Random inspection report
Care homes for older people
Name: Address: Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD zero star poor service 24/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Bennett Date: 0 3 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD 01213550060 F/P01213550060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BAMH (MIND) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 23 23 The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 23 Mental disorder, excluding learning disability or dementia (MD) 23 Date of last inspection 2 4 1 1 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home 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 building work to extend the home has provided most people with single bedrooms apart from one that is shared. There are two large lounge areas, and a large dining room. The extension has also provided a new laundry, a disabled toilet and down stairs shower room. 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. Care Homes for Older People Page 3 of 14 What we found:
The focus of inspections undertaken by the Care Quality Commission (CQC) 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. The last key inspection of this service was completed on the 24th November 2009. This random visit was undertaken by two inspectors over nine hours. There were 21 people living there. The home did not know that we would be visiting that day. The reason for this visit was to check compliance with the requirements made at the key inspection. We did not look at the requirement relating to medication management, as a pharmacist inspector was to visit at a later date to do this. During this visit we looked at three care files in detail. We looked at staff training records, records of notifications the home has sent us and fire risk assessments. We spoke to the acting manager, deputy manager and three staff. We completed a Short Observational Framework for Inspection (SOFI). We completed a SOFI because due to their dementia needs, many of the people living in the home are unable to verbally tell us about their experiences. We use a formal way to observe people to help us understand what it is like to live at the home. The SOFI involved us observing seven people who live at the home for two periods of an hour each and recording their experiences at regular intervals. This included their state of well being, how they interacted with staff and other people living at the home and the environment. These are our findings: We found that three of the eight requirements from the last inspection had not been met. We made a referral to our enforcement team regarding what action to take about this. It was agreed that there was insufficient evidence to serve a Statutory Requirement Notice but a warning letter requiring that improvements are made is to be sent to the provider. We liaised with a fire officer from West Midlands Fire Service regarding the unmet requirement relating to fire safety and they have taken action concerning this. In reviewing the requirement relating to care plans we found that some peoples care plans had been re written or updated. These made them more person centred so that staff had more information about how to support individuals. One persons care plan that had been rewritten stated that the person has thickener in their drinks. This is used to help the person with swallowing and to reduce the risks of them choking. It was not stated how much thickener is to be used or of what consistency the drink should be so to enable the person to swallow safely. Staff gave different accounts as to how much they would use and did not know what consistency the persons drink should be. This could put the person at risk of choking. One care plan stated that the person should have a soft diet. Their records indicated and we observed that they did not always have this. Staff spoken to said that they would
Care Homes for Older People Page 4 of 14 sometimes try the person with different foods and they were often able to tolerate these. This could put the person at risk of choking, so impacting on their well being. There was no evidence that staff had sought the advice of the Speech and Language Therapist (SALT) before trying them with different foods. The SALT would assess whether or not their needs had changed and it was safe to do this. One person had a care plan for diabetes. This stated that staff needed to check their blood levels to ensure that the person was well. It did not state what the blood level should be for the person, so it was not clear how staff would know if the person was unwell. One staff told us what they thought it should be. As the care plan was not clear other staff may not be aware of this. Since we last visited, different recording systems had been put in place to record the times when staff had turned a person in bed to reduce the pressure on their skin. The frequency of this had improved to help reduce these risks. The tissue viability nurse had visited to assess people who were at risk of developing sore skin. In December, a nurse wrote a detailed report, as to how one person was to be supported to reduce this risk. In January a review from a nurse from the Primary Care Trust suggested that this report be put with the persons care plan so that staff would know how to support the person. This had not been done when we visited however, during the day it was put with the persons turning charts so that all staff could see this. We found that this person was not positioned in the way that the tissue viability nurse had recommended. The tissue viability nurses have spent time showing staff how to do this. Staff gave differing accounts of how the person should be positioned to reduce the risks. This could put the person at risk of their skin becoming sore, so impacting on their health and well being. Since our last visit staff have got better at reporting safeguarding incidents to the relevant authorities to safeguard the people living there from harm. Information is displayed as to who to report safeguarding incidents to and staff spoken to knew where this was. Staff demonstrated that they knew what to do to safeguard people and who to report this to. Some staff have received updated training in safeguarding. It was of concern that a nurse spoken to had not received this training, as staff said they would report any safeguarding issues to the nurse in charge. However, the acting manager said that this member of staff was booked on this training. Some staff have received training in dementia since we last visited. The acting manager stated that other staff are to receive this training and it is planned that all staff will have this. This is important, as a nurse who is in charge of shifts, told us that they had never received any training in dementia. We observed during the SOFI observation that staff interacted well with the people living there. Staff spent time talking to people and finding out how they were. They gave people time to talk and listened to them. Staff offered people choices about what they wanted to eat and drink and where they wanted to spend their time. When offering people choices of food they showed them the choices available and gave them time to make these choices. Staff were observed respecting people as individuals. The fire risk assessment had been reviewed and updated. This had been done by an independent fire officer who had visited the home. A residents evacuation plan had been completed. This listed each person living there and whether or not they would need to be supported to move or to wait for assistance from the fire service. Staff spoken to
Care Homes for Older People Page 5 of 14 gave differing accounts of who they would move and how they would support individuals if there were a fire. The acting manager stated that the independent fire officer was satisfied with the plans they had. We suggested that they contact the West Midlands Fire Service for their opinion to ensure that people would be assisted safely if there were a fire. Following our visit we contacted the West Midlands Fire Service to inform them of our concerns about fire safety. They visited the home on 30 March 2010 and identified deficiencies, which the home are required to address to ensure fire safety measures protect the people living there. During the SOFI observation we saw that people were being supported to move safely and were encouraged to move as much as they could themselves. This had improved since we last visited. Some staff told us that they would not use any equipment to move people around who were in bed. However, the tissue viability nurse had advised that slide sheets be used to move people. This is to reduce the friction, caused by moving, on the persons skin and would also reduce the risks of moving people to staff. Since we last visited the dining room had been moved to the smaller lounge, so it was more homely and comfortable. Staff said that this was better and made mealtimes more relaxed. Some relatives told us in surveys that this made the dining room crowded and there was not enough room for people to move around. The manager should ensure that adequate space is available when people use this room to ensure their safety and well being. Staff told us and rotas showed that staff can work one shift, followed by another shift without a break. This is a regular pattern for one nurse, who as part of their duties would be in charge of the shift and give medication to the people living there. This could put people at risk of their health needs not being met. Some people spend all their time in bed due to their needs. We visited one person in bed. They were on their side facing the wall and the paint on the wall was worn, in some places there was no paint on the wall. There were a few small pictures on the wall but none in the persons line of vision, so their view was limited and not stimulating. What the care home does well: What they could do better:
This is a random inspection and therefore not all the core standards were assessed.
Care Homes for Older People Page 6 of 14 Care plans must clearly state how staff are to support people so they are supported in the way they need to ensure their well being. Staff must support people appropriately to ensure the risk of their skin becoming sore is reduced to ensure their health and well being. All staff must receive updated training in safeguarding so they know how to safeguard the people living there from harm. Arrangements must be made to ensure that the risk of there being a fire is reduced and staff would know what to do if there was a fire to ensure peoples safety. Staff must not work long hours without a break so they can support people safely. Staff must have the training they need to know how to support the people who live there. Bedrooms should be decorated so that they provide a stimulating environment for the person, particularly if they spend most of their time in bed. Adequate space should be available for people to enjoy their meals and be moved around safely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must clearly state 28/02/2010 how staff are to support the person. So that people are supported in the way they need and ensuring their well being. 2 8 12 Staff must support people appropriately to ensure the risk of their skin becoming sore is reduced. To ensure peoples health and well being. 31/12/2009 3 38 12 People must be supported to 31/12/2010 move safely. To ensure their safety and well being and that of the staff supporting them. Care Homes for Older People Page 8 of 14 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 14 Care plans must be reviewed 10/05/2010 as peoples needs change. To ensure that staff know how to support individuals so ensuring their health and well being. 2 8 12 Referrals to other health professionals must be made where appropriate. To ensure that staff know how to support people to meet their health needs. 30/04/2010 3 8 12 Staff must follow the advice of health professionals to ensure that the risk of peoples skin becoming sore is reduced. To ensure peoples health and well being. 30/04/2010 4 18 13 All staff must receive training 31/07/2010 in safeguarding the people living there from harm. To ensure that staff know how to safeguard people. Care Homes for Older People Page 9 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 5 27 13 Staff must not work long hours without a break. To ensure that the risks to the health and wellbeing of the people living there is reduced. 30/04/2010 6 30 18 All staff must receive training 30/04/2010 in dementia. So they know how to meet the needs of the people living there. 7 38 23 All requirements made by the fire officer must be complied with. To ensure the safety of the people living there, staff and visitors. 26/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 1 People should have the information about the home so they can make a decision about whether or not they want to live there. Not assessed at this inspection. A detailed assessment should be completed before a person moves into the home to assess whether or not their needs can be met there. Not assessed at this inspection. When peoples needs change a care plan should be put in place so that staff know how to support the individual. Outstanding from the key inspection. All staff should be aware of each persons needs so they
Page 10 of 14 2 3 3 7 4 8 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations know how to support them to ensure their well being. Outstanding from the key inspection. 5 8 Pressure area risk assessments should clearly state waht the risk is so that people are supported appropriately to reduce the risk of them developing a pressure sore. Outstanding from the key inspection. Clear records should be kept of action taken and advice given by health professionals so that staff know how to support each person to ensure their health and well being. Outstanding from the key inspection. People should be supported to take part in regular activities that they enjoy to ensure they have a meaningful lifestyle. Not assessed at this inspection. All people should be served food that looks attractive and respects their dignity regardless of their dietary needs. Not assessed at this inspection. People should be offered a choice of meals to ensure they can have the food that they enjoy. Not assessed at this inspection. Staff should ensure that there is adequate space in the dining room so that people can be supported safely at mealtimes. Food records should clearly state what the person has eaten to ensure they are receiving a varied and nutritious diet that meets their individual needs. Not assessed at this inspection. Care plans should show staff how to support individuals at mealtimes so that people can enjoy their meals in a relaxed atmosphere. Not assessed at this inspection. Consideration should be given to producing the complaints procedure in a format that would be easier for the people living there to understand. Not assessed at this inspection. Redecoration should be done where needed to ensure people live in a homely and comfortable environment. Not assessed at this inspection. Chairs should be replaced where needed to ensure that
Page 11 of 14 6 8 7 12 8 15 9 15 10 15 11 15 12 15 13 16 14 19 15 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations they are comfortable for people to sit in. Not assessed at this inspection. 16 19 Sufficient lighting should be provided to ensure that people can move around the home safely. Not assessed at this inspection. External lighting should be provided so that it is safe for staff and visitors when leaving or arriving at the home. Not assessed at this inspection. Risk assessments should be completed to ensure it is in peoples best interests to lock the bathrooms, toilets and bedrooms. Not assessed at this inspection. Bedrooms should be redecorated when needed to ensure that particularly people who spend all their time in bed have an environment that is stimulating for them. Bedrooms should reflect the tastes, interests and needs of the individual. Not assessed at this inspection. Bedroom furniture should be replaced where needed so taht bedrooms are comfortable and safe for people to spend time in. Not assessed at this inspection. The home should be clean and free from offensive odours so it is comfortable for people to live in. Not assessed at this inspection. Continence pads should be stored in bags so to reduce the risk of cross infection. Not assessed at this inspection. Staff should have the information they need so they know how to support each person safely to move around to ensure their well being. Outstanding from key inspection. Records should be available to show that nurses have current registration with the Nursing and Midwifery Council (NMC) and are therefore fit to practise. Not assessed at this inspection. Copies of reports of the monthly visits by a representaive of the provider should be available to show that audits are
Page 12 of 14 17 19 18 21 19 24 20 24 21 24 22 26 23 26 24 28 25 29 26 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations taking place to improve the home for the benefit of the people living there. Not assessed at this inspection. Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 14 of 14 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
