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Inspection on 17/05/09 for Grey Ferrers Nursing Home

Also see our care home review for Grey Ferrers Nursing Home for more information

This inspection was carried out on 17th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 The information and guidance on the Control of Substances Hazardous to Health (COSHH) has been reviewed with new systems now in place to ensure higher standards. The terms and conditions of contract for funded people have been implemented to ensure that the rights of the individual are respected at all times. The internal redecoration and refurbishment is still ongoing. This will ensure that the environment is maintained to a good standard.

What the care home could do better:

The statement of purpose requires reviewing. This should include The findings from the last Inspection report and the experiences expressed by people that use the service. This aspect remains outstanding since our last visit. The service user guide should also be revised and made available. Together, all this information will ensure people can make an informed choice about living at Grey Ferrers. Better arrangements around medication management and training for staff. Medication policies and practices to be reviewed and followed appropriately. Such measures will ensure resident`s health care is protected. Every efforts should be made to seek the views of the resident from the relatives, were the individual does not have capacity. This would provide staff with the resident`s needs and wishes around personal care that should be respected and acted upon. Information on the `after life` wishes of people using the service needs to be Obtained and recorded within the individual care plans. This aspect remains outstanding since our last visit. The management and delivery of activities to be better organised. This would improve the quality of life for individuals. The arrangements for meals to be reviewed to ensure residents receive adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared. Better management and recording of all concerns and complaints (verbal and written) that come to the attention of the unit team leaders and the registered manager must be retained. The record must include the actions taken to investigate the concerns/complaints and the outcome of the investigation. The same aspects were raised at our last visit.Grey Ferrers Nursing HomeDS0000001907.V375446.R02.S.docVersion 5.2A need for staff training around adult protection, challenging behavior, first aid, moving and handling, infection control and food hygiene. All this learning for staff will benefit residents care and raise standards in the home. Improved systems for recording staff training planned and completed. This would enable the home to plan and review staff training more efficiently. The quality assurance monitoring systems to be reviewed, and shortfalls reviewed and action taken. This would ensure the home is run in the best interests of the residents. The internal redecoration and refurbishment is still ongoing. This will ensure that the environment is maintained to a good standard. This area remains outstanding since our last visit. A greater focus must be on ensuring decorations and repairs are completed promptly, to meet the needs of the residents comfort and well being. Laundry service to be improved to ensure efficient laundry systems; and that resident are always able to wear their own laundered clothes and maintain their dignity. Staff recruitment and deployment to be reviewed particularly around weekend cover. This will ensure residents receive care from consistent carers that know and understand their needs well. Staff recruitment procedures to be reviewed to ensure better tracking of the staff recruitment process. Staff to be confirmed in post upon completion of all the required checks. Criminal Record Bureau (CRB) checks to be undertaken every three years for staff in line with good practice. This will ensure residents are cared for by safe staff. Improved infection control procedures to prevent infection, toxic conditions and the spread of infection at the care home. Provide staff with training; and improve health and safety procedures and practices. Residents would benefit from living in a clean and hygienic home.

Key inspection report CARE HOMES FOR OLDER PEOPLE Grey Ferrers Nursing Home Priestly Road Blackmore Drive Leicester Leicestershire LE3 1LQ Lead Inspector Helen Abel Key Unannounced Inspection 17th May 2009 10:00 DS0000001907.V375446.R02.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Ferrers Nursing Home Address Priestly Road Blackmore Drive Leicester Leicestershire LE3 1LQ 0116 2470999 0116 2558364 brownpj@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) Manager post vacant Care Home 120 Category(ies) of Dementia (120), Old age, not falling within any registration, with number other category (120), Physical disability (120) of places Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical disability - Code PD The maximum number of service users who can be accommodated is: 120 12th August 2002 2. Date of last inspection Brief Description of the Service: Grey Ferrers is a 120-bedded care home providing personal and nursing care for older persons. Accommodation is provided within four separate units, these are known as Brandon, Bradgate, Stewards Hay and Woodville providing care for older persons with nursing, physical disability and dementia needs. Each unit is comprised of a large dining/ lounge area, a small quiet lounge, toilet, washing and bathing facilities and single room private accommodation. The home is located on the outskirts of Leicestershire and is easily accessed by public transport from the City of Leicester and from the County. The home is purpose built and is accessible to service users with disabilities. Accommodation is located on the ground floor. Each unit has a spacious lounge and adjacent dining area, which look out over the gardens. All bedrooms are single occupancy and many open directly onto the garden. The home is currently managed by an acting manager and employs Registered General nurses, Registered Mental Health nurses and care staff. The home has ample parking and is close to a number of social amenities. The weekly fees range from £458 to £800 per week. There are additional costs for expenditure such as hairdressing, private chiropody, toiletries, newspapers, etc. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 5 The home provides information to residents and prospective residents in the form of a Statement of Purpose that describes the services it offers. The last Inspection Report is displayed in the reception area. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Care Quality Commission is upon outcomes for residents and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting four people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. Because people with dementia are not always able to tell us about their experience of the service, we invited an Expert by Experience who spent over three hours time talking to residents and weekend visitors, in particular residents with dementia; looking at the quality of care received; looked at the quality of meals and refreshments served; and talking to staff involved with people’s care. This information gives us an indication as to how the service supports people living with dementia in the home. The Expert by Experience compiled a short report and extracts were included in the body of this report. The visit was unannounced on a Sunday morning at 10.00am until 5.30pm. The acting manager and a regional manager assisted the Inspector and Expert by Experience during our visit. Planning for the visit included assessment of the notifications of significant events, service history, complaints and concerns which had been received by the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and we looked at the feedback received from questionnaires circulated to people who use the service, relatives, and staff. People who lives at the home are referred to in this report as residents. The quality rating for this service is 1 Star. This means the people who use this service experience Adequate Quality outcomes. What the service does well: Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 7 People have good information available to them to help them, to make an informed choice about living at the home- booklets about dementia care, residents and relative’s information, and a specific booklet about Grey Ferrers Nursing and Residential home are available. A relative of a resident told us “I was given a pack of information before we started.” “I know my family looked on the intranet at the last inspection report and then choose this home.” Assessment procedures are in place and are outlined in the written information. There are blue coloured complaints and compliments leaflets available at reception. There are opportunities to make suggestions, compliments and complaints. One resident told us about the benefits of attending the Visitors Forum. She had attended one meeting and felt listened to and was pleased to meet managers. The acting manager confirmed they were setting up new Forums for residents and relatives, and a support group for relatives. This would benefit residents and their relatives ensuring the service is run in their best interests. Residents and relatives gave us mixed comments about staff in the surveys; “I have visited Grey Ferrers on an almost daily basis. I am aware of the excellent care provided there and have a good working relationship with the home’s manager and the staff in the Woodville Unit.” “Better team work amongst staff. Quality of staff varies – seems to be a high staff turn over recently” “I have observed staff and sure my relative is extremely well looked after with great care and dignity.” Staff were seen to responding in a caring but firm way with an incident involving a resident displaying challenging behaviour. There are two activity coordinators who work across the week except Saturdays. The activity coordinator was observed with six residents taking part in group discussion and art work, and listening to music of their time. What has improved since the last inspection? Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 8 The information and guidance on the Control of Substances Hazardous to Health (COSHH) has been reviewed with new systems now in place to ensure higher standards. The terms and conditions of contract for funded people have been implemented to ensure that the rights of the individual are respected at all times. The internal redecoration and refurbishment is still ongoing. This will ensure that the environment is maintained to a good standard. What they could do better: The statement of purpose requires reviewing. This should include The findings from the last Inspection report and the experiences expressed by people that use the service. This aspect remains outstanding since our last visit. The service user guide should also be revised and made available. Together, all this information will ensure people can make an informed choice about living at Grey Ferrers. Better arrangements around medication management and training for staff. Medication policies and practices to be reviewed and followed appropriately. Such measures will ensure resident’s health care is protected. Every efforts should be made to seek the views of the resident from the relatives, were the individual does not have capacity. This would provide staff with the resident’s needs and wishes around personal care that should be respected and acted upon. Information on the ‘after life’ wishes of people using the service needs to be Obtained and recorded within the individual care plans. This aspect remains outstanding since our last visit. The management and delivery of activities to be better organised. This would improve the quality of life for individuals. The arrangements for meals to be reviewed to ensure residents receive adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared. Better management and recording of all concerns and complaints (verbal and written) that come to the attention of the unit team leaders and the registered manager must be retained. The record must include the actions taken to investigate the concerns/complaints and the outcome of the investigation. The same aspects were raised at our last visit. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 9 A need for staff training around adult protection, challenging behavior, first aid, moving and handling, infection control and food hygiene. All this learning for staff will benefit residents care and raise standards in the home. Improved systems for recording staff training planned and completed. This would enable the home to plan and review staff training more efficiently. The quality assurance monitoring systems to be reviewed, and shortfalls reviewed and action taken. This would ensure the home is run in the best interests of the residents. The internal redecoration and refurbishment is still ongoing. This will ensure that the environment is maintained to a good standard. This area remains outstanding since our last visit. A greater focus must be on ensuring decorations and repairs are completed promptly, to meet the needs of the residents comfort and well being. Laundry service to be improved to ensure efficient laundry systems; and that resident are always able to wear their own laundered clothes and maintain their dignity. Staff recruitment and deployment to be reviewed particularly around weekend cover. This will ensure residents receive care from consistent carers that know and understand their needs well. Staff recruitment procedures to be reviewed to ensure better tracking of the staff recruitment process. Staff to be confirmed in post upon completion of all the required checks. Criminal Record Bureau (CRB) checks to be undertaken every three years for staff in line with good practice. This will ensure residents are cared for by safe staff. Improved infection control procedures to prevent infection, toxic conditions and the spread of infection at the care home. Provide staff with training; and improve health and safety procedures and practices. Residents would benefit from living in a clean and hygienic home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good information available to them to help them, to make an informed choice about living at the home. 1,2,3 EVIDENCE: There is a range of information provided to new and existing residents. The statement and service user guide is still in draft format and is currently being reviewed. Information provided is called – Residents and Relatives Information. There is separate booklet about Grey Ferrers Nursing and Residential Home. Another booklet available is called – Caring for Someone with Dementia. Such information is presented with photographs, in a bound Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 12 version, is informative and will help a new person decide if they would like to live in the home. A relative of a resident told us “I was given a pack of information before we started.” “I know my family looked on the intranet at the last inspection report and then choose this home.” Assessment procedures are in place and are outlined in the written information. A new resident had joined the home two days before the Inspector visited and had sufficient information in place to enable staff to provide appropriate care for her. A family member visiting confirmed how well she had settled in. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal and health care are well met, however shortfalls around medication management could lead to poor care. 7,8,9,10 EVIDENCE: Relatives of resident users told us, “Staff are very caring, and very patient. I know staff keep very calm” “It’s very good here staff are under pressure. They do very well.” “The staff are very friendly. It’s like coming into my mums own home when I come here!” Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 14 All care plans viewed were found to be well presented with a photograph of the individual and included clear information. The Map of Life record was seen in care plans and was found to be a useful tool. Staff could learn more about the residents life, and provide a more personalised service. Daily records were up to date and detailed and all plans had regular reviews or were being formally reviewed. Medication records were sampled in Bradgate Unit and Woodville Unit. They were found to be generally completed well. Some issues around ‘thick and easy’ agents were not properly recorded, and will be looked into by the acting manager across the whole home. Another issue around inappropriate storage of items in one of the cold secure storage areas will be looked at by the acting manager. This aspect has the potential to put people’s health and welfare at risk and a recommendation has been made. See also Management and Administration section. In one of the units the medication room door was left open. This left the medication area unsecured and could put residents at risk of harm. Mediation areas were found to be clean and tidy and were maintained with appropriate room temperatures. In both units different practice was in place for returning medicines safely to the Pharmacist. The BUPA policies and procedures around the destruction of medicines should be reviewed and improved upon. Further medication administration staff training should be arranged. All these measures will ensure resident’s medicines are safeguarded. One visitor told the Inspector when ever there are hospitals appointments staff tell him and a family member will attend. Another relative told the Inspector she was worried, but knew the nurse in charge was taking action with other health professionals on behalf of the resident. Care plans showed reviews of health care and body charts, weighing charts, ‘cots side’ requests to keep residents safe in bed, and other risk assessments to reduce harm to residents. Residents told us, “Medical care is generally very good.” “They provide a caring environment.” A relative of a resident told us, “Staff know how to get my relative to swallow her tablets, as she was being difficult with them.” A survey from a relative told us, “Do not like male carers dealing with our mothers toilet needs and changing her. If she was aware she would be Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 15 horrified.” Every efforts should be made to seek the views of the resident from the relatives, were the individual does not have capacity. This would provide staff with the resident’s needs and wishes around personal care that should be respected and acted upon. From the four residents case tracked only two had detailed recorded in their End of Life plan. Steps should be taken to ensure the changing needs of a resident around dying and death are raised and recorded, where possible. Following on the inspection managers confirmed the End of Life care is treated seriously and the End of Life Plan is in place as soon as possible. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are flexible visiting arrangements for residents, and some activity provision. Meal sizes do not always support residents needs, preferences and quantities required, and in some cases can put them at risk. 12-15 EVIDENCE: The Expert by Experience confirmed some residents were given some simple activities (e.g. ball throwing) which they enjoyed. One Ukrainian lady experienced difficulty in understanding English. Her general observation was that more appropriate activities for all residents are needed. A relative told us,” More activities, exercusions and visits needed.” Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 17 Residents were observed sitting in groups quietly in the lounges, six people were seen taking part in group discussion and art work, and listening to music of their time. Musical entertainers come into the home at intervals. Community Crops (growing) activities are available and different units have a World Cruise theme, a country each to celebrate. There are two activity coordinators who cover over the week except Saturdays. Surveys confirmed consistently from residents, their relatives and staff there were not enough activities available in the home. Residents need opportunities to participate in activities that match their expectation, preferences, social and cultural needs. Better management and organisation of these activities must be provided and maintained. A relative told the Expert by Experience the music played on the loudspeaker was inappropriate to the age of the residents. One of the managers agreed and confirmed the same observation. She told us changes would be made. Visitors were seen coming and going and were offered drinks and made welcome by staff. One relative confirmed she had attended the home’s Visitors Forum and felt included and listened to. Any issues could be raised openly around the care of people at the home. She welcomed this and confirmed “meals” were discussed and being looked into by managers. The Inspector observed the serving of a hot lunch of a roast meal. Soft options were also provided and resident’s individual dietary requirements met. The home has recently consulted with residents and relatives about their meal choices and wishes and is reviewing the menus. The Inspector found the Sunday roast meal was satisfactory. The desert of sherry trifle was found to lack any flavour. The Expert by Experience confirmed all the residents and relatives with whom she spoke with were satisfied with the food provided. However, one resident needed more drinks. One relative said that the content and variety of sandwiches had deteriorated. When apple crumble was cooked, the apples were tinned and too hard for some residents to swallow. The menu board stated that a cooked meal was being served but, relatives stated that sandwiches were more often served instead. Many of the surveys returned from residents, relatives and staff confirmed under-What the Service Can do Better- told us “There should be a choice of what they can eat, which is often not available.” “Portion sizes are small.” “Not enough to eat.” “Better selection of pureed puddings instead of mouse.” “Would like to see freezers on units, so residents don’t have to eat melted ice cream, and can eat their ice cream when the main kitchen is closed.” Throughout our visit staff confirmed residents meal portion sizes were variable. Some days there was not enough food, other days there was. To Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 18 ensure residents receive adequate quantities and nutritious diets, meal provisions must be reviewed and improved upon. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for recording complaints are not maintained and reduce the opportunity for resolving problems promptly and can put residents at risk of poor care. Residents are not adequately protected from harm. 16,18 EVIDENCE: The home has received fourteen complaints since our last visit. The home’s complaints record procedure was not being followed. Complaints were not well organised to allow for proper detail of action taken in response, or any overall monitoring being undertaken. The Expert by Experience confirmed - Residents did not know of complaints procedure. The complaints procedure is in draft format in the statement of purpose. The home is reminded the arrangements for dealing with complaints and the Care Quality Commission contact details should be held in the statement of purpose. There are blue coloured complaints and compliments leaflets available at reception. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 20 A recent safeguarding issue around care, staff training, health and welfare is being investigated by the home and the outcome will be passed onto the local authority. One resident in one part of the home was seen displaying challenging behaviour, throwing drinks, and kicking tables over, shouting at staff and other residents. Staff were seen to responding in a caring but firm way whilst reassuring the person. A visitor told us, “Staff get hit and kicked sometimes. They are so patient I don’t know how they do it.” Staff confirmed during our visit and in the surveys a need for more training around safeguarding vulnerable people from abuse and challenging behaviour training. One staff member told us they had received adult protection training upon their Induction some years ago. The managers at the home agreed these training needs would be provided. The regional manager confirmed ongoing adult protection training is scheduled to start soon. Such learning would ensure staff understand and deal with behaviour approiaptely and protect residents from harm. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive a comfortable, clean environment with shortfalls around laundry facilities and upkeep of the home. 19,20,21,23,24,25,26 EVIDENCE: The Expert by Experience received mixed comments from residents and their relatives about Brandon and Stewart Hey:“The decoration needs attention. Cleanliness of a resident’s room was an issue. Several DIY jobs needed doing, e.g. handrail in one bedroom had come off and had not been replaced. Toiletries disappear. Carpet in Stewards Hay lounge and kitchen floor in Brandon House need cleaning.” Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 22 Comments from surveys from residents, their relative and staff told us, “On many occasions when I enter my relatives room the floor is always sticky underfoot. I have mentioned this but the problems still exists.” “Would like to see new furniture, curtains and bedding.” “Need more furniture and décor as is very dated.” “Outdated bed linen and bed throws.” “Good quality beds. The bedrooms are well furnished.” The service should review maintenance and renewal plans and ensure the home is kept safe and well maintained. Residents will benefit from living in a safe and comfortable home. The Inspector visited Woodville and Bradgate unit and found the communal areas to be clean, fresh and well organised. Resident’s case tracked bedrooms were viewed and were found to be personalised and comfortable. Relatives told us “My relative’s bedroom is always clean, it’s never dirty.” “The lounge is large, nice and comfortable.” “There was a mix up with the resident’s clothes. The staff sorted it out immediately.” A number of the same concerns were raised with the Expert by Experience, the Inspector, and from comments across the surveys around resident’s clothes and the laundry service. They told us, “The residents were not always wearing their own clothes. Laundry ‘gets lost’. “One partner (of a resident) had bought 24 pairs of socks for a resident. They had all been lost.” “Better laundry services. Named clothes go missing. People in un-coordinated clothing.” “We complain often regarding our relative’s clothes. We take in new clothes marked with her name and number on. When they are sent back from the laundry they go missing or come back badly washed and never ironed. My relative is often in other peoples clothes.” Laundry systems should be reviewed and better organised to ensure residents wear their own laundered clothes and maintain their dignity. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in staff recruitment, and staffing levels would provide better protection for residents. 27-29 EVIDENCE: Residents and relatives gave us mixed comments about staff in the surveys, “I have visited Grey Ferrers on an almost daily basis. I am aware of the excellent care provided there and have a good working relationship with the home’s manager and the staff in the Woodville Unit.” “Better team work amongst staff. Quality of staff varies – seems to be a high staff turn over recently” “I have observed staff and sure my relative is extremely well looked after with great care and dignity.” Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 24 Relatives told the Expert by Experience, “Three visitors commented on the rapid turnover of staff. Liaison between staff and relatives needs improving. Two relatives had not been informed of the care worker (for their relative) for 12 months. Staff recruitment records were viewed and found to be generally in order with the required checks in place. Better recruitment tracking could help improve the staff recruitment systems. One staff member was awaiting a criminal records bureau (CRB) check. They were working with residents and had been assigned a mentor to work with until they can work safely alone. There was no evidence of the mentor system, on staff rota’s, and in the Homes Annual Quality Assurance Assessment (AQAA). To ensure residents are protected staff should not commence work until all the required checks are completed. It is good practise for staff (CRB) checks to be undertaken every 3 years with all staff. These measures will ensure residents are cared for by safe staff. The acting manager now has counter signatory status to make the CRB process for new employees more time effective. A number of staff told us of their concern for the high and regular use of agency staff, and whether they can always quickly understand and meet residents. The use of agency staff was found to be most evident over weekends. Following on our visit managers told us agency staff are being employed more whilst the home goes through a staff recruitment drive. Staff recruitment and deployment to be reviewed to ensure appropriate staff are employed to meet the needs of the service. Copies of staff training certificates are held for each staff member. A number of staff asked for more training in First Aid. (See Management and Administration section.) The acting manager confirmed progress is being made to ensure staff receive training in National Vocational Qualifications (NVQ’s). Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 health and welfare of residents has not properly been protected by the management arrangements and quality assurance systems. 31,33,35,37,38 EVIDENCE: The acting manager was available during our visit and was able to assist the Inspector and the Expert by Experience. Her application to be the Registered Manager is being progressed by the Care Quality Commission. A regional manager was also present and also assisted. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 26 The homes Annual Quality Assurance Assessment (AQAA) was found to largely include the same information from the previous year and did not reflect the practice in the home. The AQAA tell us:- the home is supported by a national team of quality and compliance officers whose roles include supporting quality issues within the home, auditing and providing guidance on policies, procedures and practice. They have an annual internal and external Customer Satisfaction Survey. These measures were not evident during our visit. The home should review their quality assurance monitoring systems based on seeking the views of the residents and meeting the aims, objectives and statement of purpose of he home. One resident told us about the benefits of attending the Visitors Forum. She had attended one meeting and felt listened to and was pleased to meet managers. The meeting dates are advertised on each individual unit. Other residents and relatives spoken with did not know about the Forum. The acting manager confirmed they were setting up new Forums for residents and relatives, and a support group for relatives. This would benefits residents and their relatives ensuring the service is run in their best interests. Staff consistently told us they needed training around first aid, and moving and handling. Following on our visit managers confirmed they have their quota of first aider’s with the current complement of staff; and 100 of staff have undergone moving and handling training. Infection control and food hygiene training should also be provided to meet shortfalls around current health and safety practices. (See also Health and Personal Care section). There were no specific training plans in the homes AQAA around safe working practices. Establishing annual training schedules; and the systems to evidence training is done, due and planned, were identified by the home as two areas for development. Money for an identified resident was being held by the home. Records were viewed and were in order. The Inspector suggested checks are made to ensure the individual who does not have capacity, and has no family members living in England, has all their needs met around clothes and other items. Hand washing solutions for entering and leaving the units are in place but are not being routinely used. The Inspector and Expert by Experience were not reminded about this, or noticed messages/signs being available or highly visible. This practice in the home should be reviewed to ensure there is understanding and practice to prevent the spread of infection and communicable diseases. This will ensure a hygienic and cleaner home for residents and reduce the spread of infection. Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 27 Health and safety checks are confirmed completed on the AQAA. The home was found to be generally clean and tidy but improvements around maintaining standards of health and safety should be addressed. Grey Ferrers Nursing Home DS0000001907.V375446.R02.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 3 x 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x 2 2 Grey Ferrers Nursing Home DS0000001907.V375446.R02.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. Standard OP9 Regulation 13 Timescale for action The registered person shall make 31/05/09 arrangements for the recording, handling and safekeeping safe administration and disposal of medicines received into the home. Staff to receive training around the destruction of medication. Practice must reflect written policy and procedure. 31/05/09 Requirement 2. OP9 13 3. OP12 16 To consult with residents about a 17/07/09 programme of activities arranged for by or on behalf of the care home. To provide adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time maybe reasonably be required by residents. 17/06/09 4. OP15 16 Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 30 5. OP16 22 The registered person shall establish a procedure for considering complaints which must be followed and made appropriate to the needs of the service user group. 17/06/09 6. OP18 13 The registered person shall make 31/08/09 arrangements by training staff to prevent residents being harmed, or suffering abuse or being placed at risk of harm or abuse. The premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. The premises must be kept in good repair. Arrange for the regular laundering of linen and clothing. To ensure residents are protected staff should not commence work until all the required recruitment checks are completed. Ensure that all times suitably qualified, competent and experienced persons are working at the care home in such numbers apparipate for the health and welfare of the residents. The registered person shall establish and maintain systems for reviewing at appropriate intervals and improving the quality of care provided at the home. 31/08/09 7. OP19 23 8. 9. OP26 OP29 16 7 31/05/09 18/05/09 10. OP29 18 18/05/09 11. OP33 24 31/08/09 Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 31 12. OP38 13 The registered person shall make 30/06/09 suitable arrangements for the training of staff in first aid; and to provide safe systems for moving and handling residents. The registered person shall make 30/06/09 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. 13. OP38 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Ensure procedures and processes around taking samples from residents are reviewed in line with good practice and protocols. This would ensure residents health and welfare is met. Every efforts should be made to seek the views of the resident from the relatives, were the individual does not have capacity. This would provide staff with the resident’s needs and wishes around personal care that should be respected and acted upon. Steps should be taken to ensure the changing needs of a resident around dying and death, are raised and recorded (where possible). Laundry systems should be reviewed and better organised to ensure residents always wear their own laundered clothes and maintain their dignity. Better recruitment tracking would help improve the staff recruitment systems and keep residents safe. 2. OP10 3. OP11 4. OP26 5. OP29 Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 32 6. OP29 Staff checks (Criminal Record Bureau Checks) should be undertaken every 3 years with long serving staff. These measures will ensure residents are cared for by safe staff Ongoing training should be provided to all staff to ensure they complete the required mandatory training and service specific training to enable them to fulfil their roles and responsibilities and meet individual needs. Better record keeping around Annual training schedules and the systems to evidence training is done, due and planned. This would ensure residents are cared for by trained staff. 7. OP38 8. OP37 Grey Ferrers Nursing Home DS0000001907.V375446.R02.S.doc Version 5.2 Page 33 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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