Inspection on 11/12/07 for Grange Park Nursing Home

This inspection was carried out on 11th December 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 Park Nursing Home 04/05/10

Grange Park Nursing Home 24/02/10

Grange Park Nursing Home 21/10/09

Grange Park Nursing Home 27/10/08

Grange Park Nursing Home 01/02/07

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

CARE HOMES FOR OLDER PEOPLE Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 11th December 2007 07:00 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 Grange Park Nursing Home DS0000066743.V351674.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 Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange Park Nursing Home Address 133 Himley Road Himley Dudley West Midlands DY1 2QF 01384 23991 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) Grange Park (Dudley) Nursing Home Limited Mrs Susan Dorothy Bishop Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (10), Terminally ill (10) of places Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2007 Brief Description of the Service: Grange Park is a purpose built care home offering nursing & personal care mainly to older people, though it is able to offer some nursing beds to younger adults. The home changed ownership during May 2006. It is situated just outside Dudley town centre and has good public transport links with Dudley and other local shopping centres. There is a car parking area at the front of the premises. To the rear there are patio and lawned areas, bordered by fencing and mature trees in places and presenting a very pleasant outlook. The interior of the home provides single and double occupancy bedrooms on two floors, some of which are en-suite. The ground floor offers a reception area, offices, communal lounges, a dining room, two conservatories, a small smoking room, kitchen, laundry and a range of bathing and showering facilities. Fees are not included in the Statement of Purpose or the Service User Guide Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit to the home took place of over one day. On this occasion three inspectors took part in this inspection. We have used a variety of methods to help us make the judgements about the home in this report. We have used information from the Annual Quality Assurance Assessment (AQAA) the home sent to us. We looked at people’s care plans using our case tracking process. This means that we looked in depth at the care and treatment of some of the people living in the home. This enables us to make a judgement about how the home is meeting people’s needs. Our specialist pharmacy inspector looked at the medication systems the home has in place and their findings are also included in the report. We asked the people who live at the home and their families to make comments about it by completing our “have your say” questionnaires. The comments have been included in this report. We also looked at staff files and training records to make sure the home continues to recruit people safely. We looked at staff rotas to make sure that there is enough staff on duty to meet people’s needs. Throughout the inspection we spoke to the people who live there, the staff on duty and the registered manager. We would like to thank everyone for their hospitality throughout the day. What the service does well: People said that the home always makes them feel welcome. They told us that before they moved into the home they were given plenty of information about it to help them make the choice about moving in. The staff team are friendly and caring and try their best to help each person. People told us “The care my mother receives is second to none. There will always be instances when small oversights are made in a home where people are looked after”, “the staff are wonderful, I don’t know what I’d do if it weren’t for them”, “they work hard, good as gold”. “if I want anything I only have to ask”. Apart from a few grumbles people told us that the food in the home was very good. “it’s always good and there is loads of it” Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 6 The home has good systems in place to deal with complaints. The manager will always act upon concerns when they are raised. “Any concerns are dealt with immediately and I wish that more nursing homes were like Grange Park”. What has improved since the last inspection? What they could do better: The manager has introduced a new care planning system. It was evident when looking through care records that there are still gaps in this system. Staff must make sure that they take time to review care plans and up date risk assessments as peoples needs change. Staff are aware of these shortfalls in record keeping and are trying to address them. Medication procedures within the home need to be improved to make sure that people are safeguarded at all times. Medication errors must be reported to the CSCI using the Regulation 37 notification. The home needs to develop the activity programme for all the people living there. The manager is aware of this and is trying to recruit a new member of staff to coordinate activities. Some of the people who live in the home are not happy with the quality of food that is provided for them. They said “Food not always as it should be. I made a complaint about the food, the sandwich fillings. The nurse took a photo of the sandwiches”. There are also unplanned changes to the menu that people are not consulted about at the time. Generally the home is well maintained but there are areas that require attention such as the kitchen and the dining room. Both of these rooms need Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 7 to be deep cleaned and cleaning schedules implemented to make sure that cleanliness is maintained. A relative also told us “I have reported the light not working but nothing done about it seem very slow about repairs”. The manager needs to review the staffing levels in the home. At present staff are supplied in numbers to allow them to provide basic care only. Staff told us during the inspection that they felt rushed and had no time to sit and talk to the people who live there. People told us “ Time issue so many residents, not enough staff especially in the mornings. Sometimes I don’t see any staff in the small lounge”. “ Time is lacking for staff to sit and talk to the residents”. The manager needs to continue to develop the Quality Assurance System the home has in place. This will help her to know that they are running the home in the best interests of the people living there and she will be acting upon their wishes. The owner must consider the installation of an emergency call system so that staff do not have to rely on shouting loudly to alert others in emergency situations. 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 Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 8 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 Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 9 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): 1,3,4,5,6 Quality in this outcome area is adequate. People who may choose to live at this home can feel confident their needs will be assessed in full prior to admission. They will have information upon which to make a decision about moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has their Statement of Purpose and Service User guide available for people to read in the reception area of the home. The home has recently updated the Statement of Purpose and keeps it under regular review. The document does require minor adjustments that would make it even more informative for prospective service users such as the inclusion of fees each person is expected to pay for residency and arranging for the document to be available to prospective service users in different formats such as pictorial or audio. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 10 People who answered our questionnaires said that they had had enough information about the home prior to moving in. The information had helped them to make a decision about living there. One person told us “ I came twice actually, second time I just turned up without an appointment. I wanted to see what it was like when they did not know I was coming. I was given a lot of written information at the time of mum’s admission. I choose this home because of the layout of the home, lots of little lounges. Thought it would suit Mum better that one big lounge and everyone sitting around edge”. The manager told us that each person would have his or her needs assessed in full prior to admission. They do this to make sure that the home is able meet people’s needs. At present the home does not write to people after an assessment has been completed to confirm that their needs will be met once they move in. It was recommended to the manager that this should happen in the future. We looked at the case files for some of the people who live here. We did this as part of our case tracking process. It was pleasing to see that all of the files we saw had completed assessment of needs. Once these assessments have been completed the home will use the information to help plan the care that people need. The home has a number of people living there with complex and specialist needs. We noted that training in these specialised areas needs to be improved in order for staff to have a basic understanding of the needs and conditions of the people they are caring for. Staff told us that they are about to begin Dementia care training with the local college. The manager is also planning training in person centred care for staff in the near future. This home does not provide intermediate care services. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10,11 Quality in this outcome area is adequate. People who use this service will generally have all of their needs met. Medication practices could be improved but do generally safeguard the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a new care planning system has been introduced. This has been a huge task to undertake and is still not completed. We looked at the care plans for four people. We found that they were generally completed well and staff have tried to be person centred in their planning. For instance in one person care plan we saw “sometimes I am unsteady on my feet and need the help of one carer to walk with me”. The care plan then gave good information on how staff were to do this. The home routinely risk assesses each person for falls, malnutrition, moving and handling and bed rails. Some of the information was disjointed and did not always reflect the changes in service users conditions. Such as one person Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 12 was identified as being “at risk” on their pressure sore risk assessment but the fact they had Diabetes had been missed off the chart. If this had been included, as the form requests, the actual score would have been higher placing them in the “high risk” category instead. This could mean that service users may not get the equipment or the increased care they need to prevent pressure sores developing. There are a few service users who have pressure sores at this home. One member of staff told us “if we are busy sometimes a dressing will get left for the next shift to do, there has been times when it has been left till the next day”. Staff also told us that they had not had any recent training in tissue viability or pressure area care. Given the number service users with grade 3 and 4 pressure sores in this home it is recommended that all staff have further training in tissue viability and pressure area care. Another person was experiencing a high number of falls, whilst it was clear from talking to staff that action had been taken to reduce the risk to this person, this was not clear when reading through their notes. This person’s falls diary did not reflect the number of recorded falls in the home’s accident logs and daily notes. People who require short-term interventions did not have care plans to show this. For example we found one person who had been prescribed anti biotics for a urine infection, there was no care plan to demonstrate how the home would address this. Nutritional risk assessments are completed and staff have been recording the weight for most of the service users. There were some gaps in the recording of this information and this was bought to the manager’s attention during the inspection. Service users told us they are seen by their doctor on a regular basis. For those service users who do not require nursing care they are also supported by the district nursing service that supply equipment and practical help for them. One relative told us “Physically Mum is much improved since she came in here. The doctor comes once a week but is called if needed in between”. Despite these shortfalls in records and recordkeeping staff were able to tell us verbally about the care and attention each person needed. This was reassuring to hear. Staff said, “getting the care plans up and running has taken ages, we know that they are not perfect but we are trying really hard to improve things. The reviewing of all the care plans is next I know that they are over due”. Systems were in place to ensure that medication storage was secure and that people who use the service were protected from harm. Medication was seen stored in two locked medicine trolleys, which could be transported around the home to ensure that residents received their medication safely. A lockable refrigerator was available for the safe storage of medication requiring cold Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 13 storage. The temperatures were recorded and monitored daily, however the records did show that medication was sometimes not stored within a safe range. The storage arrangements for ‘controlled drug’ medication met the required safe storage arrangements, which means that medication with special storage arrangements were protected by safe and secure procedures within the home. It was therefore disappointing that some money was found stored in this cabinet. It was removed during the inspection. Some nutritional liquid feeds were seen stored in the kitchen, which were not safe or secure. The liquid feeds were not labelled and therefore staff would not be able to identify the correct liquid feed to give or to know when to re-order further supplies. Senior members of staff had undertaken a medication training course on the safe handling of medication and further training for other members of staff was arranged for 12th December 2007. A medication procedure was available to staff, which means that safe procedures to protect residents from harm could be followed. It was therefore disappointing that there had been a medication error within the service, which had not been reported to CSCI according to the medicine policy. The majority of the medicine records seen were recorded with a signature for administration or a code was recorded to explain why medication had not been administered. Some of the medicine records seen did not document the amount of medication that had been given to a resident, particularly when the directions stated ‘one or two tablets’ to be given. This is not good practice and means that some medication records did not accurately document how much medicine a resident had been given. It was also of concern that the records for the application of creams, ointments and the administration of liquid feeds did not record who had administered them. This means that some of the medicine records were not accurate and therefore did not protect the health and welfare of the people who use the service. Systems for checking that medication had been administered correctly were not all available. For example, records for the receipt of medication were available and recorded every month, however there were no medication disposal records available within the service. Some medication could not be checked to ensure it had been administered correctly because the date of opening of the medication container was not documented and also monthly balances of medicines were not available. This means that a full medication trail could not be undertaken to ensure that medicine belonging to people living in the service were handled safely. Four care plans were seen. There was little or no written information to inform staff about medication. For example, medication for one person was to be administered ‘covertly’ or without their knowledge. There was a letter available, which did confirm that a team of people including a doctor, social worker and a relative had agreed to this form of medication administration, however there was no further information to inform staff how to administer the Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 14 medication safely. The assistant manager explained in detail how the medication was administered and it was clear that a lot of advice had been sought from a pharmacist, however there were no written records confirming this in the care plan. This means that due to a lack of detailed records it was difficult to follow and check the history of medication for people who live in the service and also to know whether the medication had been administered correctly according to the doctor’s instructions. People told us that they are treated with respect and that staff try to uphold their wishes when they receive care. We saw staff knocking toilets doors prior to entering them and staff were heard talking to service users politely. Some people told us that they do have to wait for help and assistance at times. One person’s relative said “she relies on the lady next to her to call for help because she cannot reach the buzzer”, and “ What is lacking is the personal touch staff come and ask Mum a question but don’t wait for her to answer”. Another person said “the care my mother receives is second to none. There will always be instances when small oversights are made in a home where people are looked after”. The home needs to develop its end of life planning for service users. In all of the files we looked at this area had not been addressed. It is acknowledged that this is a sensitive area for people to discuss and some people will not want to do this. The home must show that it has taken the time to approach people about end of life care even if they do not wish to make any plans. Should people not want to make their wishes known then the home should clearly record this in the service user plan. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 15 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 adequate. People could be better supported to take part in activities. Generally meals are satisfactory but there is room for improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us the home needs to develop its social calendar for service users. A relative said that they “ Have events, singer at Christmas, bit of entertainment. But they need more one to one sessions”. When we spoke to staff they told us “they are the last things we have to think about because we are so busy”, “activities, we try really hard but its not easy fitting it in around the other jobs like toileting and bathing”. Service users told us about a carol concert that had been planned and a jewellery party. They said “they do try to get us involved with things but they are pushed and I don’t like what they do all the time”. “I’d like to go out and get some fresh air”. During the inspection we had to opportunity to sit with service users in the lounges. We noted that there was little interaction between people and staff were not visible to service users. We sat for half an hour in one lounge without seeing a member of staff. The manager said that she is aware of this and hopes that Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 16 the recruitment of an activity coordinator in the New Year will improve things for service users. Service users and visitors said, “ Always made to feel welcome”; “Oh yes visitors come when they want. Some of mine come as late as 8.30 PM”. We spoke to the manager about the Mental Capacity Act 2005 and training for the staff. She told us that training had been arranged but due to a mix up staff had been unable to attend; they are currently waiting new dates for training. This is positive, training should give staff an understanding of their role and accountability in supporting people under the Mental Capacity Act 2005. At present the home does not act on behalf of service users when dealing with their finances but does encourage people to manage their money themselves. We observed both breakfast and lunchtime meals during this inspection. The manager told us that sixteen people need help and assistance during meal times. This means that staff are very busy during this time. The home employs trainees to assist with this but on this occasion they were not appropriately supervised and had not received food hygiene training before commencing this task. We also noted that the menu displayed in the dining room did not reflect the choice of meals given to service users on the day of inspection. We were told the “turkey burgers have been taken off we don’t want to give them turkey this close to Christmas”. Changes to menu’s should only happen following consultation with service users, we pointed out that there may have been service users who were looking forward to turkey burgers and may have been disappointed they had been removed from the menu. The home does ask service users for their choice of meal a day in advance of it being prepared. There are a number of people who live at this home who have dementia who may not be able to remember what they ordered so far in advance the manager was asked to review this process of meal ordering. We sat with service users and ate lunch. We observed that there is only enough seating for thirty-six people; the home is registered to accommodate fifty-one people. We asked staff what they would do if the home was full and all the service users wanted to eat in the dining room. They were unable to answer the question. The dining tables were laid although it was observed that service users had to ask staff for drinks and condiments during meal times. It is recommended that these items be available on the table for service users use. The dining room despite its limited size has been pleasantly decorated and would offer a relaxing place for people to eat their meals once some improvements have been made. For instance repairs to the windows so that service users can see out and a deep clean of the room particularly by the serving hatch for the kitchen. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is adequate. People who live in this home can feel confident that their views will be listened to and acted upon in most cases. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure is displayed in the reception area of the home. There were some minor amendments needed such as a change of address for the CSCI. People who use the service said, “they try to sort things out straight away”, “I do know how to make a complaint but I have never needed to”. “They are very helpful and always try to help”. Staff said that they would always try to resolve issues and record them in the complaints record. The manager said in their AQAA “I have introduced residents and relatives meetings, I have arranged for all staff to attend adult abuse awareness training. I have an open door policy and request residents and relatives come and talk to me if there is a problem”. During the inspection one service user reported that a sum of money had gone missing from her room. The manager said that she would investigate this. We were notified using the Regulation 37 form but it was disappointing to see that neither the person’s social worker or the police had been informed of the alleged theft. This lack of action on the manager’s part may reduce the Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 18 confidence that service users have for her in dealing with other issues that may arise. There have been no Adult protection investigations during the past twelve months. Staff said that training is being arranged. This is pleasing to hear because the training matrix shows that there are gaps in Adult Protection training. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 19 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): 19,26 Quality in this outcome area is adequate. The home is generally well maintained but improvements are needed to improve its cleanliness in some areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We toured the home and spent time with some of the people who live there. Generally the home is odour free, pleasantly decorated, there is still room for improvement. The manager told us “It is down to finances. If any equipment is needed then this is provided no problem. But with decorating we have had some things done, but it is being done a bit at a time”. The owner told us “I have spent thousands on the home since we took over. We have had some new carpets; beds lots of things have been done. We have got plans and are trying to get things done”. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 20 We spent time in the dining room; we saw that some of the windows need to be replaced because of the condensation inside the sealed units. This means that the view out of the dining room is obscured and service users cannot see through them clearly. This was also the case in a number of bedrooms we looked at. The manager told us that as bedrooms become available they are completely refurbished ready for the next person to move into. More recently a shower room has been converted into a store cupboard, this means that the excess continence products that had been stored in the bathroom can now be stored in their own cupboard and free up the bathroom. This should make bathing a more enjoyable experience for service users. It was pleasing to see that bed rails are being maintained, and each person is risk assessed before they are put onto their beds. If service users are at risk of pressure sore development the home has equipment available to do this. For those service users who do not require nursing care the district nursing service provides their pressure relieving equipment. The dining room and the kitchen both require a deep clean, it was disappointing to see that the drinks trolley was rusty and dirty, the cups and mugs on the trolley were also stained. We asked staff if the cups were dirty one member of staff told us “no they are the clean ones”. The kitchen would benefit from cleaning and the development of a detailed cleaning programme for staff to follow to make sure that cleanliness is maintained. We identified some concerns regarding the kitchen, which could place the people who use the service at risk. We saw the cook come in from the car park dressed in his ‘ kitchen whites’ wearing these clothes from outside into the kitchen could transmit bacteria and therefore pose a food hygiene risk. We saw that there was a build up of debris under the stainless steel counter located next to the cooker. The cook cleaned the microwave. We looked at it after it had been wiped and saw food bits and fat particles on the back wall of the microwave. The inadequate cleanliness of the microwave was highlighted in the homes last Environmental Health reported dated 29 January 2007 which read; “ The internal surfaces of the microwave oven were covered in food debris’” clearly this has not been adequately addressed. We saw that the wall cupboard that stores the cups had bits and debris on the shelves. The shelves in the pantry had exposed chipboard on their edges. Environmental health had made a recommendation in their report dated 29 January 2007 for this to be addressed their report read “ The wooden shelving edges consisted of bare chipboard. Repaint the edges so as to provide a surface capable of being easily and effectively cleaned”. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 21 We saw big square plastic tubs in the pantry and in the lower cupboard next to the cooker that contained for example mixed fruit and custard powder. We showed these to the cook, as there were no expiry dates on the tubs, preventing catering staff from knowing if and when they should be discarded. All toilets and bathrooms viewed had liquid soap and paper towels. No gloves or aprons in toilets and bathrooms this could increase the risk of cross infection to service users. We looked in the laundry and saw that the laundry staff are using rubber gloves to handle the washing. We pointed this out to the manager and asked her to provide disposable gloves for use in future. Thick rubber gloves can harbour more bacteria and therefore add to the risk of cross infection. 25 staff have undertaken some infection control training and the manager has plans for every staff member to do this in future. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 22 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. People who live in this home may have to wait for periods of time before they receive assistance from staff. Staffing rotas do not always take into account the dependency and needs of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who use this service and their relatives also told us “ Time is an issue so many residents, not enough staff especially in the mornings. Sometimes I don’t see any staff in here”, “ Time is lacking for staff to sit and talk to the residents”. “I feel rushed sometimes but it’s not their fault”. We also spoke to the staff on duty they said “we have time to get the basics done but it can be a rush, it would be nice to be able to sit and chat with the residents but you always feel worried because you know others are waiting”, “I feel quite stressed some days because I think I’ll never get it all done”. The manager told us that staffing levels are within agreed limits. We discussed this with her and asked that staffing levels be reviewed given the fact there are so many highly dependant people living in the home that require care. In the Annual Quality Assurance Assessment the manger indicated that over twenty one of the current thirty seven people living in the home need the assistance of more than one carer at any time. There are also over fifteen people who need help during meal times. All of the people living there need help with washing Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 23 and dressing from the care staff. The current staffing levels may mean that some people are waiting for longer periods for their needs to be met. This also means that the home finds it difficult to offer person centred care as a result of limited staff numbers. Staff are now beginning to undertake regular training. This is an improvement since the new manager has taken up post. Currently there are twelve of the twenty-three care staff with a National Vocational Qualification Level 2 and a further seven staff working towards this. One staff member said, “the training is getting much better now, it did go down a bit but it feels like its back on track”. We looked at staff recruitment files for four staff; we found that there were some areas for improvement. These were discussed with the manager during the inspection. We asked her to make sure that when staff begin employment with only a PoVA first check in place they must be supervised until such time as their Criminal Record Bureau (CRB) is returned. The home also employs younger people we asked to manager to make sure that they are appropriately supervised when working in the home. This means not being left alone with service users to complete personal care. It was pleasing to hear from the manager “now you have pointed this out to me I have made arrangements. All staff must be supervised until I receive their full CRB”. We looked at records of induction for new staff; we found that currently the induction process needs to be improved in order to support new staff. The manager told us that she is trying to improve the induction for new staff and that will include the Skills for Care induction standards. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38 Quality in this outcome area is adequate. People who live in this home are supported by a manager who is committed to improving the service for their benefit. The health and safety of people is protected by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Susan Bishop manages the home. She has recently completed the registration with the Commission for Social Care Inspection (CSCI). She has a number of years experience managing care homes and said that she is enjoying her new role. The Clinical lead nurse who is an experienced Registered General Nurse supports Mrs Bishop in her role. One relative told us “things have got better since the new manager”. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 25 We looked at the work the home has undertaken in relation to the quality assurance system. The manager told us that there are plans to get the system up and running in the new year. They have developed audits that will help them evaluate the effectiveness of the care they provide, the environment people are living in and health and safety issues. The manager also told us that they regularly consult with the people living in the home and their families by inviting them to regular resident and relative meetings thus giving them the opportunity to comment. The manager was asked to consider using questionnaires for residents and their families to give another opportunity for them to be able to tell the home what they think of the service they are receiving and any suggestions, compliments they may have about it. The home has good systems in place for handling service users money. The manager showed us the storage facilities for money, we recommended that these be improved the current arrangements are a locked box in a filing cabinet. Service users may feel more confident if their money was kept in a more secure location. Some of the service users monies were checked and were found to be in order. The home keeps records of all transactions and expenditure for each of the service users. Health and safety records for the home need to be improved. The manager told us that some safety checks on the wheelchairs, showerheads and window restrictors had not been completed recently. It was pleasing to see that other maintenance records for the home were up to date. Such as the gas appliances, fire fighting equipment and lifts. The home regularly records the hot water temperatures in each person room to make sure the risk of legionella are reduced. We noticed that the home does not have an emergency call system in each room. When we asked staff what they would do in such a situation they said “we shout loudly”, “shout as loud as you can”. This is not ideal and was bought to the attention of the provider during the inspection. He stated that he is considering a new system but had yet to make a final decision. Mandatory training for staff is now back on track. Staff said that before the new manager started training had begun to slip and was not happening. “I think I have been to so much training recently I don’t think there’s anything left for me to do”. “Things got left and I suppose staff training was one of them but it is getting better, there’s always something going on”. The home must also make sure that the procedure for reporting to CSCI notifiable incidents, deaths or accidents as detailed in Regulation 37 is improved. For example informing CSCI when people have MRSA in the home. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 26 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 X 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 27 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 OP4 Regulation 18 (c ) (1) Requirement Greater numbers of staff must have training in pressure sore prevention, tissue viability, dementia care to make sure their knowledge is up to date and based upon current best practice. The home must ensure that risk assessments are accurately completed at all times so that people’s needs are appropriately met. People must have their weight recorded on admission and at regular intervals after that. The frequency of which will be determined by their nutritional risk assessments. Staff must make sure that they maintain accurate daily records for each person living in the home. Care plans must be in place when people develop short-term problems such as a urinary tract infection. This will help make sure peoples needs are met. A system for recording the safe DS0000066743.V351674.R01.S.doc Timescale for action 01/04/08 2 OP7 13 (4) (c) 01/03/08 3 OP8 13(4) (c) 01/02/08 4 OP8 17(3) 01/03/08 5 OP8 12(b) 01/03/08 6 OP9 13(2) 01/03/08 Page 28 Grange Park Nursing Home Version 5.2 7 OP9 13(2) 8 OP18 13(6) 9 OP27 18 (1) (a) 10 OP29 19 (1) 11 OP29 19(11) 12 OP38 37 disposal of unwanted medication must be available to ensure that all unnecessary medication is removed and documented from the service. This is to ensure that medication is handled safely and to protect people who use the service from harm. Medicine records for the administration of medication must be clear in documenting what has been administered and which member of staff was involved in the administration in order to ensure that the people who use the service are safeguarded and medication has been administered as prescribed. The manager must make sure that all allegations of theft are reported to the appropriate agencies such as the police and social services. People who use this service must have adequate numbers of staff on duty to meet their needs at all times. Staffing levels must be kept under regular review to ensure that this happens, especially when people’s needs and dependency’s change. People who use this service must be confident that the recruitment processes the home has are improved and will safeguard their interests. This must include relevant references for each employee in all cases. When people commence employment without a CRB and only a PoVA first check in place the home must be able to demonstrate how it has safeguarded people in the home until a satisfactory CRB disclosure is returned. The manager must notify the DS0000066743.V351674.R01.S.doc 01/03/08 01/03/08 01/02/08 01/01/08 01/01/08 01/01/08 Page 29 Grange Park Nursing Home Version 5.2 CSCI of all incidents, deaths as detailed in regulation 37. This will include people who have MRSA. 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 OP1 Good Practice Recommendations The homes statement of purpose and service user guide should include details of the fees people are expected to pay for. If the home wishes to offer specialist dementia care this should also be reflected in the Statement of Purpose. Greater numbers of care staff should receive training in person centred care. A system should be introduced to ensure that accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner. Care plans should document up to date medication records. This is in order to ensure that medication records for people who use the service are accurate. A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. Safe storage of money should be reviewed in order to prevent the joint storage of medication and money and therefore safeguard the people who use the service. Safe storage of liquid feeds should be reviewed to ensure that individual prescribed liquid feeds are stored safely and are clearly identified for people who use the service. Medication errors should be reported to CSCI according to the service’s medication policy Greater numbers of staff should be available to support people in pursuing activities of their choice. People who live in this home should feel supported by the staff to uphold their rights. It is recommended that all care staff receive training about the Mental Capacity Act 2005 and their roles and accountabilities to the people DS0000066743.V351674.R01.S.doc Version 5.2 Page 30 2 3 OP4 OP9 4 5 OP9 OP9 6 7 8 9 10 OP9 OP9 OP9 OP12 OP14 Grange Park Nursing Home 11 12 13 14 15 OP15 OP18 OP19 OP19 OP19 16 OP26 17 18 19 OP27 OP29 OP33 20 21 OP35 OP38 they support. People who live in the home should be consulted about unplanned changes to the menu and their wishes taken into account. Greater numbers of staff should receive training in adult protection (safeguarding adults) People who use this service should be able to summon assistance when they need it. It is recommended that an emergency call buttons be installed for this purpose. It is recommended that both the kitchen and the dining room are deep cleaned. Cleaning schedules for each area are implemented and adhered to. Consideration should be given to increasing the number of dining room chairs and tables so that all the people living in the home have the choice of eating there should they wish to do so. Laundry staff should be supplied with disposable gloves for single use only. Gloves and aprons should be available in toilets and bathrooms so that they are accessible to staff and reduce the risks of cross infection. The manager should provide regular up date training in infection control procedures. Younger workers should always be supervised whilst they are working. Staff must be at least 18 years old before they provide personal care to service users. The manager should continue to develop the quality assurance system in the home so that she can feel confident she is acting in the best interests of the people living there The home should consider more secure storage facilities for people’s money. Greater numbers of staff should benefit from food hygiene training. Grange Park Nursing Home DS0000066743.V351674.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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