Inspection on 17/05/07 for Grange Nursing Home

This inspection was carried out on 17th May 2007.

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 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 16/05/06

Grange Nursing Home 14/11/05

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 Julie E King Key Unannounced Inspection 17th April 2007 09:15 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.V335388.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. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 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 roy@grangenursing.entadsl.com 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.V335388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2007 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 visit 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.V335388.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was completed in one day as part of The Grange’s key inspection. During the visit some members of staff, residents, management and multidisciplinary healthcare team (MDT) members were spoken to. Most areas of the internal environment were also inspected. Documentation, especially staff files, resident’s care files and medication administration records were examined. What the service does well: What has improved since the last inspection? What they could do better: The accuracy of the daily reports needs to be improved, especially references to resident’s falls; and all staff training and personnel records require improvement. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 6 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. Grange Nursing Home DS0000020907.V335388.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 Grange Nursing Home DS0000020907.V335388.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): 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs appear to be met, and the home is now able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: Since the previous inspection the provider has invested in a completely updated pre-admission assessment and care planning system which was being implemented for all residents at the time of this inspection. All residents now have a pre admission nursing assessment before they are admitted to the home; the manager, or one of the nurses in the home undertakes the assessment. Residents, family and other health care professionals known to the resident contribute to the assessment. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 9 Pre admission assessments provide an assessment of actual and potential needs of each prospective resident; thus allowing a care plan to be developed. It was required that the pre admission assessment tool is utilised in more detail to ensure that all prospective resident’s needs are fully identified, therefore providing adequate information upon which to formulate a more detailed care plan. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS outpatients appointments, opticians, dentistry, and tissue viability nurse specialist (TVNS) input at the home when needed. Grange Nursing Home DS0000020907.V335388.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): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s individual health, personal and social care needs are recorded, providing staff with most of the information they need to meet each resident’s care needs. Medication management is inadequate, potentially placing residents at risk. EVIDENCE: A random selection of resident’s care files were examined, including newly admitted residents and any resident with a wound. All care files seen were in process of being updated to reflect the expectations of the national minimum standards, and all seen evidenced a significant improvement since the previous site visit. Risk assessments have been expanded and are now more detailed regarding resident’s care needs related environmental risks such as those associated with the use of bed rails, immersion bathing, etc. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 11 Medications were not fully compliant with regulations. This is the second concurrent time this has happened. The findings of concern were gaps in the medication administration records (MARs), especially for ‘as needed’ medications; and the medication fridge and room temperatures were outside of the required ranges. Numerous eye medications were stored in the fridge, despite the fact that some of them are supposed to be stored at room temperature. Grange Nursing Home DS0000020907.V335388.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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. 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, such as outings, bingo and manicure therapy. Since the previous inspection a designated activities co-ordinator has been recruited for 20 hours per week- a welcome addition to the staff team according to residents and relatives spoken to during the site visit. Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors in the communal lounges, or in their own bedroom. The gardens are accessible and tidy, and are an ideal setting for residents to sit with their relatives, especially in the summer months. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: The Grange has an efficient complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that service users, relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’ (reporting concerns regarding poor practice), in accordance with the Department of Health ‘No Secrets’ guidelines. The CSCI has not received any complaints about this service since the previous inspection and site visit. Most of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most resident’s rooms are personalized, providing the residents with a homely, comfortable place to live. EVIDENCE: The Grange has pleasant gardens to the front and rear of the property that are accessible to residents. A patio area with seating is also provided. The home benefits from a conservatory and an additional quiet lounge for relatives and families to use as they wish. Most communal areas and bedrooms were examined, and some evidenced ongoing decoration and / or refurbishment, albeit to varying degrees. Bedrooms were highly personalised, with many service users bringing in their own furniture, etc. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 15 There were two rooms that had a slight malodour, and the inspector was informed that consideration is being given regarding management of this problem which will be resolved as soon as possible. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a consistency within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: A selection of staff personnel files were examined as part of the case-tracking process. Some files contained the required documents and records, but most are still in process of completion. CRB and POVA evidence was available, as were references, some training information, NVQ training, proof of identification and basic inductions. Records of staff training lack sufficient detail and do not evidence the competence of staff to do their jobs. The specialist care training needs of staff must be reviewed to ensure the health, safety and well being of all residents. Supervision records are below the required standard, a further requirement will be issued to ensure that all staff files contain all the required information and records as required under the Care Homes Regulations 2001 (Amended 2006). Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 17 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): 31,33,35,37,38. Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. There is adequate leadership to staff from the home’s management that helps provide stability for residents. EVIDENCE: The manager is a first level nurse who has been in post for many years. The manager appears not to have had regular documented support and supervision, thereby limiting effectiveness in her role. This needs to be addressed in order to ensure that the leadership provided at the care home is good and will also help to ensure that the manager can be more effective in–a key component of the internal quality assurance processes, assisting the care home to meet National Minimum Standards. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 18 All staff receive training in fire prevention, and have fire drills, but not at the necessary frequency as required by the fire authorities. The registered provider and the inspector discussed the requirements for staff fire drills and training, and the need for a designated member of staff to complete a recognised fire marshals course. It was also strongly recommended that at least one member of staff completes suitable and sufficient training regarding the use of, and risks associated with bed rails. Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 19 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 X X 2 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 20 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 OP7 Regulation 15(1) Requirement Timescale for action Finding - inadequate service user 30/06/07 care plans RequirementThe registered person is required to, after consultation with the service user or a representative of his, prepare a written plan (the service user’s care plan) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall Make the plan available to the service user Keep the service users plan under review Where appropriate revise the care plan Notify the service user of any such revision. 2. OP3 14 Finding - inadequate pre admission assessments Requirement The registered person shall not provide accommodation at the care home to a service user 30/06/07 Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 21 unless the needs of the service user have been assessed by a suitably qualified or suitably trained person, there has been appropriate consultation regarding the assessment with the service user or a representative of the service user, and the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the needs of the service user in respect of their health and welfare. 3. OP9 13(2) Findings - medications not been managed or administered in accordance with good practice guidelines RequirementThe registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medications received into the care home, and ensure that all records pertaining to the service users are kept up to date and accurate at all times. 4. OP30 18 Findings- Inadequate staff training and development, supervision and appraisals RequirementThe registered person is required to ensure that at all times suitably qualified, competent and experienced staff are working at the care home in such numbers as are appropriate to the health and welfare of service users; and ensure that all persons working at the care home receive training appropriate to the work that they Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 22 29/06/07 31/07/07 perform; and the registered person is also required to ensure that all staff are appropriately supervised at all times. 5. OP31 9 The registered provider must 31/07/07 ensure that the home’s manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. FindingsIncomplete staff personnel records RequirementThe registered person is required to ensure that all records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate at all times. 7. OP38 23(4) FindingsInsufficient fire training for all staff RequirementThe registered person is required to ensure that all staff have suitable and sufficient fire training at regular intervals, including the procedures for saving lives. 8. OP38 13 Findings Insufficient staff training regarding the checking and assessment of bed rails 31/05/07 31/05/07 31/07/07 6. OP37 17 Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 23 RequirementThe registered person must ensure so far as is reasonably practicable the health, safety and welfare of service users and staff; and must ensure that suitable training is provided to all staff responsible for checking and managing bed rails. 9. OP33 24 The registered person is required to improve the standard of care at the home, including the standard of nursing. 31/07/07 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. Refer to Standard OP7 Good Practice Recommendations It is strongly recommended that all trained staff receive ongoing training in care plan writing to ensure appropriate care plans are created for all residents on an individual basis, and to assist in compliance with the Nursing & Midwifery Codes of Conduct. It is recommended that a designated person completes a recognised fire marshals training course. 2. OP38 Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Grange Nursing Home DS0000020907.V335388.R01.S.doc Version 5.2 Page 25 - 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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