Inspection on 01/07/08 for Henwick Grange

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Poor 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.

Other inspections for this house

Henwick Grange 12/02/09

Henwick Grange 14/07/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Henwick Grange 68 Hallow Road St Johns Worcester Worcestershire WR2 6BY Lead Inspector Sandra J Bromige Unannounced Inspection 1st July 2008 12:35 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henwick Grange Address 68 Hallow Road St Johns Worcester Worcestershire WR2 6BY 01325 351100 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) Southern Cross Op Co Limited Manager post vacant Care Home 56 Category(ies) of Dementia (56), Old age, not falling within any registration, with number other category (56), Physical disability (56) of places Henwick Grange DS0000072113.V367402.R01.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: Both Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 56 Physical Disability (PD) 56 Dementia (DE) 56 The maximum number of service users to be accommodated is 56. 2. Date of last inspection New service Brief Description of the Service: Henwick Grange Nursing Home is a large Victorian building with purpose built extensions. The home stands in pleasant well maintained gardens, providing seating for residents and relatives to sit outside when the weather permits. The home is conveniently situated within the boundary of the City of Worcester. There is ample parking at the home for visitors and a frequent bus service to and from the City. The home provides a vehicle for transportation of residents, which is suitable for people with a physical disability. The home has changed ownership this year and is now owned by Southern Cross Op Co Limited. There is currently no registered manager in post. The home is registered to provide nursing care and accommodation for a maximum of 56 residents with dementia, a physical disability or frailty due to old age. There is good access into the home via a ‘touch pad’ operated automatic door. Accommodation is provided over two floors with a passenger lift providing access to first floor rooms. Up-to-date information relating to the fess charged for the service is available on request from the home. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes We, the commission undertook an unannounced inspection of this service over two half days. This was a key inspection of the service, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence, which shows continued safety and positive outcomes for residents. During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the interim manager. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening. Three people living at the home were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ and where evidence of the care provided is matched to outcomes for residents. Before the inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the manager for completion. The AQAA is a selfassessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Some of the information has been included within this inspection report. A new owner has recently purchased the home and they were registered with us on the 3rd June 2008. We have not received any complaints about this service since the new owner took over. There have been two recent referrals to safeguarding following concerns raised by visiting healthcare professionals to the service. The concerns relate to healthcare provision, care records, management of medication and staffing numbers at the home. These concerns are currently being investigated by Worcestershire County Council who are the lead agency for safeguarding people with the co-operation of the new owners. What the service does well: They make sure people who decide to come to stay at the home know about their rights and responsibilities because there is a contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 6 The home supports residents to maintain their religious beliefs, interests and activities as they employ two activity co-ordinators who provide activities seven days a week. The home welcomes visitors at all times of the day so that residents are able to keep in touch with family and friends. Comments included, ‘I find the staff and home very caring and friendly.’ Residents have a varied choice of meals to ensure they are offered a nutritious and wholesome diet. Comments received from residents say ‘meals are adequate, tasty, healthy and varied’; ‘there is plenty of variation’. The home has a complaints procedure on display and residents told us they knew how to complain. Staff have received training about safeguarding people and were very clear of the action they would take to protect the residents in the home from harm. The home is an extended Victorian property within the City of Worcester. The home provides transport which is suitable for people in a wheelchair. There is an electrically operated front door to enable access for people with a physical disability. The home is light, clean and well maintained. The gardens are very well maintained and accessible to residents. Comments from residents say, ‘the home is bright & cheerful & clean’. ‘We appreciate the quietness of the gardens and the warmth of the house in the afternoon and evenings’. What has improved since the last inspection? What they could do better: Information in the pre-admission assessment needs to be more detailed and cover all the needs of the resident so that the information can be used to formulate a care plan prior to admission to the home. Care plans and risk assessments need to be in place when people are admitted with sufficient detail to enable staff to understand and meet the health and care needs of the residents. They need to be reviewed and updated when care needs change. Residents need to be assessed before bedrails are used to make sure they are safe for use with each resident. Medication administration records need to be improved to show what had been administered and or the reason why the medication was not given. Staff need to be reminded about how they refer to the use of continence pads to make sure residents privacy and dignity is maintained at all times, as staff referred to them as ‘nappies’. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 7 Approved door locks should be fitted to all bedroom doors to ensure they provide privacy and safety for the residents. The home should look at the way they serve meals to residents upstairs to make sure food temperatures are maintained whilst staff are serving and assisting residents to eat their meals. The new owners should review the use of the three-bedded bedrooms to make sure there is sufficient space for each resident to use the room in comfort. Another washbasin should be installed in the laundry and staff should use disposable gloves when loading the machines with soiled laundry to prevent cross infection. The new owners should review the numbers of staff employed and their individual skills and competencies to make sure residents are not placed at risk of harm. Before registered nurses are employed the home need to make sure they hold a current registration with the NMC to make sure residents are not placed at risk of harm. The NMC is the professional body, which maintains the current register of nurses and upon re-registration every year they monitor if nurses have kept up to date with current practice. This is why employers need to check nurses’ registration with the NMC before they employ them. New staff need induction training and all training appropriate to their role to make sure staff and residents are not placed at risk of harm. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 8 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 Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who decide to come to stay at the home know about their rights and responsibilities because there is a contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. People cannot be confident that the care home can support them, as there is not always a thorough and accurate assessment of their care needs, which tells the home all about them and the support they need. The service does not provide intermediate care. EVIDENCE: Written surveys from residents confirmed they had received a statement of the terms and conditions of stay at the home. The contracts were seen for identified residents during the inspection visit, which told them the total weekly fee, their contribution and the amount of the nursing care contribution paid by the Primary Care Trust. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 10 The pre-admission assessment of a recently admitted resident was poorly completed. For example, it stated the resident needed bedrails but did not show the reason why the resident needed to use bedrails due to poor sitting balance. It did not provide enough information to enable the home to formulate a care plan for this resident upon admission. The person who did it did not sign the assessment therefore we do not know if a competent person carried out the assessment. The resident was being funded by social services and there was no Community Care Assessment provided prior to admission so that the home can make sure they can meet the required care needs for his resident. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Thorough and robust care plans and risk assessments are not in place to ensure people’s health, personal and social care needs are met. People cannot be confident they are being given their medication as prescribed, which places them at risk of harm. People’s privacy and dignity is not being maintained at all times. EVIDENCE: A recently admitted resident had no care plans or risk assessments in place. A resident with an identified feeding problem did not have a care plan in place to demonstrate how the home will meet the care needs for this problem. A resident had bedrails in use with no risk assessment in place to assess the safety of the use of bedrails for this resident. Two residents case tracked had bedrails in use and there was no signed consent agreeing to the use of bedrails. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 12 A skin assessment for a resident who was assessed as being ‘high risk’ of developing pressure sores had not been reviewed since October 2007. Two residents who had Waterlow skin assessment scores of 22 and 26 were not on the appropriate pressure-relieving mattress as the trained nurse stated the mattress they were on was suitable for a Waterlow skin assessment score up to 20. The moving and handling risk assessment for a resident case tracked stated staff were to use the conventional hoist and small sling to transfer the resident. A carer stated to transfer this resident to a wheelchair, two carers stand the resident up and the resident leans on their hands and no equipment is used to do this. This is not in line with the risk assessment and places the resident and staff at risk of harm. A resident had a care plan for breathing problems, which were stated as ‘high risk’. The action plan stated, ‘monitor respiratory function daily by noting rate, depth of respirations’. There was no evidence of this being done. A trained nurse when asked for this information stated she was ‘not aware of the need to do this’. The action plan also stated ‘regular review of chest by physio there times per week’. The last notes written by the physiotherapist were dated 9th June 2008. A resident’s mobility care plan stated they needed regular reviews by the physiotherapist, but the last entry in the notes by the physiotherapist were dated 13th March 2006. Concerns have been raised recently by a visiting healthcare professional about the quality of the healthcare, care plans, management of medication and the physiotherapy being stopped in the home. Theses concerns have been referred to the lead agency for safeguarding people for investigation. Written information from residents’ stated ‘I feel that I need a shower every day even though I have a disability I am used to being clean and tidy. Sometimes my hair is left to go greasy so I would like a shower and hair wash everyday which doesn’t happen at the moment’. ‘Mostly staff are brilliant except there are occasions where communication is poor and my needs and arrangements are not met’. ‘Can wait up to 20 minutes to one hour to use the commode’. ‘Does not always happen straight away. Sometimes the request has to be asked several times, but eventually it does happen’ The information in the Annual Quality Assurance Assessment completed by the provider prior to the inspection states, ‘Individual care plans are produced and reviewed regularly together with any risk assessments. We have our own physiotherapist available 3 times’. The findings of the inspection show this to be an inaccurate self-assessment of the quality of the service provided. The current medication administration record for an identified resident had 11 gaps where there was no signature or code entered to show whether the medication had been given or not been given. There was no care plan for the Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 13 pain relief prescribed to be given ‘when necessary’. A trained nurse was asked why a resident was taking anti convulsive medication, as there was no mention of epilepsy in the care plan, she stated she was ‘not sure’. A resident had ‘cavilon’ barrier cream in use in their bedroom, which had been prescribed for another resident. A second resident had a tub of ‘aqueous’ cream in use in their bedroom, which had been prescribed for another resident. A prescribed ointment was not securely stored in the resident’s room. Staff had been administering ‘Temazepam’ as prescribed to an identified resident, but the label on the medication bottle was illegible. This is all evidence of poor management of medication. Residents’ spoken with were clean, tidy and nicely dressed. A resident confirmed they were given the care they needed and another resident told me they were happy living at the home. One relative spoken with stated they had not seen the resident’s care plan. They were not happy at first with the care but they are now. Residents’ privacy and dignity was seen being respected as staff were seen to knock on doors before entering and to close doors when giving personal care, although it is not being maintained at all times as two staff spoken with referred to continence pads as ‘nappies’ and there was a green poster on a residents bedroom door stating ‘Infection control’. The home needs to ensure a more subtle way of reminding staff and visitors are used to ensure the resident’s privacy and dignity is maintained. There was also a shortfall in the environment that has the potential to compromise privacy. The locks seen on a number of bedroom doors are not approved locks, as they do not allow the resident to lock their bedroom door upon leaving the room and although residents appeared to be able to lock the door from the inside, they are not able to open and unlock the door in a single action by depressing the door handle. For health and safety reasons these locks should meet the agreed criteria and enable emergency access and protect residents from entrapment. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports residents to maintain their religious beliefs, interests and activities, although this is not supported through a social care plan. The home welcomes visitors at all times of the day so that residents are able to keep in touch with family and friends. Residents have a varied choice of meals to ensure they are offered a nutritious and wholesome diet. The service of cooked meals needs to be reviewed to ensure food is maintained and served hot. EVIDENCE: The home employs two activity co-ordinators and a programme of activities is provided seven days a week. Each room contains information about the activities provided, although staff are aware this needs to be reviewed and updated as it does not reflect the current activities that are available in the home. On the day of the inspection staff and residents were playing games in the lounge. The home has a large selection of games for residents to choose from and residents had chosen to play cards and dominoes. The activity coordinator gave examples of the time and how they support the more frail residents who spend most of their time in bed. None of the residents’ case tracked had a social care plan. Communion is provided each month and staff Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 15 spoken with were aware of the religious needs of residents case tracked. Clergy and priests from other faiths also attend the home. The home provides transport, which is also suitable for residents in wheelchairs to enable residents to get out and about in the community. A four-week rolling menu is provided which offers a choice of meals and desserts. Residents were seen eating in the dining room, although this room is not big enough to accommodate all of the residents in the home. The majority of the residents appeared to eat their meals in their rooms. The meals were plated and covered and sent upstairs on the tray trolley. There was no means of keeping the food hot during service. Staff confirmed they had eight residents upstairs who needed assistance with eating and only four staff were available. The interim manager stated they might be considering providing a heated trolley to keep the food hot. Currently if staff need to reheat the meal they have to take it back downstairs to the kitchen to reheat the meal in the microwave. Comments received from residents about the food included, ‘meals are adequate, tasty, healthy and varied’. ‘I need to eat more fruit and veg which hasn’t been available recently’. ‘There is plenty of variation’. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. If residents have concerns with their care, they or people close to them know how to complain. Records show that concerns are looked into but the home is not responding to all written complaints in writing. The home is not protecting residents from harm. EVIDENCE: The home has a complaint’s procedure, which is on display in the home. Six out of the eight surveys received from residents indicated they knew who to complain to. The complaint records do not contain the evidence to show that the home is responding to all written complaints in writing. The interim manager had not seen a copy of the new provider’s complaints procedure. Care staff spoken with were aware of the home’s complaints procedure. We were invited into the home without being asked for any identification. This is the first time this inspector had visited this service. Criminal Records Bureau checks are being done before staff start work in the home, although the result of an identified Criminal Records Bureau disclosure had not been risk assessed. A trained nurse had started work in the home without a Nursing and Midwifery Council (NMC) personal identification check (PIN) being done and had not received any induction or training upon employment. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 17 Care staff spoken with had received training about safeguarding people and were very clear of the action they would take if they suspected a resident may be at risk. There have been two recent referrals to safeguarding following concerns raised by visiting healthcare professionals to the service. The concerns relate to healthcare provision, care records, management of medication and staffing numbers at the home. Worcestershire County Council who is the lead agency for safeguarding people is investigating these concerns. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People would benefit from improved facilities and space in shared bedrooms to ensure they are comfortable and have sufficient space to allow them to have their own possessions around them. EVIDENCE: The new owners have stated in the Annual Quality Assurance Assessment that a programme of redecoration has already commenced. They maintain high standards of decoration and cleanliness to reduce the risk of infection. Every area of the home and its gardens are wheelchair accessible and routine maintenance is carried out in-house whilst our specialist equipment (hoists etc) are on service contracts. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 19 Surveys from residents told us ‘the home is bright & cheerful & clean’. ‘We appreciate the quietness of the gardens and the warmth of the house in the afternoon and evenings’. ‘The appointed staff daily carry out a systematic cleaning programme to leave the rooms healthy clean’. On the day of the inspection the home was clean and tidy and there were no unpleasant odours. A resident case tracked was sharing a bedroom with two other residents. The resident had mobility problems and there was only space on one side of the bed for staff to attend to the care needs of this resident. The space between this bed and the adjacent bed was cramped with only a bedside chest separating the two beds. The resident did not have an overbed table and had nowhere to put down the empty drinking beaker so they gave it to the Inspector to put down. This resident and the resident in the adjacent bed did not have access to a call bell. There was a washbasin in the bedroom although there was no storage by the washbasin for the residents’ personal washbowl and toiletries, these were seen being stored in the bottom drawer of the bedside cupboard. The lock on the door was not the approved type (refer to health and personal care section). The laundry was sited in the grounds in a separate building. It was a good size and layout. There was only one sink and staff confirmed this was used for washing their hands and for hand washing residents clothing. Reusable gloves were being used for loading soiled washing into the machines. These are both issues of concern for the management of infection control. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be confident that all the staff in the home are suitably trained and competent and that checks have been done to make sure they are suitable to care for them. EVIDENCE: At the time of the inspection there were two trained nurses and 10 care staff on duty. The off duty for the two week period around the inspection shows staffing levels fluctuate between 10 and 12 each morning. On the day of the inspection staff spoken with stated ‘OK at the moment’, ‘today OK’. Written comments from residents said, ‘I feel the ratio of staff to residents could be improved. They do not always seem to have the time to do the little extra things like grooming and being sociable with the residents. The staff are also very slow at answering the bell’. ‘Don’t seem to be enough staff’. A comment in staff survey said ‘usually there is not enough staff specially at weekends and some are phoning off sick’. The interim manager told us they have a shortfall of trained staff at present and are recruiting. Two recent safeguarding issues have included concern about staffing levels, and the turnover and competency of the staff. The health and personal care section of this report refers to shortfalls in the quality, assessment and recording of care contributing to the outcome judgment for this section. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 21 The Annual Quality Assurance Assessment states the home ‘are continuing care staff NVQ training to reach the target of 50 at NVQ level 2 or equivalent’. The dataset shows 13 staff currently have NVQ level 2 or equivalent and seven staff are working towards this qualification. The Annual Quality Assurance Assessment says, ‘all nurses are registered with the NMC. The home conducts induction training and regular updates’. This is an inaccurate assessment of the service. Two staff files were seen. All the information required was in place with the exception of a risk assessment for a Criminal Records Bureau disclosure, there was no Nursing and Midwifery Council (NMC) Personal Identification Number (PIN) check to make sure the nurse was registered with the NMC, and no written evidence to show that either staff had received any induction training. Two staff spoken with had not received any moving and handling training in the last 12 months, this included one new member of staff. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management, ownership and administration procedures of the home has recently changed which is likely to cause a degree of anxiety for the people living and working in the home. The environment is safe for people and staff as it continues to be well maintained. EVIDENCE: The registered manager resigned at the beginning of June 2008 and the home is currently being led by one of the trained staff as the interim manager whilst the provider recruits another manager. The interim managers time is not all supernumerary as she advised they are short of trained staff at present. The service has been recently purchased and registered with a new provider. The interim manager stated since the new provider took over there has not Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 23 been any formal consultation with people regarding the quality of the service. Internal audits are carried out each month for example; medication, environment and action plans are in place subject to the findings. The Annual Quality Assurance Assessment cites ‘effective quality assurance monitoring in place’ as an example of evidence of what they do well. It does not tell us how they monitor the quality of the service and how they collate and use this information to inform their judgement about quality. There is no mention of the home being monitored by senior managers, which is a requirement of the Care Home Regulations. The management of residents’ monies has recently been audited by the new provider and transferred to a computerised system. Evidence was seen of deposits and withdrawals from an identified account and some receipts were missing. We were told staff are adapting to the new systems and procedures but the absence of receipts for expenditure of residents monies may lead to poor outcomes for residents as it may place them financially at risk. Monthly maintenance checks were recorded for bedrails and window restrictors. Chemical data sheets were available in the laundry for the laundry chemicals in use. No goggles were available for staff to wear whilst changing the chemical bottles. Aprons and disposable gloves were provided. The information in the Annual Quality Assurance Assessment confirms all equipment has been serviced in the last 12 months. Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 24 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 X 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14(1) Requirement A pre-admission assessment must be carried out before admission and must be sufficiently detailed to enable staff to formulate a care plan necessary to ensure residents’ needs are met. Care plans must be in place and sufficiently detailed to enable staff to understand and meet the health and care needs of residents. Care plans must be reviewed and updated in light of any change in care needs so that residents can be sure their needs will be met. A bedrail risk assessment must be done prior to use to ensure the safety of the resident. An immediate requirement was made. Medicine records for the administration of medication must document what has been administered or record a reason why it was not administered in order to ensure the residents’ who use the service are safeguarded. DS0000072113.V367402.R01.S.doc Timescale for action 31/08/08 2 OP7 15(1)(2) 30/09/08 3 OP7 14(2) 31/08/08 4 OP7 13(4)(7) 01/07/08 5 OP9 13(2) 31/08/08 Henwick Grange Version 5.2 Page 26 6 OP29 19(1)(b) 7 OP30 18(1) Prior to appointment of 31/08/08 registered nurses the home must obtain details and evidence of a current registration with the Nursing & Midwifery Council to ensure residents are not placed at risk of harm. New staff must receive induction 31/08/08 training and training appropriate to their role upon employment and updates at regular intervals to ensure that residents and staff working in the home are not placed at risk of harm. 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 Refer to Standard OP10 OP15 Good Practice Recommendations The home should ensure staff receive training about the privacy and dignity of residents to ensure it is being maintained at all times. The home should review the service of meals to residents upstairs to ensure food temperatures are maintained whilst staff are serving and assisting residents to eat their meals. The home should reduce the occupancy of the threebedded room to make sure there is sufficient space for each resident to use this room in comfort and to enable them to furnish it with their own possessions. A programme should be drawn up and implemented for the fitting of approved bedroom door locks to ensure they provide privacy and safety for residents. A separate basin should be fitted in the laundry for staff to wash their hands to prevent cross infection. Laundry staff should use disposable gloves when loading soiled laundry into the machines to prevent cross infection. The home should review the numbers, skills and competency of the staff employed in the home to ensure residents are not placed at risk of harm 3 OP19 4 5 6 7 OP24 OP26 OP26 OP27 Henwick Grange DS0000072113.V367402.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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