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Inspection on 18/04/07 for Deerwood Grange Nursing Home

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

This inspection was carried out on 18th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

The manager and relatives described how the residents were admitted to the home. This included visits by relatives, discussion between the relatives and the management team, assessments of the residents needs by the homes management team and social workers and relatives being given details about the home known as its statement of purpose and service users guide. These good practices ensure that the home is appropriate to meet the needs and aspirations of the residents. The relatives views and opinions of the staff and management are very positive and they believe they work very hard and are dedicated to doing their best for the residents. Staff records show they are safely recruited including background checks, available in good numbers and in the main are well trained. This may mean that the needs of residents are effectively met and their vulnerability protected.

What has improved since the last inspection?

There have been some health improvements for residents, as a visiting optician has seen many residents and the manager has now made arrangements for a dentist to visit the home. There has been an improvement in how residents` privacy and dignity is considered when they are receiving personal care and more staff have undertaken manual handling training to help residents move and walk more safely. The standard in food presentation, quality and taste has improved making the meal times more appetising and enjoyable for the residents. There have been a lot of repairs and some redecoration in the home including new carpets, furniture and some repainting. This makes the home safer and more comfortable for the residents. There has been an improvement in hygiene and odour control, including staff being able to safely wash their hands in sluice areas, the kitchen being kept cleaner and odours being controlled. This will help improve the health and welfare of residents. The managers have started to do quality audits, where they ask for the views and opinions of residents, relatives and other persons involved with supporting residents at the home. This is regarding how well or otherwise they do in meeting the needs of residents. The manager has written a report about it and it is available for people to read.

What the care home could do better:

There are several requirements that have not been addressed and were issued at the last inspection, those most significant to improving the service received by the residents have been carried forward as requirements of this inspection, some of these include; Improving the plans to meet each residents needs, including timely reviews and updates of the plans when needs change. There were serious concerns at this inspection about care plans and the manager was advised in writing of immediate requirements to make improvements, the organisation have responded to this advising of what they are going to do to improve. There remain some significant poor standards, which are unsafe when staff are moving residents, yet staff have had moving and handling training. It has been a requirement that staff undertake infection control training, with regard to the recent poor report from the Environmental Health officer it is imperative that staff do this training to maintain good standards and not to putresidents at risk. The manager did advise that all improvements required by the environmental health officer had been a done. The manager has introduced a quality audit process yet there remains no regular reports from the responsible individual for the MIND organisation of the findings when this person visits on an unannounced basis. At this inspection there were additional requirements and some of these include; Improving the care plans so that they do include more information about the choices and preferences of residents so that they have their very individual needs met by the staff. The staff need to regularly measure the weights of residents so any changes can be quickly reported to the doctor. The records staff keep about residents medication must be improved so that they ensure residents receive correct levels of their medicine. The toilets must have proper locks on the doors to ensure the residents can use them in privacy but also so staff can access if there is an emergency.

CARE HOMES FOR OLDER PEOPLE Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD Lead Inspector Sean Devine Unannounced Inspection 18th April 2007 08:00 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.V336556.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.V336556.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.V336556.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. 21st April 2006 Date of last inspection Brief Description of the Service: Deerwood Grange is a large 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 residents 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 residents with mainly single bedrooms and only a small increase in numbers accommodated. 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 residents over the age of sixty-five with a diagnosis of dementia and/or mental health issues. The residents do have contracts and the manager since the inspection visit has advised that the fees for this care service are £545.00 each week. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was visited unannounced by a regulation inspector over a one day period. The inspector was able to meet with many residents and their relatives whose comments about the home have been included within the report. The inspector was able to observe care being given to the residents by the staff, talk to staff about the care they give and also discuss the standards of care with the homes manager. Three residents with varying care and nursing needs were the focus of a large part of the inspection. This included looking at their care and nursing records, meeting the residents and talking with some of their relatives. The inspector looked at most communal areas where the residents spend much of their time and also personal care areas such bathrooms and toilet areas. Records about health and safety and how the home is managed were looked at, this included for example staff files, quality assurance and reports from other visiting agencies such as Environmental Health. The home also has a record about the complaints they have received which is maintained by the manager, this record detailed three complaints during 2006 and no complaints during 2007. What the service does well: The manager and relatives described how the residents were admitted to the home. This included visits by relatives, discussion between the relatives and the management team, assessments of the residents needs by the homes management team and social workers and relatives being given details about the home known as its statement of purpose and service users guide. These good practices ensure that the home is appropriate to meet the needs and aspirations of the residents. The relatives views and opinions of the staff and management are very positive and they believe they work very hard and are dedicated to doing their best for the residents. Staff records show they are safely recruited including background checks, available in good numbers and in the main are well trained. This may mean that the needs of residents are effectively met and their vulnerability protected. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are several requirements that have not been addressed and were issued at the last inspection, those most significant to improving the service received by the residents have been carried forward as requirements of this inspection, some of these include; Improving the plans to meet each residents needs, including timely reviews and updates of the plans when needs change. There were serious concerns at this inspection about care plans and the manager was advised in writing of immediate requirements to make improvements, the organisation have responded to this advising of what they are going to do to improve. There remain some significant poor standards, which are unsafe when staff are moving residents, yet staff have had moving and handling training. It has been a requirement that staff undertake infection control training, with regard to the recent poor report from the Environmental Health officer it is imperative that staff do this training to maintain good standards and not to put Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 7 residents at risk. The manager did advise that all improvements required by the environmental health officer had been a done. The manager has introduced a quality audit process yet there remains no regular reports from the responsible individual for the MIND organisation of the findings when this person visits on an unannounced basis. At this inspection there were additional requirements and some of these include; Improving the care plans so that they do include more information about the choices and preferences of residents so that they have their very individual needs met by the staff. The staff need to regularly measure the weights of residents so any changes can be quickly reported to the doctor. The records staff keep about residents medication must be improved so that they ensure residents receive correct levels of their medicine. The toilets must have proper locks on the doors to ensure the residents can use them in privacy but also so staff can access if there is an emergency. 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.V336556.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.V336556.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): Standards 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has demonstrated that it does have the ability to ensure that residents and representatives are provided with enough information to decide on whether Deerwood Grange can meet their needs and aspirations. This ensures that residents are not placed in the wrong care environment and that their needs can be appropriately met. EVIDENCE: It was the view of the relatives that they were involved in making a decision on whether Deerwood Grange was a suitable home to meet the needs and aspirations of the residents. The process included the home and social workers completing assessments of needs, relatives visiting the home and relatives reading through and asking Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 10 the manager questions about the service users guide and the statement of purpose. Three residents care files had a contract about terms and conditions of residency at the home, which advised them of their rights, conditions and any restrictions on their residency. The three residents who were case tracked had some ongoing assessments of daily life and there was evidence that an assessment before admission had been completed by a nurse or social worker to identify the residents’ current needs and presenting risks. Deerwood Grange Nursing Home DS0000024837.V336556.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): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it does have the ability to effectively meet the needs and manage the risks of residents. There are some poor practices and omissions that will negatively effect the health and well being of the residents and may put them at increased risk. EVIDENCE: Residents files contained some written care plans and risk assessments completed following assessments of their needs. The assessments covered many areas of daily life and the risk assessments looked at areas such as nutrition, moving and handling, falls and skin condition. There were some care plans for personal care yet they did not always refer to the preferences of residents, although the guidance was clear and concise. One resident did not have any care plans for personal care including dressing and no care plans for oral care. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 12 There were concerns identified in the daily records written by staff that when residents health needs were changing that new care plans were not being written and similarly with risk assessments. The manager was advised of this at the inspection and issued with an immediate requirements letter. The Director of Operations for MIND has since written to the Commission detailing the immediate actions the home will take to meet the current health care needs of the residents. The risk assessment documentation is not good as it does not always clearly record a risk management plan and will often refer to a care plan. There were further poor practices as residents were not being weighed regularly or their body mass indexes recorded and staff were often putting residents to bed early or residents remained in bed without care plans of how all their needs were to be met. Some residents were receiving aromatherapy treatment yet there was no care plan about why it was needed and what the aim of its was. Residents daily records about healthcare were very limited and did not support the relatives view that the residents healthcare needs are well met by the home. The relatives advised that the staff always inform them about any changes to health and arrange medical care such as arranging a doctor to visit. They also commented that the staff have arranged chiropody and opticians. Staff were observed giving care to residents. It was often difficult for staff to communicate with residents however they did always advise what they were doing, such as hoisting, moving in the wheelchair and feeding residents meals; it was seen to been given with a good degree of dignity. All personal and physical care was given in private. Staff were observed on one occasion using poor moving and handling techniques to help move a resident up in a wheelchair. Residents were seen to dress differently, they had different hairstyles yet many of the female residents did not wear make up. Relatives informed the inspector that residents do not have to purchase toiletries, that these are provided by the home. This may mean they are not able to choose what they like and this needs to well managed and include their choices. The home manages all residents’ medication and uses a monitored dosage system. The medicines for the three residents being case tracked were assessed. All residents had a medication administration record (MAR). For one of the three residents there were some gaps on the MAR, it was not evident the medication had been administered or omitted, as there was no signature or coding on the MAR. Medicines are safely stored in locked cupboards within the homes’ clinic area. A medicine fridge is in use for some medications, however the temperature of the fridge is not adequately Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 13 monitored and recorded to ensure the medication is safely stored. The home appropriately stores controlled drugs and there are records of when they are received and administered in a controlled drug register and upon the MAR. The controlled drug register had not been properly completed, it was evident that for one resident on one occasion a smaller dose was administered than what was prescribed and on another occasion the current stock had been entered incorrectly in the register. The managers often undertake medication audits and provide a brief report on findings. It was disappointing to find that such errors are not being identified during the audits and actions to remedy these poor practices are not being undertaken. This may mean that residents are being put at risk. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it has the ability to effectively meet the daily life and social activity needs of the residents. There are no written plans about how to meet these needs and very few records that these needs have been met. This may mean that residents are involved in activity as determined by staff, and not their choice, which could effect the residents well being. EVIDENCE: The home employs activity workers on a part time basis. The relatives believe that these workers are a real attribute to the home. The activity workers engage with residents through one to one conversations and planned activities such as painting or football. Relatives commented that some staff play the guitar and sing with some of the residents. The activity workers were observed spending time conversing, walking, looking at books and helping with feeding residents their meals. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 15 Prior to lunch the activity worker spent time with two particular residents. The residents had significant communication deficits yet the activity worker was able to engage in a meaningful conversation. It was evident the activity worker had a good knowledge of the residents biography and history as work and family were often discussed. The activity worker continued to engage by reinforcing the residents name and eventually both the resident and the activity worker went for a walk. There is at present no routine programme of activity. There is very little recorded information in residents’ files about activities and social occasions in the home. The manager advised that from Monday to Wednesday there is a focus upon one to one activities and eight hours of small group activity such as skittles and going out into the local community. She also advised that there are monthly visits from the local church (C of E) and visits upon request from the local Catholic Church. Recent records of residents who have met with the clergy could not be found. All residents had some evidence of a life history assessment on their care files yet there were no supporting care plan for individual activity plans. The manager and the relatives advised that the relatives manage the finances of residents as the residents do not have the capacity to do it safely. The residents rooms were not seen on this inspection however relatives advised that they are invited to bring in personal possessions to help residents feel more at home and to help recognise who they are. The lunchtime meal is a large-scale event, conducted over one sitting at approximately 12.45pm each day. The food is served from a hot trolley in the dining room. The menu is advertised on a notice board. It was not at all clear how residents have chosen the meal they want, staff were not observed discussing what was on the menu, it was only discussed when staff sat next to residents to feed them or when meals on plates were put in front of residents at the dining table. The lunch meal presented to residents appeared good in terms of taste, quality and presentation. There were some very good staff practices to make the lunchtime meal a social event, such as getting residents talking to each other and not rushing any residents with their meals. However there were also some poor practices including cutting up all meat for each resident, staff were heard saying “I’m cutting it up for anybody” and wiping residents mouths after the meal without any explanation. During the lunchtime meal some staff comments were rather patronising and included “here you are lovey” and “have a drink my sweety”, on the whole what conversation there was with residents were limited to activity workers and nurses who were assisting with meals and administering medication. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not fully demonstrated that it has the ability to effectively manage complaints and to safeguard residents. This may mean that serious concerns that have a negative impact on the lives of residents may be unresolved and effect residents well being. EVIDENCE: The relatives who spoke with the inspector said they had no reason to complain, one relative commented “I always discuss it with staff before anything becomes too serious”. The manager does keep a record of complaints, this was available for inspection and recorded three complaints in 2006, and there were some entries on the record of when and how it had been responded to. More information is needed as detailed in the homes complaints policy, including acknowledgment in writing to the complainant and a written response post investigation, included where needed the action taken to make improvements. The home has informed the Commission of issues surrounding the safeguarding of residents and has taken where needed necessary actions to ensure the safety of residents. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 17 After the inspection visit had finished the manager sent a training matrix to the Commission it recorded that all staff have undertaken training in the Protection of Vulnerable Adults. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not fully demonstrated that it does have the ability to provide the residents with an environment that is in all areas safe and that helps with their recognition. This may mean that resident’s health and welfare is put at risk and that the residents’ potential to know where they are and what they may be doing is not helped. EVIDENCE: A tour of the premises was undertaken and significant improvements since the last inspection were noted in decoration and refurbishment, this included some new dining room chairs, corridors and doors being repainted, new carpets in the lounge and on the main staircase and new kick boards on many doors. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 19 The downstairs toilets need improvement to ensure they have locks as they do not have any and this area also requires better hand washing facilities, to ensure the privacy and safety of residents. In this toilet area there are clinical waste disposal bins, yet there were no offensive odours. The dining room appeared to be much brighter, which is good for residents as it is very often where many of the residents spend much of their time. The curtains in the dining room were hanging down in places and the dining room tables need replacing as they have been damaged and can no longer be adequately cleaned. There is a large bathroom on the ground floor with a hi / low bath appropriate to the needs of residents and to help staff withy moving and handling; there is also a clinical waste disposal facility. An environmental health officer visited the home in November 2006 and issued ten legal requirements to improve safety, nine were issued about cleanliness and one issued about lighting. The manager advised that all had been addressed and that levels of cleanliness and hygiene would not fall again. There appears to be little sign posting or visual cues to aid residents with recognition for different areas of the home. There is some evidence of contrasting colours to aid recognition of doors and walls and this should be considered for other areas and equipment used by residents in the home. The garden area is fully accessible for all residents; there is a large lawn area and a sensory part of the garden. Several residents were seen to go for walks with staff in this area. Relatives were very pleased with the environment; they commented that it is always clean and tidy even for such a busy place. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has demonstrated that it does have the ability to provide the residents with staff who are available in good numbers, well trained and who have been safely recruited. This may mean that the needs of residents are effectively met and their vulnerability safeguarded. EVIDENCE: The relatives commented that they are pleased with how the staff care for the residents. In their opinion the staff give 100 and are dedicated to their job. They did comment that at certain times of the day such as in the morning and at mealtimes they wish there were more staff, but realised you would always wish this however many staff were on. One relative commented, “most staff are excellent and they know their little ways”. The manager advised that there is at present a service and staffing review. At the time of inspection without the manager there were five staff on duty in the morning and four in the afternoon of which one was a trained nurse. In addition there are ancillary staff who work in the kitchen and there are also domestics. The manager advised that the four staff who are on duty in the Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 21 afternoon are supported by the cook who works until 6.15pm to assist with the residents teatime. At nighttimes there are two care staff and a trained nurse on duty. The manager did not advise of any staff leaving and the training matrix indicated that there are currently ten care and activity staff (out of 12) with the appropriate national vocational qualification award. The manager provided training files for three members of staff, which were poorly structured. It was agreed that the manager would update the training matrix and forward a copy to the Commission, which was received. The training matrix indicated that all staff have attended mandatory training such as fire safety, COSHH, food hygiene and manual handling. It was evident that staff have not attended infection control training as required at previous inspections and that some staff are now in need of some refresher training. Some staff have attended training that is specific to meeting the needs of the residents, this includes a tissue viability course, dementia awareness, diploma in aromatherapy, care of dying and communications in dementia. However there are several care staff who have not attended training to meet the needs of residents who have a dementia illness. The recruitment practices of the home were assessed for three staff, it was evident that all required background checks including work history, Criminal Records Bureau disclosures and written references are taken up, application forms completed and interviews staged before appointments are made. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 22 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, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not fully demonstrated that the management and administration is effective to meet the needs of residents. That essential processes of monitoring staff performance and audits of care have not identified shortfalls that put the health and well being of the residents at risk. EVIDENCE: The relatives advised that the manager and deputy manager were approachable, that the office door was always open for them to go in and have a chat. Several relatives commented that the managers often spent time with the residents and staff. The manager was observed on many occasions Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 23 spending time with residents and talking with relatives and staff. The managers point of view was that the home provides a high standard of care and did not think the last inspection report reflected on what they actually achieve, she mentioned longevity of life and the quality of care. It was disappointing to find that after being issued with requirements to improve care planning and risk assessing at the last inspection that it has not been addressed and in part the process where needs of residents have changed has deteriorated further. During the course of the inspection it was apparent that the Commission are not being informed of events that will adversely affect the well being of residents; this included residents health issues, medication errors and the lift breaking down with residents having to stay in their rooms. Since the last inspection the manager has commenced a process of quality audits and has written a report on her findings. Residents and relatives were asked questions and the report was written in October 2006. Residents and relatives were asked such questions as “are the meals of good quality”, “are you happy with the levels of activity in the home”, “do you feel happy here” and “do you like the people here”. Where there are areas for improvement the manager has written an action plan within the report and detailed when it would be accomplished. For example; The manager and staff are to ensure that the care planning process involves the relatives and significant others with a timescale to be completed within 3 months. It was not evident that this is a continuous process, as the inspector was not provided with any recent quality audits and indicators are that care planning has deteriorated. Relatives advised that they were involved with some questions about the home last year but as yet they had not been involved this year. The manager advised that there were no recent reports from the responsible individual available at the home, yet there are regular unannounced visits. The Commission has not received any recent Regulation 26 reports from the Responsible Individual. The manager advised that they do not provide a safekeeping service for residents’ money or their valuables, that this is managed by family members. Relatives who spoke with inspector confirmed that they do oversee personal finances, yet the home provides all toiletries. The three sampled staff files all had recent records of supervision yet the evidence indicated that these meetings had not been conducted regularly. The recent supervision records include agendas such as training and development and health and safety issues in the home. Some older records of supervision were found to be very brief. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 24 The records about health and safety including maintenance were seen. It was evident that the utilities used in the home being gas, electric and water are regularly tested and serviced. Equipment including fire alarms, emergency lights and equipment are regular tested and serviced. The staff regularly attend fire drills and the outcomes are recorded. The home has a fire risk assessment. Other equipment used in the home such as the passenger lift, profile beds, hoists, kitchen and laundry equipment are also tested and regularly serviced. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 2 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A 2 X 2 Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2)1 2(1) Requirement The registered manager must ensure written care plans are available describing how the care needs of residents are to be met. The care plans must be clear and concise. These care plans must be reviewed to ensure the changing needs of residents are planned for. Previous timescale of 31/5/06 not met, requirement is carried forward. The care plans must detail the choices and preferences of the residents to ensure they meet their individual needs. The registered manager must ensure that written risk assessments are available describing how the risks to residents are to be managed. These risk assessments must be reviewed routinely and following the changing needs of residents. Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 27 Timescale for action 17/05/07 2 OP8 15(1)(2)1 2(1)13(4) 17/05/07 Previous timescale of 31/5/06 not met, requirement is carried forward. 3 OP8 12(1)(a) 13(4)(c) The registered person must ensure that each resident has a regular measurement of their body weight or body mass index to ensure that any changes are quickly identified and reported to the doctor. 18(1)(a)(c The registered manager must )(i) ensure that all staff practice in 13(5) moving and handling residents is safe to prevent any injuries. Previous timescale of 31/5/06 not met, requirement is carried forward. 5 OP9 13(2) The registered person must 10/05/07 ensure that accurate records of residents’ medication are maintained and that all medication can be accounted for to make sure that residents receive the correct levels of medication. The registered person must 10/05/07 ensure that all medication is safely stored within its product license; to do this the staff must adequately monitor and record the medicine fridge temperatures. The registered manager must 30/05/07 ensure that care plans regarding fulfilling activities, recreation and pastimes of residents are fully implemented and recorded. Previous timescale of 31/5/06 not met, requirement is carried forward. 8 OP15 16(2)(i) The registered manager must ensure that a menu with an alternative option is available for DS0000024837.V336556.R01.S.doc 17/05/07 4 OP8 10/05/07 6 OP9 13(2) 7 OP12 15(1) 12(1) 24/05/07 Deerwood Grange Nursing Home Version 5.2 Page 28 residents / relatives to choose the meal for the resident. The option must be offered. Previous timescale of 30/6/06 not met, requirement is carried forward. The registered person must ensure that staff do not cut up the food for residents who have the ability to do so themselves. This must be done to help residents maintain their own abilities. The registered person must ensure that any complaints received are administered as detailed in the organisations Complaints policy including providing acknowledgement and details of actions taken where appropriate, this will help the complainant decide on whether the complaint has been satisfied. The registered person must ensure that all toilets have appropriate locks on the doors to maintain the privacy of residents and to allow staff access in an emergency. All staff must receive Infection Control training. Previous timescale of 30/9/05 not met, requirement is carried forward. The registered person must ensure that all care staff receive training in dementia awareness which will help them have an understanding of the illness and provide them with the skills they need to meet the residents needs. The registered provider must ensure that regular monthly unannounced visits are DS0000024837.V336556.R01.S.doc 9 OP15 12(4)(a) 13(4)(c) 10/05/07 10 OP16 22(2)(3)( 4) 30/05/07 11 OP21 12(4)(a) 30/05/07 12 OP30 18(1)(c)(i ) 31/07/07 13 OP33 26(1-5) 30/05/07 Deerwood Grange Nursing Home Version 5.2 Page 29 undertaken and reports of visits are available at the home. This must include consultation with residents, relatives, staff and include an inspection of the premises. Previous timescale of 31/7/06 not met, requirement is carried forward. 14 OP36 18(2) The registered person must ensure that staff have regular supervision. This will ensure staff have adequate support to do their work. The registered person must ensure that any events in the care that adversely affects the well being of residents are reported to the Commission without delay. This will meet Care Home Regulations and help protect residents. 30/05/07 15 OP38 37 10/05/07 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 OP15 Good Practice Recommendations The registered manager should consider ensuring that staff offer or know which condiments residents like on their meals. The registered manager should consider the impact the environment has on residents with a dementia and implement strategies to improve the environment, such as places of interest, good signage and the effects of colours in décor. 2 OP19 Deerwood Grange Nursing Home DS0000024837.V336556.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V336556.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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