstrably based on current good practice. Collingwood Grange Nursing Home DS0000017599.V339236.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 Good. This judgement has been made using available evidence including a visit to this service. Significant improvement was found in the home’s care planning practices and record keeping. Residents have holistic care plans detailing individual needs and aspirations and health needs. Staff work to clear, robust practices in the provision of palliative and terminal care with specialist support where needed. The principles of respect, dignity and privacy are put into practice in the delivery of care and operation of the home. Residents are protected by the home’s medication procedures and practices. EVIDENCE: There were 68 residents accommodated at the home and one resident in hospital at the time of the inspection visit. Twenty-two residents occupied bedrooms on the floor referred to be staff as the dementia care unit. Of this number, eight residents have a diagnosis of dementia and mostly other residents accommodated on this floor, have a range of other conditions that increase their frailty and vulnerability. Additional measures are in place on this floor, intended to ensure residents safety and security, including a digipad entry and exit system. The manager confirmed ongoing discussions with lift engineers to agree fitting an appropriate device to Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 13 the lift to ensure vulnerable residents accommodated in the dementia unit are unable to activate the lift unaccompanied by staff or relatives. Staff who regularly work in this unit and who know the residents well were confident that none of the current residents would be able to gain access to the lift without staff assistance and therefore not considered at risk. It was agreed with the manager however that priority would be given to carrying out formal risk assessments specific to this potential hazard for all ambulant residents accommodated on this unit. The care plans sampled detailed residents’ named nurses and key workers. The new care needs assessments and care planning documentation has been implemented for all residents and staff trained in its use. Care plans were comprehensive in content and include all daily living activities and goals, nursing needs objectives and a range of risk assessments. They afford the reader good insight into residents’ holistic needs. The care plans sampled were signed and dated by staff and regularly reviewed. The signatures of residents recently admitted or of their representative, were recorded signifying agreement to their care plans. A concerted effort was evidently being made to obtain written agreement to care plans for all residents. Observations confirmed the need for all nurses to follow BUPA procedures for generating pressure sore prevention care plans where signified by risk assessment scores. It was recommended that these specify types of pressure relieving equipment to be used . Discussions with a nurse identified further training needed to ensure she was informed in BUPA’s procedures to enable appropriate selection of pressure relieving mattresses and cushions. This shortfall in knowledge however was not posing a risk to residents on the basis that the manager reported good management oversight of this area of practice. The home has a sustained good reputation for pressure sore prevention. With one exception pressure sores being treated at the time of the visit were present on admission. Good wound assessment and treatment plans are available and monthly pressure sore treatment is audited by management. It is recommended this audit incorporates review of pressure sore prevention plans. The manager stated that the majority of residents including those funding their own placements though placed through Care Management arrangements were in receipt of ongoing Care Manager reviews. Review records were not inspected and a nurse could not locate one review record requested. Review records were not on the care records sampled and recommendation made for these records to be held on care files. The manager confirmed BUPA policy for privately funded residents not in receipt of Care Management reviews to have regular internal formal reviews that they and their representatives are involved in. The manager confirmed there were a small number of residents, approximately four to which this applied and their reviews were acknowledged to be overdue. It was stated that these reviews would be carried out. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 14 Life history information on residents’ files includes milestones in their lives and other significant information, enabling an individualised approach to care. Staff working on the dementia unit were observed using various techniques and reminiscence materials to illicit information from residents about their lives. It was good to indirectly observe the warm relationships between some of the staff and people living on all floors. Observations suggested that residents receive the level of support they need to enable them to dress appropriately and maintain individuality, appearance and dignity. Whilst the home’s management and policies promote equality and diversity discussions had with the deputy manager and manager’s personal assistant identified the need for diversity training for nurses and care staff. Based on available information it was concluded that residents health care needs were being met. Residents are registered with General Practitioners (GP’s) from a number of practices and GP’s visit the home by request. Newly admitted residents’ from outside the local area are required to go through the PCT to register with a GP practice. Feedback from residents and their relatives in comment cards confirmed overall a high levels of satisfaction with the medical care received by residents. Complaint records examined however highlighted recent difficulties experienced by staff in their contact with a General Practitioner (GP). This was in relation to requests for a visit and referral to hospital for further pain assessment for a former resident admitted for palliative care. Residents are registered with a number of GP surgeries and staff reported positive relationships and good support from most GP’s. Comments received from a GP confirmed staff always seek medical advice and act upon it to manage residents health care needs. It was also stated that staff care about residents and are “well meaning”. The GP made a generalised comment that there was a need for improvement in the home’s management of medication and dressings, though no specific examples given about shortfalls. The inspector sampled medication storage and recordkeeping during the inspection visit. Medication administration was also observed and was in accordance with procedures and considered safe. Controlled medication records and storage was sampled and found to be satisfactory. Daily medication audits are undertaken of medication administration records and any discrepancies or omissions are addressed with the relevant nurse at the time. Discussions were had with nurses and care staff about the homes medication policies and procedures. It was evident through these discussions, that the staff had a good understanding of the same. Dressings were not inspected on this occasion. Professional assessment advice and input to staff training was provided by a Continence Advisor. Care records sampled included assessment information being collated by staff specific to incontinence products. The inspector endevoured to establish whether staff were acting on the advice of the Continence Adviser in their practice. Records of this advice however were not located on the files sampled. Feedback received from one resident that staff Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 15 did not appear trained to fit an incontinence aid properly which sometimes resulted in incontence and embarrassment, was drawn to the attention of the manager; she agreed to follow this matter up and ensure this was addressed with further training. Care plans had been produced for promotion of continence and management of incontinence and catheter care. Practice observed was managed discreetly and respected privacy. Feedback from a another resident who reported at times have to wait a long time for the commode was also discussed with the manager. In following up this matter management should consider other critical comments about staffing received from residents and relatives which are detailed in the section of the report related to staffing. Odour control throughout the home was very well managed and all comments received from residents and relatives expressed a high level of satisfaction with standards of hygiene and cleanliness. An excellent development has been provision of wall mounted dispensers for antibacterial gel for the use of staff and residents’visitors in bedrooms, bathrooms and toilets and in other areas to enhance existing infection control methods. Arangements were in place for residents’ to access optholmic, audiology and dental services. Chiropody needs were met by private chiropodist. The inspector noted referal had been made for NHS chiropody services for one resident through a diabetic clinic. Private physiotherapy and aroma therapy can be arranged. It was positive to observe strong links between the home and a local Hospice. Staff reported receiving excellent support and guidance from palliative care specialist nurses who visit the home and can be contacted 24 hours a day for advice. End of Life advanced care planning was included in the home’s care planning process. A nurse confirmed an individualised approach in this matter. A palliative care plan viewed demonstrated the process empowered a resident to be in control of decisions about palliative and terminal care. A complaint from the relative of a former resident admitted for palliative care had been fully investigated under the home’s complaint procedures. Records examined did not identify any weaknesses in the delivery of palliative care within the home’s direct control. Residents’ preferences are respected where known and as far as practicable in planning care routines. A number of residents confirmed they were not woken exceptionally early. A resident stated when first admitted night staff had woken him with an early morning cup of tea. Because he then had a long wait until breakfast was served he requested that he not be disturbed before a specified time. He said that staff all respect his wishes in this matter. A staff member on the ground floor stated usually there was one nurse and one care assistant on night duty and on occasions, two care assistants. Staff working on the ground floor stated generally only a couple of residents were up and dressed when day staff reported for duty. They were confident that it was not the practice to wake residents up. Observations of practice and routines on the Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 16 dementia unit confirmed staff did not assist residents in preparing for bed until after supper. In discussions with staff regularly working on this unit they were consistent in stating no more than four residents were up and dressed when they reported for duty in the mornings. They too were confident that night staff only assisted those residents who were already awake in getting up and dressed. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 17 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 Excellent. This judgement has been made using available evidence including a visit to this service. Routines of daily living activities are flexible and varied. Improvements since the last full inspection have ensured an individualised approach to establishing and responding to the social needs and interests of people using this service. Social activities are creative and well managed affording daily variation and interest for people living in the home. Meals offer choice and variety of home cooked food and meet dietary needs. EVIDENCE: Since the last inspection a second part time activities co-ordinator has been recruited. The activity coordinators have jointly developed the home’s activities programme, responding to suggestions from residents for quiz nights and more trips in the community. The inspector had a brief conversation with the new activities co-ordinator as he was preparing the mini bus to take three residents out for a drive after lunch. He planned to stop somewhere for afternoon tea. One of the residents was a wheelchair user and a staff escort going with them. The activities coordinator confirmed he was very much enjoying his new post and was observed to have formed positive relationship with individual residents. The mini bus has wheelchair access and is shared with other local BUPA homes. The inspector expressed disappointment at the company logo being on the side of the vehicle that can be stigmatising for residents when out in the community. It was recommended this be removed. Residents waiting to Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 18 go on this trip expressed how much they were looking forward to it. The activity coordinator confirmed effort made to offer opportunities for going out to all residents able and wishing to do. The senior activities coordinator has been working on developing a suitable activities programme for people with dementia. She reported having attended a workshop to extend her knowledge in this area. She was evidently highly motivated to offering appropriate social stimulation for residents with dementia or other disorders causing memory loss. The inspector commented positively on the creative approach to reminiscence activities. A ‘memory lounge’ had been developed in a style and with furnishings and memorabilia that stimulated conversation, drawing on residents’ long - term memory. The senior activities coordinator described a regular event in which residents were served lunch in this room. This environment was stated to have enhanced social interaction and communication between residents and with staff through use of reminiscence techniques. The home is building up its activity resource materials. A monthly newsletter is produced and effort made to encourage residents to socialise with each other. Every morning on weekdays there is an open invitation to residents to get together for coffee, tea or sherry served in the reception; also to meet up in a ground floor lounge for a chat, to read newspapers and listen to music. A resident commented, “ Every effort is made to encourage me to join in activities and take interest”. Another resident commented on feeling lonely and isolated in the home despite these social events. This person perceived a higher proportion of people with dementia admitted since BUPA had purchased the home and stated the impact of this was detrimental to this person’s quality of life. This was qualified stating there were fewer residents to converse with. The same resident said “my friends visit me regularly and my stimulus comes from outside”. This feedback was passed on to the manager to ensure an appropriate balance of needs when accepting admission referrals and allocating rooms. The activities programme is varied and includes social events open to relatives and friends of residents. In this way the home supports residents in maintaining contact with friends and relatives. Birthdays and special days are celebrated, for example, Christmas festivities, VE commemoration day, Tricia’s Easter Parade and St George’s Pub Night. In May this year some residents and staff took part in a Ten Pin Bowling competition at a leisure centre, their opponents being residents and staff from another BUPA care home. A resident who took part told the inspector “it was great”. A Pat the Dog scheme arranges regular visits of a dog and his owner and this was taking place on the day of the inspection visit, to the obvious pleasure of a number of residents. A mobile library service visits the home also talking newspapers and books were available for individual residents who were fully or partially sighted. A selfemployed hairdresser provides regular hairdressing services in the home’s hairdressing salon. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 19 Residents have opportunity to practice their religious beliefs. A Roman Catholic Priest administers Holy Communion at the home and another Religious Minister visits. There is also a bible group. Whilst there were no residents accommodated practicing other religious beliefs, assessment processes for new residents identify diverse and religious needs and effort would be made, according to staff, to accommodate the same. The dementia unit is a recent development and it was understood that residents accommodated on this floor prior to its new designated purpose, had been offered alternative accommodation on other floors. The home’s management and activities coordinators emphasised that people living in the dementia unit were not isolated or segregated. It was stated that they are encouraged and supported in using the wider environment of the home with additional supervision. Examples include observation of a resident accommodated on the dementia unit enjoying a cooked breakfast in the ground floor dining room on the day of the inspection visit. Provision of a full cooked English breakfast was a monthly event and used as a social occasion. Later residents from the dementia unit were seen using the garden with a staff member. A fete had taken place in the garden the weekend prior to the inspection visit and residents from all floors had been encouraged to go. Though there are some specialist activities available more suited to people with severe memory impairment, residents from the dementia unit also participate in generic activities taking place elsewhere in the home. They were stated by staff to attend social occasions and had opportunity to participate in local excursions in the mini bus. The home’s menu offers a choice of food and a wholesome, appealing diet. Nutritional assessments are undertaken routinely on admission and periodically repeated. Where necessary nutritional care plans are put in place. The inspector met briefly with the head chef who confirmed good communication between nurses and the kitchen, enabling dietary needs to be met and provision of suitable textured meals and drinks to meet individual needs. Weights are monotored monthly and weight gain and loss dealt with appropriately. Lunch was observed on the ground floor and dining tables were well presented with tablecloths, napkins, condiments and menus on each table. Lunch observed on the ground floor was a substantial 3-course meal served with a choice of wine and followed by cheese and biscuits. Staff serving food wore suitable protective aprons and gloves. Staff practice was observed also in the dementia unit whilst assisting residents’ with their meals. Staff sat down with residents at tables and gave residents’ time to chew and enjoy their food. Practice at the time of the evening meal was also briefly observed on all units. This was a lighter 3-course meal or sandwich or snack of choice available as alternatives. The main kitchen and serveries were clean and organised. Chefs and kitchen assistants wore clean protective clothing. Discussions with the head chef confirmed she had appropriate qualification and relevant training and Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 20 experience to cater for and meet the nutritional needs of people living at the home. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 21 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 Good. This judgement has been made using available evidence including a visit to this service. The home’s complaint procedure has been issued to all residents. Complaint records demonstrate that the home’s management is responsive to complaints. Whilst acknowledging systems are place for residents who are able to raise concerns, observations indicate the need to ensure accessibility of the complaint procedures for all residents. The home’s procedures and the staff training programme ensures an appropriate and timely response to allegations or suspicions of abuse. EVIDENCE: Copies of the complaints procedure were available in the reception area for visitors and all residents stated to have been provided with a copy in their rooms. The complaint’s log was seen and all formal complaints were clearly recorded with details of actions taken and copies of any correspondence. The Commission for Social Care Inspection had not investigated any complaints about the home in the period since the last full inspection. Discussion took place with the manager about the management of complaints and dissatisfaction expressed by relatives that were not documented as formal complaints. The inspector was informed that effort was made to respond immediately to try to resolve any problems. It is recommended that records be maintained of these ‘lower’ level complaints to demonstrate action taken to resolve problems. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 22 Records of compliments were examined. A recent note from a relative stated “Thank you for all the help and support to my father, kindness to my family and understanding during difficult times and for wonderful care” Another said “ On behalf of my whole family thank you for wonderful and excellent care to my mother. Your skill and devotion, energy and warmth made her final years easier to cope with”. Information received from two Care Managers consulted as part of the inspection process confirmed occasions when relatives brought “concerns” to their attention, stating some appeared to be related to a change in management style at the home. The inspector discussed feedback from a resident with the manager who had criticised the home’s management style expressing the view it could be “warmer”. This resident perceived the manager not to be as approachable or accessible and she might be and felt she should initiate discussions with residents. This resident pointed out this was important as residents meetings that take place, whilst affording opportunity for raising issues and concerns, was not the forum to discuss confidential matters. Out of the four surveys received back from residents, this individual and one other resident confirmed knowing how to make a complaint. The other resident clarified “I would tell a carer or nurse but don’t really know how to contact the manager”. Two other residents stated they did not know how to make a complaint. This information was passed on to the manager who was open to constructive criticism and agreed to look again at whether any changes are necessary to strengthen communication between residents and management. It was noted that at the time of the last inspection part of the role of the manager’s personal assistant was to provide effective liaison between the home’s management and residents. This employee had just returned from a period of long – term absence and now she has resumed work this might resolve the problem. The manager is conversant with and promptly follows the Surrey Multi-agency Procedure for Safeguarding Vulnerable Adults as necessary. These procedures are located on all floors. Staff questioned during the visit responded appropriately to questions regarding what they would do in the event of receiving an allegation of abuse or having suspicions of abuse. They were clear of the types of abuse and who to report to. The manager and staff stated they had had in- house safeguarding vulnerable adults training. The manager reported being unable to secure a place on multi-agency Safeguarding Vulnerable Adults training organised by Surrey County Council. She confirmed she was waiting to be allocated a place. The home’s records confirm two referrals investigated under Surrey’s Multi-Agency Safeguarding Vulnerable Adults Procedures since the last full inspection. The allegations were unsubstantiated. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 23 The inspector met briefly with the home’s administrator to clarify systems for safeguarding residents’ money. It was noted that records are held of relatives/advocates/solicitors authorised to administer residents’ financial affairs. Where the home has responsibility for the safekeeping of residents’ personal allowances robust arrangements were in place for security of their money, backed up by good record keeping practices. These residents have access to their money when they need it. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 24 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): Standards: 19, 26 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home’s location and physical design and layout of the premises and garden enable residents to live in a safe, clean, well-maintained and comfortable environment. There is evidence of a continuous maintenance, and of recent redecoration and replacement of carpets in some corridors. EVIDENCE: The home was clean throughout on the day of the inspection visit and odour control was excellent. Toilets and bathrooms are wheelchair accessible and suitably equipped. Those sampled were clean and hygienic. All communal lounge and dining areas are spacious and comfortable. The bedrooms all have en-suite facilities and those viewed were observed to be furnished to a good standard. Residents are encouraged to personalise their bedrooms. During the past twelve months carpets have been replaced on the ground and first floor corridors and the second floor corridor has been Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 25 redecorated. The manager has identified some communal areas are in need of redecoration though it was not clear when this was to be addressed. This year there has been significant financial investment in the home with imminent plans to replace the nurse call system. There has been recurrent problems with the existing system and additional hand held bleeps had been recently purchased to enable staff to efficiently respond to call-bells. Adverse comments were received from two resident about delays in responding to call bells. One stated “when staff are in short supply I sometimes have to wait unacceptably long for the commode. This is uncomfortable and embarrassing”, the other said, “ Staff always respond quickly when called on using the emergency buzzer but I sometimes have to wait a long time for less important needs to be met”. This information was communicated to the manager by the inspector. As this information was extracted from comment cards it was not possible to establish whether matters had improved since the acquisition of additional hand held bleeps. The manager reported personally monitoring call bell response times daily, checking automated records of the same and following up lengthy response times when noted. The manager acknowledged sometimes delays in responding to call bells occur at times of heightened activity, for example during meal times when staff are assisting frail residents with their food. Residents were using the furnished terrace and garden area on the day of the inspection. The large garden was tidy and flower borders and hanging plants were well maintained. The home’s two guinea pigs were stated by staff to bring pleasure and added interest to residents and their visitors, particularly grandchildren, when out in the garden. The recently designated dementia care unit is being gradually developed in order to create an environment that is comfortable, stimulating, promotes a sense of freedom whilst incorporating appropriate safety measures. Staff and management are aware of the importance of visual cues in this environment to enhance residents’ sense of security and promote confidence when navigating their way around their home. The manager confirmed the long-term intention to replace unsuitable carpet designs in this unit with plain carpets when they become due for renewal. Orientating cues are being introduced in this environment, for example, toilet seats appropriately marked to aid recognition. Staff have placed a suitable visual cue on the bedroom door of a resident, which is meaningful to this person. This has enabled freedom of choice and independent movement. It was positive to note the intention to provide suitable colour coded cues in this area through décor and fittings intended to enhance the well-being, security and behaviours of residents’ with dementia. The inspector suggested reference to current research information to support staff in considering environmental factors that create a positive dementia care environment. The premises and garden area is wheelchair accessible. Suitable aids and equipment are available including a range of pressure relieving mattresses and Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 26 cushions, sling and standing hoists. Residents have personalised slings and the inspector was informed these are laundered daily. Wheelchairs are for residents’ personal use and noted to be in good condition. Use of bedrails was subject to risk assessments carried out and obtaining written consent for their use from residents or as appropriate, from their representatives. Bed bumpers are available for use with bedrails if necessary, to minimise risk of injury or entrapment. Records were examined of regular health and safety checks of bedrails carried out by the home’s maintenance person. Further comment is made on observations of potential hazards associated with compatibility of the combination of bed rails, beds and mattresses later in this report in the section entitled Management and Administration. Also on risk prevention measures planned specific to access to the passenger lift from the dementia unit. Laundry facilities were observed to be clean and hygienic and the personal laundry system appeared satisfactory. The tumble driers were functioning on the day of the inspection though note taken of a recent recurring history of mechanical failure with both machines. Contingency arrangements had been made at these times using a local launderette facility and the purchase of a small drier designed for domestic use. The manager anticipated the commercial tumble driers would be replaced with new machines in the next financial year or sooner if necessary. The basement commercial kitchen was clean and organised for the time of day. With the exception of the waste disposal system that required a new part, and stated to be on order, all other kitchen appliances were functional. Records confirmed a programme of regular maintenance for the premises, grounds and appliances. It was stated that an air conditioning unit was to be purchased for the kitchen for the benefit and welfare of catering staff. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 27 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 good. This judgement has been made using available evidence including a visit to this service. Increased staffing levels at the time of the last inspection are being maintained. Based on available information recommendation has been made for further review of staffing levels, routines and staff deployment to ensure needs of residents are fully met. Staff recruitment procedures are robust and safeguard residents. Whilst the staff induction and training programme overall enables staff to do their job recommendation has been made for further training for some staff groups. EVIDENCE: There had been significant staff turnover in the past twelve months, 24 in total. The reason for this was not established though the manager did refer to staff morale issues. Comment is made on this in the section of this report entitled Management and Administration. At the time of the inspection visit the home had a full compliment of nursing staff. Job vacancies included a weekend receptionist also care assistant posts, which had been advertised, and interviews were planned. The inspector was informed that the home had not had a gardener for some time and the maintenance person assumed some gardening responsibilities working additional hours some evenings and weekends. Increased care staffing levels noted at the time of the last inspection were being maintained as evidenced by feedback from staff and examination of a sample of staff rotas. This is achieved through flexible working arrangements with the cooperation of individual day and night staff prepared to start work Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 28 earlier than shift times. Twilight staff had not been recruited as originally intended. The home has two bank staff and the intention is to expand the care bank, recognising the need to do so to prevent permanent staff from becoming tired. Minimum staffing levels are consistently maintained as evidenced by rotas inspected and feedback from staff. Agency staff are not used. A nurse informed the inspector of controls in place to limit overtime hours to ensure safe practice. Discussions with individual members of care staff identified they perceived staffing levels at the home to be adequate to meet the needs of residents. Observations during the course of the inspection visit however revealed nurses to be constantly very busy throughout their shifts. A nurse consulted acknowledged competing time pressures on nurses however did not consider this compromised the safety of clinical practice. The impact of this however constrained availability of time for nurses to communicate with residents; feedback from some residents confirmed they regretted staff did not have more time to spend with them.The same nurse was observed to have formed positive relationship with individual residents and made time during his busy shift to have brief chats with them whilst balancing other workload priorities. This nurse was exceptionally warm and caring towards residents and he and other staff shared lighthearted humour with residents who clearly were stimulated by and appreciated this attention. Feedback on staffing levels from the four residents who returned survey cards confirmed staff were usually available when needed though one resident referred to times when staff were overstretched and having to wait an unacceptable period of time for the commode. Another resident said that staff always responded promptly when the emergency call bell was used but there were times when this individual had to wait a long time for “less important needs” to be met. A relative suggested the home could improve by staff spending more time with residents. It was good to receive such positive comments about the conduct of staff in the surveys returned to the inspector. A resident stated “ Staff are attentive always, the same staff care for me each week so I don’t have to get used to different staff, staff couldn’t have been kinder to me”, and a relative also referred to staff’s kindness and having every confidence in their skills. New staff personnel files have been recently implemented and those sampled were well organised. These records demonstrate robust recruitment procedures in compliance with statutory requirements. Discussions with the deputy manager and the manager’s personal assistant included how the home manages equal opportunities and team diversity (age, ethnicity, gender, sexual orientation and cultural) during recruitment, induction and training activities. Equality of job opportunities was demonstrated in records of job applications and interview notes. The staff team is multi – cultural in composition and the inspector was informed that for staff whose first language is not English, there is a minimum acceptable standard for written and spoken English Language, demonstrated in the completion of job application forms and at interviews. This Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 29 ensures staff competencies in communication skills to be sure all staff can perform their role and duties. The home has a predominance of female to male staff employed in the delivery of personal care, reflecting the gender composition of residents currently accommodated. The new care planning system ensures information is sought and recorded on residents’ preference of staff gender for delivery of intimate personal care. The inspector suggested that staff record the source of this information if residents are unable to supply this themselves. Discussion took place with the home’s training coordinator during the course of the inspection visit. Her remit includes coordinating the staff induction and statutory training programme and maintenance of training records. She is one of two moving and handling trainers employed at the home. The home has a training room and at the time of the visit first aid training was taking place, which was open to staff from other BUPA homes. It was noted that the home no longer maintains a team training matrix as stated in information recently supplied to CSCI by the manager. Whilst acknowledging records of staff induction and training are available on staff files it was agreed that the training matrix would be reinstated to provide a master record of all statutory training for the team. Records sampled confirmed induction and mandatory training in place and induction records signed off by the manager. Areas of discussion with the training coordinator, deputy manager and the manager’s personal assistant included suggestion for consideration to be given to using some staff meetings as forums for service specific training/discussions about practice. Areas where this would be beneficial include care of residents who have Parkinson’s disease and in management of incontinence and promotion of continence. It was suggested that learning sets could be beneficial to nurses professional development by tasking them with responsibility for looking up evidence based practice research and sharing this with nurse and care assistant colleagues. The training coordinator is not responsible for organising, recording and monitoring nurses clinical refresher training. It was recommended that records of this training be maintained and an overview maintained by management. Recent clinical training was stated to include syringe driver management, wound care and peg feeding. The deputy manager had recently attended an end of life training event and information from this he said would be cascaded to other nurses. A palliative care specialist nurse had recently given a talk to staff. It was positive to note the excellent progress in exceeding the minimum ratio of trained members of care staff since the last full inspection. The manager confirmed this had been achieved through the commitment of staff to the National Vocational Qualification (NVQ) programme of training, which was ongoing; also by recruitment of staff possessing NVQ qualifications. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 30 Information received from the manager prior to the inspection visit referred to staff morale issues over the past 12 months, attributed to turnover in residents. Staff consulted during the inspection visit were mostly positive about the home and a number emphasised they obtained job satisfaction and enjoyed working at the home. The manager stated effort was being made to promote team working, empowering staff through training and promoting transparency of views. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 31 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, 32, 33, 35, 36, 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The manager has been registered by the Commission for Social Care Inspection since the last full inspection. Though overall management and administration of the home was judged effective, observations identified the need to review and strengthen the home’s management in the manager’s absence. Staff supervision systems have improved and health and safety practices, quality assurance and financial systems overall safeguard people using services and their best interests. EVIDENCE: Since the last full inspection of the home the manager has been registered by the Commission for Social Care Inspection (CSCI). She confirms currently working towards achieving the Registered Managers Award qualification. The manager was unavailable to be present for most of the inspection visit but did attend the feedback session. In her absence the home’s deputy manager and Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 32 manager’s personal assistant jointly facilitated the inspection process. Observations confirmed that although the home is overall satisfactorily managed there are some areas in which management arrangements could be strengthened. Specifically it is important for the deputy manager to ensure he is sufficiently informed and aware of where to locate information relevant to the management of the home in the manager’s absence. It is suggested that the manager may wish to review the roles of the deputy manager and her personal assistant to ensure there is no inadvertent role ambiguity. It was found that the deputy manager was over- reliant on the knowledge base of the manager’s personal assistant to the extent that this was of concern to the inspector. It is suggested this be reviewed and consideration given to any additional support or training necessary to strengthen the senior management team. Other areas of discussion with the manager included feedback from a resident whose perception was of a change in the home’s admission criteria, though it is acknowledged the manager stated this was not the case. This individual perceived there to be a higher proportion of residents admitted with dementia and other conditions that significantly decreased opportunity for social interaction with other residents since the home was purchased by BUPA. It was noted that the home’s management was mindful of this issue in the allocation of bedrooms. The home was operating in compliance with its conditions of registration. Discussion took place with the manager regarding a condition not specified on the current registration certificate displayed. The manager stated she no longer required this condition and was aware that she would shortly have opportunity to request this be removed from the register as part of a certificate review taking place by the CSCI. The complaint procedure needs to be more accessible for all residents. It is recommended that management note the suggestion of one resident who expressed the view that the manager needed to be more ‘visible’ and ‘on the floor more, initiating and encouraging verbal feedback from residents’, many of whom who are unable to participate in residents’ meetings. It is acknowledged that the manager’s time is finite and responsibilities for managing such a large establishment are considerable. Consideration could be given to developing the role of the deputy manager in this area and looking at other ways of making the complaints, compliments and suggestions policy more accessible. The inspector met with the administrator and discussed the administration of financial systems, also sampling financial records safeguarding residents’ financial interests. This area of the home’s activities appeared efficiently managed and residents have access to their money held in accounts administered by the home when they need it. The inspector was informed of past arrangements for external financial audits though these records not Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 33 available for inspection. It was noted that the Primary Care Team notified the home and residents or their representatives of entitlements for nursing contributions, which was deducted from the fees of self-funding residents, also back payment. A current employers and public liability insurance certificate was displayed. Observations during the course of the inspection visit found the atmosphere of the home to be friendly and welcoming. The receptionist and the manager’s personal assistant were exceptionally helpful not only to the inspector but towards other visitors. With the exception of one resident other residents and relatives who contributed information to the inspection process, also staff, made no adverse comments about the management style at this home. One resident felt the manager could be more approachable and the atmosphere “warmer”. The manager and deputy manager had received training to enable them to effectively supervise staff since the time of the home’s last full inspection. A supervision matrix was examined which demonstrated a clear supervision structure in operation. Gaps in individual supervision for care staff were explained by the recent long-term absence of their supervisor. The manager’s personal assistant, who previously held the post of senior care assistant, assumed this role. Though she was not responsible for the line management of care staff it was understood that this worked well. The deputy manager has responsibility for supervision of nurses and a small number of gaps in their individual supervision records was discussed with him. He explained difficulties at times in meeting with nurses as planned who could not always be released from their duties for this purpose. The need to review and overcome this barrier to nurses’ individual supervision was agreed. Supervision arrangements include a combination of group and individual supervision methods. Records sampled evidenced individual 1:1 supervision meetings planned once every three months. Although the National Minimum Standard of six supervision sessions per annum is not met, current arrangements appeared adequate based on available information. Staff stated there was an open door policy providing access to line manager’s to discuss and resolve issues in between planned individual supervision meetings. Staff were observed to be following appropriate health and safety practices and had received mandatory training to ensure their safety and the safety and welfare of residents. The maintenance person was responsible for health and safety maintenance of equipment and systems and ensuring service records maintained and regular safety audits carried out. The maintenance person had reorganised these records and demonstrated due diligence in discharging his responsibilities for the safety of the premises and equipment. A health and safety audit had been carried out by the health and safety manager employed by BUPA prior to the inspection visit. This had highlighted a potential hazard of entrapment in the combination used of beds, bedrails and mattresses for individual residents. Though remedial action had been taken to Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 34 minimise this risk following discussions between the inspector and the maintenance person it was recommended that the manager ensure further review of the adequacy of the action taken and this was agreed. The manager also agreed to carry out formal risk assessments for ambulant people currently accommodated in the dementia unit to ensure they are not at risk if they access and operate the passenger lift unsupervised. Also as a matter of priority to arrange for an appropriate safety device to be fitted to the lift so that it cannot be opened or activated by vulnerable residents accommodated in the dementia unit. Reports of monthly provider visits were examined and seen to comply with statutory requirements in terms of being unannounced, areas inspected and consultation with residents, staff and visitors. Information provided by the manager confirmed resident/relatives meetings were periodically held and customer surveys carried out by BUPA and internally by the home. Changes in response to feedback from residents included changes to menu, introduction of quiz nights and increased frequency of mini bus trips. At the time of the last inspection management had just surveyed Care Manager’s and General Practitioners and the manager gave an example of a change implemented in response to their feedback. Various audit systems were in place; those examined included pressure sore treatment, social activities evaluations, fire safety maintenance and practices, gas and electrical and portable electrical appliance testing and monitoring of hot water temperatures. The manager’s attention was drawn to the requirement to notify the CSCI of specified incidents relating to pressure sores and diagnosis of MRSA infection. The manager was unaware of the needs to do so and confirmed this would take place in future. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 35 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 4 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations For the service users guide to be updated to reflect alternative arrangements since the mobile shop has ceased. Also to state clearly that a non-smoking policy is in operation at the home. For care staff to be competent in fitting continence aids and all nurses and care staff to receive diversity training. For risk assessments to be carried out for vulnerable residents accommodated in the dementia unit who may access and activate the passenger lift without staff DS0000017599.V339236.R01.S.doc Version 5.2 Page 37 2. 3. OP7 OP7 Collingwood Grange Nursing Home 4. OP7 5. OP8 6. OP13 7. 8. 9. OP16 OP16 OP18 10. 11. 12. 13. OP19 OP27 OP30 OP31 14. OP31 supervision. Where potential risks are identified for risk management strategies to be implemented. For all residents and where appropriate their relatives/representatives to be afforded opportunities for review meetings to ensure an ongoing inclusive approach to care planning. Recommendation is also made for review records where these exist to be maintained on residents care files and not in separate files. For nurses to be fully familiar with BUPA’s procedures to enable selection of appropriate pressure relieving equipment. Additionally for nurses to ensure care plans for pressure sore prevention are generated when signified by pressure sore prevention risk assessment scores. Pressure sore prevention strategies including equipment should be included in these care plans. It is recommended that the monthly pressure sore treatment audit be broadened to encompass monitoring these matters. For the company logo on the side of the vehicle used to transport residents on excursions in the community to be removed. This is potentially stigmatising and embarrassing for residents. For ‘lower level’ complaints not dealt with under the home’s complaint procedure to be recorded with details of action taken and of outcome. For review of the effectiveness of current systems for making the complaint procedure accessible to all residents. It is recommended that the manager enrol on the next available training course on the Surrey Multi-agency Procedure for the Protection of Vulnerable Adults. (Brought forward from report of 26/01/06, 31/05/06 & 18/12/06) For record keeping to demonstrate a planned approach to maintaining standards of decoration. For further review of the adequacy of staffing levels including review of practice, routines and staff deployment. For records to demonstrate management monitoring of nurses updating their clinical practice. For the deputy manager to ensure he is sufficiently informed and aware of the location of relevant information to enable him to fully discharge his responsibilities when in charge of the home in the manager’s absence. The manager should ensure that the deputy manager receives any further training and support needed to develop the deputy manager’s confidence. For notification to the CSCI of pressure sores grade 2 and DS0000017599.V339236.R01.S.doc Version 5.2 Page 38 Collingwood Grange Nursing Home 15. 16. 17. OP31 OP36 OP38 18. OP38 above present on admission or acquired in the home. Also the presence of MRSA infection. For review of the roles of the deputy manager and the manager’s personal assistant to ensure no ambiguity of their roles. For review of arrangements for nurses to receive individual supervision whilst on duty to ensure their responsibilities are covered in their absence during these meetings. For a safety device to be fitted to controls of the passenger lift from the second floor access to minimise risk of vulnerable residents being trapped in the lift or leaving the unit unobserved. For further review of combinations of bedrails, together with types of beds, mattresses and uniqueness of bed occupants to further minimise hazards of entrapment. Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Collingwood Grange Nursing Home DS0000017599.V339236.R01.S.doc Version 5.2 Page 40 - 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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