CARE HOMES FOR OLDER PEOPLE
Le Grand Nursing Home Le Grand Nursing Home 103 Preston Old Road Freckleton Preston Lancashire PR4 1HD Lead Inspector
Mrs Christine Marshall Unannounced Inspection 12th January 2006 5:15 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 Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 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.V271644.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Le Grand Nursing Home Address Le Grand Nursing Home 103 Preston Old Road Freckleton Preston Lancashire PR4 1HD 01772 679300 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 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.V271644.R01.S.doc Version 5.1 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. 18th August 2005 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 service users aged 65 years and over; the home has a condition of registration for two named service users under the age of 65 years. 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. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of two unannounced inspection visits, scheduled from 1st April 2005 to 31st March 2006. The inspection took place during the evening and was carried out by the home’s designated lead inspector. The inspector looked around the home, including most bedrooms, lounges and the dining area. Plans of care for the people living at the home were examined. The inspector spoke privately to a number of the residents. There were no relatives available during the inspection visit. What the service does well: What has improved since the last inspection?
The home has not made any improvements since the previous inspection visit. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 6 What they could do better:
The home is experiencing problems with the management of the home in that there is no registered manager or established deputy manager. A number of issues were found on this inspection visit. Because there is no registered manager and the deputy manager, the home is experiencing problems providing registered nurse cover for the home. This could result in there not being a registered nurse on duty at all times. The provider, Dr Vachhani has been advised that this is a requirement under the Care Homes Regulations 2001. On the day of this inspection there were only three members of staff on duty to look after 24 residents. The period of teatime and early evening is one of increased activity at the home, and the staffing levels need to be reviewed to make sure that the residents are getting the care that they need during mealtimes and for personal hygiene and bedtimes. A concern has been raised with the Commission about eight residents being got up early in the morning without theirs or their relatives’ written consent. When these residents’ care plans were examined, only two had written consent. A member of staff told the inspector that only four residents were got up before 7am and the inspector saw that two of the four residents did have written consent for an early rise. Dr Vachhani was advised that any resident who preferred to get up before 7am should have these wishes written in their care plans and signed by either themselves of their relatives. However, on the follow-up visit of the 17th January 2006 evidence was shown that seven of the eight residents did have consent to early rising. Medications systems are in need of review; handwritten drug sheets should have the signature of the person writing the instructions, with a witness signature to ensure that the details are correct. Wheelchairs did not have the footplates on and this could cause injury to the resident who is being moved. A full check and repair of all wheelchairs needs to done to make sure that they are all safe to use. Staff should be trained and reminded that footplates must be attached to wheelchairs, unless an assessment has been done and a disclaimer has been signed by any resident who does not want to use the footplates. Two bathrooms were in need of tidying up, the waste bin lids were not in place properly and this caused an offensive smell. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 7 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. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 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.V271644.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement has been made. EVIDENCE: These standards were assessed on the previous inspection visit and were met. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Medication systems do not fully ensure that the residents are safe. EVIDENCE: The home has policies and procedures for the administration of medications and these may need reviewing due to the change in the home’s management. All drugs are recorded on receipt and there is an appropriate disposal system in place. The records that are used for the giving out of tablets and medicines are hand written and without signatures; this needs to be reviewed. The nurse who is responsible for the writing of the records must sign them and a second person should also check and sign that the records are correct. This makes sure that the right drugs are given to each resident. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 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): 14 & 15 Residents are satisfactorily nourished; however they may not be given full choices of daily living. EVIDENCE: A concern has been raised with the Commission that some residents, who are not able to make their own decisions, are being got out of bed very early in the morning. The staff on duty at the time of this inspection said that there were four residents who got up between 6am and 7am, and four residents who got up between 7am and 8am. These residents’ care plans showed that two had recorded the choices of getting up early, and these were signed by the resident or their relative. The other six care plans noted that the residents must be got up for early assistance with their breakfast; these were signed by a member of staff. However staff were given written instructions requiring residents to be assisted to early breakfast to enable staff to carry out other duties. This is in conflict with the notes in some care palns and indiactes that the homes routines are currently set around the staff team rather than the needs and preferences of the residents. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 12 It was advised that residents must be given a full choice of when they get up in the morning, and not have their choices compromised so as to accommodate staff routines. The evening meal looked satisfactory and there was plenty of choice and good quantities. All pies and cakes are home made and comments from the residents were all good. It was noted that the evening meal is not recorded for each resident, and this should be available in case any resident gets ill or loses weight, when a full picture of what the resident has eaten will be in place. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 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): No judgement has been made. EVIDENCE: These standards have not been assessed. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 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): 26 Bathrooms are not kept pleasant and hygienic. EVIDENCE: Two bathrooms had incontinence waste bins with the lids not fitted properly; this led to the bathrooms having an offensive odour. Generally the bathrooms were untidy and cluttered. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 15 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): 27 The numbers and skill mix of staff do not meet the service users’ needs. EVIDENCE: The duty rota showed that there were inadequate levels of staff to accommodate the care needs of the residents living at the home. One registered nurse and two care staff were on duty during this inspection visit, to look after 24 residents. Some residents were left in their wheelchairs for quite some time, waiting for assistance from the staff. Morning and evening routines for the residents are led by the numbers of staff on duty, rather than by the choices and needs of the residents. The inspector was unable to access recruitment files (Standard 29) during the evening visit. A further inspection visit will be made in respect of this. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 16 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 & 38 The health and welfare of the residents is not fully safeguarded. EVIDENCE: The home does not have a registered manager or a deputy manager. The providers Mr and Mrs Vachhani are currently overseeing the daily running of the home. The majority of the wheelchairs did not have the footplates fitted and this could cause injury to the person being moved in the chair. The inspector has advised Dr Vachhani that this is a safety hazard and that staff must be made aware of this and their practice monitored. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME 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 X 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X 2 Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? No 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 OP99 Regulation 13 Requirement Handwritten medications should have two signatures in place in accordance with the Royal Pharmaceutical Society guidelines. Residents must be given a full choice of daily living routines, and not attended to according to the homes’ routines that are set because of the low staffing levels. A record must be kept of all food given to each resident at teatime. Bathrooms must be kept clean and hygienic. Staffing levels must reflect the assessed care needs of the residents and extra staff must be brought in to cover periods of increased activity in the home. Wheelchairs must have the footplates on to ensure the safety of the residents. A full overhaul of the homes’ wheelchairs must be undertaken and staff must be made aware of their responsibilities under the Health & Safety Regulations.
DS0000006054.V271644.R01.S.doc Timescale for action 18/02/06 2 OP14 12 18/02/06 3 4 5 OP15 OP26 OP27 17 Schedule 4 16 18 18/02/06 18/02/06 18/02/06 6 OP38 13 18/02/06 Le Grand Nursing Home Version 5.1 Page 19 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 1 Refer to Standard OP7 OP31 Good Practice Recommendations Care plans should contain residents’ written consent to them getting up before 7am in the morning. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection as soon as possible. Le Grand Nursing Home DS0000006054.V271644.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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