Inspection on 23/05/05 for Hatherley Grange Nursing Home

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Hatherley Grange Nursing Home 17/05/07

Hatherley Grange Nursing Home 16/11/05

Hatherley Grange Nursing Home 09/11/04

Hatherley Grange Nursing Home 18/05/04

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

CARE HOMES FOR OLDER PEOPLE Hatherley Grange Nursing Home 26 St. Stephens Road Cheltenham Gloucestershire GL51 3AA Lead Inspector Janice Patrick Announced 23 May 2005 10:00am 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. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hatherley Grange Nursing Home Address 26 Stephens Road Cheltenham Gloucestershire GL51 3AA 01242 251321 01242 547322 HatherleyGrange@ALMONDSBURYCAREFSBUSIN ESS.CO.UK Almondsbury Care Ltd. 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) Mrs Sheila Ann Crew Care Home with Nursing 25 Category(ies) of DE Dementia (25) registration, with number of places Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th November 2005 Brief Description of the Service: This care home specialises in the care of the elderly person with dementia, but has 3 places for those under 65 years suffering from the same illness. It is located on the outskirts of Cheltenham town in a residential area. It is close to many local shops and a church. It can offer both single and double bedrooms, set out over 4 floors accessed via a shaft lift or stairs. On the ground floor there is a large lounge, conservatory dining room and smaller quiet area. Viewed from the conservatory and accessed via a ramp, is a small but safe patio area.The Home has a qualified nurse on duty at all times, with care staff who are experienced in the specialised needs of service users with dementia. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection between 10:00hrs & 17:00hrs. The Manager and her immediate Line Manager were present throughout. Both were helpful and open to the process. 5 service users were spoken to in some detail and several others briefly, according to their ability. 2 relatives and 3 staff members were also spoken with. Various records and documentation were inspected. A tour of the building was undertaken. The current registration category of DE Dementia on the Homes Registration Certificate implies that the Home takes service users under the age of 65years with dementia. The Home actually specialises in the care of the elderly person with dementia and therefore the category should read DE (E) Dementia. This will be altered accordingly by the CSCI. However, three beds are to be retained for those with dementia under the age of 65years, DE Dementia. A mental health category MH is not to be added. There were no requirements made in the last inspection report. What the service does well: The very specific needs of those who have dementia are well understood in this Home. The care delivered is very individualised and a lot of patience and kindness is afforded to the service users. The level of staff interaction with the service user is high and a good proportion of the day is devoted to this. Service users’ health and wellbeing is reviewed regularly and appropriate action is taken if needed. The Manager has a good relationship with external and hospital professionals and is able to receive advice when needed. The care documentation is comprehensive and organised. The Home is clean and very well maintained, but retains a comfortable and ‘homely’ environment. Staff are good at offering support, where needed, to relatives who may find it difficult achieving a degree of quality time with their loved one, who has dementia or related mental health problems. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 6 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. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 7 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 Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 8 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) 2 & 3 Although all service users or their representatives receive a contract, with terms and conditions, which allows them to be fully informed regarding fee payment. A robust pre admission assessment process provides staff with adequate information about an individual and ensures that their care needs can be met on admission. EVIDENCE: Service users’ files showed that those paying their fees privately and those receiving a contribution towards their fees, were each receiving a contract and a copy of the Homes terms and conditions. One visitor, who was responsible for paying her relatives contribution each month, was fully aware of the amount he had to pay, the contribution he was receiving towards the fees and what ‘she’ had signed on his admission. A ‘top up’ is requested from those receiving funding towards their fees and the amount is stated within the contract. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 9 The company has subsequently forwarded a copy of its private contract, which states that the provider benefits from any Nursing care contribution from central government (RNCC). The Manager carries out a comprehensive pre admission assessment and with additional pieces of information gathered from other health care professionals and relatives is able to decide whether the Home can meet the individual’s needs. Admission is then on the basis of a months trial. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 10 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 & 10 The written care plan does not always clearly define ‘how’ a service user’s need is being met, therefore not always giving clear written guidance to staff. In the process of delivering care, the service users’ privacy and dignity are preserved. EVIDENCE: The written care plans seen identified individual needs and stated what the preferred outcome was to be, but in several examples it was not clear ‘how’ this was to be achieved. The documentation in use was discussed and it was agreed that this was probably not helping the process and would be reviewed. Additional assessments are carried out, including the Registered Nurse Care Contribution (RNCC) assessment. Specific risks are assessed and the appropriate action to ensure an individual’s safety is planned. Relatives are often involved in this process and sign the plan to verify that they’re in agreement, if they’re not the issues are discussed and the action negotiated. The GP, along with other health care professionals such as the Chiropodist, Dentist and Optician all ensure appropriate health care review. All care is delivered in the privacy of a bedroom or bathroom in a manner that upholds the person’s dignity. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 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) 13 Service users and visitors are encouraged and supported to maintain contact, in order for both to achieve quality time together. EVIDENCE: The Manager described several scenario’s where relatives have required support and guidance from staff when visiting or taking their loved ones out. The aim is for each to enjoy their time together. Several visitors were seen at the time of this inspection, some visit everyday, others not so frequently. One relative said she now enjoyed visiting because she knows she has the support and friendship of the staff. Another likes to visit every day and finds this tiring, but is beginning to realise with staff help, that if a day was missed, this would not be such an upset for the relative as initially imagined. Another service user is visited regularly by a relative who does not feel confident enough to take them out, so staff fill this gap and take the service user out. Community involvement is limited, but the local church is very supportive. A group of relatives who became friendly with each other when they had loved ones in the Home, still meet at Hatherley Grange for coffee and have been of support to present relatives. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 12 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) 16 & 18 The Home has a Complaints Procedure and reassurance is assured through the effective and fast response to any small concerns. Service users are protected against abuse through good use of appropriate policies and procedures and through staff awareness of the risks involved. EVIDENCE: The Home has not received a complaint for many years, but one small concern, described to the Inspector by the Manager and the person that made it, was dealt in a manner that clearly satisfied the relative and the problem has never arisen since. The complaints procedure is laid out in the Home’s terms and conditions and displayed within the Home itself. The name and address of the Commission was updated during the inspection. The Inspector recommended several different methods that would help the Home enable someone to make a suggestion or voice an anonymous concern. The Home adheres to key policies and procedures that are designed to protect vulnerable service users. Staff received training on elder abuse in April 2004 and are due to update their knowledge shortly. Recent guidance on Adult Protection from Gloucestershire County Council and Primary Care Trust (PCT) has been received and ‘whistleblowing’ procedures have been discussed in response to this. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 13 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) 21 & 22 The Home has appropriate facilities, aids and adaptations, which meet the needs of the service users safely. EVIDENCE: Wash hand basins are available in each bedroom. It has been recommended that four small, cloakroom size washbasins in the basement bedrooms, be changed in the future for a larger version. This is not an immediate concern as none of the present service users wash themselves and therefore do not use them independently. Toilet facilities are located on each level, although sometimes in another part of the corridor, through another door from the bedrooms. Two toilets are near to the lounge. A mixture of baths, showers and specialised equipment allows for choice and individual ability. Some equipment is sourced from the Primary Health Care Trust (PCT) and other items are brought by the Home as required. All service users are assessed regarding their need for specialised equipment and its appropriate use. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 14 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 & 28 The Home provides a stable care team, which is well balanced in training and experience and who are able to meet the needs of the service users at all times. EVIDENCE: Staffing levels during the daytime meet the needs of the service users. The Inspector highlighted her concern regarding the number of night staff and requested that a review of the night staff numbers and how they are deployed be carried out. The Inspector also sought reassurances that staff on duty at night could communicate with each other in the case of an emergency. The Manager has conducted an audit of recorded accidents during the night time hours and discussed the other issues with her night staff. The Manager has confirmed that there are enough staff on duty but that the Inspectors recommendation for staff to have pagers has been taken up. The Inspector noted the record of accidents and falls. These were not excessive. Records also demonstrated appropriate action being taken when service users were found to be wandering at night. Several members of the care team are qualified nurses in their country of origin, but are not registered to practice in the UK. The Manager described their care practices as being of a high standard and along with other staff members, who either have their NVQ Award in Care or who are keen to undertake this, enables the team to deliver safe and competent care. Two of the qualified nurses are trained in mental health nursing and have specific experience in nursing those with dementia. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 15 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) 31, 32, 36, 37 & 38 The Manager runs the Home with a clear vision of the standards she wishes to obtain for the service users and achieves this through good leadership and a well supervised workforce. The Home is run with the health and safety and rights of this particular group of service users in mind and offers adequate protection. EVIDENCE: The present Manager has worked at the Home for many years and works alongside the rest of the care team, as do all her senior staff. Channels of communication and levels of supervision are therefore well maintained. Regular supervision sessions are recorded and staff meetings held routinely. The Manager is currently undertaking the Registered Managers Award as required by the Care Home Regulations 2001. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 16 A weekly environment check ensures that all aspects of health and safety within the Home are reviewed. Any findings requiring action are fed back to the maintenance person and also form part of a broader quality assurance audit system. All relevant documentation is organised and well maintained. The standard of décor and general maintenance in the Home is commendable. The Home also aims to meet with the recommendations and requirements from external agencies such as the Fire Services, Environmental Health Department and the Care Home Regulations 2001. However, it was noted that the recommended smoke seals to some doors, were still outstanding. This was to be rectified immediately following this inspection. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 17 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 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION x x 3 3 x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 2 2 Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 18 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 7 Regulation 15 (1) Requirement The written care plan must state clearly the action staff are to take in order to meet the service users needs. The recommendation made by the Fire Officer for doors to have smoke strips must be completely met. Timescale for action 31st July 2005 31st July 2005 2. 38 23 (4)(c) 3. 4. 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 16 21 27 37 Good Practice Recommendations Concern and suggestion slips should be placed in reception along with a box for placing these in. The washbasins in bedrooms 2, 3, 4 & 6 should be replaced with a larger version. Night staff should carry pagers to be able to communicate with each other in the event of an emergency. The name and details of the person holding Power of Attorney should be kept within the persons care file. Hatherley Grange Nursing Home D51_d03_16457_Hatherley Grange_v217786_230505_stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucestershire GL3 4AB 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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