Inspection on 27/10/08 for Grange Park Nursing Home

This inspection was carried out on 27th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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 11/12/07

Grange Park Nursing Home 01/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF 0138423991 Telephone number: Fax number: Email address: Provider web address: grange.park@btconnect.com Name of registered provider(s): Type of registration: Number of places registered: Grange Park (Dudley) Nursing Home Limited care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home 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. 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 stated in the service user guide were £495 per week for nursing care and £395 per week for residential care. Care Homes for Older People Page 4 of 33 0 10 10 Over 65 50 0 0 Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out over two days during October 2008. On the first day one inspector visited the home alone. On the second day a second inspector assisted with the inspection. An inspector from the regional registration team also visited on the second day to discuss the plan to develop a dementia care unit in the home. As part of the inspection some questionnaires were sent to the home so that some people who lived there and some staff could give us their views on the home. These were returned to us after the inspection had been completed. During the inspection three care staff were spoken with in addition to the manager and assistant manager. Some maintenance documents were also looked at to make sure that the home was Care Homes for Older People Page 6 of 33 safe. The recruitment files of three staff were looked at as well as the care files of three people using the service. This was to determine how well the home was meeting their needs. We also spoke to five of the people living in the home and two visitors to get their views about the home. Prior to the inspection the home completed and returned to us an Annual Quality Assurance Assessment. This gave us some additional information about the home and what improvements they had made since the last key inspection of December 2007. At the time of this inspection the home had received one complaint. This had been in relation to care and food issues. This had been appropriately investigated and the manager had responded to the complainant. One adult protection had been raised regarding someone admitted to hospital from the home. What the care home does well: What has improved since the last inspection? What they could do better: The home needed to ensure that the care plans continued to be improved and that greater detail was provided so that the staff knew how to provide assistance to the people living in the home. Care Homes for Older People Page 8 of 33 The staff needed to ensure risk assessments were fully completed to ensure that they were truly representative of the situation. Staff should take responsibility for recording the tasks they had undertaken themselves. Some improvements needed to be made to the management of medicines in the home to ensure people received their medicines as prescribed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people moving into the home are assessed before they move in to ensure that the home can meet their needs. The people moving into the home have sufficient information on which to make an informed decision about whether the home is suitable for them. Evidence: There was a service user guide in place and available in the reception area of the home. It had been recently updated and the fees charged were included in it so that people thinking about moving into the home would have all the information they needed to enable them to make an informed decision. The admission process for one person living in the home was looked at. A preadmission assessment had been carried out by the home to ensure that the needs of the person moving in could be met by them. The assessment looked at several areas Care Homes for Older People Page 11 of 33 Evidence: of need including personal care, mobility, diet and leisure activities. A letter was sent to the individual informing them whether their needs could be met at the home and if so, that they would be admitted on a three month trial basis. There was a contract in place giving the terms and conditions of residence at the home. The fees and room to be occupied were inluded. The home does not provide rehabilitation services. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people living in the home were generally well met. The documentation did not always evidence the care that was being provided and how it was to be provided. It was difficult to evidence that staff were always undertaking the tasks as required. The privacy and dignity of people living in the home were respected. Evidence: The files of three people who were living in the home were looked at to see how well the home was able to meet their needs. Two of the files were for people who had high nursing needs and one was for someone receiving residential care. There were care plans in place for all three people. There was a section for a personal profile where details of significant relationships, life story summaries and hobbies could be recorded. The level of detail in this section was variable. For one of the individuals there were no details recorded in this section, for the others there were some good details that gave an indication of their background and hobbies. Care Homes for Older People Page 13 of 33 Evidence: The care plans were split into support plans for individual areas of need, for example health promotion, tissue viability, nutrition, personal care, mobility, emotion and mental well being, recreation, safe environment and so on. For one individual who was totally dependent on staff for all care and prone to pressure ulcers developing the care being provided was good. The individual was being nursed on an air wave mattress, having regular turns, having food and drink intake monitored. The management of wound care was good so that the long standing ulcers were healing well. Good records were being kept for the management of pressure ulcers including photographs and grading on a regular basis. Advice was available from tissue viability specialists if needed. As requested at the last inspection short term care plans were in place for dressings. Discussion with the nurse in charge indicated that decisions about wound management were based on past experience, advice from other professionals and training courses attended. However, none of these courses were certificated and it was advised that it would be useful to have certificated training to ensure that any decisions being taken in the home are based on current good practice. There were some very good details for staff to follow where someone was on a continuous feed regime however the regime for rotation of the peg needed to be recorded. Some of the support plans could be further improved by including more detail. This is particularly important for people who cannot tell the staff how they want their needs to be met for example if they have dementia or cannot communicate verbally. In personal care plans the way individuals need to be helped should be recorded, for example, whether they like to have a bath or shower, how they have their hair washed, when oral care is to be provided how is this to be done and by whom. We were told that for one person only the nurses were to provide oral care due to the risk of choking however this was not recorded in the care plan. The support plans needed to be updated when plans changed, for example, one person who used to sit out in a chair for a couple of hours a day had not been able to do so for the past few months but the support plan had not been updated to reflect this. Staff needed to be mindful that where turn charts were being used that they recorded the position of the individual at each turn. They had not been doing this. Where people could not be weighed an alternative way in which weights could be monitored shoud be used such as measuring the circumference of the upper arm. Care Homes for Older People Page 14 of 33 Evidence: Risk assessments were in place for bedrails, falls, nutrition and tissue viability. One of the nutritional assessments appeared not to be fully completed and described the individual as being of average weight when the person appeared to be quite thin and had only been weighed once since April 2008. The same individuals falls risk assessment had sections that had not been completed which would give a false scoring. Staff needed to ensure these were fully completed in order to get a realistic risk assessment. Monthly evaluations of the support plans were being carried out. Staff needed to ensure that the evaluations were accurate and if changes were identified that these were put into the support plan. For one individual the evaluations stated that bed rails were no longer in use however, they were still in place and discussions with senior staff indicated that there continued to be a need. There were bed rail risk assessments in place however, it was recommended that an improved version was accessed from the the Health and Safety Executive. The nursing staff made a record of all the care provided. This issue was discussed with the manager as nursing staff were recording and signing for tasks they had not undertaken personally. It would be advisable for care staff to record the tasks they undertook and the nursing staff record the tasks they undertook. There appeared to be good relationships with medical personnel ensuring that people received adequate health care. There was contact with general practitioners, district nurses, tissue viability nurses, chiropodists, dentists and opticians. The manager had informed us that some medicine had gone missing in the home prior to this inspection. She had looked into the matter but could not determine where the medicine had gone. Some additional audits had been put in place since. Examination of the medicines during the inspection showed that the medication was being stored appropriately. Nurses could give medication to all the people living in the home however, senior care staff were only able to give medicines to people receiving residential care. This was achieved by separating the medicines into two separate trolleys. The home was carrying out some random audits, usually checking the blister packs and occasionally boxed medicines. We were told that they were concentrating on the residential trolley.The medicine administration records (MAR) did not show who had administered the liquid feeds, creams or ointments. This issue was also identified at the last inspection. Some liquid feeds had not been booked in so it would not be possible to carry out an audit. In one instance it was identified that the pharmacist had put four times for the administration of a medicine however it had been prescribed to be given three times only. This error was identified by the home but not until several Care Homes for Older People Page 15 of 33 Evidence: days laters. This would indicate that staff were not checking the medicines closely enough to identify mistakes and take remedial actions as soon as possible. Creams were dated on opening ensuring they could be disposed of within a reasonable time. The controlled medicines register was checked and found to be correct. Fridge temperatures were being monitored ensuring that medicines were being stored at the correct temperatures. The home was due to receive some medicines that needed to be stored at temperatures lower than normally required and were in the process of checking with the pharmacist of any potential effects on other medicines. Examination of the medicines administration records in the nursing trolley showed that there were some gaps where the individuals administring the medicines had not recorded that they had been given. Staff must sign the records if medicines have been given or record why they have not. Checking of some of the boxed tablets showed that the amounts received, administered and remaining in the box did not tally and in the case of one table indicated a shortfall of 23 tablets. In another instance too many tablets were remaining indicating the person was not getting the medicine as prescribed. Where medicines were put directly through the peg site the home needed to ensure that the medicines were suitable to be adminstered through this route. A record of any advice received should be made in the individuals file. Where individuals were able to administer some of their medicines a self medication risk assessment was needed to determine their ability to do so and regular compliance checks needed to be carried to ensure that they continued to take responsibility for this task. There was no indication that peoples dignity and privacy were not being observed. Bedroom, bathroom and toilet doors had the appropriate locks in place. It was pleasing to see that people were routinely asked whether they wanted to have a key to their bedroom and in some cases people had opted to have one. One person told us that they kept losing their key so they had decided not to have another one. Staff were seen to address people by their preferred names and knock on bedroom doors before entering. The home was making efforts to discuss end of life issues with the people living in the home or with their representatives. This is a delicate issue and needs to be pursued Care Homes for Older People Page 16 of 33 Evidence: with sensitivity but it is an important issue to have information about. However, if people do not want to discuss the issue this should be recorded in the care files and the subject broached again at an appropriate time in the future. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were a number of activities available for people living in the home to take part in if they wanted. Visitors were made welcome in the home and could visit at all reasonable times. There were choices available at mealtimes and the diet was nutritious and guidance was sought on the menus. Not everyone was happy with the meals. There did not appear to be any rigid routines in the home. Evidence: The AQAA told us that people were able to get up and go to bed when they wanted. This was confirmed by the people spoken to during the day. One person told us that there were often parties and celebrations in the home and that they liked to go and join in however their partner was not interested and so remained in the bedroom and watched television. The home has bedrooms that can be used as double rooms by couples but if this becomes an unsuitable situation they are given separate rooms as close to each other as they wish. Care Homes for Older People Page 18 of 33 Evidence: There was an activities programme displayed on the notice board and this showed that there were regular trips to the Merry Hill Shopping Centre. There were monthly in house entertainments arranged and regular activity sessions during the week. Details of advocacy support was also displayed on the notice board. There was an activities co ordinator in the home and we saw that she was in the home on both days of the inspection. One of the people living in the home told us that she was in the home for a couple of hours a day and this was supported in records seen in the home. It was pleasing to see that she undertook one to one sessions for people who were not involved in group activities. One person told us that the activities were not suitable for a younger age group. There were weekly visits from the church to speak to people who wanted to speak to them. This enabled them to have their religious needs met. Visitors were welcome in the home at all reasonable times and they were seen to come and go at various times of the day. Some were seen playing cards in the dining room with the people they were visiting. The home had a four week rolling menu which showed that a varied and nutritious diet was available. People spoken to during the inspection confirmed that they were given choices each day. They were consulted about the meals one day in advance, however, if they changed their minds this change was facilitated. They also confirmed that they could have drinks and snacks through the evening. We were able to join the people living in the home for lunch on one of the days. Although there was no room to sit with people in the dining room we were able to observe lunch from the conservatory. The meal was well presented, hot and appeared to be enjoyed by the people eating in the dining room. The manager noted that staff were not sitting at the table with the people they were helping to eat but were stood uo whilst assisting and she quietly corrected their practice. Records were kept of the food and fluids people had. The food records for a period of 9 days were looked at for one person. Unfortunately, staff had not consistently completed these records and it was noted that afternoon food and fluid charts were not being filled. Also during this period the records showed that the individual had had chicken casserole and lamb hot pot on four occasions. This was mentioned to the manager who stated that that would not happen. This could only mean that the staff Care Homes for Older People Page 19 of 33 Evidence: were not being accurate in their recordings. One of the people spoken to during the day commented that there were too many casseroles and and too much chicken on the menu. One of the surveys returned to us said that there were too many casseroles and hot pots on the menu and the quality of meat was poor. The manager should monitor this. It was good to know that the home had been working with the Food for Health Advisor in the Dudley Public Health Department and had been awarded a gold award for nutritious meals being provided in the home. Special diets were provided and included some meats being pureed. One person told us that the puddings did not always meet their dietary requirements. The manager should look at this area of the meal plans. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their representatives were able to raise any issues concerning them. The complaints procedure was accessible to people in the home. There were adequate policies and procedures in place to safeguard the people living in the home. Evidence: There had been one complaint recorded in the home since the last inspection and it had been appropriately addressed. No complaints had been logged directly with the commission. There had been one adult protection raised regarding some unexplained bruising following the admission to hospital of one of the people livivg in the home. The individual had not returned to the home and we were told by the home that no feedback had been received by them about any investigations or findings. Staff had had training in adult protection since the last inspection. There was a complaints procedure available in the reception area of the home and relatives spoken to said that they could raise issues at the home. Some of the people living in the home told us that there was not always someone available to speak to as the office was not open at weekends, the manager was not always there and the sister was too busy to listen to them. Care Homes for Older People Page 21 of 33 Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The structure of the home means that the needs of the people who live there can be met. It was clean, comfortable and odour free. There was no suitable bath available but an adequate number of toilets and showers were available through out the home. Evidence: A tour of the communal areas of the home was undertaken and some bedrooms were sampled. This confirmed that the the work identified in the AQAA had been completed. The work included the refurbishment of the downstairs shower room, the replacement of the kitchen floor and some equipment. Bedrooms were being redecorated as they became vacant and before they were re-occupied. New beds has also been purchased for several bedrooms and additional security measures had been put in place at the front of the home following some recent problems. There were a number of bedrooms with en-suite facilities. Bedrooms seen on the day were personalised to the liking of the occupants and suited their needs. The home has a number of double rooms that can be occupied by couples if they wanted to share however, the home did not routinely have people who did not know each other sharing in the double bedrooms. Care Homes for Older People Page 23 of 33 Evidence: It was noted that some of the windows needed to be replaced as there was condensation in the sealed units that restricted vision through them. One of the lounges on the ground floor had been redecorated and looked very comfortable. Discussion regarding the bathing facilities in the home identified that there was currently no suitable bath in the home. The parker bath that was installed had not been serviced for some time and therefore was not being used and the other baths were not being used as they were unsuitable. On testing the hot water from the showers it was found that the hot water temperatures were not restricted to 43 degrees and found to be very hot. Both the service of the Parker bath and the restriction of the hot water temperatures had been addressed by the manager by the end of the inspection. The dining room provided tables and chairs for 24 people and we were told that other people preferred to eat either in their rooms or in the lounges. A drinks machine had been put in place in the dining room to enable visitors to be able to have drinks. New garden furniture had been purchased for the use of the people living in the home and lighting in the corridors had been reviewed. The flooring in the lift was torn and lifting posing a possible tripping risk. The manager told us that this was in hand. All areas of the home were accessible to the people living in the home. There were adaptations in the home including walk-in showers, emergency call systems and adjustable height beds. The kitchen and laundry were seen and found to be clean and tidy. All the works identified here during the last inspection had been addressed. It was noted that the conservatory used by the inspector for lunch was cold and there was no heating in it. The manager should arrange for some additional heating in the conservatory areas. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels were able to meet the needs of the people living in the home. Any significant change in the needs and numbers of people living in the home may require an increase in staffing levels. The staff had had sufficient training to ensure that they had the skills and knowledge to care for the people living in the home. Staff knew their roles in the home. Evidence: The staff rota was looked at and it showed that there were generally 4 carers and a senior carer on duty during the early shift and 5 carers during the late shift. There was always a nurse on duty and during the day the manager and assistant manager were generally available as well. There were also domestic, catering and laundry staff available. In addition there was an activities co ordinator also available. This level of staffing appeared to be adequate for the number of people living in the home and the current level of need. However, some people living in the home told us that the staff were very busy and there were inadequate numbers of staff available. Changes in numbers and needs will mean that the staffing levels need to be reconsidered. In addition to the manager and assistant manager three care staff were also spoken to during the inspection. The staff showed that they understood their roles in identifying issues of adult protection and the effects of dementia on individuals and how they Care Homes for Older People Page 25 of 33 Evidence: were to meet their needs. They showed awareness of the needs of the people in their care,hower, during the inspection the emergency nurse call was activated. Unfortunately the reponse was not as quick as it could have been. The manager was aware of this and was going to address the matter. The recruitment files of three staff were looked at and these showed that the recruitment procedure ensured that POVA and CRB checks were undertaken before individuals were employed as well as two references. This ensured that only suitable people were employed in the home and the people living in the home were safeguarded. There were skills for care induction packs in place and the manager had completed the paperwork to show that the individuals were safe to work unsupervised. There had been a good amount of training available for staff. This included manual handling, fire, dementia awareness, challenging behaviours and abuse. The majority of staff had either completed or were in the process of completing NVQ level 2 training. This meant that the staff had the appropriate skills and knowledge to look after the people in their care. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management structures in the home work well to ensure that the health and care needs of people living there are met. Health and safety in the home is generally well managed but some actions were identified during the inspection that needed attention. Evidence: It was obvious from discussions during the inspection that the manager was wholly committed to providing good care at the home. The manager was not a qualified nurse but worked closely with the assistant manager who was a qualified nurse. The assistant manager took a lead on all clinical issues although the manager had overall responsibility. The system currently worked well however the manager should discuss with the owners what plans would be put in place to provide clinical support if the assistant manager was not available for work at the home for any length of time. Care Homes for Older People Page 27 of 33 Evidence: Staff reported that the manager was approachable and would listen to any issues raised. The manager ensures that paperwork is stored in a way that is compliant with data protection legislation. The records for monies held on behalf of people living in the home were looked at and found to be acceptable. There were receipts available for all expenditures. It was recommended that any purchases made on behalf of the people living there are signed by two members of staff if the individuals themselves cannot sign for the purchases. The equipment available for use by the staff or people living in the home is well maintained except as mentioned earlier the Parker bath which had not been serviced for some time and the hot water from the showers not being restricted to 43 degrees. The registration certificate on display in the home showed an error and this was now being addressed by the commisions registration team. During the inspection there was a discussion with the proprietor and an inspector from the registration team regarding the development of a dementia care unit on one of the first floor wings. The owner was requested to reconsider the application and consider the feasibility of the unit being located on the ground floor. As part of the quality monitoring in the home some audits and questionnaires were sent to people who had an interest in the running of the home. Although the results of these were discussed between the manager and the owner of the home the results and any plans arising were not collated into a plan that could be presented to people living in the home or their relatives. It was recommended that the results were shared with interested parties. There was some evidence of residents and relatives meetings being held however the frequency of these could be increased. Some relatives told us that they were unable to attend the meetings due to the meetings being held in the daytime. It is recommended that the times of the meetings be varied to enable more people to attend. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be administered as prescribed and the records must evidence this. This will ensure that the people living in the home received their medicines as prescribed. 19/12/2008 2 9 13 Audits must be carried out for medicines in the trolleys for both nursing and non nursing care. This will ensure that all the people living in the home receive their medicines as required. 19/12/2008 3 25 23 Adequate heating must be provided in all areas of the home used by people living there This will ensure that all areas in the home are of a comfortable temperature. 31/12/2008 Care Homes for Older People Page 30 of 33 4 38 23 The manager must ensure that the flooring in the lift is made safe. This will ensure that the people using the lift are safe from tripping over. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care staff should record the tasks that they undertake themselves. This will ensure that individuals take responsibility for tasks they undertaken. Care plans should include clear details of how staff are to meet all areas of need for the people living in the home. They should be updated as needs change. This will ensure that staff are fully aware of how peoples needs are to be met. Care plans should indicate to staff how specific tasks such as rotation of peg tubes are to be carried out. Turn charts must be appropriately completed. This will ensure that the people living in the home receive the care that they need. Weights should be monitored as identified in the care plans and where individuals are not able to be weighed an alternative way of monitoring their weight should be identified. Staff need to check with the pharmacist the suitability of medicines being administered through the peg site and any advice given should be recorded. All medicines and liquid feeds must be booked in appropriately and checked against the prescriptions to ensure the strengths and prescribing instructions match. This will ensure that people receive their medicines as prescribed. The MAR charts should show who has administered the liquid feeds and creams and ointments. This will ensure that responsibility is held by the individuals administering these. Staff must ensure that accurate records are kept of the food and fluid intake of people living in the home. It will Page 31 of 33 2 7 3 4 7 8 5 8 6 9 7 9 8 9 9 15 Care Homes for Older People then be able to assess whether people living in the home eat a balanced and varied diet. 10 11 12 15 25 27 The manager should monitor the variety of food served. This will ensure that the food served in the home is varied. Windows should be replaced to improve visibility. Staffing levels should be kept under review as numbers of people living in the home, or the needs of the people living in the home increase. This will ensure that there are always sufficient staff available to mee tthe needs of the people living in the home. Senior nursing staff should undertake certificated training in tissue viability. This will ensure that decisions made in the home are based on recent knowledge and good practice. The residents and relatives meeting times should be varied to enable more people to be able to attend. There should be two signatures for any transactions carried out on behalf of people living in the home. This will ensure that the people living in the home are safeguarded. 13 30 14 15 33 35 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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