Inspection on 14/11/05 for Grange Nursing Home

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grange Nursing Home 25/11/08

Grange Nursing Home 17/05/07

Grange Nursing Home 16/05/06

Grange Nursing Home 12/05/05

Grange Nursing Home 16/11/04

Grange Nursing Home 16/04/04

Grange Nursing Home 19/08/03

Grange Nursing Home 17/09/02

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

CARE HOMES FOR OLDER PEOPLE Grange Nursing Home Grange Drive Heswall Wirral CH60 7RU Lead Inspector John McCabe Unannounced Inspection 14th November 2005 09:30 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 Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 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. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Grange Nursing Home Address Grange Drive Heswall Wirral CH60 7RU 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) 0151 342 6461 0151 342 8299 Grange Nursing Home Course Change Limited Helen Stringer Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: Grange care home is situated in Heswall on the Wirral Peninsular. The home is located close to amenities such as shops, pubs, and a public library. The home provides nursing care for 30 residents. All residents have their own GP, specialist nurses visits the residents when needs arise; all residents have access to their NHS entitlements. There are comfortable lounges and a dining room; residents may entertain their visitors in the communal lounges or in their own bedrooms. Ample car parking space is available to the front of the home, well cared for gardens to the front and rear of the home. Therapeutic diets can be catered for in the home, for residents who have a medical condition. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 0930 hours both the registered provider and the registered manager were on duty. A full tour of the premises took place; the home was clean and tidy. Both staff and residents were spoken with about the service. Residents informed the inspector that home was a happy place and staffs were caring, and always polite and courteous to them. All relevant documentation for residents and staff were reviewed. The unannounced inspection took three hours. What the service does well: 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. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 6 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 Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, The homes admission procedures are well documented and includes various risk assessments for the residents, this ensures that the home stays within the category of resident agreed with the commission, and that the residents identified care needs can be met by the skill mix of the workforce in the home. EVIDENCE: All residents in the home are provided with a statement of terms and conditions, plus a contract when they move in to the home on a permanent basis. Residents are able to visit the home or have an overnight stay before they move in on a permanent basis. The homes senior nurses undertake a nursing pre admission assessment on residents before they are admitted to the home. Other health care professionals known to the resident are also involved in the assessment. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 8 Care staff in the home undertake specialist care training, i.e. dementia care, challenging behaviours, diabetes etc. The training is ongoing; to ensure that the assessed and changing care needs of the residents can be met. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8.9.10,11. Care plans, risk assessments, daily health records for the residents are up to date and checked monthly by the senior nurse in the home. This ensures that the care needs of the residents are identified, and the appropriate care given by carers. EVIDENCE: All residents in the home have an individual care plan, which is initiated on admission to the home, and reviewed by the senior nurses on a monthly basis. Health records are documented daily for each resident, this includes any critical incidences plus any visits from GPs, specialist nurses etc On the day of the inspection, no pressures sores on residents were reported to the inspector and it was positive to note that most of the care staff have undertaken training on tissue viability. The Primary Care Trust (PCT) tissue viability nurse will visit the home at any time if needs arise. No resident in the home self medicates, all medications for residents are administered by the nurses in the home. The protocols for the receipt, storage, and documentation of medications in the home are in accordance with the Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 10 National Minimum Standards (NMS). A Clinical Waste Disposal Company is responsible for removing the unwanted drugs of the residents. Resident’s documentation is kept secure in accordance with the Data Protection Act 1998. The residents told the inspector that their privacy and dignity is always respected when personal care is being undertaken for them, especially in the shared bedrooms. Some of the residents have informed the home manager what funeral arrangements and death rites they prefer. All residents in the home can access their NHS entitlements, which include, dentists, chiropodists and opticians. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Residents have choice and flexibility how they spend their day in the home, and pursue leisure activities according to their choice and preferences. This allows independence and individuality for each resident. Residents receive a balanced diet offering variety, which reflects the residents’ preferences. EVIDENCE: Residents in the home are asked on admission, about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in. A physiotherapist and occupational therapist visit the home weekly and undertake activities with residents who choose to do so. There must be documented evidence of how residents participated in the organised activity; it should be recorded in the resident’s personal file. Visitors are allowed in the home at any reasonable time of day and residents may entertain their visitors in the garden (in summer months), communal lounges, or in their own bedroom. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 12 The residents told the inspector that they enjoyed the variety of food in the home, and were looking forward to their poached chicken and/or savoury mince for lunch. Some of the residents prefer to take their meals in their own room rather than go to the dining room. This choice is respected and catered for. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17, 18. The homes policy and training programmes for POVA, and Whistle blowing, ensure that the homes residents are protected from any potential abuse. EVIDENCE: There have been no internal complaints, or complaints to the commission since the last inspection. The home has robust complaints procedures, which are documented in the residents guide and the staff handbook. Many of the residents used their postal vote in the last General Election. The care home has up to date information on the Protection of Vulnerable Adults. This information is communicated to new employees on their induction course. On the day of the inspection there was evidence that many of the staffs in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. The standard of the homes environment is good, providing residents with an attractive, safe and homely place to live. EVIDENCE: The home is clean and tidy, and is decorated to high standard. The resident’s ground floor lounge has recently been decorated and looks very bright and welcoming. On the day of the inspection the homes kitchen was being completed after refurbishment. The front and rear gardens of the home are well maintained and cared for. A number of residents informed the inspector that they enjoyed sitting out in the warm weather. Many of the residents have personalised their own bedrooms and those residents who share a room have consented to do so. Screens are available in Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 15 shared rooms to ensure privacy when personal care is being provide for a resident. There are adequate communal bathrooms and toilets; most of the bathrooms have assisted baths for residents who need help bathing. Recently, all the homes water storage tanks were cleaned, and the water supply tested for Legionella bacteria, which proved negative. The homes infection control policy is up to date and includes the prevention and spread of Methicillin Resistant Staphylococcus Aureus (MRSA) and Hepatitis B. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The standard of vetting and recruitment practice has declined with the appropriate checks not being carried out on new staff. This means that the residents are at potential risk. EVIDENCE: Personal files of newly appointed staff were reviewed, all new staff in the home have up to date and valid enhanced CRB/POVA clearance certificates. However, the application/reference documentation for a recent employee (carer) was not satisfactory. The file contained a limited work history, (nine months) which did not match the referees that were stated on the application form. The carer provided two referees, both requests for references sent out by the resigistered persons, were returned to the care home as “Unknown”. A written reference from a recent employer was available, who stated that the carer had been in employment for one year, but on the carers application form it stated that he had only worked in the same company for four months. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 17 The registered persons assured the inspector that documentation for this carer would be re checked, and the carer risk assessed before being allowed on duty again in the home. The inspector evidenced the Personal Identification Numbers (PINS) of some of registered nurses in the home, which was documented on Nursing Midwifery Council (NMC) stationary. However, three of the registered nurses PINs were out of date (August and October 05). Nurses do have an individual responsibility to ensure that their PINS are up to date and valid; also the registered person must also ensure that nurses working in the home are properly registered with the NMC before being allowed to undertake the duties of a registered nurse in the home. A legal requirement will made in this report to ensure that the registered person has the PINS of the registered nurses working in the care home. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. EVIDENCE: Both registered persons have successfully achieved the NVQ Level 4 qualification; the homes manager is a first level nurse with 21 years of care home management. Three registered nurses were on duty supported by care workers and ancillary staff during the unannounced inspection. Staff and residents told the inspector that, the home was run in an open transparent way with both staff and residents having regular meetings with the manager; the meetings are minuted and actioned upon. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 19 All staff in the home have documented supervision six times per year, and this helps to ensures that all staff have the opportunity to discuss with the manager and other senior nurses, any issues, which can effect or improve the care for the residents. Documented supervision of all staff gives the staff and managers opportunities to discuss their own /or identified training needs. Where possible residents look after their own financial affairs as the home doesn’t hold any bank accounts for individual residents. The homes certificates of insurance and worthiness for machinery, gas, electricity, fire equipments, lift, hoists were in date and valid, including the homes Employers Liability Certificate. Currently, there is no trained first aid person on night duty; the registered person is required to ensure that personnel are given formal first aid training. Both residents and staff files are kept secure in accordance with the Data Protection Act 1998. Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 18 Requirement Timescale for action 31/12/05 2 OP29 18 3 OP38 13 The registered person must ensure that all new staff appointed to the home have authentic documentation and two references, one from the previous employer. The registered person must 31/12/05 ensure that all Registered Nurses working in the home have up to date Personal Identification Numbers (PINS) issued by the Nursing Midwifery Council (NMC) The registered person must 31/12/05 ensure that a member of the night staff has valid in date First Aid Certificate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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 Grange Nursing Home DS0000020907.V262276.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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