Inspection on 16/03/06 for Herrington Grange Nursing Home

This inspection was carried out on 16th March 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Herrington Grange Nursing Home 16/10/07

Herrington Grange Nursing Home 05/10/06

Herrington Grange Nursing Home 13/11/05

Herrington Grange Nursing Home 09/03/05

Herrington Grange Nursing Home 01/10/04

Herrington Grange Nursing Home 09/03/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Herrington Grange Nursing Home Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW Lead Inspector Lesley Scriven Unannounced Inspection 16th March 2006 09:50 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 Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Herrington Grange Nursing Home Address Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW 0191 584 5854 0191 512 0958 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) Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons) Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (10), Physical disability of places over 65 years of age (30) Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: Herrington Grange is a privately owned care home, which is located in a village in a semi-rural area. It is reasonably close to a range of local facilities including shops and a Church, and is also near to a bus stop. The home may provide permanent accommodation with personal care support and nursing for up to fifty older people, some of whom may have a physical disability. A limited number of physically disabled adults under the age of sixty-five may also be accommodated within this total number. The home’s entrance is level, and a shaft lift provides access between floors. Accommodation is laid out over both the ground and first floors. Each has self-contained lounges and adequately equipped bathrooms. All bedrooms have en-suite toilet facilities. The building shares it grounds with another care home owned by the same company. The grounds are well kept, there are acessible paved areas for service users, and car parking is available. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection visit, an alert raised through Sunderland Social Services’ multi-agency policy for ensuring the protection of vulnerable adults (MAPPVA) has been the source of enquiry by professionals from Social Services, the Health Care Trust, the Police and the Commission for Social Care Inspection. The matter is now close to being resolved. This unannounced inspection was carried out by one inspector over a period of six hours and forty minutes on one day. None of the specific issues raised by the MAPPVA alert was considered as part of the visit. The views of thirteen of the people living at the home were gathered. One visiting friend and one relative were spoken with and two service user case files were read. A small sample audit of the home’s system for receiving, storing, administering and disposing of medication was carried out, along with a small audit of service user’s financial records. A partial tour of the premises looked at the standard of accommodation and facilities on offer and arrangements for maintaining safe living and working conditions. The manager, two qualified nurses, five care staff and housekeeping and catering staff were asked about how the home meets service user’s specialist needs. What the service does well: What has improved since the last inspection? A peripatetic manager, who is familiar with the service, is temporarily running the home. She is in the process of auditing all service user care-plans to check that they are being written and carried out to the required standard. Plans are Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 6 in place to help nursing staff to improve their care-planning skills and keep better records. Some communal areas and service user’s bedrooms are being redecorated and users and families have been consulted about new colour schemes. People spoken with said they are looking forward to the improvements. 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. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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 the following standard(s): None of these standards was assessed on this occasion. Standards 3, 4 and 5 were assessed and met at the last visit. It is not necessary to assess standard 6, since the home does not provide an intermediate care facility. EVIDENCE: Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7 and 9. Standards 8 and 10 were assessed and met at the last inspection. Care-plans and risk-management plans written by qualified nurses do not properly address each service user’s full range of needs. This means that care staff are not always able to provide exactly the right kind of support at the right time. Adequate systems are in place to enable qualified nursing staff to safely assist people with medication. EVIDENCE: The home’s peripatetic manager is in the process of auditing all service user care-plans to check that they are being written and carried out to the required standard. Through supervision and training she is aiming to help nursing staff improve their care-planning skills and keep better records. Neither of the two service user files chosen at random by the inspector as part of a case-tracking exercise had been audited. Care-plans for the first service user had been kept up-to-date in respect of the person’s physical nursing and healthcare needs, which included diabetes and Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 10 impaired mobility, and these were being properly met. The plans failed however to address the individual’s mental-health needs. There was no riskassessment in place or guidance to help care staff respond to the person’s behaviour, which can sometimes upset the other people who live and work at the home, and as a result challenge the service. Without properly written risk-assessments and risk-management plans, care staff are unable to offer the right kind of personalised support at the right times to safeguard people from harm whilst still promoting independence, choice and well-being. This needs to be changed so that people can live together safely and benefit from a more harmonious environment. Plans for the second service user were more holistic and looked at the person’s needs as a whole, including those related to their social life. They failed however to fully address the user’s physical health needs. As an example the inspector noticed over the lunch period that the person’s wheelchair did not offer the correct postural support to ensure comfort, especially while they were eating and drinking. Nothing had been done to resolve this problem, even though it had been recognised by the manager. Contact should have been made with an occupational therapist; instead staff were using a domestic ‘scatter’ type cushion, which is not adequate. The manager and nursing staff therefore need to make links with other associated health professionals outside the home, so that service users can enjoy a wider range of services that will better meet their needs. The manager also needs to be aware that once a service user’s mental health needs become the primary focus of their care, then advice must be sought from the Commission for Social Care Inspection about the home’s ability to continue to meet those needs in light of its registration status. Only qualified nursing staff are authorised to assist service users with medication. A small sample audit showed that proper and safe procedures are followed when medicines are administered and satisfactory records are kept. Good systems are also in place for ordering and disposing of service user’s medicines. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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 the following standard(s): 13 and 14. Standards 12 and 15 were assessed and met at the last inspection. Service users are encouraged to keep in touch with families and friends and maintain links with the local community. Herrington Grange is managed so that the people who live there can to some degree influence how the home is run. Service users can exercise some choice in their daily routines, but this could be improved. EVIDENCE: Visitors are made welcome at Herrington Grange. This was confirmed for the inspector by one service user’s relative and also another person’s close friend, who visits daily. Both said that the manager makes good efforts to keep them informed and involved. One added that she thought the staff provided very good care and praised their patience and professionalism. Many of the people who live at the home said that they are able to have visitors at any time, and that they are helped to keep in touch with families by telephone too. Staff also encourage people to make use of local facilities, such as the shops, Church and hairdressing salon, and most service users are registered with a local GP. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 12 The peripatetic manager ensures that ‘resident’s meetings’ are regularly held, where service users and their families and supporters are invited to consider issues relating to the running of the home, in which they all to a degree, have a say. Topics recently have included social activities - in light of the temporary absence of the home’s activities co-ordinator - and the redecoration of the home and individual bedrooms, with everyone being encouraged to choose new colour schemes and bedding. These opportunities to speak up enable service users to influence how the service operates and exercise some control over their lives. More however could be done to enable people to make choices on a daily basis. For example, everyone the inspector spoke with enjoyed the lunchtime meal of broth and dumplings, but no one in the dining room knew what was being served. One lady guessed she was having soup since the place setting included two spoons. Because people hadn’t been offered a choice or an alternative beforehand, some were given broth even though they didn’t like it. Another lady told staff that she would rather have an alternative because she didn’t eat vegetables, and asked for a sandwich. After a considerable wait, she was given shepherd’s pie. She didn’t really like that either, but said she didn’t want to make a fuss so accepted the meal. The manager does display a menu in the dining room. On the day of inspection this reflected what was being served, but because it was printed in a small typeface and pinned to a notice board located at head height in the corner near to the serving hatch, it was not accessible to wheelchair users or people with impaired vision. By the end of the day steps were being taken to put this right, although extra thought still needs to be given as to how everyone might be consulted about their choices in advance of mealtimes. This will ensure that everyone is served with a meal that suits them, and enable alternatives to be served at the same time as the main selection. A more organised approach will benefit kitchen staff too. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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 the following standard(s): None of these standards was assessed on this occasion. Standards 16 and 18 were assessed and met at the last inspection. The home is presently subject to a multi-agency enquiry in response to an alert made through Sunderland Social Services’ MAPPVA (protection of vulnerable adult) procedures. Safeguarding adults practices will therefore be assessed at the next inspection, when the enquiry has been completed. EVIDENCE: Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26. Herrington Grange is generally well maintained and kept in a good state of repair. The communal areas are pleasantly decorated and furnished and some planned improvements are underway. This makes the home a pleasant place to live. Housekeeping staff keep the home clean and free from infection to the benefit of everyone’s health. EVIDENCE: The home is purpose-built and its environment is accessible to service users and their visitors. The company arranges for maintenance and redecoration to take place on a regular basis and plans are in place for individual bedrooms and some of the communal areas to be improved over the coming months. Service users and their families have been consulted about new colour schemes and some people told the inspector that they are looking forward to a fresh new look. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 15 The Jacuzzi bathroom is presently out of order, but there are sufficient alternative assisted bathing facilities available until the bath is replaced with a new accessible shower. Housekeeping staff receive health and safety training and keep the home clean, tidy and free from odour and infection. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards was assessed during this visit. Each was assessed and met at the last inspection. EVIDENCE: Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38. Standard 33 was assessed and met at the last inspection. The home is being temporarily run by one of the company’s peripatetic managers who is a qualified nurse. She has a good deal of management experience. Service user’s finances are properly managed to protect people from financial abuse. Arrangements for maintaining fire safety in the home are not adequate to properly protect the people who live and work there. EVIDENCE: The home is being run on a temporary basis by one of Four Season’s peripatetic managers, Mrs Linda Burgess, who is a state registered and qualified sick children’s nurse. She has a National Vocational Qualification Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 18 (NVQ) at level V in operational management and is also an NVQ assessor/verifier. She has worked as a manager in hospitals and care homes, and has operated her own nursing agency. The peripatetic manager has worked at Herrington Grange in the past, so is familiar with the service. She is assisted in her duties by a team of qualified nurses. Mrs Burgess is working with the home’s nursing and care staff to audit and improve their professional and care practices and record keeping. This work will hopefully soon be reflected in the quality of care and support experienced by service users. Proper procedures are followed by staff assisting users with their finances. Good records are kept of all transactions made, and these are checked by the company to protect people against financial abuse. Adequate fire safety arrangements however, are not in place. The home’s fire risk assessment fails to identify all of the existing hazards and does not set out clear guidance for staff about control measures that should be put in place to minimise the risk of fire occurring. Oxygen cylinders in the first floor treatment room are not securely stored and there is no signage in place to alert people to the hazard. Doors throughout the home are wedged open and this too compromises fire safety. The manager has said that some service users for health reasons require regular monitoring and supervision and this is why bedroom doors are kept open. One service user who has to spend a lot of time in bed told the inspector that he likes to have his door wedged open, to stop him from feeling isolated. He said he enjoys the company of staff and likes to talk to them as they pass his room. Nevertheless, wedging open doors endangers people’s lives if a fire takes place. If doors must be held open for good reason, then proper devices should be fitted, which trigger automatic closure in the event of a fire. These should be provided by the home for service users on the basis of individually assessed need. Additionally, where bedroom doors are held open by proper fire-safety devices in future, privacy screening should also be provided, so that people’s dignity might be better preserved. Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 19 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 Regulation 15(1,2) 17(1) Sched. 3 Requirement Service user care-plans must be specific to the full range of each individual’s needs. Staff must complete holistic riskassessments for all service users. These must also address risks associated with people’s mental health needs. The peripatetic manager must carry out a full fire risk assessment for the home’s premises. Doors must not be chocked open. Proper fire-safety devices must be provided by the home on the basis of individually assessed need. An immediate requirement form and serious concerns letter were issued in this regard. Timescale for action 16/04/06 2 23 (4) 17/04/06 Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 21 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 OP4 Good Practice Recommendations The manager should be aware that once a service user’s mental health needs become the primary focus of their care, then advice must be sought from the Commission for Social Care Inspection about the home’s ability to continue to meet those needs in light of its registration status. An application for variation for identified individuals may be considered. The manager and nursing staff should make links with other associated health professionals outside the home, so that service users can enjoy a wider range of services, e.g. occupational therapy, that will better meet their needs. Service users should be supported to exercise choice at mealtimes. Individuals should be consulted in advance about the options available to them. This will enable everyone to enjoy a meal that suits them, and alternatives can be served at the same time as the main selection. 2 OP4OP7 3 OP14 Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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. Extracts may not be used or reproduced without the express permission of CSCI Herrington Grange Nursing Home DS0000018196.V257236.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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