Inspection on 01/08/07 for Le Grand Nursing Home

This inspection was carried out on 1st August 2007.

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

Le Grand Nursing Home 16/05/06

Le Grand Nursing Home 12/01/06

Le Grand Nursing Home 18/08/05

Le Grand Nursing Home 09/02/05

Le Grand Nursing Home 12/10/04

Le Grand Nursing Home 08/03/04

Similar services:

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

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

CARE HOMES FOR OLDER PEOPLE Le Grand Nursing Home Le Grand Nursing Home Preston Old Road Freckleton Preston Lancashire PR4 1HD Lead Inspector Ms Jenny Hughes Unannounced Inspection 1st August 2007 10:00 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 Le Grand Nursing Home DS0000006054.V338584.R02.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. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Le Grand Nursing Home Address Le Grand Nursing Home Preston Old Road Freckleton Preston Lancashire PR4 1HD 01772 679300 01772 679669 legrandnursing@hotmail.com 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) Dr Maganlal Khimchand Vachhani Mrs Nootalkumari M Vachhani vacant post Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate one named person under 65 years of age within a maximum of 28 people. To accommodate one name person under 65 years of age for 2 weeks respite care within a 12 month period. 16th May 2006 Date of last inspection Brief Description of the Service: Le-Grand Care Home with Nursing is located in Freckleton and offers care and nursing to 28 older people. Accommodation is provided in a purpose built, single storey environment. All bedrooms meet the National Minimum Standards size requirements and have en-suite facilities. Each room is furnished to a satisfactory standard and personal possessions are welcomed with each service user. There are three lounges and a dining room. There is adequate parking for visitors. A bus route is close by as is the village with all its facilities and services such as shops and post office. Dr and Mrs Maganlal Khimchand Vachhani own the home. There is a Statement of Purpose and Service Users Guide available; this is a set of written information that tells you about the care service that is offered, who the manager and staff are and what the resident can expect if he or she decides to live at the home. As at 1st August 2007, the fee scale ranges from £386 to £547 per week, with additional charges for chiropodist and hairdresser visits, and any extra newspapers and toiletries requested. Further details regarding fees can be obtained from the owners. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit to the home, in that the owners were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. Before the visit took place, the registered providers were asked to complete an Annual Quality Assurance Assessment, where they outline the services being delivered and any developments that have been made. Surveys were received from people who live at the home and their relatives, and visiting professionals. During the site visit, some staff records and peoples’ care records were viewed, alongside the policies and procedures of the home. The home does not have a registered manager at present, and a named qualified nursing staff member was in charge of the day-to-day running of the home at the time of the visit. Each shift has a named qualified person in charge. The registered providers, referred to in this report as the owners, were also present, and they visit and help with the running of the home most days. The owners, nurse in charge, people who live at the home, and care staff, were spoken to, along with visitors who called during the day. Their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: Le Grand is a very welcoming and homely place for people to live. The decoration and furnishings are of a good standard, making the environment a comfortable and relaxing place to be. The three lounges give choice for residents on where they prefer to sit, and the airy dining room with its pine furniture and matching table linen makes for a pleasant mealtime atmosphere. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 6 The gardens are well maintained, with seating areas for the better weather. Although there is no manager at present, the home has some long-term staff, who lead by example with good practices and professional attitudes. All of the residents spoken to by the inspector said that the staff were very nice, friendly, and kind. “The staff are very friendly and approachable”, was a comment on a survey returned. The home has achieved the Investors In People Award, showing that staff are effectively developed through good training, support and guidance. The owners are very committed to providing good care, and have been trying to ensure the good standard continues while there is a lack of manager for the staff to take the lead from. The residents said that the owners are there most days, and always have a chat with them, and help out. Care plans for residents are clear for staff to understand how to best look after each individual, and personal routines are respected. Meals are home-cooked, varied, with well-balanced choices. They are well presented, with meal times being pleasant and unrushed. Residents said that they enjoyed the meals, and there was a good choice. Visitors are welcome at any time, with communal space available as well as using their own rooms to have private chats. “In the time mum has been there, she has been well looked after and has been as happy as she can be in the circumstances. I find the staff very caring” was a comment on a survey. At one meeting a resident expressed his satisfaction by saying “I can’t find any problems, no matter how hard I look!” What has improved since the last inspection? What they could do better: Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 7 The home generally provides good care, from committed staff. However, the lack of manager to oversee and guide over the last year has caused some practices to be less efficient than they should be. The owners said that a suitably qualified person has now been recruited, and is due to start in the manager’s post in October 2007. There is a good medication policy and procedures in place, but on occasion records are not fully completed. The owner confirmed that these are checked, and there needs to be some evidence of this. A named person responsible for all medication processes would be able to monitor all aspects. Criminal Record Bureau disclosures are requested for all staff, but occasionally some new staff have started work before the appropriate disclosure has been returned. Staff must not start work without a disclosure, or a Protection of Vulnerable Adults check, when they may start with supervision. Poor practices are not accepted at this home, and the owners were able to discuss incidents they had identified, and what corrective action they took to benefit the resident. However they should make sure there is formal evidence of when this has been noted, including the action taken. The activities programme should continue to be developed, as a group plan, and also for individuals, to encourage as many as possible to participate in some form of stimulation. 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. Le Grand Nursing Home DS0000006054.V338584.R02.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 Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information the home gives to people about the services available, and the way it gathers information about people who want to live there, means that proper choices can be made about the suitability of the home. Some information needs to be reviewed so that people are up to date with their knowledge. EVIDENCE: Information about the home is provided to all residents. A ‘Prospectus’ for the home holds very detailed information all about how the home operates, with past inspection reports included. This is available for any interested party to view. Some information was out of date, such as staff names. These information documents should be regularly reviewed and updated. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 10 A Service User Guide is given to all residents, and could be found in each bedroom used. This outlines what each person can expect from the home, along with what the management structure is. Advice was given that this could be made more user friendly for residents to read. Individual records are kept for each of the residents, and there is a set procedure for admitting someone to the home. A checklist is used to make sure nothing is missed. A pre-admission assessment is used by management to check that staff can give suitable care to each person, before the manager agrees that the home is the right place for the person to live. Detailed information about the care needed by the residents was seen on four selected files. The owners and senior staff said that trial periods were offered so that people could have time to decide whether they were happy to stay at the home, and also so that the home could make sure they could provide the right care. “The contract was discussed in detail before it was issued” commented a relative, confirming it was clear what care the home was going to provide. “We were able to view the home with limited notice several times before deciding it was the right place, with all our questions answered”, said another family member. “My daughter found the home, and told me all about it”, commented a resident. GP’s responses to a survey said that “ I think le Grand is quite well run”. Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs for everyone living at Le Grand is well organised, meaning people benefit from individualised care and support. Medication procedures are good but occasional lack of complete records could cause the wrong action to be taken and affect the residents’ welfare. EVIDENCE: Individual care plans are available, identifying the areas of need for each person, and with clear instructions for staff for what they must do to meet that need. The systems have been reviewed and further improved since the last visit. Assessments and consent forms were all signed by the resident or their family in agreement. Consent forms are in place for such as self medication, the use of cot sides and wheelchair restraints, and whether the resident would like a door lock. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 12 Reviews of the care plans of the four files viewed had taken place monthly, to make sure the information about the resident’s care needs was up to date. Staff make daily records, which include good information about each person. A Handover Data Sheet, which has a précis of the events relating to each resident during the previous shift, is used to efficiently pass on relevant information to the next shift. All information is cross-referenced across appropriate records. Diverse and individual needs are addressed, the staff adjusting the care to suit the person. One person’s care plan gave staff clear guidance on how to encourage them to eat, and the best way to help feed them. Some residents were seen to be given one to one support when needed, for example at meal times, or when a little help is needed to enjoy a cup of afternoon tea. The assistance was given quietly and tactfully, chatting to the resident all of the time. A resident who had poor mobility was given time and attention from staff, to explain what was happening, and to make them feel part of the proceedings. Needs are met by arranging specialised care, for example hearing aids are fitted, special diets are planned, staff have an awareness of the needs of someone with poor sight by replacing objects in the same place, and talking through what they are doing. There is good detail on pressure area care, and the records show the care given was very successful, with good further prevention guidance given. Healthcare visits from, for example, the GP, dentist, chiropodist, dietician, and physiotherapist, are recorded, and show their visits made are regular. “Of COURSE I receive medical support when I need it and when I ask for it,” commented a resident. Residents can choose to go where they wish in the home. There are three lounges, so one resident, who said she prefers to sit quietly, sat alone in one lounge, while several others sat with a television on in another. Some preferred to stay in their own rooms. Residents commented that visitors called often, and they could use one of the lounges to chat, or go to their own room for privacy. Medication was stored in a lockable trolley within a secure designated medication room. The home uses Boots pharmacy guidance for their medication procedures. The records seen were mostly up to date, although there were several omissions in the recording of medication administered that day. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 13 Medication received by the home is recorded, and any returns are recorded and signed for by the qualified staff on duty. The owner confirmed he made regular checks of the medication procedures and records, and brought errors to the attention of the staff. The inspector advised that a named responsible person to audit and monitor medication processes would help maintain an efficient system. Only qualified staff administer medication. Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents daily lives and social activities are generally well catered for, and all people benefit from living in a home that works to ensure that people are provided with opportunities to live lives that are fulfilled. EVIDENCE: The individual care plans include information on each person’s life history, their religious needs, and what activities they like. Staff address any diverse and individual needs to make sure each person is treated equally and feels as much at home as possible. “I like listening to music as I am blind. And staff enjoy listening to my jokes” said a resident. Visitors call regularly, a visitors book giving good evidence of this, and those visitors spoken to said that they were always welcomed when they arrived. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 15 Some activities take place, and a hairdresser was washing and setting the hair of two residents on the day of the visit, with a few more residents ready and waiting to go to the hairdressing room in their turn. A meeting the owner had held with the residents confirmed in the minutes that several weren’t really interested in playing games such as bingo, dominoes or darts, although they enjoyed a quiz. The owner said that they were happy to follow whatever the residents wanted to do. Most enjoyed trips out to the local large garden centre, to Fairhaven Lake, or just shopping. “Trips out, usually monthly, are excellent”, commented a relative. One resident said they liked to read, and opportunity was given to get books from the library, while another liked it when staff read stories and articles to them. Another resident liked to go for walks around the village, with a risk assessment carried out, and also liked to do small jobs in the garden. The resident proudly showed garden tools, and evidence of his working life as a gardener, which he kept in his own room. One resident said that they weren’t bothered about joining in, and just liked to sit quietly in the small lounge, “staff ask me if I’m alright though”, she added. Staff try to stimulate residents when they can by sitting and chatting, and they devise the activities programme between them, dependent on what the residents wish to do. The inspector discussed the benefits of having a named person responsible for a more structured activities programme, for groups and individuals, which may encourage and motivate more people to participate. The menus are on a four week cycle, with each day’s menu on display at the dining room entrance. Staff served food in the pleasant dining room, helping tactfully when needed. “Mum has always enjoyed her food, and has had all she has wanted,” said a relative. Residents said that they usually liked the meals, and enjoyed the glass of wine they could have with their Sunday lunch. They also liked the change of having a tea-time buffet every month in the lounge. Occasionally residents prefer their meal in their own room, which they are able to do. The owners are not involved with any of the residents’ finances. All rooms have secure space, and the home’s safe can be used on request. Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a complaints procedure in place, with a complaints book to record any complaints, which may come to the manager’s attention. The home’s complaints book has no records of complaints. Several residents spoken to said they would tell the staff if they were not happy with something. “I would speak to Dr and Mrs Vachhani if I was not happy” stated a resident. “I am happy here,” confirmed another. A visitor said that they would “tell one of the staff I suppose” if he had a problem, but “it would be better if there was a manager. It’s different people in charge all the time, because they work shifts”, but they added that they had no concerns and were happy with the way their relative was looked after. Several ‘thank-you’ cards and letters of compliment from family and friends were seen. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 17 There is advocacy information available for anyone who is without relatives and who might need someone to speak on their behalf. Staff spoken to knew about the Adult Protection procedure, and what to do if they had any concerns. They said they would always act if they thought a resident was at risk. Also if it was a member of staff causing concern they would inform the manager. Evidence of this was seen following an incident involving an ex-staff member. It was clear that the welfare of the residents was the prime objective of the staff, and the whistleblowing procedure was followed correctly. All staff attend abuse awareness training. “Staff have always been open honest and caring, and I have always been contacted if something is wrong,” said a relative. “Staff have always responded promptly when I have needed to alert them,” commented another. Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well-maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a very pleasant, safe, and homely place to live. EVIDENCE: The home is set in its own well-maintained grounds, with a protected garden area with a lawn, and flowerbeds. Residents said they enjoy sitting outside in the better weather. Most people like to sit near the front door and watch the comings and goings to the home, and there was evidence of this at the inspector’s arrival at the home, with a few chairs and an umbrella just outside the porch area. “I sometimes like to sit out if it’s good weather,” said one resident. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 19 Domestic staff were in the process of the daily routine cleaning of the home at the time of the visit, and all of the rooms were clean, fresh and tidy on viewing. “One of the things I noticed when viewing was how fresh and clean the home is”, commented a relative. The bedrooms, all ensuite, were nicely furnished and decorated, and were full of resident’s personal belongings, such as photographs and pictures, ornaments and flowers. One resident had his old gardening tools carefully and safely stored in his room, proudly showing them to visitors. The owners discussed their ongoing plans to renew furnishings in the home. The dining furniture was due to be replaced, and some areas’ decoration refreshed. There is ongoing maintenance to keep the standard of the environment at a good level, and a maintenance book is completed by staff to notify of anything that needs to be mended or changed. There is plenty of communal space with three lounges, a dining room, and ample space to sit in the large entrance hall. People can choose where they want to be, and were seen moving from one place to another as they wished. Grab rails, assisted baths, lifting and bathing hoists, and raised toilet seats all go towards helping the mobility of people around the home. Call systems in every room are regularly checked. The laundry room was clean and tidy, with an organised system being used to protect against cross infection, and to make sure there is no misplaced clothing. Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is properly staffed, which means that the residents are supported by sufficient numbers of well trained and appropriately qualified staff. There is a risk to residents if staff commence work without proper checks being completed first. EVIDENCE: Two files were selected and although there is a thorough recruitment procedure, it was found that on occasion staff were starting work before a POVA 1st had been returned, and while the return of the CRB disclosure was being waited for. These are checks that must be returned with appropriate results, prior to starting employment. The owner confirmed that these staff were always supervised while at work. CRB disclosures were available for all other staff. All new staff have induction training and are given a staff handbook, which gives guidance on working practices in the home. “New care staff shadow the senior carer when they start work. She can then assess that they are competent”, said the owner. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 21 A staff rota of trained nurses, care staff, and domestic staff showed who is on duty at any time. The owners confirmed they monitor the assessed needs of residents, and accordingly staff numbers. They were advised to always ensure there are enough staff to cover busier periods in the home, for example in a morning to help people get up. Many staff have worked at the home for a few years. “I really like working here. It’s a good team, with approachable employers. I do think we are missing that one person in charge now though. The owners do what they can, and are very supportive.” said a staff member. “We all support each other”, commented another staff member. A training matrix was seen showing all the training attended by qualified and unqualified staff, such as tissue viability, nutrition and dementia awareness. Training in Fire safety, dementia awareness, safer patient handling and continence awareness has also been provided. National Vocational Qualifications have been achieved by 70 of the care staff. “We are having refresher training, and I feel up to date with procedures,” said a staff member. Le Grand Nursing Home DS0000006054.V338584.R02.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): Standards 31, 33, 35, and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The owners and senior staff work to improve services and to protect the health and safety of residents. However, there is no registered manager to lead and support the staff as a role model, and to develop high quality services. EVIDENCE: The home does not have a registered manager at present, but an appointment has been made. Until the new manager starts working at the home the day-today running of the home is carried out by a named member of staff who is a Registered Nurse, and who is on duty that day. The owners of the home are also present at the home most of the time. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 23 The owners must appoint a suitably qualified person to manage the home and to register with the Commission for Social Care Inspection. At this visit they confirmed that a suitable person is to start in this post in October 2007. Staff were generally happy with the leadership in the home, finding it very open and positive. Several commented that the lack of a permanent manager had occasionally given a feeling of no direction, and they were looking forward to having a named responsible person in charge again. The owners and staff hold a regular meeting for residents and relatives, to discuss any issues, either as a group or confidentially, to try to improve the service they provide if necessary. At one meeting a resident said “I can’t find any problems, no matter how hard I look!” There is regular and ongoing communication within the small staff group, with a handover session being done at shift change. The friendly, chatty atmosphere was noted. The owners regularly have informal chats with the residents, and were seen doing this at the visit. The residents said that the owners always spoke to everyone and listened to what they had to say. The home is not responsible for handling any residents’ finances, and they either manage them themselves, or family help in this area. Supervision of staff in the form of regular one to one meetings take place, with full records made. These are targeted to each staff member’s individual needs, and identify training needs and confirm correct working practices. The home has achieved the Investors In People Award, showing that staff are effectively developed through good training, support and guidance. Procedures in the home are regularly reviewed and updated if needed, and the management team are open to suggestions on ways to improve systems. Accidents are all recorded, and easily referred to through an accident log. This crosschecks to individual files. The owner was able to discuss the investigation and outcomes of queries raised by some accident records made, and was advised to formally make it clear that the issues had been addressed and correctly dealt with. The owners confirmed in their pre-inspection information that all maintenance services on any equipment in the home were up to date. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 24 Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 26 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 OP31 Regulation 9 Requirement The service must employ a suitably qualified and experienced manager who is registered with the CSCI (Timescale of 31/08/06 not met) Medication taken by residents must be recorded at the time it is administered, ensuring complete records at all times The registered person must ensure that new staff do not start work until the appropriate disclosures have been returned. The registered person should make sure that the information in the Statement of Purpose and Service User Guide is reviewed and up to date Timescale for action 31/10/07 2. OP9 13(2) 01/08/07 3. OP29 19(1)(b) Schedule 2 4,5 01/08/07 4. OP1 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000006054.V338584.R02.S.doc Version 5.2 Page 27 Le Grand Nursing Home 1. 2. 3. 4. Standard OP9 OP9 OP12 OP38 It should be made clear that medication audits have taken place The service should use an appropriate person to be responsible for medication processes to help maintain an efficient system at all times. The registered person should use a more structured, and individual, activities programme, which may stimulate more people to join in. The registered person should ensure there is clear formal evidence of the action taken following issues relating to the welfare of residents, for example, unexplained accidents. Le Grand Nursing Home DS0000006054.V338584.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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