CARE HOMES FOR OLDER PEOPLE
Littleport Grange Grange Lane Ely Road Littleport Ely Cambridgeshire CB6 1HW Lead Inspector
Lesley Richardson Key Unannounced Inspection 13th September 2007 10:30 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 Littleport Grange DS0000024311.V350884.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. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Littleport Grange Address Grange Lane Ely Road Littleport Ely Cambridgeshire CB6 1HW 01353 861329 01353 862878 littleportgrange@btconnect.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) Dove Care Homes Ltd Catherine Ann Mary Doswell Care Home 75 Category(ies) of Old age, not falling within any other category registration, with number (75), Physical disability over 65 years of age of places (75) Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Old age not falling within any other category (OP) - 75 Physical Disability over 65 years of age (PD(E)) - 75 Date of last inspection 15th January 2007 Brief Description of the Service: Littleport Grange is registered as a care home with nursing for up to 75 older people. Although the home is registered with 75 beds the home has chosen to accept only 66 people, so that they may be more comfortable. Accommodation is provided in a large detached property set in attractive and well-maintained grounds on the edge of the town of Littleport. There are local amenities within walking distance and the city of Ely is a short drive away. The house is on three floors made accessible by two lifts and stairs. There are a number of lounges and dining rooms available to residents. There are 58 single and four large double bedrooms, most with en-suite facilities. There are registered nurses on duty at all times as well as day care and night care assistants, administrators, cooks, housekeepers, bed makers, laundry workers, maintenance man, gardener and full time activities co-ordinator. Fees for the home range between £478.00 and £630.00 per week, a full range of fees is available from the home upon asking. The Commission for Social Care Inspection report is available in the manager’s office for people at the home or relatives and visitors to the home who wish to read it. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of this service and it took place over 7 hours and 15 minutes as an unannounced visit to the premises. There were two regulation inspectors and a specialist pharmacy inspector present during the inspection. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. Information obtained through returned surveys from relatives and visitors has also been used in this report. It is disappointing that only six surveys were returned from relatives and visitors, and none from people living in the home. Two people commented that surveys were not easily available in the home. Five requirements from the last inspection have not been met. There have been a further 6 requirements and 2 recommendations made as a result of this inspection. Information obtained during 4 random inspections carried out between this inspection and the last key inspection in February 2007 has also been used in this report. This is a poor service. What the service does well: What has improved since the last inspection?
There have been 4 random inspections since the last key inspection in January 2007, including inspections to look only at whether statutory notices have been complied with. These inspections have shown that the way care plans are written and the information in care records, like diet and turn charts, has improved. So has the way the home stores and gives out medications, weekly audits are carried out on medication storage and records. Although, the home must still improve the way it does things in these areas and this is written in
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 6 the next section. Information about people is obtained before those people move into the home and referrals are made to health care professionals, like dieticians, when this is needed. Complaints and protection (safeguarding adults) issues are dealt with by the home much better now. All complaints are looked at, including verbal complaints and concerns. This means the home looks at all the concerns they are told about and does something about them, but they can also look back at the records and see if there are any trends developing. Staff members have training in how to make sure people are protected from abuse. Inspections over the last few months show staff members have had more training in areas where this knowledge is essential to make sure people are looked after properly. These include moving and handling, and protection from abuse. Staff are not given training for specialist areas, like dementia care, and this is something the home needs to work on to make sure staff members can also look after people with these needs. Almost 30 of care staff that are not nurses have a national vocational qualification in care. A quality assurance survey has been carried out by the home, and they asked people living there what they think. This information was looked at but there is nothing yet to show how it has changed or will change the way people at the home are looked after. Maintenance and service checks for equipment and systems in the home are carried out at the required intervals. What they could do better:
Although the way care plans are written has improved, there are still things that must be included and at the moment are not. Information about how to do particular tasks must be included, for example, how someone wants to be washed and what they can do for themselves, and how to distract someone, not just that this is needed. If advice is given by a health care professional, all of the departments that provide things for that person must be told, e.g. the kitchen must be told if they have change a person’s diet or add things to it, otherwise there is no point in getting the advice. The way staff members treat people in the home must continue to improve to make sure people are treated with dignity and respect. There doesn’t appear to be as much obvious behaviour by staff that treats people like children, but there are still practices that are concerning for their lack of thought. For example, people are given eardrops while sitting in the dining room waiting for lunch. Another person said she doesn’t like to press the buzzer for staff to help her to the toilet because she has been shouted at. People are not taken to the toilet quickly enough, or helped to clean food from their clothes and wheelchairs after meals. As shown above, people do not always get the care they would like and they are not treated in a way they choose. Basic choices of which meal they can have and what clothes they wear is available, but not how or when the care is given.
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 7 Records of the receipt of medication must be improved to ensure there is an accurate audit trail and to demonstrate that medication is given as prescribed to people who use the service. Practices for the handling and administration must be improved to ensure medication is given to people who use the service in a way that is safe and protects their individual privacy and dignity. Although most areas in the home are clean and tidy, more attention must be given to toilets. One toilet was soiled, had an open and overflowing container for soiled incontinence pads and an open container for sharps (needles, razors, etc). The toilet was still dirty and untidy several hours later. This isn’t good for people using the toilet, but also means there is a safety and infection control concern. There are concerns about the number of staff working, or the organisation of the staff that are working. People are left for too long before they are taken to the toilet. Recruitment checks are not fully completed before people start working at the home. Two references are not obtained, which means the home does not know enough about people to be able to make a proper decision. Where there are health issues, these are not looked at fully and records are not kept to show any support the person may need. Records are kept for maintenance and servicing of equipment, but there are no records showing the fire drills that are carried out. This must be done, so that the home knows that all of it’s staff have practiced what to do if there is a fire. 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. Littleport Grange DS0000024311.V350884.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 Littleport Grange DS0000024311.V350884.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 and 6 Quality in this outcome area is good. The home obtains enough information to be able to assess whether it can meet the needs of the person wanting to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been very few admissions to the home since the last key inspection and therefore only one person’s file was looked at for pre-admission information. An assessment from the placing social care team was available in the file and gave details about the person, their needs and their abilities, and their likes and dislikes. The home did not carry out their own assessment of this person. The manager said this was because the person only made the decision to come into the home just before admission. The home does not provide accommodation for intermediate care or rehabilitation.
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Some improvement has been made, but actions of staff and the care that is given must change to give person centred care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Practices and procedures for the safe handling and recording of medication were examined by a specialist pharmacist inspector. The registered provider had given staff clear and detailed procedures for the safe and appropriate handling of medication. Facilities provided for the storage of medication are secured the temperatures well controlled. Stocks of medication in use have been reduced and no expired medication was found in the medication storage room. However, a tub of an ointment for one person resident in the home was found in her room and this was out of date even though it had been recorded as being used the previous week.
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 11 Records were kept of all medicines coming into and leaving the home. The dates of receipt of some medicines received outside the regular monthly ordering cycle were incomplete so it is sometimes difficult to fully audit the medication in use. Records were kept when medication was given to residents. However there were some problems with these records. • Where medication is given in variable doses, e.g. one or two tablets, the actual dose given is not always recorded. • Changes were made to dosage instruction on the medication records, which were different to the instructions on the prescription signed by the doctor. • A course of an antibiotic for one resident had been recorded as “course completed” after five days even though further supplies remained in the medication cupboards and the prescribed quantity was for a course of 15 days. • An ointment used to treat one resident was found in her room but no record of this was made on the medication record chart. Most residents had their medication given to them by designated trained nursing staff. Additional training has recently been provided following concerns about medication at previous inspections. A few people held some of their own medications in their rooms but any risks to either themselves or to other people living in the home had not been assessed. This could be putting people in this home at an unnecessary risk. Nurses were watched giving medicines to some residents at lunchtime. Two residents were seen to have eardrops administered while sitting at the dining table surrounded by other residents. This is not only intrusive; it does little to respect the privacy and dignity of the person receiving the treatment. Additionally the technique and the quantity of eardrops used would not ensure effective treatment. Medication was also left unattended on top of the medication trolley in a busy corridor while a nurse administered medication to residents in the dining room. This is unsafe practice and puts residents at unnecessary risk since medication could be taken inappropriately. Four random inspections since the last key inspection show there has been an improvement in the way care plans and other records are written and the detail of information recorded since the last key inspection. Although further improvement is still needed to make sure people get the care they need. Each person in the home has their own set of care plans that guide staff members in how to care for them. There are two sets of these records, so that a copy can always be kept in the person’s room and is easily available for information. Care plans are no longer pre-printed, which means staff have to think about the care each person needs when they write the plans. However, there are
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 12 still areas that are written in a clinical style, are task orientated, do not give adequate information and plans do not show how each person wants to be cared for. For example, one person’s plan shows they need help from staff to have a shower, but there is nothing to tell staff how much staff should do for this person, or what the person can do for themselves. Another person can become agitated and the plan for this advises staff the person can be easily distracted, but doesn’t tell them how this can be done or what to use to distract the person. Although care plans are reviewed every month, they are not always updated when needs change or if new information is known about someone, which means the information is not used to plan care. In the review of a plan for maintaining safety, staff are told the person tends to flail his arms, but the care plan hasn’t been revised to show what risk this poses or how to make the person safer. Needs that were identified in a pre-admission assessment have no associated care plans. One person’s pre-admission assessment shows the person had a catheter in place, has a wound dressing and, although the person is able to take medication themselves there is some concern about them sometimes not taking the medication. Staff said the person doesn’t now have a catheter and staff administer medication, but there were no care plans in place for any of these needs or to show staff how they should now be looked after. Nor had the dressing been looked at, although the person had been living at the home for over a week. Risk assessments are completed for things like, falls, nutrition and the risk of developing pressure sores. Referrals to health care professionals are made, but the advice is not always passed on to everyone involved in that person’s care, and sometimes referrals are not made at all. For example, changes to diet regimes are not always passed on to the kitchen. The person involved at this inspection does not have a weight loss that would cause the same level of concern as a similar issue found at an inspection in May 2007. This means the kitchen is still not being given the correct information to provide the diet that is recommended for the person in question. Another person had to take her dentures out so that she could speak to us because she had lost weight. Her care records showed this was approximately 5kg, but a referral to a dentist had not been made when her dentures became too lose to comfortably wear. There has been some improvement in the privacy and dignity offered to people living at the home since the last key inspection, but again, this needs further improvement. Although people at the home said staff are usually polite, they also said they often have to wait a long time for staff to help them to the toilet and one person said she doesn’t like to repeatedly ask as some staff have shouted at her. After lunch we were speaking to people at the home; two people had food remnants on their clothes and one person’s wheelchair also had food remnants on the footplate. Although staff members took this person out of the room, the food remained on her clothes and wheelchair after she came back. As seen in other parts of this section and in other sections in this
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 13 report there is still much staff need to do to make sure living at the home are treated with respect. Two thirds of people visiting the home said they think the home usually meets the needs of people in the home and usually gives the care that they expect to be given. However, a third of these people said this only happens sometimes, and care around hygiene and taking people to the toilet is not always given when it is needed. Littleport Grange DS0000024311.V350884.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 and 15 Quality in this outcome area is poor. Activities and the way the home is run does not enable people living there to have much choice about what they do or the care that is given to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator who organises a programme of events and things for people to do. These include a ‘wine and biscuits’ afternoon and exercises provided by Sports for All, as well as bingo and quizzes with the co-ordinator. Relatives who returned surveys said they think the activities co-ordinator does a good job and the activities and crafts are excellent. However, people at the home said there are only limited activities and some days they get bored. One person said there is bingo two afternoons a week, and others also said they would like to go outside sometimes, but staff rarely help with this. One relative commented in the survey, “(the) gardens are delightful but many paths are just too bumpy for wheelchairs”. Activities are printed and a copy is given to everyone in the home, but the notice for the month of September 2007 shows half of the planned events are for bingo and quizzes alone. Although there is some information that the personal social
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 15 interests of people at the home are recorded, this doesn’t appear to have an effect on the activities provided. Relatives said they are able to visit when they want. A third of people returning surveys said the home only sometimes keeps them up to date with issues and helps their relative keep in touch with them. Although it was acknowledged that it was not always possible for everyone to do keep in contact and one person said, “if we ‘phone up messages not always passed on”. Two thirds of people returning surveys said they are kept up to date with issues and one person said they are called immediately if there are any problems. The home provides a different menu every day, containing 6 different main meals, from which people can choose what they would like to eat. Staff members sit with people who need help to eat, and although their attention is mostly on that person, there are not enough staff to make sure this is possible throughout the meal. It is unlikely, from comments in other areas of this report that most people at the home are able to exercise choice about how they live on a day-to-day basis. People living in the home said they ask to go to the toilet, but then have to wait a long time before staff attend to them. They would like to go outside more often but are often not able to do this. Medication needing physical care is given in public areas. So, although people may be able to choose what they wear on a daily basis and what they eat at mealtimes, a wider choice of daily care and how this is given is not provided. There are examples where people have said they reluctantly ask for care because of the possible reactions from some staff members. Littleport Grange DS0000024311.V350884.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 and 18 Quality in this outcome area is adequate. There have been improvements in this area, but staff understanding and care practices must improve more for people to feel their concerns are listened to and to be safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: CSCI has received no complaints directly about the home since the last key inspection, but the home has received 20 complaints in the last 12 months. This also now includes verbal complaints, which are recorded and looked at in the same way as written complaints. One recent complaint was emailed to the home, this had been investigated and responded to in the correct timeframe, but a copy of the original complaint had not been kept with the records. This should be done, so that the investigation is thorough, the proper outcome found and the correct action taken. Two thirds of the visitors who returned surveys said they know how to make a complaint and the response to any complaint they’ve made has been appropriate. However, two comments received show this does not always have the desired effect, “I usually complain to matron, used to be enough but not now”, and “any concerns are usually dealt with, however, things tend to slide again, making necessary to raise them again”. As seen in another section in this report, some people at the home do not ask for their care needs to be met because they are worried about the reaction of some staff members. The fact that this issue continues suggests people have not felt able to complain and have their care improved.
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 17 Nearly all staff members have received training in safeguarding adults from abuse, which should mean staff have a good understanding of abuse and when and how to report incidents. However, an incident of physical aggression between two people living at the home, where one person was pushed over, was recorded in the accident records but was not reported to the local adult protection team. The manager was not aware of the incident, which means that there are staff who do not have a good understanding of abuse and that it should be reported, even when between vulnerable adults. The manager was also advised the incident must be reported to the adult protection team. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. Not all parts of the home are clean and some areas pose a particular health and safety risk to people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been some repair and renovation work at the home since the last inspection; the small dining room has been redecorated, flooring has been replaced in the ground floor corridors and the main communal area has also been redecorated. There was concern in one visitor’s survey about the difficulty in wheeling people around the grounds. However, information provided before the inspection show work has already been done to give wheelchair access to the sunken garden and there are plans to resurface other paths around the gardens. Most of the home was clean and tidy during the inspection, but it was noted that carpets in some areas are looking worn and need cleaning. Of particular
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 19 concern was one communal toilet that had no lock on the door, just a notice on the outside of the door saying engaged or vacant. The outside of the toilet was dirty with faeces, a specific bin used for soiled incontinence pads was overflowing and had not been closed properly, and there was an open sharps disposal box half full. We looked at the toilet again 3 hours later and although there were cleaning chemicals in the toilet, the pad bin was also soiled and the outside of the toilet bowl was still soiled. One visitor to the home expressed concern in a survey about heating and hot water in individual rooms. A person living at the home said she had never had hot or warm water in her room in the 3 years she had been at the home. Staff confirmed there was no hot water on the day of inspection due to a problem with one of the boilers, but a workman had been called to look at the problem. However, because we could not assess this fully during the inspection a requirement has not been made. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. Staff recruitment, training and staffing levels do not ensure the home provides person centred care or meets all the needs of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A training matrix was provided during the inspection, which shows most staff members at the home have received required health and safety training, including medication training for all staff giving medication. However, there was no information about any staff members having received training to meet specific needs, like dementia. Training records for two people who had started working at the home in the previous 3 months show they had been given mandatory training, but no other training to help them care for people at the home. Information provided before the inspection shows almost 30 of nonqualified care staff have a NVQ at level 2 or above. Recruitment records for two staff members employed in the 3 months before this inspection were looked at. Only one reference for each employee was received before they started working at the home. A reference for one person, received after that person started working at the home, advised of a health problem. However, there were no records to show the home had discussed this with the employee or what support they may have offered.
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 21 There are a number of examples in this report that indicate staff numbers at the home are not high enough; people having to wait for over an hour to be taken to the toilet, soiled clothes not being changed and toilets not being cleaned properly. A number of comments in returned surveys said there are not enough staff working at the home at weekends in particular. A recommendation was made at the last key inspection that staffing levels should be reviewed to make sure care is not reduced at weekends. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. Improvements to quality assurance means people at the home are asked their opinion, but action taken to improve the home based on this is not known, which means the home may not be run in the best interests of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a nurse and is registered with the Nursing and Midwifery Council. She has been managing the home for a number of years and has gained a management qualification equivalent to a NVQ level 4. The home conducts surveys of people living at the home, relatives and staff members to find their views about the home. A copy of the results of the most recent survey is available in the home, although this doesn’t include any
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 23 information about action taken or how the home plans to improve. It does include a range of comments, both positive and negative, that people have made. A newsletter is written for people at the home and the manager said residents’ meetings are held on a regular basis and minutes are taken. However, the last minutes available were for April 2007. It was not possible to assess how safely the home looks after money they hold on behalf of people living there, as the person responsible for this was not available. However, the manager said people who need access to money would be able to obtain this from petty cash. This will be looked at in more detail at another inspection. Information provided before this inspection shows equipment, like hoists, lifts and fire-fighting equipment has been serviced or tested as recommended by the manufacturer. Records for fire safety equipment and training were looked at and had been carried out, except for records for fire drills. The person responsible for recording maintenance checks said a fire drill had last been carried out approximately 3 months before this inspection. A record of all fire drills must be kept. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X 2 3 Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15(1) Requirement Care plans must be written to show staff how to meet needs, with enough detail to show how care or tasks are to be completed, and they must be revised if care to be given changes. This is so that people receive the right care to meet their needs. Advice from health care professionals must be put into practice to make sure health needs are fully met. Medication must be administered safely, as prescribed and records for the receipt; administration (or non administration) of medicines must be accurate and complete. Medication must not be used beyond its expiry date. Medication must be administered in a way which ensures effective treatment. This is to make sure that residents receive the medicines prescribed for them.
Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 26 Timescale for action 10/11/07 2 OP8 13(1)(b) 10/11/07 3 OP9 13(2) 31/10/07 4 OP9 13(4) A documented risk assessment must be in place for all people who look after their own medication in order to minimise the risks to people in this service. Care must be given in an appropriate way and appropriate timeframe to make sure people are treated with respect. (Previous timescales not met.) 31/10/07 5 OP10 12(4)(a) 31/10/07 6 OP14 12(2) People living at the home must 31/10/07 be able to make choices about how they would like to receive personal and health care. (Previous timescale not met.) All staff must have an adequate understanding of abuse and safeguarding adults reporting procedures. All incidents of possible abuse must be reported to ensure people at the home are safe. (Previous timescale not met.) 15/11/07 7 OP18 13(6) 8 OP26 16(2)(k) Arrangements must be made to 31/10/07 keep the care home clean and hygienic, and for the suitable disposal of general and clinical waste. This is so that people can live in a safe and pleasant environment. (Previous timescale not met.) Staff must not be employed at the home until all the information required in Schedule 2 is obtained or checked. This is to make sure new staff members are safe to work with vulnerable people. (Previous timescales not met.)
DS0000024311.V350884.R01.S.doc 9 OP29 19 23/10/07 Littleport Grange Version 5.2 Page 27 10 OP35 17(2) Schedule 4(9)(a) Accurate records must be kept for the receipt, return or use of service users money. (This requirement was not assessed on this occasion.) Records must be kept of every fire drill undertaken in the care home to show staff members have received this training. 13/09/07 11 OP37 17(2) Schedule 4(14) 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP16 OP33 Good Practice Recommendations A copy of the original complaint should be kept with details of the investigation, outcome and action. The quality assurance report should also include details of how the results will develop and improve the home. Littleport Grange DS0000024311.V350884.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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