Inspection on 13/05/08 for Leeming Bar Grange

This inspection was carried out on 13th May 2008.

CSCI found this care home to be providing an Good 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

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

CARE HOMES FOR OLDER PEOPLE Leeming Bar Grange Leeming Bar Grange Leeming Lane Leeming Bar North Allerton DL7 9LT Lead Inspector Rachel Martin Key Unannounced Inspection 13th May 2008 09:30 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 Leeming Bar Grange DS0000070938.V365921.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. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leeming Bar Grange Address Leeming Bar Grange Leeming Lane Leeming Bar North Allerton DL7 9LT 0845 271 0791 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) stgeorgeslodge@orchardcarehomes.com www.orchardcarehomes.com Orchard Care Homes.Com Limited Heather Elaine Middleton Care Home 60 Category(ies) of Dementia (60) registration, with number of places Leeming Bar Grange DS0000070938.V365921.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 only - code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: 2. Dementia - Code DE, maximum number of places 60 The maximum number of service users who can be accommodated is: 60 NA Date of last inspection Brief Description of the Service: Leeming Bar Grange is a new, purpose built care home. The building of the home was completed in 2007 and it was registered with CSCI in November of the same year. Leeming Bar Grange is registered to provide residential care for up to 60 people with dementia. It is not registered to provide nursing care. The home is owned by Orchard Care Homes.Com Limited. The home is located on the edge of Leeming Bar and has a pleasant, rural outlook. The home provides purpose build accommodation on two floors, with modern lift access. All of the bedrooms having en-suite toilet, washbasin and shower facilities. Communal bathrooms with specialist bathing equipment are also available for people who prefer to have a bath. Communal toilets are also available at convenient places around the building. A number of communal lounges, seating areas, dinning rooms and a conservatory are provided, so that people have a choice of where to spend their time. The home stands in large grounds and has a large, pleasantly landscaped garden area that is accessible from the conservatory. A car park is also available. At the time of this inspection the home’s fees ranged from £530 to £580 per week. This does not include additional items and services, such as hairdressing, personal toiletries and chiropody. Up to date information about fees and terms and conditions should always be sought directly from the home. Leeming Bar Grange DS0000070938.V365921.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 2 star. This means that the people who use this service experience good quality outcomes. This was the first key inspection of a new service. Before the inspection the home’s manager completed a self-assessment and returned it to CSCI. This assessment told us what the home did well, what needed to be improved and provided information about the service, its staff and the people living there. Surveys were returned by one person living in the home, two relatives and a health care professional who works with people who live at the home. The inspection site visit took place on 13th May and was carried out by one inspector in one day. At this time the home had been registered for about six months. During this visit the inspector spoke to the home’s manager, staff and people living in the home. A selection of records were inspected and the inspector looked around the building. Time was also spent observing the lunchtime meal and some of the care practices at the home. What the service does well: The home has in place good systems for assessing people before they move in and people felt that they had been given plenty of information to help them decide if Leeming Bar Grange was the place for them. Comments made by people’s relatives included “we were provided with lots of info, advice and help in the decision to move dad and his ongoing care, very open and communicative”. Each person has a comprehensive and up to date record and plan of their care, which includes information that has been provided by people’s families, other professionals and information about people’s preferences. The manager and staff interact well with the residents and people are cared for in a pleasant and friendly way. For example, staff talked to people, spent time singing and dancing with residents in the lounge, asked what people wanted and explained what they were doing. Comments made to us included “all the staff appear to try their hardest to provide for all his needs. Also due to their monitoring they identified medical concerns and assisted in getting medical treatment, for which the family is truly grateful”. The home provides a variety of activities that are carried out and encouraged by care staff. Some residents have pots of plants in the garden to look after and others help to look after the home’s rabbits. There are plans for an activities co-ordinator once the home has more residents living there. Church Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 6 services and Jehovah’s Witness meetings take place regularly for residents. Visitors are made welcome and can visit when they want to. The meals provided looked appetising and people get biscuits, fruit and homemade cakes with the morning and afternoon tea trolleys. Comments made to us included “open ended visiting, flexible routines, choices offered”, “they encourage families to be involved”, “good atmosphere, good facilities and good communication, encourages families to visit at any time” and “good meals”. People at the home and their relatives know how to complain and felt that the manager and staff were approachable and would deal with any concerns they had properly. The home provides a clean and pleasant place for people to live. It offers modern facilities and is decorated, furnished and equipped to a high standard. There are a number of different communal areas for people to spend time in and pleasant gardens and grounds. Relatives said “the setting is lovely. The layout of the lounge and dining rooms encourages communication between residents and feels like a real home. The main reception/hall always has a nice buzz to it”. What has improved since the last inspection? What they could do better: At the time of this inspection some medication practices in the home needed to change. We found that staff were sometimes putting people’s medication into little pots with their names in and taking the pots around the home on a tray in order to give people their medication. Staff would then return to the treatment room to complete the medication administration record (MAR) once everyone had received their medication. This is called secondary dispensing and is not a safe practice. There were also issues around the storage of some medications and record keeping that needed to be improved. This is important so that medication does not loose its effectiveness through incorrect storage, so that staff can check that people are getting the medication they need and so that any errors can be easily identified and followed up. The way staff are deployed during meal times needs to be looked into by the home’s management. We found that people sometimes had to wait for their meals and the support they needed with eating, because staff were busy. Staff also need training on how to help people with feeding, as staff were seen trying to feed two people at once while stood up. This is important so that people get the individual support they need and that mealtimes are a pleasant and dignified experience for people. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 7 Although the home carries out checks on all of its staff, the manager needs to make sure that all of the required information is obtained about new staff before they start work. This is important so that people are protected from potentially unsuitable staff. 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. Leeming Bar Grange DS0000070938.V365921.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 Leeming Bar Grange DS0000070938.V365921.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): 3&6 People who use the service experience good quality outcomes in this area. People are provided with information and have their needs assessed, to make sure that the home can meet their needs and is somewhere they want to live. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: In the home’s self-assessment they told us that information about the home is available in reception and that people are encourage to visit the home and look around. This was observed and confirmed during the inspection. Some people can to look around the home to see if their relative might like it. The manager and staff spent time showing them around and explaining what life at Leeming Bar Grange was like. The self-assessment also told us that people are assessed before they come to live at Leeming Bar Grange, so that people know that the home can meet their needs. Four people’s care records were looked at during the inspection visit. These records contained assessments of people’s needs and information that had been provided by other professionals and people’s families. This means Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 10 that the home has good information to help them provide the care and support people need when they move in. People thought that they had been provided with plenty of information to help them make decisions about coming to live at Leeming Bar Grange. Comments made by people’s relatives included “we were provided with lots of info, advice and help in the decision to move dad and his ongoing care. Very open and communicative”. Leeming Bar Grange DS0000070938.V365921.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 People who use the service experience good quality outcomes in this area. People’s needs are set out in comprehensive and up to date care records and staff care for people in a friendly and dignified way. Improvements have been made to the way the home manages medication, to make sure people always get the medication they need. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager told us that each person has a record and plan setting out their care needs. She also told us how the home follows a ‘person centred’ approach and involves families in completing care plans. This helps to make sure people are treated as individuals and their preferences are taken into account. We looked at four people’s care records. There were some places where more detail could be included. For example, one person’s care plan talked about their ‘diabetic diet’, but didn’t provide any information about what this meant for that person. However, in the main the care plans that were looked at were comprehensive, up to date and provided a lot of information about people’s needs. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 12 On the day of this inspection we saw that people looked clean, tidy and were appropriately dressed. Staff interacted well with residents and treated people in a nice way while they assisted with their care. For example, staff talked to people, spent time singing and dancing with residents in the lounge, asked what people wanted and explained what they were doing. Staff asked people if they needed assistance in a quiet way, maintaining their privacy and dignity. One resident who returned a survey said that they ‘usually’ received the care and support they needed, that staff listened and acted on what they said and that they ‘always’ received the medical support they needed. Two relatives who returned surveys said the home ‘always’ and ‘usually’ met the needs of their relative. Comments made to us included “all the staff appear to try their hardest to provide for all his needs. Also due to their monitoring they identified medical concerns and assisted in getting medical treatment, for which the family is truly grateful”. People’s care records showed that people received support from other professionals when needed. For example, one person had seen the doctor, district nurse, the chiropodist and attended a clinic recently. A staff member showed us how medication was administered and a number of records and storage arrangements were checked. Generally the arrangements for administering medication were fine. However, at lunchtimes staff were sometimes putting people’s medication into little pots with their names in and taking the pots around the home on a tray in order to give people their medication. Staff would then return to the treatment room to complete the medication administration record (MAR) once everyone had received their medication. This is called secondary dispensing and is not a safe practice. Medication should be administered to each person directly (from the container in which it was dispensed by the pharmacist) and the appropriate record entered onto the MAR at that time. The management were made aware of this at the time of the inspection and the practice was stopped straight away. We randomly checked a selection of MAR’s and found a number of examples where the recorded balances, number of signatures for medication administered and the actual number of tablets left did not add up. Some eye drops needed to be used within 28 days of opening, but staff had not recorded the date they were opened on the container. This meant that staff did not know when to dispose of them and that people might have been given eye drops that were no longer effective. The treatment room was very warm and the room temperature was not being monitored. There were also some medications being kept in the fridge that did not need to be. Staff should always check the label and make sure that medication is being stored within the recommended safe temperature parameters. An appropriate controlled drugs cabinet and register were being used. A number of records in the controlled drugs register were checked against the appropriate MAR’s. The majority of these were up to date and accurate. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 13 However, for one resident when we compared the recording in the controlled drugs register and on the MAR the balance of drugs left in the home did not match. This was found to be due to a recording error on the MAR and was corrected by the member of staff on duty at the time. There was no evidence that people were not getting the medication they needed or that anyone had come to harm as a result of these issues (for example, there had been no reported drug errors and the needed medication was in stock and being administered to people according to their prescriptions). The management started to look into these issues straight away and promptly put in place regular checks, training and monitoring of staff practice to make sure that things improved. Leeming Bar Grange DS0000070938.V365921.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 People who use the service experience good quality outcomes in this area. Staff interact well with residents and encourage people to take part in activities and social events. Routines are flexible and people are given choices about daily life where possible. Wholesome and nutritious meals and snacks are provided, but meal time service, help with feeding and the way softer diets are provided could be improved. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home does not currently employ a dedicated activities coordinator, although there are plans to do this when the home has more residents. At the moment care staff provide activities and the company’s centralised activities coordinator helps to organise events. Some people had potted plants in the garden and the home has 2 rabbits, which residents help to look after. During the morning staff were seen in the lounge having a sing-along and encouraging people to get up and dance. People seemed to be enjoying this, singing, laughing and joining in with the dancing. Staff were seen to talk and interact with people throughout the day. The home’s self-assessment told us how they hold a church service each month and that meetings are held every Tuesday for the home’s Jehovah’s Witness residents. A staff member was spoken to about this and they seemed to have a good understanding of the things they needed to be aware of when caring for and supporting a Jehovah’s Witness. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 15 A resident who returned a survey said that there were “sometimes” activities arranged by the home that they could take part in and that they “always” liked the meals at the home. When asked if the home supported people to live the life they choose one relative said “usually” and the other said “I believe so”. Other comments included “friendly supportive care”, “they encourage families to be involved” and “ good atmosphere, good facilities and good communication, encourages families to visit at any time even with young children who like to run around”. A health care professional said the service “usually” supports people to live the life they choose and “usually” responds to people’s different needs. Comments included “open ended visiting, flexible routines, choices offered” and “good meals”. Staff described how people could get up and go to bed when they wanted, that there were no restrictions on visiting and that some people (those who wanted and were able) had a key to their rooms. A new chef has recently been appointed and we talked to him about the food provided at Leeming Bar Grange. He told us how he tries to makes things the way people like them and confirmed that they provide a choice of meals and cater for a variety of dietary needs. For example, he explained how he made fortified milkshakes for people who needed building up and usually cooked extra potatoes and gravy because people liked these with their meals. During the inspection we saw the morning and afternoon tea trolleys going around the home. These contained drinks, plus biscuits and fruit in the morning and scones and cakes in the afternoon. We observed the lunchtime meal in one of the home’s dining rooms. The tables were nicely set with tablecloths and napkins. Staff served the meal from a hot trolley, asking people what they wanted. On the day of the inspection the choice was shepherds pie or cheese, potato and bacon pie, both served with chips, vegetables and gravy. This was followed by rice pudding. The food looked nice and appetising. However, for some time one staff member was left alone to serve and assist 19 residents. This meant that it took a long time to serve people and that at one point one staff member was stood up and trying to feed two people at once. This is not good practice and is not dignified or pleasant for the people being fed. The home also needs to consider how it can provide softer diets for people in a more appealing and appetising way. We saw two people being given their food in large bowls, with staff simply mashing the vegetables and mince together with a fork before feeding them. Leeming Bar Grange DS0000070938.V365921.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 People who use the service experience good quality outcomes in this area. Information about making complaints is made available, so people know how to raise concerns. Where there have been concerns these have been appropriately reported and handled, so that people are protected. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home’s self-assessment told us that the home has a complaints procedure and that this is displayed in the home’s reception. This was seen on the day of the inspection. A resident who returned a survey said that they “always” knew who to speak to if unhappy and “yes” they knew how to complain. Relatives who returned surveys said they knew how to complain, one said the service “always” responded appropriately to any concerns raised and another said “no concerns raised to date”. There have been no formal complaints made since the home was registered, either directly with the home or through CSCI. Since the home was registered there has been safeguarding issues raised about a member of staff at the home. However, this was reported to the local authority and CSCI and investigated by the home’s area manager. The area manager was spoken to about this and the investigation appears to have been conducted appropriately. Staff training on the protection of vulnerable adults (PoVA) has started, although not all staff have completed this training yet. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 17 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 People who use the service experience excellent quality outcomes in this area. The home provides a safe and very comfortable and pleasant place for people to live and spend their time. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: We looked around the building and gardens during the inspection. Leeming Bar Grange is a new, purpose built care home. The home’s self-assessment told us how the rooms are spacious, provide en-suite toilet, shower and washbasin facilities, and that each room has a fridge, TV and DVD player. These facilities were seen during the inspection. People’s rooms contained their own possessions and were comfortable and homely. The home’s furnishings and decoration were of good quality and provided a comfortable and pleasant place for people to live. The home was decorated in soothing colours and there were plenty of accessories that created a homely and comfortable feel. Communal space is divided into a number of smaller lounges, dining rooms, seating areas and kitchen areas where staff, residents Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 18 and visitors can make snacks and drinks. The conservatory provides a pleasant seating area, with views over the main garden. Relatives said “the setting is lovely. The layout of the lounge and dining rooms encourages communication between residents and feels like a real home. The main reception/hall always has a nice buzz to it”. Staff were aware of the work of Stirling University and the Alzheimer’s Society around dementia care and were able to explain why blue had been used to colour toilet doors, handrails and toilet seats. Staff said that it helps people recognise them and is one of the last colours that people with dementia lose recognition of. There were also photo frames on each person’s door, with pictures in them to helped people recognise their own room. One person who returned a survey said that the home is “always” kept fresh and clean. A health care professional said the home was “clean”. On the day of the inspection the home was found to be clean, tidy and there were no unpleasant smells. The laundry was modern and fully equipped, with appropriate maintenance arrangements were in place. The main garden area provides an enclosed and nicely landscaped outside space, where people can enjoy fresh air. A number of people had potted plants to look after and plants that offer sensory stimulation (nice smells and touch) have been planted. There are also plans to enclose other parts of the home’s grounds and provide more secure outside space for people to enjoy. This will be necessary as the home becomes fully occupied and there are more residents needing secure access to outside space. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. Staff are provided in appropriate numbers and are being provided with training, so that they will have the skills they need to do their jobs. Employment checks are completed on new staff, but in a few cases these have not always been completed before staff start work. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: One person who returned a survey said that staff were “always” available when they needed them. Relatives said that staff “always” and “usually” had the skills and experience to look after people, with comments including “as a new and expanding home, there have been a lot of new faces – the majority of whom appear to have the appropriate skills and usually a smile” and “a super home with super staff…all the staff have been very supportive and understanding”. A health care professional said staff “usually” had the right skills and experience to meet people’s needs, saying that they “appear to do so” and describing staff as “very approachable”. We looked at staff rotas. These showed that staff are usually provided in appropriate number for the number of residents. Discussions with the manager indicated that staffing levels will be increased appropriately as more people come to live at the home. However, the home should consider how staff can be used better during mealtimes and other busy periods, to ensure people are getting the level of support that is needed. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 20 We looked at the training records for four staff. These showed that staff had received training in a range of topics, including food hygiene, medication, dementia awareness, health and safety, protection of vulnerable adults and nutrition. It was good to see that the majority of care staff had received dementia care training. The overall training matrix that was given to us during the inspection (showing all staff and the training they have received) showed that a number of staff hadn’t yet received all of the training that they needed. For example, some staff hadn’t received manual handling or infection control training. However, staff and management confirmed that training is being provided on an ongoing basis to ensure that all staff get the training they need. The home’s self-assessment told us that 29 of care staff had achieved an national vocational qualification (NVQ) in care and that a further ten staff were working towards an NVQ. We looked at the recruitment records for four staff. These showed that the home had carried out a good recruitment process, including criminal records bureau checks and obtaining two written references. However, in two cases staff had started work before a second written reference had been received. The care home’s regulations set out what information home’s must obtain before staff start work (including two written references) and the home must make sure it collects this information before staff start work. This is important so that people are protected from potentially unsuitable staff. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 21 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 good. The home has a suitable manager and systems in place to make sure the home is safe and providing a good service to the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Leeming Bar Grange is registered with CSCI. She has a management qualification and has experience of working in care homes. During the inspection she was interacted well with the residents, acting in a friendly and supportive way. Residents and staff would come to speak with her in the office and obviously felt happy approaching her. The homes manager is supported and managed by a wider management team, including a support manager who visits the home regularly. The home uses the company’s quality assurance system. This is a system of audits and checks that the manager and area managers complete, to make Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 22 sure the home is providing a safe and good service. Records of the completed audits were available and seen during the inspection. The system includes staff and family questionnaires, but these have not yet been used with the home only having been open for a short while. The manager confirmed that a family meeting is going to take place in June and will give people’s families a chance to be involved and give their views. People who returned surveys and were spoken to during the inspection felt that the home’s staff and manager were approachable and would listen to their suggestions. We checked the way the home helps people to manage small amounts of personal money. The home only helps people to manage small amounts of personal money, with other financial affairs being managed by people’s family, solicitor or the local authority. We checked the records and arrangements for four people. These records included appropriate receipts and were up to date and correct. Every month the petty cash and financial records are checked by the area manager to make sure people’s money is being handled appropriately. Systems are in place to monitor health and safety at the home. A fire risk assessment has been completed by an external contractor, the manager has completed a fire marshals course and fire drills take place monthly. We looked at the home’s maintenance records. The majority of regular checks on fire equipment, hot water outlets and other safety equipment were being regularly completed. However, some checks were not being done as often as the home’s policies and procedures said they should. For example, the monthly showerhead disinfectant record was blank and the last quarterly wheelchair checks had been done in December. The manager confirmed that a new maintenance person has been employed and will be able to focus on completing these maintenance checks. Most of the home’s equipment is new and the home’s self-assessment told us that appropriate servicing and inspection arrangements are in place. Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 23 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 3 X X N/A 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 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 3 X 3 X 3 X X 3 Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NA 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. 2. Standard OP9 OP29 Regulation 13(2) 19 & Schedule 2 Requirement The secondary dispensing of medication must not take place. All of the required information specified in the care homes regulations must be obtained before staff start work in the home. Timescale for action 30/06/08 30/06/08 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 OP9 Good Practice Recommendations Eye drops and other medication which expires within a specific timescale after opening should be clearly dated/labelled, so that staff know when to dispose of it. All medication should be stored within the safe and recommended temperature parameters. Clear and accurate records and a clear audit trail of medication entering the home, being administered, being carried over from one month to the next and being DS0000070938.V365921.R01.S.doc Version 5.2 Page 25 2. 3. OP9 OP9 Leeming Bar Grange removed from the home should be maintained. 4. OP15 Staff should receive training and guidance on assisting people with meals, particularly feeding people in a dignified and pleasant way. Staffing levels and deployment at meal times should be reviewed, to make sure that people get the help and support they need in order to experience a pleasant and dignified dining experience. The home should review how meals for people who need a softer diet are prepared and presented, to ensure their meals are appetising and appealing. Staff training should continue and ensure that all staff receive training in key areas, such as health and safety, fire, PoVA, infection control, manual handling and food hygiene. Maintenance and safety checks should be carried out in accordance with the home’s policies and procedures. 5. OP15 6. OP15 7. OP30 8. OP38 Leeming Bar Grange DS0000070938.V365921.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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