Inspection on 09/01/07 for Grangemoor House Nursing Home

This inspection was carried out on 9th January 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 found no outstanding requirements from the previous inspection report, but made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grangemoor House Nursing Home 25/06/07

Grangemoor House Nursing Home 21/12/05

Grangemoor House Nursing Home 22/02/05

Grangemoor House Nursing Home 17/08/04

Grangemoor House Nursing Home 26/01/04

Grangemoor House Nursing Home 18/09/03

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

CARE HOME ADULTS 18-65 Grangemoor House Nursing Home 110 Cannock Road Burntwood Walsall Staffordshire WS7 OBG Lead Inspector Mrs Mandy Brassington Key Unannounced Inspection 9 January 2007 10:00 Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 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 Grangemoor House Nursing Home DS0000022328.V325846.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 Adults 18-65. 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. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grangemoor House Nursing Home Address 110 Cannock Road Burntwood Walsall Staffordshire WS7 OBG 01543 675711 n/a 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) Grangemoor Care Homes Andrew Mark Winter Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19 December 2005 Brief Description of the Service: Grangemoor House is nursing home situated in Burntwood registered to accommodate 23 persons. The home in a residential area of Burntwood with good access to public transport and community facilities. The home is currently registered to admit residents suffering from a mental disorder, excluding learning disability or dementia (23) from the ages of 18 years and over. The home accommodates eight persons over the age of 65. A minor variation is required to ensure this is within the home registration. Accommodation is provided on two floors. On the ground floor, there is a lounge and smoking lounge, a dining room, kitchen, laundry facilities, five ground floor rooms, one of which is shared, an open shower and toilet facilities. The first floor has a range of shared and single rooms, a computer room/meeting room and suitable bathing and toilet facilities. A number of individuals are independent in relation to personal care and accessing community activities and support. The home needs to review its aims and objectives and give clear information within the Statement of Purpose as to the philosophy and practices of the home. At present, the home provides limited support for specific therapeutic activities to individuals to promote their mental health, independence and ongoing rehabilitation. The manager, Mr Andrew Winter informed the Commission on 16 January 2007 that the fee level for the home ranged from £480 to £487 per week. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered all of the core standards. The inspection took place over 7.5 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection and an Expert by experience visited the home for 3 hours, discussing the service with individuals. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. A tour of the home was undertaken. On the day of the inspection, the home was accommodating twenty-one people. Prior to the inspection visit, survey information has been obtained from service users and their relatives. Three comment cards were received back from relatives and four from service users. The inspection included an examination of records, indirect observation, discussions with six service users, the nurse in charge, and three staff on duty. Case tracking of four care plans was undertaken. Observation of daily events took place. Staff records were unavailable for inspection. The inspector observed a member of staff administer medication, and inspected the storage system and medication procedures. The Expert by Experience ate lunch with the service users. An Immediate requirement notice was issued on the day of the inspection for six requirements, and a further sixteen requirements and four recommendations were made as a result of this visit. What the service does well: Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 6 The home has a well-established team of staff and the staff group is balanced and diverse to enable individuals a choice of male or female staff, and the staff team are of varying ages. The staff provide a warm reception and have open and positive relationships with service users. Staff were observed communicating at a pace to suit individuals and using appropriate forms of communication. Service users were relaxed in the company of staff and spoke of them with high regard. Individuals felt safe at the home and able to speak to members of staff. Comments received from relatives reported they are happy with the care and support provided. A number of service users are independent in relation to personal care and accessing the community. The home takes a sensible approach to managing risk to enable individuals to retain their independence. Each year, the home organises a holiday for service users, if they wish to go away. In 2006, service users choose to go to Blackpool. Service users meeting take place each week and individuals have an opportunity to voice any concerns and comment on the daily management of the home. The home also conducts a quality assurance questionnaire and reports on the findings. What has improved since the last inspection? What they could do better: The Statement of Purpose does not reflect the current service provided by the home in relation to rehabilitation and promoting individuals living skills. The home needs to demonstrate how this can be provided within the current staff team. The home provides limited daily activities and service users are not involved with living skills, such as shopping and food preparation. For a number of individuals, leisure activities and community access is dependant upon staff support; a review of staffing needs to demonstrate how and when individuals receive this support. The home must ensure that service users or their representative are involved with the initial care planning and subsequent reviews. Where restrictions have Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 7 been placed upon individuals, this needs to be agreed with the service user, the placing authority and to consider the use of an advocate. The care plans need to record proactive plans of care for individuals where the assessment has identified complex behaviour, and to review how this is monitored to ensure continuity and its on-going effectiveness. The home needs to ensure there are robust medication procedures. There are concerns regarding the receipt of medication and subsequent audits, recording of the Medication Administration Records (MAR) and storage of medication that requires a cold temperature. The home needs to develop appropriate systems to ensure necessary documents are available for inspection. It was not possible to complete an inspection of staff records and training as the required documents were unavailable. 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. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A care management assessment is completed for all new referrals and information regarding the home is provided to service users. The home needs to consider the Statement of Purpose, which currently does not reflect the service provided within the home. EVIDENCE: The Statement of Purpose records that the home will ‘aim to promote independence, normalisation and on-going rehabilitation of the individual, and promote growth and achievement where possible rather than increasing dependency’. The aims and philosophy of the home were examined throughout the day. It is a concern to the Commission that there was little evidence to demonstrate how the home promoted individual’s mental health, and provided support with living skills within the home and the community. This was discussed with the nurse in charge. The home must demonstrate through a review of staffing how it meets individual needs within the agreed aims of the home. The Statement of Purpose must accurately reflect the service provided. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 10 There had been one new referral since the last inspection. Examination of the care file revealed that a care management assessment had been completed prior to admission. The nurse in charge reported that the manager also conducts an assessment to ensure the home can meet the needs of the individual. The home accommodates eight persons over the age of 65. The manager needs to apply for a minor variation and demonstrate how the home meets individual’s needs. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place for all service users and based on assessed needs. The plans including restrictions placed upon individuals have not been appropriately agreed with service users. EVIDENCE: A sample of four care records showed that care plans had been formulated based upon the known needs of the service users; the plans focused on the nursing model of the Twelve activities of Daily Living. Assessments of risk were incorporated into the plan of care. Specific information relating to identified behaviour concentrated on reactive planning, and the nurse in charge confirmed that specific recording, triggers to the behaviour and a record of frequency was not clearly maintained; all information was recorded in the daily record. It was therefore difficult to assess the effectiveness of the plans and it was agreed that additional information regarding antecedents and Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 12 developing proactive plans of care would improve the support for the individual. Other information in the service users assessment gave explicit information about the needs of the individual, for example, where there was a specific diagnosis, or dependency upon alcohol and the action. None of the care plans sampled contained any evidence of service user involvement. Discussion with staff revealed the plans were written and reviewed by the qualified staff without service user involvement or service user representative. The nurse in charge commented that individuals would be able to have access to their plan of care. It is required that service users be involved with the care planning and review and the home must evidence this. Where individuals to not wish to participate a record of this decision must be maintained and kept under review. The plans of care recorded restrictions placed upon individuals in relation to personal monies and for consumption of alcohol. The registered manager must ensure that consent is obtained from the service user for any restriction and agreed with the placing authority, and where appropriate the home must consider the use of an advocate. At present, the home provides limited support with living skills to enable individuals to increase their level of independence. The home must ensure that in line with the Statement of Purpose, for individuals who wish to participate in daily activities, independent living tasks, and have access to community facilities, appropriate staff support must be provided. Through a review of staffing, the home must demonstrate how it can provide meaningful daytime activities of individual’s own choice and according to their interests and capability. It is recognised that due to the needs and identified health issues, a number of service users would choose not to participate in gaining further living skills or becoming independent. This was discussed with the nurse in charge, and it is required that in consultation with individuals, that this be recorded in the plan of care and reviewed with the placing authority. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals have had the opportunity to go on holiday and take part in community leisure activities. The home needs to review the current resources in the home to demonstrate how individuals are able to develop living skills and regularly access the community with support, in line with the Statement of Purpose. EVIDENCE: A number of individuals are independent in relation to accessing leisure facilities and within the community. A care plan and risk assessment has been completed for identified risks involved in the community such as road safety and vulnerability. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 14 Service users have an opportunity to attend an art class, relaxation and keep Fit in the home on a weekly basis. A number of individuals attend a Local Centre and are involved with working for a therapeutic wage. During 2006, the home has organised a trip to a pantomime, a theatre performance at a local School, Musical events including an Entertainer visiting the home, A trip to the Black Country Museum and individuals were given the opportunity to visit Blackpool for a few days in the Autumn. All service users spoken with spoke highly of the events. Around the home were a large number of photographs of trips and holidays over the years. The ‘Choices of Home’ outcome reports that the home’s Statement of Purpose states that the home ‘aims to promote independence, normalisation and ongoing rehabilitation of the individual, and promote growth and achievement where possible rather that increasing dependency’. From discussion with service users and staff, observation of practices and discussion with the Expert by Experience, it was noted that individuals have limited opportunities to engage in living skills in the home or access community activities on a daily basis. Staff confirmed that a minimum of two members of staff are required on duty at all times and therefore there is only one member able to support individuals in the community for appointments or activities. In conversation with the Expert by experience, one service user commented that ‘nothing goes on most of the time. You just sit and have a smoke.’ Discussion with one person revealed that staff will purchase personal shopping. The person stated ‘ I wish I could go out a bit more, nobody takes me out.’ This was discussed with the nurse in charge who stated the individual does not always like to go out in inclement weather but confirmed that there may not be sufficient staff on duty to take the person shopping if another person requires support. One person reported that they attend a local church on a weekly basis, and as part of a group, visited Lourdes. The service user reported that members of the church or staff will ensure that they are able to attend the Sunday Service. The purpose of the home and specific support and intervention was discussed at length with the nurse in charge. The manager needs to review the staffing provided in relation to lifestyle and support needs and identify how the home is able to meet the needs of all individuals and promote mental well-being. Within the review, the home is to demonstrate the therapeutic intervention provided by the home to support individuals with recovery and support for individual’s mental health. Individuals reported that they are able to receive visitors on a flexible basis and visit family members and friends in their home unsupported. A number of service users spend time in the family home. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 15 The Expert by Experience ate lunch with the service users. On the day of the inspection, the lunch was cheese and potato pie, with tomatoes and bacon, or salad, with arctic roll for dessert. The Expert by Experience and individuals spoke positively regarding the meals served on that day. Individuals reported that changes in the menu are discussed at residents meetings. During the meal in discussion with the Expert by experience, service users stated that the food was good, and two people mentioned that they had special food, a buffet and a cake on their birthday. Meals are served to individuals and staff do not join service users for meals. A small number of service users are able to access the kitchen with staff support to make refreshments and snacks. One person has chosen to be responsible for laying and setting the tables. Staff reported that service users have access to regular drinks and snacks through out the day and evening and that individuals are able to have drink-making equipment in their room. The home provides a special menu for a number of individuals who have diabetes and two individual who are vegetarians. One person stated that there is always a suitable alternative to meat products available in the home. Service users are not involved with the shopping for the home or meal preparation, this is completed by staff. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home ensures that service users receive appropriate health care and support although; the home needs to ensure there are robust medication procedures and storage in place to ensure the health and welfare of service users. EVIDENCE: Staff reported that a number of individuals are independent in relation to personal care. Where support was required, staff were observed providing appropriate support and service users confirmed that staff were available within the home. One individual needed bed guards. The plan of care recorded an assessment of risk. It is required that bed guards are risk assessed and a regular maintenance schedule is introduced. A copy of the Medicines and Healthcare Products Regulatory Agency (MHRA) Advice Sheet, Issue SC 2 for Bed rails was given to the nurse in charge to support the home. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 17 Plans of care recorded identified health care needs and a record was maintained of appointments with health care professionals and any outcome. A number of service users have regularly access to a Community Psychiatric nurse (CPN). On the day of the inspection, one individual was observed being supported by the nurse in charge to attend a planned appointment and providing information and support upon their return to ensure understanding and reduce any anxiety. All individuals are registered with a local General Practitioner and individuals are able to attend appointments in private. Discussion with staff demonstrated a good knowledge of individual’s needs and how they could provide appropriate support. During the inspection, staff were observed respecting individuals preferences and giving appropriate support. The home employs a large group of staff, many working on a part time basis. This has resulted in providing a diverse staff team with a range of skills and knowledge from both genders and across a large age range, thus giving service users a choice of who they would prefer to receive support from. The home has a separate locked room used to store all medication. Medication is received weekly from a local pharmacy and staff record the details including quantity. One member of staff writes all Medication Administration Records (MAR). It is required that where there are handwritten entries two members of staff check each entry and sign to ensure accuracy. It is also recommended that a review of the current procedure be carried out. A large amount of medication is received into the home, and on each shelf of the medication trolley, the bottles were two or three deep. It is recommended that a larger trolley be purchased to safely accommodate all medication. Medication is also stored within a locked tin in a fridge in the kitchen. The fridge temperature was recorded at one degree. Medication stored included insulin which is not to be stored under two degrees. It is required that a suitable separate secure medication fridge is provided and a daily record of maximum and minimum temperatures be maintained. Inspection of MAR sheets demonstrated there were a small number of gaps in recording and one individual had a refused some medication on several days. An audit of medication could not be carried out, as the home does not maintain the records needed. The home is required to develop a suitable system for stock control and audit the MAR sheets on a regular basis. One person self-medicates and medication is given to the service user on a weekly basis. Staff are to sign the Medication Administration Record to record Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 18 that the weekly supply has been given to the service user. A plan of care and assessment of risk had been carried out. An immediate requirement notice was issued in relation to the current medication storage and procedures. The home must ensure there are robust systems in place to ensure the health and welfare of service users. Due to the concerns identified within the Key Inspection, a Pharmacy inspection is to be conducted in the home. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to voice concerns or complaints individually or within the weekly meetings. The complaints procedure needs to be amended to inform individuals of their right to contact the Commission at any time. EVIDENCE: The home has a complaints procedure displayed in the home with details of the Commission. The Procedure records that if service users are dissatisfied with any outcome or if it is of a serious nature then individuals can contact the Commission. The Complaints procedure needs to be reviewed to inform service users that they may contact the Commission at any time. Discussion with service users revealed if they had any concerns they would have no hesitation of talking to staff. Staff confirmed that individuals would raise concerns. There was no record of any complaint made in the home. It is required that the home keeps a copy of all complaints including ones made verbally and details of any outcome. The home has ‘Residents Meetings’ every Sunday and staff and service users reported that individuals are able to voice any concerns and discuss the events in the home. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 20 From discussion with service users and from information provided in comment cards, individuals and their family are satisfied with the home and feel safe and supported. Discussion with staff revealed they were aware of the Vulnerable Adults Procedure and how to deal with suspected abuse or any disclosure. A number of service users monies are subject to restrictions. Any restriction needs to be agreed to by the individual, placing authority and where appropriate an advocate involved. This is addressed within the outcome area of Individual needs and choices. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a relaxed and homely atmosphere and provides sufficient facilities for all individuals. Service users are able to personalise their bedrooms but are not able to lock the doors. EVIDENCE: The home is situated in a residential area of Burntwood. Accommodation is provided on two floors. On the ground floor, there is a lounge and smoking lounge, a dining room, kitchen, laundry facilities, five ground floor rooms, one of which is shared, an open shower and toilet facilities. The first floor has a range of shared and single rooms, a computer room/meeting room and suitable bathing and toilet facilities. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 22 There are shared and single bedrooms on both floors. Bedrooms had been personalised to reflect individual interests and two bedrooms inspected, had been refitted by service users and their family. In discussion with the Expert by experience, service users commented that the smoking room had recently been decorated and the home was ‘warm and cosy’. The bedrooms could not be locked; discussion with service users revealed some individuals would like to be able to lock their room. It is required that individuals are consulted regarding having a key to their bedroom. Following assessments of risk, suitable locks are to be fitted in consultation with the fire officer. The shared rooms had privacy curtains fitted. In two of the rooms inspected a large number of the curtain hooks were missing, resulting in the curtains drooping. It is required that this be addressed. There are two vacancies at the home, one within a single room and one vacancy in a shared room. The manager must ensure that for people moving into a shared room there is a clear positive choice to share. One first floor bathroom off the dining area does not have a thermostatic valve fitted to the bath. Where there is full body immersion, appropriate devices are to be fitted to regulate the temperature of the water to ensure the health and welfare of service users. An immediate requirement notice was issued in relation to ensure this is completed urgently. There is professional laundry equipment in a separate laundry room. Staff reported these have a sluice facility and meet required standards. Staff revealed that individuals are responsible for bringing their laundry to the room and clothes are washed separately. It is recommended that where individuals are incontinent, the home have red alginate bags available, so laundry can be transported in a sealed environment. The home was clean and tidy and maintained to a good standard. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are encouraged to develop skills and competences to support individuals in the home. Suitable systems are to be developed to ensure all required staff records are available for inspection. EVIDENCE: On the day of the inspection, the nurse in charge was working from 7.30am – 2.30pm and there were two support workers on shift from 8.00am to 3.00pm. In the afternoon the registered nurse worked from 2.30pm to 9.30pm and two support workers were on duty from 3.00pm to 10.00pm. At night, there is one registered nurse and one support worker on duty. Domestic support is provided for five hours in the morning by two staff and for two hours in the evening. There is currently a vacancy for four hours laundry support. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 24 The inspection was conducted with the nurse in charge who worked later that day to support the inspection process. As noted within the outcome area for Lifestyle, a review of staffing is required to identify how the home is able to meet the aims of the service as recorded in the Statement of Purpose, and how the current staffing is able to provide suitable therapeutic activities and support with independence, leisure activities and support in the community. A copy of this report is to be forwarded to the Commission. Staff records are stored securely in the office; the Manager holds the key. On the day of the inspection, the manager was on Annual leave and it was therefore not possible to examine recruitment or training records. Service users commented to the Expert by Experience that they were not involved in the recruitment process. One folder in the office contained some information regarding training but did not include the year the training had taken place and staff were unable to confirm the dates. Information within one folder recorded that all staff had obtained a Criminal Records check (CRB), but there were no details of the disclosure number and corresponding date. The Pre-inspection questionnaire did not record the date the CRB had been applied for or returned as required. Through discussion staff reported that an interview had been conducted and that moving and handling training, fire training and Food hygiene training had been carried out. The manager must ensure that suitable systems are in place to ensure required documents are available for inspection. Discussion with staff revealed that obtaining an NVQ qualification is promoted in the home. One member of staff had achieved an NVQ II and reported that the process had been valuable in relation to being aware of up to date practices and how to use this information in the home. One member of staff on duty was working in the home as a College Placement to achieve NVQ II. Staff confirmed that supervision takes place in the home. The registered nurses are responsible for completing supervision with care staff and reported that this occurs a minimum of six times a year and includes personal development and addressing care issues. The home does not have staff meetings. It is recommended that these occur a minimum of six times a year and are recorded. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 25 From observation and discussion with staff it is evident that staff are aware of individuals needs and are committed to providing a good service within the resources that are available. The Expert by Experience identified that staff were courteous and respectful and gave a warm welcome. Service users confirmed that staff were ‘very good’ and ‘great’. One person commented that she preferred speaking to older staff as ‘younger staff don’t use the same sort of words’. The diverse range of the staff team means that this person’s preference to work with older members of staff can be met. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the Home and there are competent and knowledgeable qualified nurses on each shift. EVIDENCE: The registered manager has worked at the home for a significant number of years and has suitable experience of working and supporting individuals with mental health needs. Discussion with service users and comments from one relative within a comment card reported, ‘Andy is always good and always willing’. ‘I am very satisfied with the excellent level of care provided by the management and staff.’ Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 27 The inspection was conducted with the Nurse in charge who stated she was a registered nurse for people with Mental Health needs. The nurse in charge had experience of working in a home in the community and demonstrated extensive knowledge and understanding of individual’s needs and the support required. Relationships between the nurse in charge and service users were viewed as open and relaxed with appropriate forms of communication used. The nurse reported that the staff team work well together and recognise each other’s strengths. Individuals are able to complete quality assurance questionnaires regarding the service. A recent audit was completed in December 2006 and the findings were made available to service users and displayed on the notice board. Fire records were examined. There was evidence that regular tests and fire drills had taken place weekly. The evidence regarding testing of emergency lights was not available in the home. It is required that the home provides evidence that suitable checks are carried out for the lighting system. The manager carries out a monthly fire risk assessment checklist. Due to the changes in legislation that came into force 1 October 2006, the home is required to carry out a comprehensive fire risk assessment in relation to the buildings by a competent person. The Fire risk assessment needs to be linked to the dependency levels of the service users and to include an Emergency Contingency Plan. The home is to develop a plan for ultimate evacuation to a place of safety and consider the needs of the service users and staffing levels. Due consideration is to be given to access alternative accommodation and emergency contact numbers. This plan is to be reviewed regularly and updated to reflect any changes. Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 X 28 X 29 2 30 X STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 1 X Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 29 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 2 Standard YA1 YA3 Regulation 4 (1)(2) Care Standards Act Part II Requirement To review the Statement of Purpose to ensure it reflects the service provided The registered person is required to apply for a minor variation the individuals over the age of 65 and demonstrate how the home meets the needs of the individuals. To review the plans of care to include proactive management of behaviour and appropriate monitoring. Evidence of service users or service user representative involvement with devising and review of plans of care Any restriction within the plan of care must be agreed by the service user, placing authority and advocate or representative if appropriate To evidence where the needs of individuals does not support participating in living skills To consult service users regarding suitable activities within the home and the community, and for these to be implemented DS0000022328.V325846.R01.S.doc Timescale for action 09/03/07 16/01/07 3 YA6 15 (1) 12 (1)(a) 15 (1)(2) 12 (3) 15 (1)(2) 12 (2) 28/02/07 4 YA6 28/02/07 5 YA6 28/02/07 6 7 YA12 15 (1) 12 (2) 16 (2)(m)(n) 28/02/07 28/02/07 YA14 Grangemoor House Nursing Home Version 5.2 Page 30 8 YA20 13 (2) 9 YA20 13 (2) 10 YA20 13 (2) 11 YA20 13 (2) 12 YA22 22 (7) 13 14 15 YA22 YA24 YA26 17 (2) 13 (4)(a)(c) 16 (2)(c) 16 17 18 YA26 YA29 YA33 16 (2)(c) 23 (2)(c) 13 (a)(c) 24 (1)(2) 18 (1)(a) 19 YA34 19 (1)(b)(i) Staff are to sign the Medication Administration Record to record that medication has been given to one service user who selfmedicates. Hand written entries on a MAR Sheet needs to be checked and signed by two members of staff to ensure accuracy. The registered person is required to provide a separate secure medication fridge and a record of maximum and minimum temperature is to be recorded daily. It is required that a suitable stock control system be developed for all medication and implemented. To review the complaints procedure to reflect that individuals can contact the Commission at any time To keep a copy of all complaints and all outcomes, as Schedule 4 (11) A thermostatic valves is to be fitted to one first floor bath To consult individuals regarding door locks on bedrooms. Following assessment of risk, in consultation with the fire officer, to fit suitable locks. To repair the privacy curtains in the shared bedrooms To risk assess bed guards and carry out a regular maintenance schedule To complete a review of staffing in relation to how the home meets the needs of the individuals including community access, leisure activities and therapeutic support The manager must ensure that all records required in Schedule 2 are available for inspection DS0000022328.V325846.R01.S.doc 16/01/07 16/01/07 09/02/07 16/01/07 19/02/07 09/02/07 30/01/07 09/03/07 28/02/07 28/02/07 28/02/07 09/02/07 Grangemoor House Nursing Home Version 5.2 Page 31 20 YA35 YA32 19 (1)(b)(i) 23 (4)(a)(c) 23 (4) 21 22 YA42 YA42 To maintain a record of staff training and qualifications and ensure these are available for inspection To provide evidence of emergency lighting checks To carry out a fire risk assessment for the home and to be linked to the dependency levels of service users. To complete an Emergency Contingency Plan 09/02/07 19/02/07 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA20 YA20 YA30 YA33 Good Practice Recommendations To review the current medication system To provide a larger Medication trolley suitable for the amount of medication stored To provide red alginate bags Staff meetings are to take place six times a year and are to be recorded Grangemoor House Nursing Home DS0000022328.V325846.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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