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Inspection on 24/11/05 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 24th November 2005.

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

This service has staff who are well trained and supported by the management team. Relatives and families of residents have helped with providing useful information to enable the nurses to write care plans for meaningful activity and leisure pursuits. A complaints process is available to residents and their representatives, records indicate that if used a resolution or improvement in service is established.

What has improved since the last inspection?

Since the last inspection the staff team are receiving more frequent and structured supervision from the management team. Fire safety training and drills are frequent enough and detailed to promote the safety of residents and staff. The extension has provided more single rooms for residents and laundry facilities have been improved.

What the care home could do better:

The registered manager must ensure that written care plans are adequately detailed to be informative to staff and residents, that these care plans are frequently reviewed and that where possible the resident and or their family are involved. Residents must be provided with opportunity to have an optical and dental service. The management of medicine must be improved to ensure it is safe and that prescribed medicine is available to residents at all times. Environmental improvements to maintain the privacy, dignity and safety of residents are needed; these were identified at previous inspections and have been carried forward to be completed with the current building work. A system to regularly review the quality of the service needs to be developed, implemented and shared with residents and their representatives.

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 24th November 2005 09:00 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.V269094.R01.S.doc Version 5.0 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.V269094.R01.S.doc Version 5.0 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 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.V269094.R01.S.doc Version 5.0 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. 1st June 2005 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. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was conducted unannounced by one regulation inspector. The inspector had opportunity to meet some residents, the management team and informally interview a member of care staff. Two records in respect of residents care were sampled, health and safety and other service provisions were seen. At the time of this visit the work to extend the home was almost complete, the manager informed the inspector that the builders intend to complete week commencing the 28/11/05. Since the inspection a site visit has been undertaken to assess the new extension, a regulation manager conducted this. The commission has issued a new registration with new conditions. It is recommended that the previous inspection report dated 1st June 2005 be considered when reading this report. What the service does well: What has improved since the last inspection? What they could do better: Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 6 The registered manager must ensure that written care plans are adequately detailed to be informative to staff and residents, that these care plans are frequently reviewed and that where possible the resident and or their family are involved. Residents must be provided with opportunity to have an optical and dental service. The management of medicine must be improved to ensure it is safe and that prescribed medicine is available to residents at all times. Environmental improvements to maintain the privacy, dignity and safety of residents are needed; these were identified at previous inspections and have been carried forward to be completed with the current building work. A system to regularly review the quality of the service needs to be developed, implemented and shared with residents and their representatives. 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. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in respect of choice of home were not assessed. No judgement. EVIDENCE: Nil. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 The health care needs of residents are not fully met by the home, some care plans are not descriptive to staff and not regularly reviewed, access to community healthcare services is not always available for residents and medicine management may present a risk to residents. EVIDENCE: Two residents files were sampled, it was evident that concerns raised in the daily records had a respective care plan. These were seen to be informative for staff, however some care plans developed from assessments require more information such as type of diet, where a special diet is identified and moving and handling care plans need to inform residents and staff of how many staff are needed and what equipment is to be used. Some care plans such as those related to oral health care do not describe to care and nursing staff what they need to do to meet these needs. Care plan reviews / evaluations are conducted; however some are not completed on a monthly basis. Some care plans have been developed following consultation and information gathering exercises with families, such as activities, lifestyles and interests. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 10 It is a concern that tissue viability care plans are not routinely evaluated when dressings are replaced; this has been identified as a concern at previous inspections. Records indicate that residents are supported to access community healthcare services such as GP and chiropody when needed. However regular checks with opticians and dentists are not evident. Risk assessments for nutrition, tissue viability and manual handling are routinely completed and reviewed. A stock take of medicines found that levels were inaccurate, this was a concern at the last inspection. At this inspection, a resident had no supply of a prescribed medicine that was recorded as being in stock, the manager was requested to address these concerns and take corrective actions immediately. Medication administration records (MAR) were not all fully completed with gaps of when medicines were received into the home and also for medicines administered to residents. The nurses are undertaking medicine audits and it is unclear why the gaps on the MAR were not identified. Controlled drugs are in stock, but not in use as the home is awaiting a “doop kit” to destroy this medicine, however checks and records are not being completed to ensure the safety of this controlled drug. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The residents in consultation with their family are able to exercise choices and have a say in how they are cared for. Further input is needed where possible to ensure that the choices of residents are considered when planning care. EVIDENCE: Residents’ files included an assessment of lifestyles and interests, which had then been developed into a care plan to guide and inform staff in how to meet the identified needs. The assessment had included gathering information from the families of residents. However it is not clear that families are fully involved in the care planning and evaluation process, which is needed to fully inform and involve the residents. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has policies, procedures and good practices to ensure that areas of concern for residents and their representatives are raised and effectively addressed. EVIDENCE: A complaints policy is in place to support residents and their representatives to raise issues of concern. The complaint records maintained in the home are clear and reflect that concerns and complaints are taken seriously and that these concerns are managed and corrected quickly where possible. Details of actions taken to improve services are recorded. The commission has not received any complaints about this service in the past twelve months. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in respect of the environment were not assessed. No judgement. EVIDENCE: Requirements from the last inspection were discussed with manager and areas of progress seen by the inspector. Certain areas such as repainting residents bedroom doors and the garden wall have not been addressed and thus these requirements have been carried forward. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 Residents are supported by adequate numbers of staff, these staff are well trained, which ensures residents needs are met in a skilled manner. EVIDENCE: At the time of inspection the staff rotas indicated that two staff were on duty at night, one being a trained nurse, as required at the last inspection and as a condition of the new registration a minimum of three staff one of which is a trained nurse must be on duty each night. This was addressed at the time of inspection and arrangements made to ensure that this staffing level will continually be maintained. Staff training records indicate that all staff are trained in most safe working practices such as fire safety, food hygiene, moving and handling and protecting vulnerable adults. As identified at previous inspections some staff need to complete an infection control course. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 Residents are supported by a competent manager and a team of staff that are regularly supervised to ensure residents’ needs are met. Improvements are needed to ensure that the safety and quality of service is of a good standard, regularly appraised and shared with residents. EVIDENCE: The manager has been registered with the commission, and has continued to maintain and develop her personal skills in management and in the care of people with a dementia, for example IT training and commencement of a degree in dementia studies. It is the staff opinion that she is supportive, knowledgeable and is always approachable. The manager confirmed as at the last inspection that no progress had been made in consulting and seeking the views of residents, their representatives and stakeholders in respect of its performance against its stated purpose. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 16 Staff files included records of regular supervision, these records reflected upon performance, roles, responsibilities and training needs. Supervision records for trained nurses include maintaining and developing skills through training and attending relevant conferences. Fire safety is well maintained, including regular checks, service and maintenance of equipment and through staff fire drills, records of the drills need to be more informative and describe outcomes. Accidents in the home are recorded, there were seven during the three month period September 2005 to November 2005, it is required that regular audits of accidents to possible reduce prevalence are undertaken. At the last inspection it was a concern that no risk assessments had been completed in respect of staff assisting residents with moving and handling in confined spaces, such as in shared rooms, this has not been addressed. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X 2 X X 2 2 X STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X 3 X 2 Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 18 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(2)(b, c, d) Requirement Written care plans must be regularly reviewed and inform whether or not the plan is effective. Previous timescale of 31/5/05 not met, this requirement is carried forward. All care plans must fully describe to staff and resident how the needs of the resident are to be met, including type of special diets, equipment and resources for handling and moving and oral health care. All residents must have their dental and optical care needs assessed and records must be maintained. Previous timescale of 31/5/05 not met, this requirement is carried forward. Residents written plans to treat and promote healing of pressure or other wounds, must be reassessed / reviewed following DS0000024837.V269094.R01.S.doc Timescale for action 28/02/06 2 OP7 12(1) 15(1) 31/03/06 3 OP8 12(1)(a) 13(1)(b) 31/03/06 4 OP8 13(1)(b) 15(1) 28/02/06 Deerwood Grange Nursing Home Version 5.0 Page 19 each change of dressing. The home must ensure that clear information as to size and grade of wound is indicated at each review. Previous timescale 30/04/05 not met, this requirement is carried forward. All medicines must be audited, any discrepancies must be fully investigated and corrective actions taken. Previous timescale of 15/6/05 not met, this requirement is carried forward. Medication administration records must be fully completed including when medicines are received into the home and when they are administered to residents. Daily checks and records of the stock and administration of controlled drugs in the home must be maintained in the controlled drug book / register. Missing medication must be fully investigated and corrective actions taken, the missing medication must be made available to the resident. Residents and where possible their relatives must be involved in the care planning and review process. All decanted food items stored in the fridge must be appropriately labelled. The core food temperatures of all cooked meats must be taken and recorded. The temperature gauge on one fridge must be repaired. Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 20 5 OP9 13(2) 31/01/06 6 OP9 13(2) 31/01/06 7 OP9 13(2) 31/01/06 8 OP9 13(2)(4) (c) 12(1) 15(1)(2) 25/11/05 9 OP14 31/03/06 10 OP15 16(2)(g, i) 31/01/06 11 OP19 23(2)(b) Not assessed at this inspection and is carried forward. The damaged paintwork on residents doors must be repaired. Previous timescale of 30/6/05 not met, these requirements are carried forward. The garden wall must be repaired. Previous timescale of 31/10/05 not met, this requirement is carried forward. The manager must ensure that all toileting facilities are of a design that promotes privacy of the residents. All toilets walls and doors must extend from floor to ceiling. Previous timescale of 30/6/05 not met, this requirement is carried forward. The registered manager must audit the furniture and fittings in residents rooms, any gaps must be addressed or alternative provision made. This must be reflected in the homes statement of purpose. The manager must consult the residents and next of kin about the gaps and alternative provision. Previous timescale of 30/6/05 not met, these requirements are carried forward. All radiators in residents bedrooms must be fitted with DS0000024837.V269094.R01.S.doc 31/03/06 12 OP19 23(2)(b) 31/03/06 13 OP21 23(2)(a) 28/02/06 14 OP24 16(2)(c) 31/03/06 15 OP25 13(4)(a,c) 31/03/06 Page 21 Deerwood Grange Nursing Home Version 5.0 covers or be replaced with low surface temperature emitters to reduce the risk of scalding. Previous timescale of 30/6/05 not met, this requirement is carried forward. The staff roster must fully reflect the hours that staff actually work. 16 OP27 17(2) Sch 4 31/01/06 17 OP30 Previous timescale of 31/7/05 not met, this requirenmt is carried forward. 18(1)(c, i) All staff must receive Infection Control training. Previous timescale of 30/9/05 not met, requirement is carried forward. The manager must ensure that regular consultation, which is recorded is undertaken, to elicit its performance against the statement of purpose, aims and objectives. This must include residents, their representatives and stakeholders. Previous timescale of 30/6/05 not met, this requirement is carried forward. A staff risk assessment must be completed to ensure the safety of residents and staff when working in confined spaces such as using hoists and wheelchairs in shared bedrooms. Previous timescale of 31/5/05 not met, this requirement is carried forward. The outcome of fire drills must DS0000024837.V269094.R01.S.doc 31/03/06 18 OP33 24 31/03/06 19 OP38 13(4) 28/02/06 20 OP38 23(4)(e) 31/03/06 Page 22 Deerwood Grange Nursing Home Version 5.0 Sch 4(14) 21 OP38 13(4) 12(1) be fully recorded and where needed appropriate actions taken. Accidents at the home must be audited on a regular basis. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Deerwood Grange Nursing Home DS0000024837.V269094.R01.S.doc Version 5.0 Page 24 - 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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