Inspection on 18/11/09 for Elwick Grange

This inspection was carried out on 18th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elwick Grange 06/07/10

Elwick Grange 05/05/10

Elwick Grange 12/03/08

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Elwick Grange Elwick Road Hartlepool TS26 9LX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Andrea Goodall     Date: 2 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Elwick Grange Elwick Road Hartlepool TS26 9LX 01429278000 01914877865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross OPCO Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 The registerd person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category - Code OP, maximum number of places 44 Dementia, over 65 years of age - Code DE(E) maximum number of places 16 Date of last inspection Brief description of the care home Elwick Grange is a purpose built residential care home that provides accommodation for 60 people. All 60 bedrooms are spacious and have en-suite facilities. People living at the home have access to 8 communal lounge areas and 3 dining rooms. A passenger lift is available for people to access the first floor. Outside the home there are a number of car parking spaces and the home is surrounded by garden and patio areas. The home is located near to the centre of Hartlepool and is easily accessible to people Care Homes for Older People Page 4 of 32 Over 65 16 44 0 0 Brief description of the care home using cars or public transport. There are a number of shops nearby and a well-kept public park area is opposite the home. The weekly fees depend on the type of care and whether funded by a local authority. There are additional charges for items such as hairdressing, clothing, reading materials, toiletries and other personal items. Please check current fees and additional charges with the manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit we looked at information we have received since the last visit on 12th March 2008, and the last annual service review on 2nd March 2009. We looked at any changes to how the home is run. We looked at how the service has dealt with any complaints or concerns since the last visit. We asked the Provider for their view of how well they care for people in their AQAA (an annual quality assurance assessment). We received surveys from 15 residents, seven relatives, 10 staff, and one health care professional who visits the home. We made an unannounced visit to the home on 18th November 2009. We made another visit to the home on 19th November 2009. During the visit we talked with people who use the service, their relatives, manager and staff, and visitors. We joined residents for meals and looked at how staff support the people who live here. We looked at information about the people who use the Care Homes for Older People Page 6 of 32 service and how well their needs are met. We looked at other records which must be kept by a care service. We checked whether staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We checked what improvements had been made since the last visit. We told the manager and operations manager what we found on 24th November 2009. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care records must show staff how to support people with their individual needs, and must show any changes in those needs. Care records should show any changes in peoples health needs. Also records of health tests should include the outcome and results of tests. Medication records must show whether people have had medication each day. Also the medication storage room should be a suitable temperature. There must be opportunities for residents to take part in social and leisure activities. Residents must have information so they can make informed choices about meals. Care Homes for Older People Page 8 of 32 Staff who work in the dementia care unit must have suitable training in dementia care. Also the home should be able to demonstrate how it provides a specialist dementia care service. The home must have up-to-date records about what training staff have done, so it can show whether they have suitable training and so the manager can plan for future training. The home should have a registered manager. Other things which would make the home better include: the assisted bath on the ground floor should be repaired so that people do not have to go to other units to use this equipment; there should be assessments for people who want to manage their own medication; and everybody should be given a key to their bedroom, unless a risk assessments shows otherwise. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed before they make a decision about moving here so that they are assured the home can meet their needs. Evidence: This home has been open for a few years. Many of the people who live here are from the local area, and some already knew about the home before they moved here. The home provides each prospective resident with an information booklet (called a service users guide) which gives good details about the service. This information can also be made available in other ways to meet peoples diverse needs. For example, in audio-format for people who have poor sight or difficulty with reading. Before people come to live here their needs are assessed by health and social care professionals to see what sort of care they need. The manager then carries out an assessment to see if the home can meet their needs. The assessment records were Care Homes for Older People Page 11 of 32 Evidence: clear and detailed. The manager uses these assessments to decide whether the home can meet the main needs of the potential new resident. The home is currently registered to provide up to 16 places for people with dementia care needs. There is a specific unit on the first floor to accommodate 16 people with such needs. However there is little evidence to show that this unit provides a specialist service. For example, some staff stated that they have had dementia awareness training, but at this time there are no training records to show this, and there are no therapeutic activities for people with dementia care needs. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care records are not sufficiently detailed or acted on, so do not fully support people in their personal and health care needs. Evidence: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. For example how to help people with their mobility, emotional well being, and hygiene. The sample of four care plans seen at Elwick Grange are not sufficiently detailed so do not provide sufficient guidance for staff in how to support people with their planned care. Also care plans are not always updated to show changes in need. For example one persons care plan states that she is able to dress independently. However it is clear that her mobility had changed and she now requires one care staff to help her to dress. This had not been updated in her care plan. Monthly evaluations in most care plans were repetitive and meaningless e.g. no change to care plan even when there had been obvious changes in someones needs. Some monthly evaluations were about the wrong care plan goal. Care Homes for Older People Page 13 of 32 Evidence: Daily records show that one person can be aggressive in their behaviour due to their dementia care needs. However there was no care plan about this, and no behaviour management plan to show how the aggression is shown (eg verbal or physical), whether there are any potential triggers, nor any guidance for staff about how to redirect the person to help them manage their behaviour. Similar issues about care plans were also raised at a recent monitoring visit by commissioning officers of the local authority. Since then a manager from another home has been at Elwick Grange to re-write care plans. However this is a short-term arrangement and staff clearly need training and guidance in care planning. Staff need clear direction to act on changes in needs of the people who live here. The home has good access to health care services and staff felt that there are good working relations with visiting health professionals, including Community Matron, McMillan nurses and the Community Psychiatric Nurse. The home is planning to start training towards the Gold Standards Framework (for end-of-life care) in the near future. One health professional said, The home is good at palliative care and multiagency working. However the inspector was very concerned that staff do not always act on clear changes in the health needs of residents. For example monthly weight records show that one resident has had a significant weight loss of 18 kg since February 2009. However no action was taken to involve health care professionals in identifying the cause until recently. A couple of months ago the care plan indicated that weekly weight records should be kept, but this is still not being done. No food or fluid charts were put in place until a manager from another home recently began re-writing care plans and directed staff to do this. Everyone has assessments of their moving & assisting needs to show if they need support with their mobility. It is good practice that these are kept in each persons bedroom so that they are easily accessed by staff. Everyone also has an assessment of their skin integrity to show if they need support with possible pressure areas. In a sample of four care files, one persons assessments showed a significant change in their pressure care needs and their score went from low to high in July 2009. However a care plan was only put into place in November 2009 by a visiting manager from another home. Also health care records are not always fully completed. For example records of samples sent off for testing are not updated to show the results. Care Homes for Older People Page 14 of 32 Evidence: People have the choice of managing their own medications where their capabilities allow. Until recently one person managed their own simple painkillers. This was outlined in a care plan but there was no risk assessment and no signature of the resident to show that they accepted responsibility for managing their own medication. Since then the person has become unable to manage their medication. However the care plan has not been updated, so new or relief staff would not be aware that they now need support with this. Medication is delivered to the home by a local pharmacist in blister packs so that they are easy to use at the right times of day. Medication is securely stored but the room temperature of the ground floor medication room is often above the maximum temperature for medication storage. The heat in this room could compromise the chemical make up of the medication. The manager stated that a ventilation system is currently being considered by the Provider to reduce the heat in this store room. The lighting in this room is very poor so it must be difficult for staff to work in here. Most medication records were up to date, however one persons medication records had been hand-transcribed onto two consecutive medication sheets but staff had missed out one date (eg one record ended on 15th and the new record started from 17th of the month). In this way the home has kept no record of the persons medication for an entire day, so it is not possible to determine whether the resident had been given any of their medication or not for that day. Overall residents and relatives felt that people are treated with respect by staff at this home. One person said, They are all very kind to me - some are super. Another resident said, They look after me and treat me well. Two staff have recently had training as Dignity Champions. It is anticipated that they will look at practices in the home to make sure that peoples dignity is upheld. At this time people are not automatically offered a key to their own bedroom on admission. Although there is a lock for people to use on the inside of their bedroom door, they do not have a key to lock their door for when they go out of their room. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have support to lead a flexible lifestyle, but the lack of activities and information means that they have cannot make informed choices. Evidence: All the people who took part in discussions said that they can spend their day where they wish. Some people prefer to spend part of their day in the privacy of their own room, then join others for meals in the dining room if they wish. The home has a variety of homely lounges where people can watch TV or quieter rooms where people can chat. One visitor said,Its very warm and comfortable. Theres always a friendly atmosphere. However residents, relatives and staff were unanimous in their comments about the lack of activities. The record of activities for each resident on the ground floor has not been completed at all between June-November 2009. The activities co-odinator has been on sick leave for about a year and there has been no planned programme of daily activities in that time. One staff is now carrying out some ad hoc activities, such as dominoes or carpet bowls, there is a weekly exercise class, and there are occasional concerts on the ground floor for the people on this floor. However there is not sufficient activity on offer for a 60 place home. One staff said, There should be Care Homes for Older People Page 16 of 32 Evidence: more activities - residents are bored. It was most apparent in the dementia care unit that there are very few opportunities for people to engage in any social or therapeutic activities. There is little stimulus in this unit for people to engage in, for example reminiscence areas or rummage boxes. Some people in this unit had a care plan that stated they had a specific need for social stimulus. However the care plan evaluation records showed no activities provided for them or any plans for future activities. There was a steady stream of visitors to the home during these visits. Relatives commented that the staff are friendly and approachable. One visiting health professional said, Staff are courteous and respectful and I am always welcomed into the home. It is good practice that there are tea and coffee making facilities for visiting relatives to help themselves. Relatives commented that the home is a familiar resource in the local community and many visitors and residents recall when there was a school on the grounds (and some of the school buildings are still here.) The home is close to some local amenities including shops, although relatives and residents said there were not many opportunities for people to go out. There are noticeboards around the home and the manager produces a monthly newsletter with home news items and any planned social events such as themed parties. However there is no information for residents about any regular activities. Also there is no accessible information for people about forthcoming menus. At this time staff ask people what their choice is from two main options for the next day. This practice does not support people with short term memory loss. The lack of written information about menus choices for the rest of the day or week means people cannot make an informed choice. The home has a good range of dining rooms which are cheerful and pleasant, and tables are attractively set. People enjoyed a sociable dining experience. It is good practice that people can choose to dine in their own rooms or in a lounge if they prefer. People who needed assistance with their meals were supported in a sensitive way. The people who live here said that the quality of meals is very good. Meals are home-made and appetising. There are choices of traditional and modern dishes, and in most cases the meals were served to individual preference. Catering staff were knowledgeable about peoples preferences as well as any special dietary needs. However one person has recently decided to have a vegetarian diet, but this had not been communicated to the catering staff. As a result care staff only served vegetables Care Homes for Older People Page 17 of 32 Evidence: to the person as their main dish, instead of a balanced vegetarian option. Relatives commented positively on the quality of meals, although some felt it would be useful for care staff in the dementia unit to have a list of peoples individual drinks preferences, eg whether people take sugar, as some people may not be able to express this. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have information about how to make a complaint, but staff training in protection procedures does not sufficiently demonstrate that the safety of residents is safeguarded. Evidence: People or their relatives are provided with an information pack that includes details of how to make a complaint. Residents and their relatives also have opportunities to discuss concerns at anytime individually with the manager. Some relatives said that they would also feel comfortable about approaching the deputy manager with minor concerns. One relative said, If I have any worries, I feel I can speak to management, and help is always available. The home has had two recorded complaints over the past year that were investigated by the home and the complainants received a written response of the outcome. Four other complaints were dealt with through Safeguarding Adults procedures (which are led by Hartlepool Borough Council), so that several social and health care professionals were involved in looking into the complaints. These are robust procedures for dealing with suspected abuse.The manager is familiar with her responsibilities in this area. It was stated that staff have training in the protection of vulnerable adults (also called Care Homes for Older People Page 19 of 32 Evidence: POVA), and in discussions staff seemed to understand their responsibilities in this area. However at this time the training records are incomplete and there was no demonstration that staff are trained in POVA or in the local Safeguarding Adults protocols. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is well maintained so that people live in accommodation that is safe, warm, and comfortable. Evidence: Elwick Grange is a modern, purpose-built, two-storey home. There is level access into the reception area at the front of the home and there is a passenger lift to access the first floor. The home has wide corridor that makes it easy for people to get around. Overall the home is well maintained, and benefits from the input of a maintenance staff who carries out routine checks and repairs. There is good car parking at the front of the home and some seated, garden areas for people to enjoy in better weather. There is a good range of bathrooms in the home. However the assisted bathroom on the ground floor has been out of order for almost a year. This means that people who need to (or prefer to) use an assisted bath have to use the bathroom on the first floor. This means that they have to be transported through the reception area (often in their night clothes) to get to the lift to access the assisted bathroom upstairs. This compromises their dignity. Bedrooms are a good size and each has a private en-suite facility. Bedrooms are well decorated, comfortable and warm. Many people enjoy spending time in the privacy of their own room. It is good practice that the home has supported a married couple to Care Homes for Older People Page 21 of 32 Evidence: use one of their bedrooms as their private lounge. It is also good practice that doors in the dementia care unit are painted different colours to support people to distinguish between different rooms. There is also some signposting for people in this unit, such as names and numbers on doors, and pictures for bathrooms. The standard of odour control and cleanliness around the home was very good. It is clear that housekeeping staff work hard to keep this busy home so clean and hygienic. Many relatives and residents commented positively on the good hygiene and cleanliness within the home. The home has a well-equipped laundry and dedicated laundry staff. It is very good practice that the home has achieved a 5 star rating by Environmental Health Officers for its good food hygiene arrangements. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home provides suitable staff in sufficient number so that peoples needs can be met. Evidence: The staff team consists of a manager, a deputy manager, two team leaders, eight senior care staff and 28 care staff, as well as housekeeping and catering staff. There are also administrative, activities and maintenance staff. At the time of this visit there were 24 people living on the ground floor. The home provided three care staff and a senior carer. This is an adequate level of staffing for the number and needs of people living here on this floor at this time. At the time of this visit there were 28 people living on the first floor (that is, 14 people in each of the two units on this floor). The home provides four care staff (that is, two staff to each unit) and a team leader to support them. However relatives felt that it would be better if there were more than two staff on the dementia care unit to support people with engaging activities. Also some people need two staff to help with their personal care needs, so there may be times when there is no staff to supervise the remaining residents. In staff surveys several staff felt that the home provides good care and always puts Care Homes for Older People Page 23 of 32 Evidence: residents first. However they also felt that more staffing would support better activities for residents and would give them time to complete care plan records. Southern Cross is an equal opportunities employer and uses robust recruitment and selection processes to make sure that only suitable staff are employed here. In this way staff do not start work until satisfactory checks, references and police clearance (called a CRB disclosure) have been received. Around 72 of the care staff team have achieved a national qualification in care (called NVQ level 2 or 3). At the time of this visit the individual training records for staff were not fully completed and the group training record (called a training matrix) is not well kept. In this way the home was unable to demonstrate whether all staff have had satisfactory training to ensure that they are competent to carry out their job. During discussions some staff could recall having had a day of dementia awareness training in the past. However there were no records within the home to demonstrate whether any staff has had training in dementia care. Relatives also felt that people on the dementia care unit would benefit from a consistent, well trained staff team. One relative said, This unit needs staff who know the needs of the residents and are EMI (dementia care) trained. Issues about the standard of training records were recently raised by commissioning officers of the local authority during a monitoring visit. Since then a learning & development manager of Southern Cross has started working on individual training records for each staff member, but several gaps in training records still exist at the time of this visit. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The system of management has not been effective so that the protection of peoples safety is not sufficiently demonstrated. Evidence: The manager has worked at Elwick Grange here for around 5 years, mainly as the deputy manager. She has been carrying out the role of manager since December 2008, but at the time of this visit had not yet submitted an application for registration as the manager. The previous manager was in post for around 6 months and was also not registered in that time. This means that Elwick Grange has not had a registered manager in place for over 18 months. The manager is supported and supervised by an Operations Manager of Southern Cross Healthcare. The staffing structure of the home includes a deputy manager, team leaders and senior carers who are responsible for supervising the care of residents. In this way there are clear lines of accountability within the organisation and within the home. Care Homes for Older People Page 25 of 32 Evidence: However it was clear from discussions with the manager, staff and visitors that the manager takes on many more roles than her own, mainly to fill absences of other staff. For example some relatives described her as very hands-on and commented that she has even carried out housekeeping duties when a domestic staff was on sick leave. She also produces a monthly newsletter and makes herself available at most times of the day. One health professional said, The manager works long hours in many roles. However this has not supported the areas where there are notable managerial gaps within the service, for example auditing of care plans, health records, and staff training records. The manager consults regularly with residents and relatives for their views about the quality of the service. This is in the form of discussions with individuals, quarterly Residents Meetings, and drop-in surgeries twice a week. The Provider is a large national care organisation that has comprehensive quality assessment processes that includes monthly visits and audits by the Operations Manager or peer review by another manager. If requested the home will support residents to keep their personal monies safely. Their monies are kept in a group bank account. Using computerised statements, the home can then debit their account for services and purchases, such as hairdressing, chiropody and toiletries. Receipts are kept for each transaction. Any interest accrued is proportionately paid to each resident who uses the bank account. An amount of cash is securely stored in the home so that any resident who wants to withdraw money can do so. This system can also provide clear printed statements for residents or their representatives. The maintenance staff carries out and records routine health & safety checks of the building and equipment, for example water temperatures and fire alarm systems. These were in good order and up to date. It is good that the home has two staff who are trained as moving & assisting assessors as they can provide updated training to staff at anytime. However, according to the homes training matrix record, of 57 staff only half have current mandatory training in fire safety; only 14 have had some mandatory training in food hygiene; and only six have had current training in first aid. In this way it is not demonstrated that staff are trained to follow correct safe working practices. Some staff felt that training had previously been provided in these areas but could not recall when, and the manager accepted that this had not been recorded. Updated training is now being arranged. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 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, Care Homes 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 15 Where a primary care need 01/02/2010 is identified there must be a specific care plan that sets out those needs. There must be detailed guidance for staff in how to support those needs including a clear, coordinated approach involving care staff and any health professionals. Monthly evaluations must report a meaningful assessment of the progress or change in need. This is to guide all staff in how to support each person with their significant needs in a consistent, planned way, and to ensure that any changes in need are identified and acted upon. 2 8 15 Where assessments show a significant change to a residents health care needs (for example nutritional, 01/02/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 mobility or pressure care needs) there must be a care plan in place that includes details of the action being taken by care staff and health professional input, to support and improve their health. This is to ensure that people receive the right support with any changing health needs. 3 9 13 The home must keep a record of all medication administered to each resident. This is to ensure that there is a clear record of whether a person has taken their medication or not. 4 12 16 There must be opportunities for residents to engage in social and leisure activities. This is to ensure that they lead a fulfilling lifestyle where their social, physical and mental well-being is promoted. Care staff who work on the dementia unit must have suitable training in care of people with dementia-type needs. 01/02/2010 01/02/2010 5 30 18 01/03/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 This is to demonstrate that they are equipped to provide the right care for the people who live here. 6 31 8 The Provider must ensure that there is a registered manager in place. This is to ensure that the daily running of the home is managed by a person who has demonstrated they understand their legal responsibilities under the Care Standards Act 2000 and associated regulations. Training records must show that staff have current training in all mandatory areas of health & safety. This is to ensure that staff are fully trained in safe working practices when supporting the people who live here. 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 01/02/2010 7 38 18 01/02/2010 1 4 The home should be able to demonstrate that it can provide a specific service that meets the needs of people with dementia care needs. Care Homes for Older People Page 30 of 32 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 2 3 8 9 The home should keep a record of the results of any tests or samples carried out by health professionals. The temperature of the ground floor medication room must be reduced to ensure that is a safe temperature for the storage of medication. Where people manage their own medication there should be a clear assessment of their capability to manage and store their medication safely, that includes their input and signature. The assessment should be kept under review. People should be given a key to their bedroom door, unless a risk assessment determines otherwise. People should have written information about menus so that they can make an informed decision about their meals. Training records should demonstrate what training staff have had in protection of vulnerable adults and Safeguarding Adults protocols. The assisted bath on the ground floor should be repaired quickly so that people no longer have to be transported through public areas of the home to use alternative equipment. The home should keep a clear record of the training that each staff has completed to demonstrate their competency. The home should have a training and development plan to ensure that each staff is kept up to date with current practices. 4 9 5 6 10 14 7 18 8 21 9 30 Care Homes for Older People Page 31 of 32 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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