Inspection on 05/05/10 for Elwick Grange

This inspection was carried out on 5th May 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 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 18/11/09

Elwick Grange 12/03/08

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Little Sisters Of The Poor

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Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Random inspection report Care homes for older people Name: Address: Elwick Grange Elwick Road Hartlepool TS26 9LX one star adequate service 24/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Andrea Goodall Date: 0 5 0 5 2 0 1 0 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): Name of registered manager (if applicable) Southern Cross OPCO Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 60 Number of places (if applicable): Under 65 Over 65 16 44 dementia old age, not falling within any other category Conditions of registration: 0 0 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 Care Homes for Older People Page 2 of 12 2 4 1 1 2 0 0 9 Brief description of the care home 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 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 3 of 12 What we found: A random inspection was carried out on 5th May 2010. The reason for this inspection was to check whether the provider had complied with the requirements made at the last inspection on 24th November 2009. There have also been several safeguarding adults referrals since the last inspection. There has been a suspension of placements to the homes dementia care unit for the past month. The inspection visit was carried out by two inspectors. One inspector spent time in the dementia care unit, and carried out a SOFI (Short Observational Framework Inspection). SOFI helps us understand the experiences of people who are unable to tell us themselves and who are most likely to have the greatest care needs. It allows us to get an insight into the general state of well-being of individuals and staff interaction with people who use the service during the observation. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. At this time there were eight people living in the 16 place dementia care unit. There are two care staff on duty in this unit (and a floating senior care staff who also covers the other 16 place unit on the first floor). The SOFI showed us that overall there were positive interactions between staff and residents. Staff spend some time with each of the people who live in this unit, and engaged with them individually in chats, looking at books or magazines, and playing with games. Throughout the morning staff offered residents hot and cold drinks, ice lollies, plates of fruit and biscuits. People showed positive signs of well-being such a chatting to staff, smiling, singing to soft toys, and pointing to pictures in books. Care staff were warm and respectful in their discussions with residents, and validated and acknowledged any conversation that residents offered. One auxiliary staff was also warm and cheerful but occasionally used childlike expressions with residents, such as din-dins instead of lunch. A visitor commented that the activities in the dementia care unit has improved and felt that the lower number of residents means that people get a better service. They said that previously the unit has seemed frantic and task-orientated. They also felt that there had previously been some residents who were wrongly assessed for this unit as they had behaviours that distressed other residents, and took up most of staff time. It is unlikely that this staffing level could sustain the current good standard of service if the unit was fully occupied. The activities throughout the rest of the home have also improved. The home now employs two activity staff and people have better opportunities to enjoy activities inside and outside the home. Some residents now attend a Tuesday Club outside the home and activity staff take people for walks. On the day of this inspection there was also a visiting clothes show in the home for people to buy new clothes if they wanted. We looked at some care plans for people from main home and from the dementia care unit. Care plans are records that are used by all care services to show how each person needs support with their individual needs, for example mobility, personal hygiene, and Care Homes for Older People Page 4 of 12 emotional well-being. Since the last inspection the home has made care plans more detailed and clearer for staff to follow. The assessments have identified peoples main care needs and care plans were in place for their main activities of daily living. However some care plans are not fully completed. For example one person has behavioural needs and this is set out in a care plan. Recently the person has had several episodes of challenging behaviour, some of which resulted in safeguarding adults referrals and meetings. However the evaluations of this care plan were not completed for two months during that period. Also we saw from the care plans that when a new care need was identified, a new care plan was not put into place for this. An example of this was when one person had suffered from a severe nose bleed and this had required the insertion of a pack. The person had been prescribed cream to be applied following removal of the pack. There was no care plan in place to tell staff how to deal with this situation or what to do should it occur again. Another example was where a person had been admitted and identified as being at high risk of falls. A moving and handling assessment had not been completed, despite the fact that the hospital discharge letter stated that they do not always use their zimmer frame correctly. Care plans were not in place for people identified as being at risk from developing tissue damage. In some instances people had developed tissue damage but no care plans were in place to tell staff how to deal with this need. Other examples include a resident complaining of specific pain on a number of occasions but with no care plan in place. Where people had developed skin problems, for example soreness or cellulitis, we saw that there were no care plans in place to tell staff how to manage the problems. At this visit residents medications on the ground floor were looked at. We found that prescribed medications had not been administered on a number of occasions. Examples of these were non administration of drugs at the prescribed times as the person was sleeping. No review of medication administration times had been requested and so this person was not receiving their prescribed medication. Another person had missed the administration of eye drops on twenty occasions over a nineteen day period (prescribed three times per day) as they had either been sleeping or out for the day. There was no record that a review of the administration times had been carried out. There were no records of administration of prescribed creams where creams are kept in the residents bedrooms for care staff to apply. There was no instruction for staff to tell them how and when to apply the creams and nowhere for them to record this had been done. In one instance a record had been made in a persons care plan to say, creams applied numerous times during the day. One of the creams was a steroid cream that should only be applied at given times. Handwritten entries on the MAR (medication administration record) charts did not always have a witness signature or start date entered. We looked at the staff training records, staff training matrix and spoke to staff on duty Care Homes for Older People Page 5 of 12 and the manager. We saw that only nine staff had current first aid training. Some staff had not had any first aid updates since 2002. According to the matrix and staff training records, 15 staff had not received any fire training. The records also showed that some staff require updated training in health and safety issues such as moving and handling, food hygiene and infection control. The new manager said that she thought the staff training matrix was not a true reflection of the training that staff had attended, but could not provide any other evidence at the time of this inspection. Of the nine staff who work in the dementia care unit, only two had Dementia Awareness training. Another two staff from this unit have attended a one day training pack by the Alzheimers Society called Yesterday, Today & Tomorrow. In this way several staff do not have training in the main care needs of the people who live on this unit. Over the past few months there have been some instances of aggressive behaviour by a small number of residents on the first floor units. As a result about half of the full staff team (including most of the staff on the dementia care unit) have had recent training in managing challenging behaviour so they have a better understanding of how to support people when they are upset or angry. We looked at the management arrangements in the home. Elwick Grange has not had a registered manager in place for about 2 years. Over this period the home has been managed by two unregistered managers, and more recently by relief managers. In the past month a new manager has been appointed. She has previously been registered as a manager for other services, and is to apply to be the registered manager of Elwick Grange. Several staff and visitors commented that the new manager is very approachable and makes herself available to discuss matters. Staff stated that the morale has improved recently, and visitors commented that there is a better atmosphere in the home now. What the care home does well: What they could do better: There must be a new care plan whenever people have a new care need or goal, eg if they developed skin problems, so that all staff know how to provide the right care in the same way. The home must make sure that people get their medication, and if necessary should ask doctors if they need to change the time of the medication for people. The home must make sure that the record is kept of all medication that is given, including prescribed Care Homes for Older People Page 6 of 12 creams and ointments. All staff must have up to date training in mandatory health and safety matters, like first aid and fire safety. The records of staff training should be up to date at all times. All staff in the dementia care unit must have training in dementia care. The home should show how it keeps up to date with current best practice for dementia care, for example through links with national and local dementia care groups. All staff should have training in POVA (protection of vulnerable adults) and in the local council safeguarding adults procedures. 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 8 15 Where assessments show a significant change to a residents health care needs (for example nutritional, 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. 01/02/2010 2 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. 01/02/2010 3 30 18 Care staff who work on the dementia unit must have suitable training in care of people with dementia-type needs. This is to demonstrate that they are equipped to provide the right care for the people 01/03/2010 Care Homes for Older People Page 8 of 12 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 who live here. 4 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. 5 38 18 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. 01/02/2010 01/02/2010 Care Homes for Older People Page 9 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 15 Where a new care need is 11/07/2010 identified there must be a care plan developed that includes the action being taken by staff and any health professional input, to support and improve their health. This is to ensure that people receive the right support with any changing health needs. 2 9 13 The home must keep a record of all medication administered to each resident. Staff must ensure that people receive their medication. This is to ensure that there is a clear record of whether a person has taken their medication. Staff must ensure that people receive their medication in the way that it is prescribed. 11/06/2010 3 30 18 Care staff who work on the 11/07/2010 dementia care unit must have suitable training in care of people with dementia-type Page 10 of 12 Care Homes for Older People 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 needs. This is to demonstrate that they are equipped to provide the right care for the people who live here. 4 38 18 Training records must show that staff have current training in all mandatory areas of health & saefty (including first aid, fire safety,and food hygiene). This is to demonstratethat staff are fully trainined in safe working practcies 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 11/07/2010 1 1 The home should be able to demonstrate that it can provide a specific service that meets the needs of people with dementia care. It should be able to show how it keeps up to date with best practice, for example links with dementia care organisations. Training records should be able to demonstrate that all staff have received training in protection of vulnerable adults including the local safeguarding adults procedures. 2 2 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. 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