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 10/05/2010 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 7 0 7 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 1 0 0 5 2 0 1 0 Care Homes for Older People Page 2 of 12 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 was extended to provide most people with single bedrooms apart from one that is shared. There are two large lounge areas, and a large dining room. In the extension there is a laundry, a disabled toilet and down stairs shower room. The upstairs bathroom has been converted into a shower room. There is a 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 12 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 10th May 2010. This random visit was undertaken by two inspectors over seven hours. There were 19 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 Statutory Requirement Notice that was served on 19th May 2010. This was in response to breaches identified under the Care Homes Regulations 2001 Regulation 12 (1) and 13 (2). During this visit we looked at two care files in detail. We spoke to the manager, deputy manager, seven staff and two visitors. These are our findings: Since we last visited a lot of work has been done on improving care plans so that staff know how to support individuals to meet their needs. All staff had been involved in these and had been given time when not working on shift to do this. The manager said that the care plans for three people had not been started but this was planned. We looked at two peoples care plans that had been completed. Staff were asked to sign to say they had read and understood each of the persons care plans so they knew how to support them. Some staff had done this. Staff said they are asked to read care plans and are kept updated with any changes at the handover between shifts. Some care plans included a lot of detail as to how staff are to support the person. With each care plan there was a sheet titled carers information. This included a summary or sometimes repeated the information in the care plan. Care staff spoken to said this was helpful to them so they knew how to support individuals. One persons daily records showed that when staff had checked their skin, to ensure it was not sore, they had noticed that their toe nail appeared to be affecting the blood supply to their foot. They stated that they would refer this to the doctor. The persons doctors records did not include any entries about this and there was no follow up or mention of this again on the persons daily records. This could affect the persons health and well being. One persons care plan stated that staff are to move the person in their bed using a slide sheet to prevent injury to them and to staff. The person had moved to another bedroom while their bedroom was being redecorated. Staff told us this was about seven days before we visited. We visited the person in their bedroom and saw that no slide sheet was available in there. Three staff spoken to said they use a slide sheet to move the person with another member of staff and they would expect the slide sheet to be in the persons bedroom. One staff told us that they would not use a slide sheet but that two staff would move the person using their hands. This could put the person and staff supporting them
Care Homes for Older People Page 4 of 12 at risk of injury. Some staff said they had recently had training in how to prevent people getting sore skin. They said that after this training more equipment, such as slide sheets, were bought so that the equipment they need to support people is available. One care plan stated when staff should apply cream to the persons skin to prevent it from becoming sore. Five staff spoken to were not aware of how often this cream needed to be applied to prevent the persons skin from becoming sore, which could impact on the persons well being. Since we last visited staff have improved how they monitor peoples weight. Staff have detailed guidance as to how to measure peoples arms and legs if they are not able to use the weighing scales so the persons weight can be monitored. This is important as a significant loss or gain of weight can be an indicator of an underlying health need. One person had a care plan for how staff were to support the person with a health problem. This detailed what drinks the person should have and how often. None of the staff spoken to were aware of this. The manager said that this was a health problem that the person had in the past and was not currently a problem. Therefore, they said they would remove this care plan. Care plans included information about the person and what they have achieved in their life. This helps staff to know more about the person as an individual and what they like to do. It gives staff information so they can talk to individuals about things that may interest them. One person had difficulty in swallowing. The Speech and Language Therapist had visited them to assess the risks of them choking. The person had been prescribed thickener in their drinks to reduce the risk of them choking. It was stated clearly in their care plan how many scoops of thickener to use in drinks and what consistency they should be. Staff gave varying accounts of how much thickener they put in the persons drink, which could put them at risk of choking. Records of what people had eaten varied, some staff had written exactly what the person had eaten but others had written eaten well. Some staff had written the person ate 50 or 100 per cent but it was not clear what the portion was to start with. The care plan for one person stated to record exactly how much the person has eaten. This is needed to ensure the person is receiving the nutrition they need to be well. We observed that two people did not move from their chair in the dining room for at least three hours. Staff gave them drinks and snacks during the morning. Neither person was asked if they needed to go to the toilet. One person complained of having back ache. Staff rubbed the persons back to help relieve this but they were not asked if they would like to move, which may have helped them to be more comfortable. One persons records stated they were still constipated. There were no records before this that mentioned this or following this. Their care plan stated that if they did not have a bowel movement for two consecutive days that care staff were to tell the nurse about this. Their records showed they did not have a bowel movement for four consecutive days but there was no record of staff telling the nurse. Care staff spoken to were not aware of when to tell the nurse when the person had not had a bowel movement, which could impact on the persons health and well being.
Care Homes for Older People Page 5 of 12 New furniture had been provided in the lounges and dining room making the home more comfortable. Staff had listened to what relatives of people were saying about the dining room being cramped. This had been moved so that people had more room and it was a more pleasant environment to eat their meals in. Some peoples bedrooms are being redecorated and the person or their relative had been involved in choosing how this was to be done. Relatives said that the home was improving. Staff said they had more training since we last visited. They said they were having supervision with the manager, which they found useful. Staff said that all the staff are getting more involved in the running of the home and that team work was better. They said that when they use agency staff they are staff that have worked there before, so they know how to support the people living there. Staff said that the morale in the home was better. They said the manager was good and is making a lot of improvements. A lot of improvements have been made to ensure that people receive the care and support they need. However, the Statutory Requirement Notice had not been fully complied with, which could impact on peoples health and well being. We sent a warning letter to the provider requiring that the necessary improvements are made. The letter tells them that if this is not done further enforcement action will be taken. We received an improvement plan, as requested, in response to this. This stated that they are making the necessary improvements to address the requirements made in this report and ensure the well being of the people living there. 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. Staff must ensure that they administer creams appropriately to ensure that the risks of peoples skin becoming sore is reduced. People must be moved safely to avoid risk of injury to them and to staff. Staff must support people appropriately to ensure their health needs are being met, so
Care Homes for Older People Page 6 of 12 ensuring their well being. Staff should support people in a way that maintains their dignity, so ensuring their well being. 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 12 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 29 19 Records of staff recruitment must be available in the home. To ensure that recruitment procedures are robust and suitable staff are employed to work with the people living there. 31/07/2010 2 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 12 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 12 Ensure that care plans clearly reflect individuals needs. So that staff know how to support them to meet these. 30/06/2010 2 8 13 Ensure that staff know how to support people appropriately to ensure the risk of their skin becoming sore is reduced. So ensuring their health and well being. 30/06/2010 3 8 12 Staff must support people appropriately and ensure their health needs are being met. To ensure their well being. 31/08/2010 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 9 Staff should administer medication appropriately so not to
Page 9 of 12 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 put people at risk of cross infection. Not assessed at this inspection. 2 9 It is advised that further training is completed to enable staff to manage challenging behaviour without the need to administer sedating medicines. Not assessed at this inspection. It is advised that all the people living there have a medication review to reduce the reliance of sedating medicines used in the home. Not assessed at this inspection. Staff should ensure that they support people to meet their personal care needs with dignity so ensuring their well being. Outstanding from last inspection. All people should be offered regular activities to ensure they have opportunities for social interaction and to promote their well being. Not assessed at this inspection. People should be offered a varied, healthy and nutritious diet to ensure their health and well being. Not assessed at this inspection. Food records should state what the person has eaten and the portion sizes so it can be monitored whether or not the person is receiving the nutrition they need to be well. Outstanding from last inspection. There should be an induction process for agency staff so they know how to support individuals they are working with and are aware of safety procedures, if needed while working there. Not assessed at this inspection. There should be at least six staff meetings a year to ensure that staff have an opportunity to discuss the needs of the people living there and are kept updated with best practise. Not assessed at this inspection. Quality assurance systems should be in place to ensure that the home is regularly monitored and improvements can be made so it is run in the best interests of the people living there.
Page 10 of 12 3 9 4 10 5 12 6 15 7 15 8 19 9 27 10 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 Not assessed at this inspection. Care Homes for Older People Page 11 of 12 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 12 of 12 - 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!
