Inspection on 23/10/06 for Grace Manor Care Centre

This inspection was carried out on 23rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Grace Manor Care Centre 03/04/07

Grace Manor Care Centre 25/10/05

Grace Manor Care Centre 06/12/04

Grace Manor Care Centre 14/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Grace Manor Nursing Home 348 Grange Road Gillingham Kent ME7 2UD Lead Inspector Sue McGrath Key Unannounced Inspection 23rd October 2006 15:00 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 Grace Manor Nursing Home DS0000026175.V315788.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. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grace Manor Nursing Home Address 348 Grange Road Gillingham Kent ME7 2UD 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) 01634 570230 01634 580469 Grace Manor Care Limited Post Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Terminally ill (4) of places Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit service users who require nursing care from the age of 55 years. 25/10/05 Date of last inspection Brief Description of the Service: Grace Manor is a Nursing Home for Older People. The home caters for 60 people with various nursing needs. The main part of the home was an old Manor House and the décor etc. is in keeping with the period of the home. The new addition affords service users en-suite rooms and there is plenty of day space to choose from. There is a courtyard garden at the centre of the home, which is a suntrap in the summer, which service users enjoy and benefit from. The home itself is set in generally well-maintained grounds and overlooks the river Medway. The nearest town is Gillingham, which has a main line railway station and high street stores. There is some parking to the front of the building. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place over the course of two and a half days. Two inspectors were involved with the inspection. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. Service users returned several comments cards. During the inspection several visiting families were spoken with and asked to give their views on the home. Meals were seen and the activities viewed. The home stands in its own grounds and was originally known as The Grange, the internal décor is in keeping with the period of the home. New home’s are currently being built around the home and some residents have enjoyed watching the progress of the estates. None complained of any disruption. Fees: Range from £509.00 - £749.50 What the service does well: The home offers a homely environment in which to live and staff are caring and friendly. The residents enjoy a high level of organised activities but can also benefit from a one to one session if they prefer. Residents can also benefit from help in opening their private mail if they so wish. High emphasis is placed on encouraging the residents to maintain their independence for as long as possible but help is always offered when this is no longer an option. The home works closely with the local PCT and is developing good palliative facilities. The staff group is committed to providing a good service to the residents and works well as a team. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 6 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 7 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 Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users do not have access to a current statement of purpose or service users guide. Service users are protected by a contract that reflects their terms and conditions and right and responsibilities. Some service users are not having their needs fully met. EVIDENCE: The home’s statement of purpose and service user guide were viewed and found to be in need of updating. The documents did not reflect the recent changes made to the registration of the home and the management and staff organisation charts were out of date. The home had combined the two documents and it is recommended that these be produced as separate documents as they serve different purposes. It will also be a requirement that Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 9 the updated documents are made more available to all residents, and new residents and their families. Several service users and families who were spoken with were not aware they were in place. Evidence was seen in service users files that the home conducts extensive preadmission assessments to ensure they can meet the new residents needs. The manager stated that they tried not to accept emergency admissions if possible. Families confirmed that they had been involved in the admission process. Evidence was also seen that residents were issued with legal contracts and terms and condition, which gave details of terms and conditions and rights and responsibilities. Some concern was raised over the level of residents who appeared to be suffering from dementia, as the home was not registered for dementia care. Staff spoken with confirmed that they had not received training in either dementia care or challenging behaviour. The home will be required to ensure they remain within their registered category or apply for a change. The nursing needs of the residents appeared well met. The home must not continue to admit service users with a diagnosis of dementia and must consider their registration categories. The manager confirmed that all residents were offered a trial period of normally four weeks to ensure they are happy to remain and that the home can meet their needs. Visiting family members confirmed this was normal practise. The home does not offer intermediate care. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 10 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, 9and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents benefited from detailed care plans some areas of the plans need to improve. The health needs of individual’s were mainly well met and residents benefited from good multidisciplinary working. The number of residents with dementia needs to be assessed to ensure that the home is not in breach of its registration conditions. The residents’ welfare was protected by the home’s policy and procedures with regard to the handling and administration of medication. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 11 EVIDENCE: Four care plans were reviewed and were in fairly good order. It is recommended that these plans be dated and signed by service users and or relatives to evidence that they agree with the care plans. Evidence was seen that they were reviewed but the reviews dates were intermittent and not always done on a regular basis. Some were reviewed more often but the majority of the reviews did not record any changes. When spoken with residents were unaware of these plans and more effort should be made to ensure they are fully consulted with their care where possible. Few plans gave details of the care that should be offered in the case of death. The home has struggled to find a way to obtain this information and needs to continue to work towards achieving this standard. Staff require guidance on the best way to approach this delicate subject with families. All of the residents were registered with a local GP and had full access to specialist medical, nursing, dental and chiropody services as needed. Some nutritional assessments were completed. It is recommended that all new residents have a nutritional assessment undertaken as part of their admission process. Information regarding nutritional assessments was left with the manager. It was noted that the majority of residents were weighed regularly and that the home had specialist weighing apparatus. Evidence was also seen that the home managed tissue viability well and has a named specialist viability nurse in the home. Medication was reviewed and the records evidenced that the home mainly followed the Royal Pharmaceutical Guidelines. However the home’s Policy need to be updated as it does not reflect the current practise used, in that it states the home’s uses the Nomad system. There is the possibility of errors being made due to the different start dates of some of the medication in the blister packs. It is recommended that the home’s works closely with their Pharmacist to ensure that all medication start on the same day to reduce the risk of residents accidentally being without medication or using different packs. There is a high level of drugs being administered directly from pharmacy packs. The manager is advised to review the medication procedure to ensure the level of risk is reduced as far as possible. RGN are responsible for administering medication and one spoken to stated that she had recently completed a recognised ‘Safe Administration of Medication’ course, which she found very informative. It is recommended that all RGNs complete this course to ensure they maintain their expertise in this area. The controlled drugs registers were viewed and found to be in found order. During the course of the inspection staff were seen to be respectful of the residents and used appropriate terms of address. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Service users social and recreational interest and needs are well provided for with a wide range of activities organised. EVIDENCE: The home now has only one activities co-ordinator who works Tuesdays to Fridays and offers a full programme of activities within those times. This included bingo, musical movement, indoor bowling, quizzes, armchair exercises, giant hangman, a video club, musical karaoke, a library round and ball exercises. Organised social activities so far this year included Belly dancers, professional entertainers, a bonfire night party with a barbeque, a Halloween party, a summer fete and a strawberry cream tea event. Various Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 13 other social evenings were arranged with families being invited to attend all these activities. Local schools attend at Christmas time to sing carols and a local minister visit every two weeks. The activities co-ordinator will also assist residents with their private mail if they wish. Residents are encouraged to exercise choice and control over their lives where possible but staff were willing to assist if necessary. Residents confirmed they could bring I personal items on admission and the manager confirmed this was encouraged within the boundaries of health and safety requirements. The majority of the residents said the food was nice and that they had a choice. The manager confirmed that where possible fresh produce were always used. Three full meals were available every day with drinks readily available. Evidence was seen that the residents were offered a full choice at every meal. One new service users was extremely pleased that he could have a coked breakfast every day if he so wished. Specialist diets could be provided when advised by health care professionals. Staff were seen to assist those residents who required feeding in a caring and sensitive manner. One major area of concern was the conditions of the kitchen both from a structural and cleanliness point of view. This will be discussed in more detail later in the report (standard 27 and 38). Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 14 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): 16and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear and effective complaints system in place but service users and families appear unaware of its contents. Service users are protected by robust adult protection policies and procedures but staff remain untrained in this field so have the potential to put service users at risk. EVIDENCE: The home had a written complaints procedure, which was contained in the service user guide seen in the foyer, however families spoken with were unsure of the contents and where also unsure if the home had a formal procedure. The majority of families spoken with did say that if they had any complaints they would not hesitate to talk to the manager. The home had received four complaints since the last inspection. Details seen in the complaints folder confirmed all had been dealt with appropriately. The home had also received many compliments from families regarding the level of care offered to their loved ones. The home had adopted the Kent and Medway Adult Protection Policy and Procedures. Staff were spoken with displayed a reasonable knowledge of adult Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 15 protection but did confirm that they had not received formal training on the subject. Some had only covered Adult Abuse during their NVQ studies. It will be a requirement that all staff undertake Adult Protection training. The home has had one Adult Protection allegation since the last inspection and had co-operated fully with the investigations and completed the recommendations following the outcome. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 16 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, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a mainly clean environment and have safe access to comfortable indoor and outdoor communal areas. The kitchen requires urgent refurbishment. EVIDENCE: A general tour of the building was undertaken and some of the bedrooms were viewed. The home generally was found to be clean and tidy. Some odours were noted in the main foyer and in some of the bedrooms but the staff were working diligently to address these issues. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 17 The area of major concern was the condition of the kitchen and the inspection then focussed in this area. This is dealt with in more detail later in the report. (Standards 27and 38). When asked the senior confirmed that the issue of the condition of the kitchen had been raised previously with the owner and quotes for a refurbishment had been obtain but not acted upon. It will be a requirement that urgent remedial work is undertaken in the kitchen to ensure the health safety and welfare of the residents. The outside of the home is starting to look in need of redecoration and the main driveway is in need of repair. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ care, social and emotional needs are promoted by the employment of care staff in sufficient numbers. However they are at risk of harm and abuse due to inadequate staff training in basic skills. Service users health is seriously at risk due to the failure of the home to ensure and that the kitchen is maintained in a clean and hygienic state and free from dirt and unpleasant odours. (27.4) Service users are not fully protected by the recruitment procedures within the home. EVIDENCE: The ratios of care staff to service users is determined according to the assessed needs of residents, and a system operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. The home currently provides 784 hours for day care and 420 hours to support service users at night. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 19 From discussions with the manager, observations by both of the inspectors and reviewing the staff rotas sufficient staff were on duty at the time of inspection to meet the service users needs. The home employs 15 ancillary staff who work as cleaners, laundry cooks, gardener and maintenance staff. Thus allowing care staff the time to meet the needs of service users. However a shortfall was noted with regard to Nurses. The home is separated into three living areas. Randell currently has 17 service users supported by one Nurse. Abbey and Jubilee share the same staff team and currently at time of inspection had 23 service users. However they are at present only supported by one Nurse. The current shortfall in nursing cover is being provided by the Area Manager who is also a qualified Nurse. The manager is also a Nurse and supports staff where needed. The inspector discussed staffing with the manager and it was accepted that additional nursing hours were needed within the home. The manager was aware of the shortfall and was intending to recruit additional nursing staff and include it within the home improvement plan. In the view of the inspectors domestic staff are employed in sufficient numbers to ensure that standards relating to food are fully met. However at time of inspection the kitchen was found to be in a un-hygienic state. Standards of general cleaning, storage of food, procedures / working practices to ensure food hygiene and compliance with Health and Safety legislation was found to be very poor. Evidence relating to health and safety is more fully detailed under standard 38. The staff training records indicated undertaken training for some of the staff. A number of staff had not received any training according to the evidence seen. Individual and group staff training needs had also not been identified. From the evidence seen at time of inspection many staff within the home had not carried out basic training in many core skills. These courses included fire, health and safety, first aid, adult protection, moving and handling, food hygiene and infection control. The home was requested to carry out a training needs analysis and priorities training within the home and include within the home’s improvement plan. Dementia training was also identified as a need within the home to enable staff to support service users further. The home was unable to evidence that a minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) has been achieved. At present only 25 of the care staff have obtained a qualification. On information supplied by the home 10 staff have completed and 14 are completing a qualification. The manager was aware of the shortfall and will address this as part of the training requirements of the home. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 20 Grace Manor is required to ensure that there is a staff training and development programme, which meets National Training Organisation (NTO) workforce training targets and ensures staff fulfill the aims of the home and meet the changing needs of service users. 30.2 and that all members of staff receive induction training to NTO specification within 6 weeks of appointment to their posts, and foundation training within 6 months. At present the home’s induction programme for new staff does not meet with guidance and therefore does not meet with the standards. The manager is aware of this shortfall and is proposing to introduce a package of induction that meets with the required standards in future. The home showed that it undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of I.D and copies of qualification certificates, seeks two written references, confirms work status and also undertakes some telephone checks. The home’s recruitment files were seen however to be in some need re – organisation and not all of the files sampled retained all the information as required under schedule 2 of the Care Home Regulations 2001. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 21 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, 34, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users can be assured that their personal finances are secure. Staff are not adequately supervised. Service users health and safety is at risk due to the home’s failure to ensure that the home meets fully with legal health and safety requirements and that staff have received training that relates to the duties they perform. EVIDENCE: Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 22 The Manager had been in post for only two weeks at the time of the inspection but had worked at the home as its senior nurse for many years. She held the required qualifications and experience’ to register with the Commission as Register manager and was in the process of completing her application. The previous manager had left the organisation some six months previously. Throughout the inspection both the manager and area manager were open and honest and assisted in the inspection. Both managers were aware of some of the issues raised and were working diligently to address them. Staff confirmed that both were approachable and communicated a clear sense of direction and leadership. Quality assurance was discussed and although the home does undertake some basic assurance by means of asking residents to complete questionnaires they do need to expand on this to ensure full compliance with standard 33. The manager is strongly advised to familiarise herself with this standard and to implement quality assurance and quality monitoring system based on seeking the views of service users, families and of stakeholders in the community such as doctors, care managers and other professionals. This will enable the organisation to ensure it is meeting the goals they set out in their own Statement of Purpose. The organisation needs to develop a written business and financial plan for the establishment, which can then be open to inspection and be reviewed annually. Residents’ families are encouraged to handle the monies of residents who are unable to manage them themselves. The home only deals with small amounts of personal monies on behalf of residents. The records for these were viewed and found to be in good order. The system in place ensured that residents could be confident that the monies were handled securely. Two accounts were audited and balanced. Monies are kept separately in a safe. The home is again advised to ensure that residents do not go overdrawn on their personal accounts. Staff supervision was again discussed. It had been a requirement from the last inspections that all staff receive structured supervision. On examination of the records it was again found that this was patchy. Some senior staff had undertaken supervision training and now felt confident to undertake this aspect of the role, but the whole procedure needs to be better monitored to evidence that it is actually happening. Senior cares also require supervision, as do the nurses. The recording of supervision was discussed in detail with the manager and a further requirement will be made and it is strongly advised it is implemented. The home had numerous policies and the majority of these should be reviewed, especially as the home had a new manager. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 23 The inspector viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The inspector viewed the Fire Log book, which was on the whole up-to-date. The inspector was able to evidence that checks and servicing of fire safety equipment / emergency lighting had been undertaken at the required frequency. However some significant shortfall were noted. Several of the fire doors within the home did not close thus providing an opportunity for fire / smoke to move from one fire zone to another. Some of the fire door were propped open with chairs, and many other items The manager was not in possession of a fire risk assessment which had been agreed by the fire officer. Many of the staff had not received fire training and fire notice’s and fire zone area notice’s were held on to the walls with a variety of blue tack and tape. It was recommended by the inspector that the home puts together a fire book that would be stored at the entrance to the home that would provide vital information to any attending fire officer in the event of a fire. It was suggested to the manager that such a fire book could include plan of the fire zones, fire risk assessment location of any oxygen cylinders or explosive / highly combustible materials, evacuation plan, current list of service users and procedures / protocol for evacuating bed bound service users or moving them to another fire zone. This is not an exhaustive list and consultation should be sought from the fire officer with regards to what he considers as what information would be helpful / required. Not all of the electrical cupboards had a lock. The inspector requested one to be fitted as a priority. A broken lamp was found within one of the service users bedrooms. This was removed straight away. Wardrobes it some of the bedrooms were found to be unsafe and not secured to the wall. Some of the window restrictors were broken and in – operative. Many of the bathrooms / toilets were cluttered. Used gloves were found left on the side and one of the baths did not have a thermometer and the bath lift was in-operative and the wiring appeared unsafe to the inspector. Portable appliance testing was last carried out in April 05. Therefore was overdue. The home was unable to evidence that recommendations following a gas safety inspection on 12th September 2006 and an electrical test had been carried out. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 24 Staff training was evidenced as being poor with regard to first aid, food hygiene, fire, health and safety, infection control and other mandatory courses for the majority of staff. During a tour of the building accompanied by the manager, which included the kitchen, serious concerns were brought to the attention of the manager with regard to the standards of hygiene found within the kitchen. Many areas of the kitchen were found to be dirty which in the view of the inspector poses a risk of food contamination or a heightened risk to service users of food poisoning. Black mould was found growing on kitchen appliances along with out of date food stored in several cupboards. Mops were stored inappropriately in the kitchen along with personal items like cigarettes and mobile phones. A food temperature probe did not have a sheaf covering it and was stored in a dirty kitchen draw. Some recordings of food temperatures taken were evidenced. Staff working within the kitchen were following poor hygiene / working practices. Many breaches of good practice and food hygiene regulations were evidenced. The freezer was heavily iced with had uncovered food, which had suffered from freezer burn. The two fridges contained uncovered food with raw meat stored next to cooked meat. The fridge was found to be dirty with black mould growing on some of the shelves. Although basic recording systems were it place with regard to monitoring fridge temperatures, one fridge was reading 8 degree’s well above the recommended maximum of 6 degrees. Stagnant water was also found in the bottom. Staff thought a new one had been requested but were unsure if it had actually had been ordered The above is not an exhaustive list but provides a picture of evidence that the home has not taken all reasonable steps to ensure the safety of service users and in the view of the inspector was in breach of Health and Safety Legislation. A Notice of Immediate Requirement for action was issued at the time of the inspection and the home was required to take immediate action within 48 hours to advise the Commission what steps it was taking to address the issue raised with regard to the hygiene and working practices within the kitchen to ensure the safety of all service users within the home. The inspector does recognise that extensive cleaning took place within 24 hrs. The manager was requested to include within the home’s improvement plan on how it will take steps to ensure as far as possible the health and safety of service users and fully comply with the standards relating to Health and Safety. Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 25 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 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 X X 3 3 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 3 3 2 2 1 Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 26 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP36 Regulation 18(2) Requirement Care staff receive formal supervision at least 6 times a year. Supervision covers: All aspects of practise Philosophy of care in the home Career development needs Timescale for action 31/12/06 2. OP27 18(1)(a) All other staff are supervised as part of the normal management process on a continuous basis. This is outstanding from the last inspection. Staffing numbers and skill mix of 31/12/06 qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. This refers to Nursing staff. This is outstanding from the last inspection. A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved, excluding the registered manager and/or care manager, and in care home’s providing nursing, excluding DS0000026175.V315788.R01.S.doc 3. OP28 18(1)(a) 31/12/06 Grace Manor Nursing Home Version 5.2 Page 27 those members of the care staff who are registered nurses. This is outstanding from the last inspection. 4 OP1 4 and Schedule 1 The home’s statement of purpose and service user guide must reflect the aims, objectives and philosophy of care, services and facilities and reflect current management structures. The kitchen must be refurbished, as it is not fit for purpose. 31/12/06 5 OP19 23 (2)(d),5 16(2)(j) 31/12/06 6 OP27 18(1)(a) 7 8 OP18 OP30 13(6) 12(1)(a) (b) 18(1)(a) (c) 12(1)(a) (b) 18(1)(a) (c) 12(1)(a) (b) 18(1)(a) (c) 19 12(1)(a) 13(2)-(4) The manager must be able to evidence that the cleanliness of the kitchen is regularly monitored All staff must receive training in Adult Protection All staff require training in dementia care and challenging behaviour. All staff must receive mandatory training and a training matrix must be supplied to the commission. All members of staff must receive induction training to NTO specifications within six weeks of employment and receive foundation training within the first six months. Staff files must contain all of the information listed in Schedule two of the Care Standards Act. The registered person must ensure the health, welfare and safety of the residents and staff by ensuring safe maintenance is carried out on all equipment and services. The registered person must be able to demonstrate the home’s capacity to meet the assessed DS0000026175.V315788.R01.S.doc 31/12/06 31/12/06 31/12/06 9 OP30 31/12/06 10 OP30 31/12/06 11 12 OP29 OP38 31/12/06 31/12/06 13 OP4 12(1) 14(1)(d) 31/12/06 Grace Manor Nursing Home Version 5.2 Page 28 needs of individuals admitted to the home with dementia 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 OP11 Good Practice Recommendations It is recommended that daily record keeping is detailed and consistent. It is recommended that the care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed and recorded on the care plans. All staff require guidance on how to approach residents and families on this subject. It is recommended that the statement of purpose and service users guide be separated into two documents. It is recommended that nutritional assessments be undertaken on all new service users and then on a periodic basis. It is recommended that all nurses undertaken a recognised course on the Safe Administration of Medication. It is recommended that consideration be given to the condition of the outside of the building including the driveway. It is recommended that the manager seeks registration with the Commission as soon as possible. 3 4 5 6 7 OP1 OP8 OP9 OP19 OP31 Grace Manor Nursing Home DS0000026175.V315788.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local 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 Grace Manor Nursing Home DS0000026175.V315788.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. 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