Inspection on 29/07/05 for Grosvenor House Nursing Home

This inspection was carried out on 29th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Grosvenor House Nursing Home 06/12/07

Grosvenor House Nursing Home 01/09/06

Grosvenor House Nursing Home 17/01/05

Grosvenor House Nursing Home 22/04/04

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

CARE HOMES FOR OLDER PEOPLE Grosvenor House Nursing Home Coopers Hill Alvechurch, Nr Birmingham West Midlands B48 7BS Lead Inspector Mandy Burton Unannounced 29 July 2005 08:20 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Grosvenor House Nursing Home Address Coopers Hill Alvechurch Nr Birmingham West Midlands B48 7BS 0121 447 7878 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alpha Health Care Ltd Mrs Sandra Jane Dugmore Care Home with Nursing 25 Category(ies) of DE(E) Dementia (over 65) - 3 registration, with number OP Old Age - 25 of places PD(E) Physical Disablity (over 65) - 25 Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th January 2005 Brief Description of the Service: Grosvenor House Nursing Home is situated within close proximity of Alvechurch, Barnt Green, the M42 motorway, Redditch and Bromsgrove. The home has recently been extended and currently provides nursing care and accommodation for a maximum of twenty five older people. Three of these places are registered for people with a dementia related illness. Accommodation is provided on two floors with a passenger lift and stairs providing access to first floor rooms. The home has nineteen single ensuite rooms and three shared rooms all with ensuite facilities. Communal facilities are located on the ground floor and comprise of a lounge, dining room and conservatory and an additional lounge/dining room within the newly built extension. The home is owned by Alpha Health Care Limited, but the registered manager, Mrs Sandra Dugmore has responsibilty for the day to day management of the home. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 8.20am. It took place over a period of 7 hours. The main focus of this inspection was to assess care practice and to review progress made by the home to address requirements made at the previous inspection on 17.01.05. A tour of the home took place and a selection of care and staff records were examined. Eight residents, two visitors and four members of staff were spoken to during the course of the inspection. What the service does well: What has improved since the last inspection? What they could do better: 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. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 . Resident’s individual needs are assessed prior to them moving into the home, but shortfalls in completing documentation has the potential to put residents at risk and means that individual care needs may not be appropriately met on admission. EVIDENCE: All residents are assessed by a trained nurse prior to their admission to the home. The nurse is then able to establish the individual needs of the resident and to determine if these needs can be met by the home. Written records are kept of each assessment undertaken. Documentation seen for two residents recently admitted to the home was examined. Not all parts of the assessments had been covered and staff had omitted to sign and date one set of documentation on completion. A service user guide is located in each resident’s bedroom. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Appropriate systems are in place for care planning and health care screening, but failures to keep records up to date means there is no assurance that the health care needs of all residents will be met. Personal support is not always offered in ways, which promote the dignity of residents. Procedures for administering and recording any medication administered continue to be unsatisfactory and have the potential to place residents in this home at risk. EVIDENCE: Care plans were in place for each resident. Systems were in place for internal audits of care plans to be undertaken and at the time of this visit the home was part way through their own audit. While the general standard of care planning and health care screening and intervention was considered to be satisfactory there were a number of shortfalls, which required further action, which included: Not all care plans accurately reflected the current care needs of the resident concerned. Not all care plans had been reviewed at least once a month. Records for resident recorded that they had a wound. The plan was not sufficiently detailed to determine the nature of the wound, the size, frequency of assessment, and treatment necessary. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 9 The care plan for one resident with diabetes did not provide sufficient detail of how their diabetes was to be monitored and managed by staff. An immediate requirement was issued in relation to this issue. Documentation for a resident recently admitted to the home who had limited mobility had no moving and handling assessment in place, and they had not been screened for nutritional risks or the risk of developing pressure sores. Pre printed care plans that were in place for this resident in relation to mobility needs made reference to the need to refer to the moving and handling assessment, which had not been completed. Records for one resident showed good evidence that their emotional needs had been identified by staff and that the care and support to be given to the resident in relation to this was well documented in their care plan. Written policies and procedures are in place for the safe administration of medication. On the day of this visit a significant number of residents were prescribed medication for 8am. It was noted that the 8am medication round had not started at the time of this visit (8.20am) and when it was started did not finish until approximately 11am, which for some residents made the gap between their next dose of medication (due at 1pm) shorter which was unsatisfactory. These findings were consistent with practice at the home’s previous inspection. A resident spoken to also referred to frequently experiencing delays in receiving their morning medication It was however evident that residents who needed to receive medication to treat diabetes or Parkinson disease were given their medication on time. Medication administration records were seen. Issues arising at the home’s last inspection continue to be a problem. Gaps were evident in the recording and not all additions or amendments to medication prescriptions had been signed and countersigned by the persons responsible for making the changes. An immediate requirement was issued in relation to these matters. During a tour of the home two prescribed creams in resident’s bedrooms were noted to have passed their expiry date and the cream prescribed for one resident was discovered in the room of another resident. These were similar to concerns raised at the previous inspection and an immediate requirement notice was issued. It was noted during this visit that incoming post for residents is kept centrally in the home and when not possible to pass directly to the resident is kept until the appropriate next of kin/representative visits. On the day of this visit a significant amount of personal mail was observed many of which were official mail and were postmarked several months previously. It was evident from discussions held that although the residents’ next of kin had visited the mail had not been passed on or they had not been advised of it’s receipt. An immediate requirement was issued in relation to this matter. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 10 Residents in the home seen during this visit generally appeared well cared for. It was however noted that two residents had not had all of their personal care needs met, and one member of staff was heard referring to a resident in an inappropriate manner. One of these resident had been assisted to wash and dress and staff had omitted to clean the residents’ dirty fingernails and another resident was not given a shave until mid morning despite having been assisted to wash and dress and sat in the lounge for sometime. The resident concerned referred to the fact they had not been shaved and was being apologetic for their appearance. Discussion took place with regard to care practices observed during the inspection, which were considered to be unsatisfactory. One carer was observed assisting a resident to the toilet facilities. The carer concerned carried out the task making no attempt to interact verbally with the resident and with no evidence of eye contact. On another occasion a different carer went to move a resident in a wheelchair away from the dining table. The carer initially failed to explain his actions and intentions to the resident and began to move the wheelchair causing the resident to call out. The carer had not placed the residents feet on the footrests. The carer then placed the residents feet on the foot rests and proceeded to explain to them what they intended to do. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15. The meals in this home are good and residents dietary needs are well catered for. Inappropriate care practices and poor deployment of staff at lunchtime do however fail to promote and protect residents’ dignity and independence. EVIDENCE: All residents spoken to were complimentary of the food served to them. At the beginning of this inspection one resident was sat alone eating breakfast in a dining area, which comprised of a bacon sandwich, porridge and a cup of tea. When asked the resident described their breakfast as ‘fabulous’ One resident recently admitted to the home said that one of the reasons they had chosen the home was because the food was good and described the meals served to them as ‘excellent’. Two other residents spoke positively about the food with one resident specifically praising the work of the chef. The lunchtime routine was observed. Residents were able to take meals in a place of their own choosing. Seven residents were observed dining in the new dining room/lounge. Cold drinks were available to all residents with their meal, with some residents choosing to have alcoholic drinks with their meal. Loud background music was playing during lunch, however residents spoken to seemed happy with this arrangement. The inspection has highlighted a need to review the deployment of staff at lunchtime. The atmosphere over the lunchtime period appeared rushed. Staff Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 12 were observed assisting residents to eat in the dining room in between taking meals to other. Residents in one dining room were observed waiting to catch the attention of staff entering the room for assistance. A member of staff was observed serving a meal to a resident dining in one communal area, the member of staff had already walked away before the resident had the chance to ask for condiments. It was not until the carer passed by again that a request was made. Practice at lunchtime did not ensure residents were treated with dignity by all staff. One carer was observed assisting a resident to eat their meal. The carer failed to explain their actions to the resident and describe the food they were giving to them. The carer hen proceeded to stand over the resident to feed them, making no effort to interact with the resident concerned. The carer was advised by the nurse in charge to pull up a chair to sit with the resident, which they did. The carer finished assisting the one resident and then proceeded to assist another resident, and was observed standing up and leaning across the table to feed them. No verbal interaction with the resident took place. In addition to this one resident was observed asleep in the lounge, a plate had been placed in front of them containing a fried egg, chips and peas. It was approximately 15 minutes later before a member of staff returned and woke the resident to eat their meal. Another resident had been observed in the hallway and was noted to be asleep for much of the morning. At lunchtime a meal had been placed in front of this sleeping resident. Several members of staff were observed walking past the resident however it was sometime later before the nurse in charge noticed and asked a carer to remove the resident’s plate. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed. EVIDENCE: Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20, 21, 22, 23, 25 and 26 . Recent investment has significantly improved the appearance of the home but some maintenance and refurbishment is now necessary to the older part of the home in order to ensure residents have a comfortable and safe place to live. A failure to ensure infection control measures are adhered to are putting the health and well-being of residents in this home at risk. EVIDENCE: Since the last inspection five new rooms have been built, each with it’s own outdoor patio area. An additional communal bathroom has also been constructed. All bedrooms in the new wing have ensuite facilities with showers. In addition to this a communal lounge/ dining room has been built which is already being well being well utilised by residents. A large stone covered car park has been created adjacent to the home, which now provides ample parking for staff and visitors to the home. Landscaping work to this area has also recently taken placed During this visit a tour of the home was undertaken during which a number of issues were highlighted for attention: Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 15 • • • • • • • • • • • • • A number of slates on the roof were noted to have slipped or were missing. The garden paving adjacent to the conservatory was uneven and potentially hazardous to anyone accessing this area. There was evidence of a leak in the ceiling of two bedrooms. Wall tiles were missing by the wash hand basin in one room. Remedial work was necessary to walls in the lounge and dining room in the old part of the home where wall heaters had been removed. The lounge carpet in the old part of the home was badly worn and in need of replacement. Many of the vertical blinds in the conservatory were in a poor state of repair. The garden to the rear of the home accessible to residents was overgrown, and several pieces of furniture and mobility aids which were no longer in use were apparent in this area. At the bottom of the garden was a large garden shed containing a variety of aids and equipment which were no longer in use and a selection of garden tools. The shed was open. The carpet fitted in the ensuite in one room was in need of replacement. No privacy lock was fitted to the ensuite door in two rooms and a shower room. An armchair in one room was very heavily stained. The cold water tap in the first floor sluice room was in need of repair. An immediate requirement notice was issued in relation to this. Policies and procedures are in place for the control of infection. During a walk round the home it became evident that these policies were not being adhered to by all staff and an immediate requirement was issued as a result. Arrangements for the storage of equipment were limited. One shower room was noted to contain an oxford hoist and a number of slings, which had been draped over the shower cubicle. It was noted that location of the equipment prevented residents getting access to the toilet in this room. The home has a ground floor storeroom for wheelchairs. Five wheelchairs were seen two of which were observed to be in a poor condition showing clear signs of wear and tear. The home has a new passenger lift which was installed earlier this year which provides access to first floor rooms. All room accessible to residents are fitted with a nurse call bell. The care plan for one resident referred to them being able to use call bell for help, but in practice the resident concerned would be unable to do so. There was no indication of the systems put in place to ensure the residents ongoing safety. Rooms seen were very homely and personalised and showed that residents were able to bring own personal possessions in with them Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Adequate numbers of care staff are on duty during the morning but the deployment of staff during this time does not ensure care is always provided in accordance with the needs of the residents. Shortfalls in recruitment practices fail to ensure safeguards are in place to offer protection to residents living in the home. EVIDENCE: Staffing rotas are in place, which document the staff on duty 24 hours a day. On the morning of this inspection there were a total of 24 residents living in the home being cared for by a trained nurse and four carers. The home was experiencing unforeseen shortfalls in the numbers of housekeeping staff on duty. Residents spoken to give mixed feedback about staffing. One resident expressed satisfaction with staffing levels and stated that in the short time they had lived in the home they had no concerns about the numbers of staff on duty to assist them. Another resident reported that in their opinion staffing levels had got worse in recent months and that their bed was not made until midday on most days, which they did not like, and another resident said that the staff in the home were very good but always seemed to be busy. During the inspection the morning routine was observed. The routine within the home was to provide the necessary personal care and breakfast to residents and then all beds are made at the end of the morning. It was noted that many beds were still unmade at 11.30 hrs. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 17 At the commencement of this inspection (08.30hrs) eight residents were observed in the communal lounges and dining rooms, one of these residents was asleep and sat in a wheelchair with their head resting on the dining table. Two sets of staff records seen. Not all records seen contained all of the required documentation relating to each member of staff including appropriate Criminal Record check. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 37 and 38 Shortfalls in health and safety practices and the standard of record keeping have the potential to place residents in this home at risk. EVIDENCE: During this inspection a tour of the home took place and a selection of care records seen of which a number of health and safety issues were raised which included: • • • The fire door to lounge (old part) was not shutting properly. An immediate requirement notice was issued in relation to this at the time of inspection. The garden shed was not secured (see also standard 19) A moving and handling assessment had not been competed for one resident recently admitted to the home. An immediate requirement notice was issued in relation to this at the time of inspection. E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 19 Grosvenor House Nursing Home • • Staff were observed using under arm lifting techniques when moving one resident. The garden paving adjacent to the conservatory was uneven and potentially hazardous to anyone accessing this area. A fire safety inspection was undertaken at the home in July 2005. Records see of fire safety checks were satisfactory with the exception of one week. All fire doors in the new extension are fitted with the appropriate door holding devices, which will enable the doors to automatically close in the event of a fire alarm being sounded. It was noted however that despite these devices being fitted one bedroom door was being held open by chair. The home’s fire risk assessment was seen which had been updated to reflect recent changes to the environment. A variety of records were seen during this inspection which included, care documentation, medication administration records, health and safety records and personnel records. Records seen were stored appropriately. Some action is necessary to improve the quality of record keeping with particular regard to medication administration and personnel files. Accurate written records were kept of any monies belonging to residents, which were being held for safekeeping. All monies were kept securely Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 3 2 3 x 3 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 x 2 2 Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? 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 3 Regulation 12(1) 14 Requirement A full assessment of needs must be conducted prior to residents being admitted to the home. Assessments must take into consideration all aspects detailed in standards 2.3 and 3.3 . Full written records must be kept of all assessments undertaken. Care plans must be reviewed and updated at least once a month to reflect any changes in needs. (previous timescale immediate and ongoing not met) All residents must have care plans in place which accurately reflect their current care needs. (previous timescale immediate and ongoing not met) Staff must monitor and record the weight of residents on a monthly basis and take approriate action when significant weight loss or gain is evident . (previous timescale immediate and ongoing not met) A written programme of wound care management must be developed and implemented which includes systems for the assessment of wounds and Timescale for action Immediate and ongoing 2. 7 15(2) Immediate and ongoing. Immediate and ongoing Immediate and ongoing 3. 7 15(1) 4. 8 12(1) 5. 8 12(1) 15 1st November 2005 Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 22 6. 8 12(1) 7. 8, 38 13(5) 8. 8 12(1) 9. 10. 8 8, 10 12(1) 14 12 11. 9 , 37 13(2) 12. 13. 9 9 13 13 individual plans which include details of the status, size and current treatment of each wound. (previous timescale 1st April 2005 not met) Care plans must be in place for residents who have diabetees which accurately detail their normal blood sugar range and the care and ltreatment to be provided by staff. Moving and handling assessments must be undertaken and recorded for each resident admitted to the home. All residents must be assessed for the risk of developing pressure sores. Written records must be kept of all assessments. Nutritional screening must be undertaken and recorded for all residents. Personal care and support must be provided in accordance with the individual needs and preferences of each resident . Staff must sign for all medicines adminstered to residents and document a code for any omissions . Medication must be given as prescribed and directed. Creams and ointments must only adminstered to residents for whom they have been prescribed and all creams that have exceeded their expiry date disposed of. Any written additions or amendments to medication prescription records must be checked and signed/countersigned by the persons making the changes. Personal care must be provided in such a way that promotes the Immediate and ongoing Immediate and ongoing . Immediate and ongoing . Immediate and ongoing . Immediate and ongoing . Immediate and ongoing . Immediate and ongoing . Immediate and ongoing . 14. 9, 37 13 Immediate and ongoing . 15. 10 12 Immediate and Page 23 Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 16. 17. 18. 19. 20. 21. 10, 37 19, 38 19, 38 19 19 19 12 13 23 (2) 13 23 (2) 23(2) 23(2) 23(2) privacy and dignity of each resident. All residents must receive all personal post without delay Missing and slipped roof tiles/slates must be replaced. Uneven paving adjacent to the conservatory must be made safe Remedial work must be undertaken to the ceilings in rooms 8 and 9 . Wall tiles above the wash hand basin in room 12 must be replaced. Remedial work must be undertaken to the 2 walls in the lounge/dining room (old part) where heaters have been removed. External grounds maintainence must take place to ensure gardens can be safely accessed by residents. Privacy locks must be fitted to doors in ensuite facilities in rooms 1, 2, 4, and 5 and the shower room. The lounge carpet (old part ) must be replaced. (previous timescale 1st June 2005 not met) Vertical blinds in the conservatory must be repaired or replaced. The garden shed must be kept secure when not in use . ongoing . Immediate and ongoing 1st November 2005 1st November 2005 1st December 2005 1st December 2005 1st December 2005 1st November 2005 1st November 2005 22. 19, 38 13 23. 19, 10 12 24. 25. 26. 27. 28. 29. 19 19 19, 38 19 19,20 19 23(2) 23 13 23 23 23 1st December 2005 1st December 2005 Immediate and ongoing The carpet in the ensuite 1st facilities for room 4 should be December replaced. 2005 The stained armchair in room 18 1st must be cleaned or replaced as November appropriate 2005 The cold water tap in the first Immediate floor sluice room must be Version 1.40 Page 24 Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc repaired. 30. 22 23(l) Appropriate safe storage must be made availabe for equipment and lifting aids which avoids the use of communal toilet/bathing facilities. (previous timesacle 1st June 2005 not met) All wheelchairs should be assessed, and arrangements made for the replacement of any worn or damaged ones. Where a resident is assessed as not able to use the call bell system, a care plan must be in place which details how the residents safety is to be maintained Infection control policies must be adhered to at all times . (previous timescale immediate and ongoing not met) All documents must be kept in the home for each of staff as detailed in Schedules 2 and 4. All doors must fully close on their rebates. (previous timescale immediate and ongoing not met) All staff must adhere to the homes policies for the safe moving and handling of residents Fire doors must not be propped open. 1st December 2005 31. 22 13(5) 23(2) 13 1st November 2005 Immediate and ongoing 32. 22 33. 26 13 16 Immediate and ongoing Immediate and ongoing Immediate and ongoing Immediate and ongoing Immediate and ongoing 34. 35. 29 38 19 Schedules 2 and 4 13 23 13 23 36. 37. 38 38 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 15 Good Practice Recommendations It is strongly recommended that the deployment of staff at lunchtime is reviewed in order to ensure sufficient staff are readily available to provide assistance and support to E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 25 Grosvenor House Nursing Home 2. 3. 26 27 residents in an unhurried manner. It is recommended that room identification signs are dipslayed on the doors to communal bathing, toilet and showering facilities and also to sluice rooms . It is strongly recommended that the morning routine is reviwed in order to ensure residents recieve medication on time and that personal care and support can be gven in accordance with the preferences of each resident. Grosvenor House Nursing Home E52 S4111 Grosvenor House NH V241174 290705.doc Version 1.40 Page 26 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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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