Inspection on 12/03/08 for Deerwood Grange Nursing Home

This inspection was carried out on 12th March 2008.

CSCI found this care home to be providing an Adequate service.

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

Deerwood Grange Nursing Home 07/07/10

Deerwood Grange Nursing Home 10/05/10

Deerwood Grange Nursing Home 11/03/10

Deerwood Grange Nursing Home 03/03/10

Deerwood Grange Nursing Home 24/11/09

Deerwood Grange Nursing Home 08/12/08

Deerwood Grange Nursing Home 18/04/07

Deerwood Grange Nursing Home 21/04/06

Deerwood Grange Nursing Home 24/11/05

Deerwood Grange Nursing Home 01/06/05

Deerwood Grange Nursing Home 15/12/04

Deerwood Grange Nursing Home 12/07/04

Deerwood Grange Nursing Home 29/03/04

Deerwood Grange Nursing Home 06/01/04

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

The Lodge Nursing Home

Bracken House

Sunnycroft

Churchill House Nursing and Residential Home

Field Farm House

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

CARE HOMES FOR OLDER PEOPLE Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD Lead Inspector Sarah Bennett Key Unannounced Inspection 12th March 2008 08:15 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 Deerwood Grange Nursing Home DS0000024837.V360796.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. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Deerwood Grange Nursing Home Address 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD 0121 355 0060 F/P 0121 355 0060 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) BAMH (MIND) Ms Carol Mann Care Home 26 Category(ies) of Dementia (26), Mental disorder, excluding registration, with number learning disability or dementia (26) of places Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That during the waking day there must be a minimum of 2 trained staff one of whom at times could be the manager plus 4 care staff. At night there must be a minimum of three waking staff one of whom is trained. 18th April 2007 Date of last inspection Brief Description of the Service: Deerwood Grange is a large detached adapted nursing home in the Four Oaks conservation area of Birmingham. The home is approached from a driveway, and is set back from the main road. To the rear of the building are large gardens, which are utilised by the people living there in good weather. The home has 18 single bedrooms and four double rooms (shared rooms). The building work to extend the home has now been completed. This has provided most of the people living there with single bedrooms and only a small increase in the number of people living there. There are two large lounge areas, and a large dining room. The extension has provided a new laundry, a new disabled toilet and new down stairs shower room and the upstairs bathroom has been converted into a new shower room. There is a new staircase to access the first floor of the extension, access to the first floor using the passenger lift is via the original building. The home provides nursing care to people over the age of sixty-five with a diagnosis of dementia and/or mental health issues. The home is staffed 24 hours a day and there is always a qualified nurse on duty. The service users guide did not provide information about the fees charged to live at this home. A copy of the last inspection report is available for visitors. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit was carried out over one day by two inspectors; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the manager completed a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Five people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, their relatives, the acting manager and the staff on duty were spoken to. Due to the needs of the people living many were unable to verbally communicate their views about the home. Time was spent observing care practices, interactions and support from staff using the Short Observational Framework for Inspection (SOFI) tool. A tour of the premises took place. Care, staff and health and safety records were looked at. Relatives and health care professionals completed the ‘Have your say’ survey and their views are included in this report. What the service does well: Several relatives made positive comments about the home. Some of these were: “ Staff show dignity, fairness, compassion, understanding and very caring thoughts to the residents, which is a real credit to the manager and all the staff.” “I have no need to complain there is no better home than Deerwood Grange.” “ It’s like home from home, staff try to do the best they can.” Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 6 “The reality, consistency and quality of care is truly excellent. I could not achieve what Deerwood Grange has achieved for my mother. Very impressed with their skills as carers.” Health professionals are involved in the care of individuals and people have regular health check ups. This helps to ensure their health needs are met. Staff respect the privacy and dignity of each person living there so ensuring their well being. Staff have had moving and handling training so they know how to help people move and walk more safely. The presentation, quality and taste of the food is good making the meal times more appetising and enjoyable for the people living there. The home is generally well maintained, decorated and clean so it is a safe and comfortable place to live. What has improved since the last inspection? What they could do better: Care plans must be improved further so that they describe how the care needs of the people living there are to be met. This will ensure that staff know how to support each person to meet their needs. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 7 Evidence that satisfactory pre employment checks are completed on all staff before they start working at the home must be available so that the people living there are protected from harm. Appropriate action must be taken to ensure that the risks of there being a fire are minimised as much as possible. The statement of purpose and service users guide should include the relevant and required information. This will ensure that prospective service users have all the information they need to make a choice about whether or not they want to live there. Preadmission assessments should include sufficient detail so that the home can be sure that the person’s needs can be met there. All staff should have the training and support they need so they know how to support the people living there to meet their needs and ensure their well being. The health needs of the people living there should be monitored to ensure they are being met. Records of food eaten by each person should be kept to ensure they have a varied, nutritious diet and the foods they like to ensure their health and well being. The complaints log should record the outcome of complaints made to show that people’s views are being listened to and action is taken to resolve any complaints. All staff should be aware of the different types of abuse and how to report it. Action should be taken to make sure that all the people living there are protected from harm. Further redecoration and replacing of furniture and equipment should be done to make sure the home is safe and comfortable for the people living there. Files and records should be organised to ensure that records are available to show that the health, safety and welfare of the people living there is promoted and protected. 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. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective service users do not have the information they need so they can make an informed choice about where to live. Assessments of people before they move in are not sufficient so they can be assured these will be met at the home. EVIDENCE: The statement of purpose was a mission statement and did not include the required information so that prospective service users would have all the information they need about the home. It had not been updated since 2005. The acting manager said that the manager who was absent due to sickness had started to update it and that she would contact the manager to find out. Following the visit an updated statement of purpose was forwarded to us. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 10 Although it did not include all the information required in the National Minimum Standards it was tailored to the service. It described how people would be valued and their needs would be met within the service regardless of their illness or ability. The service users guide needs to include the relevant information about the home as detailed in the National Minimum Standards and include the fees charged to live there. This will ensure that prospective service users have the information they need so they can make a choice as to whether or not they want to live there. The assessment process had not been updated since the last inspection. Records sampled showed that the assessment process was not detailed. It was difficult to know how to meet the person’s needs from the information on their assessment. Part of the initial assessment asked whether the person was orientated in time, place and person. The assessment stated, “ Yes, No” so it was not clear which of these were relevant. There were no details of what support the person needed with washing and bathing. Where it was stated in some areas that the person needed support there were no details of how staff were to do this. Staff and relatives said that relatives and carers are involved in providing information about the person for their assessment before they move into the home. The service does not provide intermediate care. Therefore, standard 6, which relates to this, was not assessed. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that the health and personal care of individual’s is always met, which could impact on their well being. EVIDENCE: The records of five of the people living there were looked at. There were some improvements to care plans and risk assessments since the last inspection in that where a need was identified a plan was in place so that staff know how to support the person. Care plans stated what type of dementia the person had and how this affects their day-to-day life. They stated what support the person would need to remain independent in some areas such as eating. Staff said that they were encouraged to read people’s care plans and were given time to do this so they know how to support individual’s. They said that they were Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 12 asked to contribute to care plans as they spent more time than the managers working with individuals. Care plans assessed the mental capacity of the person in all areas of their needs. Where the person was assessed as lacking capacity measures were taken to ensure they were safe. This included locking the front door, as several people were at risk of wandering and due to their dementia now lacked the mental capacity to be able to keep safe when outside on their own. So in people’s best interests the front door is locked. Care planning has improved but further improvement is required so that people’s needs are met consistently. One person’s care plan to manage their diabetes stated that the nurses are to liaise with their GP if their blood sugar levels are abnormal. It did not state what the normal range is for that person, which could mean that nurses are not able to seek advice when needed. It also stated that the nurses are to observe the person for hyper/hypo glycaemia. There were no details as to what this is and what to look for. This could have a serious impact on the person’s health if staff are not aware of this. Some records of blood sugar levels had not been kept so staff could miss that the person needs more support with their diabetes to be well. Care plans for nutrition promoted the dignity of the person and stated that staff should sit down whilst assisting the person to eat and not rush. It stated that the person needed a ‘soft’ diet. There was no detail as to how or what texture the person’s food needed to be prepared to so they were not at risk of choking. A care plan for mobility stated that staff should use the correct hoist to move the person. However, it did not state what this was or what size sling to use so the person was safe and comfortable when being moved in the hoist. Some of the evaluation of care plans was not detailed and did not correspond with the information in the daily records. One evaluation about a person who has a visual impairment lacked knowledge of how their impairment may affect their sensory perception. It stated, “continues to crawl around the unit for no apparent reason, care plan ongoing.” This does not show that the staff have insight into how the person may interact with their environment to overcome their impairment. The acting manager said that they were waiting for advice from the Royal National Institute for the Blind (RNIB) to help them to meet this person’s needs. The people living there were dressed appropriately to their age, the weather and their gender. It was evident that attention had been paid to people’s personal care. However, one person was not wearing slippers because they said their feet were warm. The skin on their feet and lower legs was very dry Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 13 particularly between their toes. Staff need to make sure that people’s skin is moisturised to stop it breaking down and so the person is comfortable. Care plans included information on the personal care needs of the individual but they did not state how these are to be met for that person. The acting manager said that one of the qualified nurses is responsible for ensuring that staff know about tissue viability and how to prevent people from developing pressure sores. They receive regular updated training so they can lead in this area. Records sampled showed that people had regular check ups with health professionals to ensure their health needs were being met. A health professional said, “ I have visited on three occasions and felt the staff asked for help appropriately in meeting health needs. Staff adjust the care according to the needs and ask for help appropriately.” Since the last inspection staff have ensured that the people living there are regularly weighed. It was not clear how this was monitored to ensure that people do not lose or gain a significant amount of weight, which could be an indication of an underlying health need. The bowel movements of one person were recorded in their nursing notes, as they were unable to say when they had a bowel movement. The last record of this was on 24th February, prior to that it was 19th February and prior to that the 10th February. This indicates that the person is constipated to an extent that could seriously affect their health but there was no record of what action was taken to ensure their well being. It appears that staff had not recorded these well and this needs to improve. Some of the comments that relatives made about health and personal care were: “From management downwards all nurses and carers are excellent” “Staff offer excellent care and respect clients individuality.” “ I have visited my mother at varying times of day and evening, and on all days of the week. Every time without exception my mother has been receiving care of the highest order. My mother’s needs are wholly met and even exceeded by a care regime that is truly superb.” “My mother’s care has been exceptional. With an untrained eye, it seems that all of my mother’s needs are predicted accurately by staff that are well trained and quietly competent. I am confident in the home’s capacity to meet and fulfil my mother’s needs.” “ Staff value the person, irrespective of their mental capability.” “The carers seem to achieve the impossible. People are given respect and a quality of life. I think it is a very special place indeed.” “Staff look after my wife very well, dress her well and give her a lot of love.” “ My wife is well looked after by the nursing staff.” “The staff are very helpful and keep me well informed.” Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 14 SOFI observations showed that although staff only engaged with the three people being observed for 17 of the two hours when staff did interact this was good and positive. When staff interacted with individuals this improved their well being and they were more comfortable in their surroundings. Staff assisted one person to sit more comfortably in their chair using a ‘handling belt’. This reduced the risk of injury to the person and the staff who were moving them. Staff did not interact with one person who was in the lounge but not included in the SOFI observation for one and a half hours. The acting manager said this was probably because the person was asleep so staff would not disturb them. However, one visitor interacted with them and gave them a banana, which they woke up for and enjoyed eating. Sometimes people sleep because of the lack of interaction and stimulation so it should not be assumed that they do not want to be interacted with. Staff did spend some time talking to two people about the year and month they were born in and their memories, which they seemed to enjoy. Medication is stored in the clinic room and supplied by a local pharmacy. The acting manager said that a pharmacist from the Primary Care Trust (PCT) do an audit of the medication every two months. Health professionals said, “ It is a specialist home that uses therapeutic interventions to manage difficult behaviour problems rather than opting for medication. Due to the complexity of the client’s illness and severity it is probably unrealistic to expect them to manage their own medication. The staff are very keen to reduce medication to a minimum for therapeutic efficacy.” Records sampled showed and staff said that people were not prescribed a lot of medication to keep them sedated. Staff had signed Medication Administration Records (MAR) appropriately when they had given the medication to the person. Some audits of medication not kept in the blister packs that had been packed by the pharmacist did not crossreference with the amount stated on the MAR. This could indicate that medication had not been given as prescribed. However, when going through these with the acting manager it appeared that errors had been made on entering the amount received on the MAR. The acting manager said and the AQAA stated that updated training on medication is being arranged for staff as she has picked up errors on audits. Some medication has to be stored in a fridge to ensure it is effective. A medication fridge is provided in the clinic room for this. Staff test the temperature of the fridge to make sure that medication is being stored appropriately. Records of these showed that the temperatures were within the required limits. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 15 At the front of each person’s blister pack there was a photo of the person so that unfamiliar staff would know who to give the medication to. Sadly one person living there died suddenly the week before. The acting manager was observed on the phone to the undertakers ensuring that arrangements were in place for the person’s funeral. They were then talking to staff and a friend of the person to get information about them so that their funeral could include personal things about them and be conducted in the way that they would want. Staff were talking about wanting to go to the funeral and making arrangements so that the staffing levels at the home could be safely maintained. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not always sufficient to ensure that the people living in the home experience a meaningful lifestyle that reflects their age, gender, culture and interest. People are well supported to keep in contact with their family and friends so they can maintain relationships that are important to them. EVIDENCE: Care plans sampled did not all include sufficient information to know what individual’s preferences were relating to their cultural and religious background. One person’s care plan stated what their religion was but did not state whether they practised this and if so how. Care plans included detailed information about the person’s life history so that staff can understand what was important to the individual before their illness developed. The AQAA stated that people often go out and a wide range of activities is provided. All birthdays are celebrated as well as culturally appropriate events. Entertainers visit the home and people do art once a week. They have started Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 17 music sessions and accessed a local theatre. It stated that care plans need to improve to include the person’s interests. An activity worker is employed in addition to the care staff to ensure that people have an opportunity to take part in activities. Records showed that since the last inspection the number of activities offered had increased. Records sampled showed that people went to the local park and cafe, spent time in the garden, did painting, went for walks and played games. One person’s records stated that they got pleasure from aromatherapy so staff were to ensure they were offered this activity regularly. Their records showed that this was monthly until October 2007 but there was no record that they had aromatherapy since then. Some people enjoy music and staff play the guitar to them and some people enjoy singing along. It was evident from talking to relatives and staff, observations made and sampling records that the people living there are very much supported to keep in contact with their family and friends. Several relatives visited during the day and were made very welcome by the staff. A relative said, “I think it is probably the nearest you can get to your own home. Staff endeavour to make the home happy. There is always laughter and music.” Staff said that due to the needs of the people living there their ability to make choices is limited. This varied depending on the illness of each person. Staff were observed asking people if they wanted a drink and what drink they would like. People were asked what they wanted to do and where they wanted to sit. A cook is employed to cook the lunch and evening meals. The cook said that they buy fresh fruit, vegetables and meat from local suppliers and milk and bread is delivered regularly. Other foods are ordered through a supplier and delivered to the home. Relatives said, “ The cooking and food is superb, we all agree on that” and “the food is excellent.” There were plenty of food stocks available. Food opened had been labelled so it was clear when it needed to be used by to minimise any risks of food poisoning. Staff do not keep records of what each person eats so it is not clear whether or not people are receiving a varied and nutritious diet. Care plans sampled included peoples preferences about food and drink. It was not possible to ensure that theses preferences were given, as records of food eaten were not kept. The cook prepares the menus and this is put on a board in the dining room for each day. There were a number of small tables in the dining room so people did not all have to sit together. Staff were sitting to support people with eating. The people living there eat first and then staff sit to eat their meal. At this time some of the people living there were still finishing their meal. One person was sitting at the table trying to eat their sponge pudding with their fingers, as they did not have a spoon. They were unable to eat this until the Operations Director got them a spoon. They were then successful in eating their pudding and seemed to enjoy it. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 18 The menu board stated sausages and mash or sandwich for lunch. Most people seemed to have sausages and mash. The acting manager said that because of their needs the people living there are not able to make a choice between two things offered about what they eat. Staff offer the main meal and if the person pushes it away or shows they do not want it they are offered something else. The tea for the day was soup so we were concerned that some people may not get a full meal in one day if they did have sandwiches for lunch. The acting manager said that often the evening meal is a hot meal. The acting manager said that three members of staff are doing a nutrition course at a local college. This will help them to ensure that the people living there are offered a nutritious diet. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that any complaints of the people living there or their relatives are listened to, taken seriously and acted upon. Arrangements are not always sufficient to ensure that the people living there are protected from abuse. EVIDENCE: The AQAA stated there is a comprehensive accessible complaints procedure and that complaints are dealt with swiftly. One relative said, “It is unlikely that I should need to make a complaint, but I would always speak to the manager of the home first.” Another said, “I find the management very caring and approachable and small problems are soon sorted out.” The complaints log recorded a recent allegation made by relatives that the care given to their relative was insufficient. The complaints log did not record any outcome of this allegation. However, the person’s records showed that appropriate action was taken to safeguard the person including involving their social worker. A meeting was held the day before to discuss these issues. The acting manager said and the person’s records showed that the issues were being resolved. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 20 We have not received any complaints about this service since the last inspection. Records of compliments made about the service had also been recorded to show that the home welcomes the views of the people living there and their representatives. Staff spoken with said that they had received training in adult protection and the prevention of abuse. They showed awareness of the different types of abuse and how to report any abuse they suspect. The AQAA stated that all staff had received this training. Training records sampled showed that three staff had not had any abuse training and some staff had not had any updated training since 2004. All staff should have this or records need to be updated to show that all staff know how to protect individuals from abuse. Staff said and records sampled showed that some people are at risk of being hurt by some of the other people living there. Accident records did not include any injuries sustained from other people living there yet. These should be recorded so it is clear that action is being taken to minimise these risks and protect the people living there from harm. One person had a care plan for aggression, which stated what support staff should give to minimise this. The care plan did not include how the other people living there are to be protected when the person becomes aggressive. One person’s records sampled stated, “Sometimes has bruising to face, chest and body – nurses to document any bruising.” It was not clear that the reasons for this had been investigated sufficiently to ensure that the person is not at risk of being harmed by others. The acting manager said that the person often harms themselves but it was not clear what support was being given to minimise the risk of them doing this. One person’s records sampled included a care plan for how staff are to support the person when they are agitated. It was not clear how the frequency of the person being agitated was monitored to ensure that the care plan is effective in supporting the person. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvements are needed to ensure that people live in a safe, comfortable and clean environment that meets their needs. EVIDENCE: There is a large lounge and a separate quiet lounge from where the garden can be accessed in warm weather. There is a ramp leading down to the garden so that people with mobility problems can access all parts of the garden. Staff said that most people tend to sit on the terrace overlooking the garden and chairs and tables are provided for this. Records sampled showed that staff often supported people to go out in the garden. Relatives said this was good so that people could spend time outside and get some fresh air. One part is a Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 22 sensory garden where herbs are grown and tables, chairs and parasols are provided so that people can spend time in this area. Communal areas were decorated and maintained to a good standard. The decoration and furnishings reflected the age group of the people living there. The AQAA stated there is a redecoration programme but that sometimes financial constraints can affect this. It stated in the next 12 months they plan to purchase new dining tables and replace curtains throughout. They plan to involve the people living there and their relatives in deciding what would be the best environment. Water temperature records sampled showed that one of the bathrooms and one of the shower rooms were out of order and were waiting to be repaired. The acting manager said that a lot of people prefer a bath so does not impact on the people living there that much. The bath was now working but the acting manager said it works intermittently. Records showed that the shower in shower room 1 tested as 30 degrees centigrade. The recommended temperature so that the water is not too hot or cold is 43 degrees centigrade so this shower is cool and should be adjusted. In one shower room the light fitting cover had come off and was on the floor. The acting manager said that people only come in this room with staff so they would not be at risk of falling over it. However, it needs to be replaced so that the lighting is not too bright and the room is safe to use. The bedrooms of the five people who were ‘case tracked ‘ were looked at. All but one of these were well decorated. One bedroom needed redecorating, as there were scratches and stains on one of the walls. The side of one person’s bed was broken and in need of repair to make sure it was safe. Bedrooms were personalised and contained pictures and photos that were important to the person. The doors were painted the same colour and there was nothing to identify any of the rooms. The acting manager said that all the people living there need to be escorted to their bedrooms and doors are always locked on the outside to stop people wandering in each other’s bedrooms. All doors can be opened from inside the rooms. The acting manager said that one person who used to live there was able to recognise their room so a sign was put on it to help them with this. On arrival at the home there was a slight odour of urine noticed. However, this or any other offensive odours were not noted in any part of the home later in the day. The home was generally clean including the toilet and bathroom areas so the risk of cross infection could be minimised as much as possible. Domestic staff are employed although staff said that this is not always enough staff to keep the home clean. The AQAA stated all staff have had internal infection control training but need external training. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development are generally sufficient to ensure that they can support the people living there to meet their needs. The home’s recruitment policies and practices are not sufficient to ensure the people living there are protected from harm. EVIDENCE: The acting manager said that recruitment had recently taken place to fill the staff vacancies and the appropriate checks are being completed before these staff can start work. This will ensure that the people living there benefit from being supported by staff who know them and are ‘suitable’ to work with vulnerable adults. There were five care staff, one of whom was a qualified nurse on duty, the acting manager, a cook, a domestic and an activity worker. Staff said there are always five staff on the morning and afternoon shifts and three staff at night. The activity worker is always additional to the care staff. The AQAA stated the use of agency staff has reduced. All the staff working at the home on the day of the visit were permanent staff and knew the people living there well. Observations showed that this appeared to be an appropriate number of staff to support the people living there. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 24 The AQAA stated that 75 of staff have National Vocational Qualification (NVQ) level 2 or above in Care. This exceeds the standard that at least 50 of staff have achieved this to ensure they have the skills and knowledge to meet the needs of the people living there. It stated that care staff with NVQ 2 are now working towards level 3 so to improve their skills and knowledge. The records of four of the staff that work there were sampled. One of these records could not be found so there was no information as to how this person was recruited and whether they were ‘suitable’ to be working with the people who live there. Records sampled for the other three staff included a satisfactory Criminal Records Bureau (CRB) check being received before the person started working there. Some staff had not had an updated check after three years. This is recommended to ensure that they are still ‘suitable’ to work with the people living there. There were no records that a Protection of Vulnerable Adults (POVA) First check had been completed on any of the staff. This is to check that staff are not included on the POVA register, which would exclude them from working with vulnerable adults. Training records sampled showed that staff had received training in moving and handling, dementia and personhood, abuse, food hygiene, risk assessment, infection control, health and safety, fire safety and equality and diversity. Records showed that staff that have not received this training or need updated training are booked to do this. Most staff had not received training in diabetes or visual impairment. This is needed so that all staff can meet the needs of the people living there. The PIN numbers of the qualified nurses were looked at. Two of these had expired in 2007 but an updated number had not been seen by the manager to show that the nurse remained registered with the Nursing and Midwifery Council (NMC) so could continue to work as a nurse. These must be available to ensure that the people living there are protected from harm and have nurses overseeing their care who are ‘fit’ to practice. Staff said that they liked working at the home and it was a good staff team. Staff said that they look forward to coming to work. They said that the care is good and the people living at the home are happy. One member of staff said, “It’s a really nice place to work and live, I really care for the residents and think they are really well looked after.” Staff said they were always learning, not just on training courses but also from the managers and nurses at the home. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that the home is well run and the health, safety and welfare of the people living there is always promoted and protected. EVIDENCE: The registered manager was off sick at the time of the inspection and the deputy manager was acting manager. The Operations Director visited for part of the inspection and said that they were supporting the acting manager more in the registered manager’s absence. Relatives said, “ The manager is great.” Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 26 Staff said, “ It is a well run home.” The Operations Director said that the organisation now has a Clinical Governance department who are starting to monitor what improvements are being made. The Operations Director said they had a meeting with two of the trustees to go through the last report. They found that auditing had improved, they have worked with staff on the content of care plans and were aware that they need to demonstrate more the quality of the service that is provided at the home. Records of audits sampled showed that these were mainly focussed on inputs and not on the quality of the outcome for the people living there. For example it assessed whether there was a risk assessment and care plan in place for people but not on whether this was effective in meeting their needs. The report of the last visit by a representative of the provider was looked at. This also concentrated on what records and systems were in place not on how this was affecting the quality of life of the people living there. They looked at how the home was meeting the National Minimum Standards and stated “ no problems of meeting them, all up to date.” There was no mention that our quality rating from the last inspection was poor and how the home had improved in meeting any of the standards. The acting manager said that they do not provide a safekeeping service for people’s money or their valuables but that individual’s relatives manage these. Relatives confirmed that they do this. Staff spoken with said that the managers are approachable and supportive. They said that they have regular formal supervision with their manager. Staff records sampled indicated that some staff have not had regular, formal supervision. This should be available for all staff so they know how they are performing in their job role, can have 1:1 support from their manager and their learning and development needs can be identified. The general management of files was poor; files were falling apart, health and safety records were difficult to find and records lacked sequence. It was not always clear that health and safety tests had been carried out, which could have an impact on the safety of the people living there. Fire records showed that the fire equipment had been serviced the day before. The emergency lighting was in need of repair and the acting manager was arranging for the engineer to return to rectify this. Staff had not tested the emergency lighting since January 2008. This should be tested every month to make sure it is working and if not that faults can be identified sooner. Staff had regularly tested the fire alarm to make sure it is working. The fire risk assessment was last reviewed in April 2006. This should be regularly reviewed to make sure it is still appropriate in ensuring that the risks of there being a fire are reduced as much as possible. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 27 A Corgi registered engineer completed the annual test of the gas equipment in September 2007 and stated that it was safe to use. Records showed that the annual test of the portable electrical appliances was completed in January 2008 to ensure that these were safe to use. Records showed that an engineer regularly serviced the lift to make sure that it meets current safety standards. Following the visit the hoists and adapted bathing equipment were serviced and we were forwarded records to show this was completed satisfactorily. Staff had tested the water temperatures regularly to make sure they are not too hot, which could put people at risk of being scalded. Records showed that some of these were cool but there was not a record of any action taken to rectify these. They should be adjusted so that people do not have a cool bath or shower. The acting manager said after the visit that an engineer was visiting to service the valves, which would help to ensure that the water was at the correct temperature. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 28 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 1 X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X 2 2 2 STAFFING Standard No Score 27 3 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 1 2 Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes, one only partially met 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 OP7 Regulation 12(1) (a) Requirement Care plans must describe how the care needs of the people living there are to be met. This will ensure that staff know how to support each person to meet their needs. Not met since last inspection. Individual’s health records must be regularly monitored to ensure that they are well and their health needs are being met. Staff must have updated medication training to ensure they administer medication appropriately. This will ensure that people get their prescribed medication at the right time so their health needs are met. Evidence that satisfactory checks are completed on all staff before they start working at the home must be available. Evidence must be available to show that qualified nurses continue to be registered with the NMC. Timescale for action 30/06/08 2. OP8 12 (1) (a) 30/04/08 3. OP9 13 (2) 31/07/08 4. OP29 13 (6) 30/04/08 Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 30 5. OP38 13 (4) This will ensure that ‘suitable’ people are employed to work with the people living there so helping to protect them from harm. Appropriate action must be taken to ensure that the risks of there being a fire are minimised as much as possible. 30/04/08 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 The service users guide should include the relevant and required information. This will ensure that prospective service users have all the information they need to make a choice about whether or not they want to live there. Assessments should include sufficient detail so that the home can be sure that the person’s needs can be met there. Staff should ensure that people’s skin is looked after to ensure that individual’s are comfortable and not at risk of developing pressure sores. All staff should have an awareness of how having a visual impairment affects a person so they know how to support them and ensure their well being. Information about the religious and cultural activities that people take part in should be available so that staff can ensure that they offer the activities to individual’s that they prefer. Where people’s records state that a person enjoys an activity this should be offered regularly to ensure their well being. Opportunities should be given to all the people living there to make choices about their day-to-day lives as much as they are able to so they can maintain some control over their lives. Records of food eaten by each person should be kept to ensure they receive a varied and nutritious diet to ensure their health and well being. This will also show that people are being offered the food and drinks that they like. DS0000024837.V360796.R01.S.doc Version 5.2 Page 31 2. 3. 4. 5. OP3 OP8 OP8 OP12 6. 7. OP12 OP14 8. OP15 Deerwood Grange Nursing Home 9. 10. 11. OP15 OP16 OP18 12. OP18 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. OP18 OP18 OP19 OP21 OP24 OP25 OP26 OP29 OP30 OP33 OP36 24. OP37 People should be offered appropriate support and utensils to be able to enjoy their meals and eat the food they need to ensure their well being. The complaints log should record the outcome of complaints made to show that people’s views are being listened to and action is taken to resolve any complaints. Accident records should also include any injuries sustained by another person living there. This should state what action is being taken to protect people and minimise the risks to their well being. Records should clearly show how care plans for aggression are being monitored to ensure that the risk of other people living there being harmed are minimised as much as possible. All staff should have training in abuse and how to report it. Training records should record when staff have received this to ensure staff know how to protect people from abuse. Records should clearly state what investigation has been done when a person has sustained bruising to ensure they are not at risk of being harmed by others. The environment should be improved so that this suits people with a dementia such as places of interest, good signage and the effects of colours in décor. There should be sufficient washing and bathing facilities working at all times so that the people living there have a choice of having a bath or a shower. Redecoration should take place and furniture repaired where necessary in people’s bedrooms. This will ensure that all bedrooms are safe and comfortable. Light fittings should be repaired and water kept at recommended temperatures to ensure that people live in safe and comfortable surroundings. Sufficient domestic staff should be available to ensure that the home is clean and hygienic for the people living there. A further CRB check should be carried out on all staff after they have worked there for three years to ensure they remain ‘suitable’ to work with the people living there. All staff should have training in diabetes so they know how to meet the needs of the people living there. Audits of the service should assess how systems ensure that the needs of the people living there are met. All staff should have regular, formal supervision with their manager. This will ensure they know how they are performing in their job role, are well supported and their learning and development needs are identified so they can meet the needs of the people living there. Files and records should be organised to ensure that records DS0000024837.V360796.R01.S.doc Version 5.2 Page 32 Deerwood Grange Nursing Home 25. 26. OP38 OP38 are available to show that the health, safety and welfare of the people living there is promoted and protected. The fire equipment should be tested regularly to make sure it is working. If it is not faults can be identified sooner so ensuring the safety of the people living there. Water temperatures should be at the recommended temperature of 43 degrees centigrade to ensure that it is not too hot or cool for people to have a bath or a shower. Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Deerwood Grange Nursing Home DS0000024837.V360796.R01.S.doc Version 5.2 Page 34 - 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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