Inspection on 21/07/08 for East Dean Grange

This inspection was carried out on 21st July 2008.

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

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

Other inspections for this house

East Dean Grange 01/08/07

East Dean Grange 14/09/06

East Dean Grange 01/12/05

East Dean Grange 13/07/05

East Dean Grange 22/11/04

East Dean Grange 04/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE East Dean Grange Lower Street East Dean East Sussex BN20 0DE Lead Inspector Debbie Calveley Unannounced Inspection 21st July 2008 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 East Dean Grange DS0000021090.V367418.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. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service East Dean Grange Address Lower Street East Dean East Sussex BN20 0DE 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) 01323 422411 01323 422412 phillini@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is 33 (thirty three) The care home can provide personal care to older people aged 65 (sixty five) years or over on admission 1st August 2007 Date of last inspection Brief Description of the Service: East Dean Grange provides care for up to 33 older people requiring personal care. The home offers hotel style accommodation in a large detached country house situated in the village of East Dean approximately four miles from Eastbourne. The home is close to the church, village hall and public house. There is a four-person passenger lift and a chair lift that provide access to most areas except for three bedrooms in the older part of the building. All bedrooms are en-suite and decorated to a high standard. There is a communal shower. Other facilities include a variety of sitting rooms, a terrace, a drinks bar, a split-level dining room and an indoor swimming pool. The home is surrounded by well-maintained gardens and there are ample car parking facilities. All bedrooms are connected to the call alarm system, have cable TV and fitted with telephone points. Fees currently range from £741.00 to £941.00 per week, depending on need and bedroom to be occupied. These fees are inclusive of a twice-weekly taxi trip to Eastbourne. Additional charges are made for individual newspapers, visitors’ meals, chiropody, hairdressing, physiotherapy and telephone calls. The latest edition of the home’s inspection report is kept in the reception area. Current activities include art, quizzes, movement to music, talks of special interest, classical music and bingo. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at East Dean Grange will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 21 July 2008. There were twenty-six residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the cook were spoken with in addition to discussion with the Manager and maintenance person. Telephone contact was made with visiting professionals following the visit and one health professional was spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. What the service does well: The atmosphere at the home was relaxed, with communication between staff, residents and visitors being positive open and friendly. The activities meet the residents expectations at this time, and residents are involve in the planning of new activities. All parts of the home were clean, comfortable and well maintained. All residents, relatives, visitors and visiting professionals contacted as part of the inspection process confirmed a satisfaction with the home and its services East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 6 one resident saying ‘I am very well cared for the staff are nice it’s a lovely home and has good food’. The quality and choice of meals remain good and all residents spoken with were complimentary about the food. The training for staff is good, and covers a wide variety of resident related conditions, which give the staff an understanding of the residents needs. There is a robust recruitment process that protects the residents. What has improved since the last inspection? What they could do better: 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 East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. East Dean Grange DS0000021090.V367418.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 East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however little information is documented thus not ensuring their needs can be met. EVIDENCE: There is a Statement of Purpose and Service Users Guide in place, which contains information about the home and the services it provides. The Service Users Guide (brochure) is bright and colourful and contains photographs of the home and grounds. Copies of these were available on request; it would benefit visitors and prospective residents if these were more readily available. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 10 The Statement of Purpose was up to date and contained in essence the information required, however it refers throughout to accessing the Organisational polices for more information. This then becomes time consuming for the reader if they have to then approach the home for a copy of the specific policy. This was discussed in full with the appointed manager It was confirmed whilst talking to residents that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the homes information documents. A review of the care documentation confirmed that pre-admission assessments are completed by the appointed manager. The last three admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide a clear assessment of prospective residents care needs. These are completed by one of the deputy nurse managers and discussion with the acting manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was however noted that the home does not confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the manager who was advised that this should be completed in writing in accordance with the required documentation. The manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The manager confirmed that residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate care is not provided at East Dean Grange. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence including a site visit to this service. From direct observation the health and personal care needs of residents are generally met with evidence of specialist advice sought when necessary. However some residents are potentially at risk due to care plans not being updated to reflect the residents current needs. EVIDENCE: The care documentation pertaining to five residents was reviewed in depth as part of the inspection process. A new care planning system has been introduced since the last key inspection. These were found to have a comprehensive assessment format which guide staff to produce a care plan for that identified need. The majority of residents were found to have care plans specific to their needs, however very few evidenced regular review. For example, one resident was admitted to hospital in April 2008 and though she had been reassessed before discharge and the assessment stated that her East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 12 needs had changed considerably there was no evidence that her care plan had been updated to reflect these changes and did not give any guidance for staff to follow in meeting those hanged needs. In particular her nutritional needs and mobility needs, which had changed significantly. Staff were able to discuss the changes to her care. One new resident who had been in the home for two weeks had had a pre admission assessment completed, but no care plans in place to meet her needs, again staff could discuss her needs and identified her agitation and reaction to noise, but there was no guidance in place for staff to follow. It was also found that social histories and social care plans are not completed on all residents. From discussion with the manager it is understood that shortfalls had been identified within the care plans, however these had not yet been undertaken by staff thus putting residents at risk from out of date information and incomplete care plans. Whilst these shortfalls did not impact on the positive outcomes of the residents at this time due to the knowledge the staff have on individual resident, the home needs to ensure that the shortfalls are addressed to protect the residents and promote their health and well being. Risk assessments for health needs are included in the care planning format used by the home, and all risk assessments were found to be completed, but not all followed through with an appropriate plan of action when identified as required. This was discussed in full with the senior staff. It is acknowledged that a lot of work has been undertaken by the staff in changing the care plan records and documentation, but it is compromised by the lack of regular review and the updating of records to reflect residents changed needs. Senior staff confirmed that training in care planning will be ongoing. Staff spoken with confirmed that they received a full report on each resident daily, but agency staff and permanent staff also stated that they did not always read the care documentation that is kept in the main nurses station. Residents spoken with were satisfied with the care provided at the home one saying that the home ‘should be congratulated for its care’ ‘I receive good care and care workers are kind, considerate and supportive of her every need’ ‘Staff are efficient, courteous and very kind’. Further comments included ‘they look after me very well’ ‘I have my own room and the staff are kind ’ ‘ It’s my home’. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 13 The clinical room is also the staff office and there are suitable storage facilities for medication stocks and dressings, a medicine trolley is stored in the corridor secure appropriately when not in use. From direct observation the morning medications were administered safely and were in line with the homes policies and procedures. There is a small fridge and temperatures of the room and fridge are usually recorded daily, however the records evidenced that they had not been recorded since defrosting the fridge on the 16/07/08. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication including insulin administration. The systems for recording and checking controlled drugs were found to be thorough. The Medication Administration Charts (MAR) were viewed, gaps were identified and these need to be followed up by the senior staff. The MAR sheets do not include the codes use by staff for the non-administration of prescribed medicines, and there are no records kept of dates and reasons for nonadministration. As discussed during the inspection this needs to be introduced to provide vital information for the G.P and for audit purposes. The comparison signatures of staff able to administer medication were available and current. Risk assessment for those residents that self administer their medication are in place, but need regular review to ensure the residents continued safety. It was confirmed that all staff that administer medication receive training and that the staff that administer insulin receive guidance and training from the district nurse who is attached to the local surgery. Feedback from a health professional was positive regarding the home and confirmed that advice was sought as and when required. Staff were seen to be respectful and considerate to all residents whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. East Dean Grange DS0000021090.V367418.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): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. EVIDENCE: There are two activity co-ordinators who work within the home to provide activities; a weekly activity programme is displayed on a notice board. The home is currently running a “ cruise” which includes visiting a different country every week and a days meals are then dedicated to that country. The residents spoken with thought this was a fun idea and enjoyed the variety of the meals. Some residents partake in bridge evenings with a visitor to the home. The home has a terrace and well kept gardens for residents to enjoy in the good weather. Care plans evidence some residents past histories and social preferences, but they could be linked more constructively to the activity programme. The notes East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 15 kept were more of a list of who attended and who didn’t and not what the residents gained from the session. From direct observation, the morning shift did not evidence any activities and the activity programme identified that a beetle drive would take place later that afternoon. The feedback regarding activities was mixed, and some residents said that it was their choice not to attend and some said it was not too their taste. The AQAA confirmed that areas identified for improvement include Extend exercise classes and plans to develop the afternoon activities, more one to one sessions for residents who spend their time in their rooms. There is also a plan to open an in house shop for residents, thus encouraging choice and independence for residents It was confirmed by staff that the residents are supported and enabled to join local events held in the village and attend the Church Services at the nearby church. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. During the inspection visit it was noted that the reception area was always manned during the day and visitors were greeted with assistance being provided if needed. Many of the residents have individualised their bedroom with items from home and residents and relatives spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible, residents spoken with confirmed that they were consulted about all aspects of their lives. The home has an advocacy policy in place and the information regarding this is available to all residents. Breakfast and the mid day meal was observed and was seen to be organised and well managed ensuring that those residents needing assistance were given time and able to have the assistance that they needed in an unrushed manner. It was confirmed that residents had a choice at lunchtime, which included a vegetarian choice. Residents said that if they did not want the menu choices, they could choose something else. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 16 Menus are used and circulated the day prior to the meals being provided, there are no records kept on what food is eaten by each resident and it was discussed that records are beneficial in identifying appetite traits early. All feedback about the food was complimentary and comments included ‘good food’ ‘I have choices in the meals and the meals are good’. The dining areas are on two levels (split level) they are pleasant and well furnished with natural light. The tables are attractively set with napkins and tablecloths. The meals provided looked appetising and were served in a manner that ensured it looked attractive. Residents may have a glass of wine with their meal if they wish. Fresh fruit is provided, and assessable to the residents, encouraging them to help themselves. It was noted that care staff were serving and distributing the meals and entering the kitchen without using appropriate protective aprons. This practice needs to be reviewed. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has received two complaints since the last inspection, which were fully investigated. The CSCI referred one complaint to the home for investigation and the response received was prompt and evidenced a full investigation and action plan to address the areas of concern. Residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have now all received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. East Dean Grange DS0000021090.V367418.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): 19, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: A tour of the home confirmed that the home is well maintained and bedrooms are attractive with some being very personalised and all bedrooms have an ensuite facility. All bedrooms have a cable television and telephone point. Residents spoken to said that they liked their rooms one saying that the home ‘felt like his home now’. There are attractive gardens with seating areas and residents were seen enjoying the good weather. A swimming pool is attached to the property and East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 19 one resident in particular enjoys a weekly swim. This facility is appropriately monitored and checks are in place in respect of the chlorination of the pool. All residents are appropriately supervised. The home have a choice of various communal areas which are attractive and allow for different uses ensuring residents have choice and how they spend their time. There are adequate communal bathrooms and shower rooms in the home, with specialist equipment to ensure all residents can have a bath or shower. The home has specialised equipment available throughout the home to promote independence. During the inspection it was noted that staff were using lifting and supporting equipment appropriately. Call bells are provided in all areas and staff were seen to be attentive and ensured residents had access to these. The home has a range of special mattresses and seat cushions, which are used on an assessed needs basis to prevent tissue damage; the staff were able to discuss how they procure special equipment if they should need it. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. Polices and procedures for infection control are in place and are updated regularly. The home was clean and free from offensive odours on the day of the inspection. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. A sluice facility has been provided since the last inspection and the sluice and laundry areas were found clean and safe. The home provides a good laundry service. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 20 In the main good practice in respect of infection control by staff was observed during the inspection visit, soiled linen was appropriately put in red bags and all areas of the home were clean. Whilst there were gloves and aprons freely available in the home, staff are to be reminded regarding the appropriate use of gloves and it was noted that care staff do not wear aprons when serving food. These areas of poor practice were discussed. Sluice and laundry areas were found to be clean and safe. Residents were very complimentary about the laundry service indicating clothes are generally returned the same day. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need. EVIDENCE: The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the needs of the residents at this time. It was confirmed by the manager that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. Care staff spoken with said that the levels of staff on duty were sufficient to give the care required; they also said that the senior staff always helped out. Residents also confirmed that they had no complaints regarding the amount of staff. A roster is held giving names of staff on shift. Staffing levels include three care staff on duty each morning and two in the afternoon and evening. There are two waking care staff on duty at night. In addition to care staff, staff are East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 22 employed for administration, reception, cooking, activities, cleaning, laundry, maintenance and gardening. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. There is an induction programme in place and has been introduced for all staff. Files seen confirmed this. New staff are required to complete an initial induction programme and undertake mandatory training, including fire and health and safety. This leads into foundation training, in preparation of NVQ training. At present 50 of staff have an NVQ qualification. The induction and foundation training is in line with the Skills for Care guidance. The provider facilitates regular training sessions and recent ones have included safe cleaning, food hygiene, nutrition, infection control, Personal Best, moving and handling and medication administration. There is a rolling programme of training, which will ensure that staff receive the training necessary to meet the residents needs. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. EVIDENCE: Since the last inspection the registered manager has resigned and an appointed manager took up the post in November 2007. She has the necessary experience and knowledge to manage the home; she was previously employed as a manager of a domiciliary care agency for five years. She enrolled on the Registered Managers Award course in June 2008 and has worked in the home for nine months. She acknowledges there is still work to be done to meet the National Minimum Standards . East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 24 During the inspection visit there was no doubt that the appointed manager had a good working relationship with everyone in the home and everyone spoken to said that she was approachable, fair and responded to issues raised quickly. Whilst there is a clear management structure in the home with staff having designated responsibilities, systems need to be introduced as to monitoring how effectively these are working. A senior carer said that the extra responsibilities given to the senior carers allow them to supervise and monitor the standard of care more effectively. However as previously identified care records were not up to date. There are systems in place to monitor the quality in the home and include the use of questionnaires. The appointed manager confirmed that these are audited reported on and responded to. It was recommended that the use of questionnaires is expanded to staff and visiting professionals. There are resident/relative meetings and staff meetings, which are minuted. The appointed manager has reinstated the home newsletter which one resident referred to. The home does manage the personal monies for a number of their residents. Residents’ monies are held in a separate interest bearing account as per the BUPA policies and procedures. It was confirmed that the system used provides an audit trail of how transactions are managed on behalf of residents. Staff supervision has been commenced, at present not all staff have receive supervision, but there are plans in place to rectify this, senior staff will undertake training and then the manager will delegate out the supervisions of staff. As this is underway a requirement has not been made at this time, however it will be inspected at the next key inspection. East Dean Grange looked well maintained and systems are in place to report any problems to the maintenance team that need attention. Certificates relating to Health and Safety in the home were reviewed and found on the whole to be full. Full records of hot water checking are kept, there are measures in place to prevent Legionnaires disease, and the health and safety policy is up to date. It was however noted that environmental risk assessments are not fully recorded, this was discussed in full on the inspection visit. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 25 The accident book was viewed along with the actions taken to prevent a reoccurrence. It was discussed that expert advice be sought regarding those residents that have recurrent falls. The first aid boxes need to be spread out throughout the home and they need to be regularly checked and topped up. The kitchen first aid box would benefit from including a burns treatment and eyewash for immediate first aid. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 26 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 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 2 3 East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 Requirement Timescale for action 21/10/08 2. OP3 14(1) 3. OP7 15(1) That the registered person ensures that the home’s Statement of Purpose provides potential and current residents with more detailed information of the home’s facilities and services. (Timescale of 31/12/07 not met) That registered person confirms 21/10/08 in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That the registered person 21/10/08 ensures that all care plans are reviewed regularly and reflect the changing needs of the residents. That all new residents have an initial care plan in place to guide staff in meeting the needs That the registered person 21/10/08 ensures that all residents health needs are appropriately assessed on admission to the home and then regularly reviewed to ensure their continued safety and well being. DS0000021090.V367418.R01.S.doc Version 5.2 4. OP8 12 (1)(a) East Dean Grange Page 28 5. OP9 13(2) That the registered person 21/10/08 ensures that gaps in medication charts are identified and followed up to ensure the service users health needs are met. That the administration charts clearly identify the codes use by the staff for the nonadministration of service users prescribed medications and that the reasons for the nonadministration are recorded That the fridge and room temperatures are recorded daily. That photographs for identification of service users are dated and updated regularly. That the registered person ensures that the staff follow the organisational policies and procedures in place in regard to the appropriate use of gloves an infection control measures. That generic risk assessments are used to ensure resident’s safety. These should include risks presented by the garden. 6. OP26 13 (3) 21/10/08 7. OP38 13 21/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP15 Good Practice Recommendations Daily records must contain daily entries of the residents’ quality of day, including health and personal care matters. That records of all the service users intake of meals are recorded. East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 East Dean Grange DS0000021090.V367418.R01.S.doc Version 5.2 Page 30 - 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. 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