Inspection on 15/01/07 for Littleport Grange

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Littleport Grange 16/06/09

Littleport Grange 16/06/08

Littleport Grange 18/12/07

Littleport Grange 13/09/07

Littleport Grange 07/02/06

Littleport Grange 28/06/05

Littleport Grange 17/01/05

Littleport Grange 07/06/04

Littleport Grange 24/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Littleport Grange Grange Lane, Ely Road Littleport Ely Cambridgeshire CB6 1HW Lead Inspector Lesley Richardson Key Unannounced Inspection 15th January 2007 10:00 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.V328190.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.V328190.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 Limited 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.V328190.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 7th February 2006 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 some double rooms have been made into singles, and other policy changes have been made to reduce this number to 66. 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. The Commission for Social Care Inspection report is available in the manager’s office for service users or relatives and visitors to the home who wish to read it. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours and 20 minutes and was carried out as an unannounced inspection on 15th January 2007. It was the first key inspection for this home for the 2006-2007 year and was completed by the lead inspector, another inspector and a specialist pharmacy inspector. Five hours were spent with staff members, service users and undertaking a tour of the home. The inspection was conducted with the manager present. The home was asked to complete and return a pre-inspection questionnaire to the Commission before the inspection took place, and give out questionnaires to people who live at the home and visitors to the home. 17 questionnaires were returned. Information from these questionnaires and a random inspection that took place in November 2006, goes into this report along with the information found at this inspection. 22 requirements and 8 recommendations have been made as a result of this inspection. Six of these requirements have been carried over from the last inspection, as they have not been met. What the service does well: What has improved since the last inspection? Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 6 The amount of training that is available to staff members has improved; staff said they had been given moving and handling and adult protection training. Even though this has improved, much of the training staff members have is in the form of questionnaire and answer. This training alone does not usually give staff the opportunity to ask questions or practice what they have been taught. Therefore, further improvement is needed to make sure training is specific to this care home and not a ‘one size fits all’. A requirement was carried over at the last inspection for staff members to have adult protection training, and this has been given. However, this is also in a questionnaire and answer form, which may not include local guidelines. It is important that staff members are aware of these guidelines so that they can take the correct action. What they could do better: There are a number of things the home must do to make sure it meets all the national minimum standards, Care Homes Regulations 2001 and Care Standards Act 2000. They must not admit people for whom they are not registered, for example, people with learning disabilities or dementia. Records the home keeps to make sure staff are able to look after people living at the home must improve. Although care plans are kept for each person, these do not give enough detail to show staff what they must do, and they are not evaluated every month to show whether the plan is correct or something need to change. This means that people living at the home have the same care regardless of whether it is the correct care. Risk assessments are completed for some issues, such as falls, but no for other concerns, such as whether restraining a person is the most appropriate method to prevent them falling or sliding from a chair. Every person living at the home is entitled to advice from a healthcare professional, such as a dietician, falls co-ordinator, CPN (community psychiatric nurse). Although this had improved for one person, other people had not been given this opportunity. This is important to make sure people who live at the home are cared for in the most appropriate way. Care records that show how care has been given must also improve. This was highlighted at the random inspection in November 2006 and no change has been seen. There was not enough detail in dietary records to show how much food was actually eaten, or in turn charts where there were 6-8 hour gaps when that person may not have been moved from one position. There are serious concerns about how medication is managed in the home. This was looked at in depth by the specialist pharmacy inspector who found errors in the way the home stores and administers medication. Seven requirements were made about medication alone. These tell the home what they must do to make sure they meet the regulation about medication. Improvements must be made to the way some people who live at the home are treated as their privacy and dignity is not at the forefront of care practice Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 7 in the home. People who need to be hoisted from one chair to another are done so in a main communal lounge, even though this could be completed elsewhere. Not only that, but staff assess whether service users with continence issues need incontinence pads changed in full view of other people. There were a number of examples where the dignity of people living at the home was not considered, this is just one. Although activities are provided there is no information to show people who live at the home have been asked about their social interests, what they would like to continue doing or what they may like to start doing. It is important that this is the responsibility of all staff members, not just one person, as it has an impact on the well being and social needs of people living at the home. People who live at the home must be able to choose how they wish to live; there was little information in care records to show if residents had been asked everyday things, such as what their daily routine was like and if they wanted to continue getting up at the same time. More than this, residents who are not able to speak well are not given choices and are not even told when staff are going to perform tasks. The way complaints and protecting residents from abuse are managed must improve. Verbal complaints are not recorded, and the home therefore cannot then see a trend occurring, or become aware of growing concerns. There has been one incident of possible abuse where they home investigated, disciplined and dismissed the staff member before notifying any other agency. This is not in within Cambridgeshire County Council’s adult protection guidelines, and does not adhere to the Department of Health’s ‘No Secrets’ policy. Another adult protection investigation is currently being dealt with following concerns and complaints from a number of different people. Although the environment in the home is adequate, there are areas that should be addressed to make sure it is a pleasant place for people to live. There are some carpets in both individual rooms and communal areas that are stained and dirty, and there were rooms that smelt unpleasant. Storage of wheelchairs and walking frames is in an outside area, exposing them to wet conditions. This increases the risk damage and shortens the lifespan and safety of this equipment. Clean and dry continence equipment is also kept in communal areas, such as lounge rooms, which displays the fact that people sitting in that area may have these needs. The staffing level in the home on the day of inspection appeared adequate, and most people answering the questionnaire felt staffing levels in general were satisfactory. However, 1 person said it can take ½ - ¾ hour for the call bell to be answered, and two people said the staffing level was lower at weekends. Recruitment checks are completed, and although there has been an improvement in obtaining adult protection (PoVA) checks before staff start working at the home, other checks had not been completed. All documents and checks must be completed before a person starts working at the home so that the people who live there are as safe as possible. Only 20 of non- Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 8 nursing staff have a national vocational qualification at level 2 or above. This should increase to 50 . The manager is a nurse registered with the Nursing and Midwifery Council. There was an issue at the random inspection in November 2006 where her knowledge of current good practice was not acceptable. Not enough residents are asked their views about the home, what they like or don’t like and what the home could do to improve. Representatives of people who live at the home but cannot express their opinion are not asked what they think either. This is not acceptable as it means the home is not run in the best interests of everyone living there. The home looks after money on behalf of people who live there, but the system that is used to record money going in and out is not accurate enough. There is not always a record of who has taken money, what it was spent on or receipts for purchases. This leaves residents at risk of financial abuse. 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.V328190.R01.S.doc Version 5.2 Page 9 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.V328190.R01.S.doc Version 5.2 Page 10 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 poor. This judgement has been made using available evidence including a visit to this service. The systems employed to assess service users needs before admission to the home do not guarantee the home will be able to meet these needs. EVIDENCE: Pre-admission assessments are completed by the home and obtained from health and social care professionals in the community or acute care settings. These assessments give the home information about prospective service users and allow them to make a judgement about whether the home and staff will be able to provide appropriate care for that person. During the inspection it was found that two people had been admitted to the home with needs that the home is not registered to take. This is an offence under the Care Standards Act 2000; the home must not admit service users for whom they are not registered. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 11 The home does not provide accommodation for intermediate care or rehabilitation needs. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. Procedures and practices for the safe handling and administration of medicines are poor. Residents are not given medication from containers dispensed and labelled for them on an individual basis, which means dosage instructions may not be the same as those prescribed. This puts residents at risk of receiving incorrect doses of medication. Medication is being retained beyond its prescribed period of use and dosage instructions are not followed. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Care is not offered in such a way as to promote and protect service users’ privacy and dignity. EVIDENCE: Policies and procedures in place for the safe handling and use of medicines need to be updated to make reference to the changes in disposal arrangements for medicines. It is evident that staff do not always follow the Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 13 written procedures when administering medication. Procedures for the ordering and receipt of medicines are fairly robust. Staff do not have sight of the original signed prescription before it is dispensed and a copy is not retained to be able to validate the prescriber’s instructions. The procedure for administering medicines was observed at lunchtime and in general it was undertaken with due regard to the dignity and individual preference of residents. However, special instructions for medication administration e.g. “to be taken 20 minutes before food”, “take after meals”, or “take at regular intervals throughout the day” were not followed. This means residents are not receiving optimum treatment. Medication was also left unattended in a communal area while a nurse administered medication to residents in another area. An immediate requirement notice was issued to ensure the health and safety of residents. Medication storage facilities are adequate and secure but the temperature is not monitored or recorded regularly to ensure optimum storage conditions. A suitable refrigerator is in use for medicines requiring cold storage. Medication is not being disposed of promptly when it is no longer prescribed. This has increased levels of stock in use, some of which dates back to 2005 and some containers of medication are unlabelled or have had their dispensing labels removed so it isn’t possible to see who they were prescribed for. In some cases they have been retained for use by staff or for use by other residents. Medication is not always administered to residents from the container that has been supplied and labelled for them. This is unacceptable practice and an immediate requirement notice was issued. The home use mainly pre-printed forms as the profile of medicines prescribed. Records of the receipt of medicines were of a good standard but there is no record of the disposal of medicines which makes it difficult to keep account of all medication. Hand-written additions or changes to prescribed medicines do not indicate who made the entry or when. Many deficiencies were seen in the records of the prescribing and administration of medicines. Examples include, but are not limited to: • The administration of medicines prescribed in variable doses did not consistently record the number of doses given. • Medication not being administered in accordance with the printed instructions both on the record form and the labelled container. • The use of containers of medication that are not labelled for an individual resident means that there are inconsistencies between the dosage instructions printed on the forms and those on the dispensing label. • Medication prescribed to be administered “when required” did not have detailed plans of the circumstances such medication is required. • Medication prescribed for use in the eye did not state which eye to be treated. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 14 • Medication which is crushed and administered via a PEG tube did not have detailed records in the care plan of the procedures to use or if the medication is suitable for use by this route. Where residents consistently and regularly refuse to take medication, this does not appear to be discussed with the prescriber. Separate facilities are provided for the storage of medicines controlled under the Misuse of Drugs Act 1971. The cupboard in use complies with the Misuse of Drugs (Safe Custody) Regulations, but not all medication required to be stored in this cupboard is so. It is stored in an outer cupboard along with other medication. In two cases the quantity of medication stated on the label was not the same as the number of tablets in the carton. If staff are adding medication from older boxes into new supplies, this is unacceptable practice. Dedicated and suitable registers are used for the recording of controlled drugs. Administration records were satisfactory and signed as witnessed by a second person. Each service user has a range of individual care plans designed to meet their health and physical needs. However, these plans are pre-printed, giving the same direction and guidance for every service user’s needs. A small area on the plan allows staff to add personalised information about the service user to whom the plan refers. There was little personalised information however, and the plans do not give up to date information relevant to one person but no-one else in the home. For example, one person had a plan addressing pain needs, which indicated medication for pain had been reduced. There was no guidance for staff about assessing this service user’s pain level following medication reduction, or how this person expressed pain. As this person was unable to verbally communicate it is imperative staff have this information and guidance if they are to appropriately manage pain relief. Another plan for catheter management identified ongoing difficulties with the catheter blocking and bypassing, and subsequently this service user had received 9 (nine) catheter changes in two months. The moving and handling risk assessment indicated this person had an urinary infection and records detailing visits by the General Practitioner show a request that the service user receive a daily bladder irrigation. However, neither the care plan nor the daily records indicate how this is being met or the outcome. Care records, such as turn charts, food and fluid, and intake and output charts are poorly recorded, and do not give adequate information or show that the service user is receiving the care detailed in the plan or other areas. A chart recording when one person’s position was changed shows gaps of between 6 and 8 hours on 4 consecutive days, indicating the person who is at a high risk of decreased tissue viability, had not been moved. Documentation of food and fluid intake remains vague, with references to quantities eaten as, ‘½’, ‘¼’, etc, but without the initial amount available. Again, a gap in recording of 6 Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 15 hours on one day means that person’s fluid intake fell 1.4 litres short of the recommended minimum in the care plan. A requirement made at the last inspection that this be improved has not been met. CSCI will seek legal advice if this requirement is not met at the next inspection. Risk assessments are completed for some identified risks, such as nutrition, risk of skin breakdown (decreased tissue viability) and falls, but generally lacked meaning, gave insufficient detail and did not have sufficient guidelines for staff once the assessment had been completed. For example, one person has a history of falling or sliding from his chair. There was a risk assessment for falls in the care records, which showed a high level of risk when the service user was admitted to the home. The risk assessment did not identify the best way to manage these, nor did it show how the decision to restrain this person was made. Risk assessments for other service users contain inaccurate information; one person’s assessment for moving and handling needs identified there was no problem with communication, although this person’s care plan indicated they do not initiate discussion and the service user was unable to verbally communicate with the inspectors during the inspection. All six of the service users or people responding to the CSCI questionnaire on behalf of service users said they received the medical support they needed and care records indicate referral to healthcare professionals is sometimes made. However, it was identified during the inspection that there are at least three service users with dementia, none of whom have been referred to the Community Psychiatric Nurse although one had been seen by a psychiatrist. Referral to a dietician for one person, for whom weight loss, catheter problems and a pressure sore are long term and continuing issues, has not been made even though this was identified at the inspection in November 2006. The manager said the service user’s General Practitioner did not feel this referral would result in any change in this person’s condition. Nevertheless, it is the manager’s responsibility to ensure all avenues have been explored. A number of privacy and dignity issues were identified during the inspection. Two examples are detailed here. One service user was lifted using a hoist from a wheelchair to a recliner chair in the main lounge area. Once in the hoist and suspended out of the wheelchair, staff members asked each other if the person was wet or dry and patted his bottom to check if his trousers were wet. Another service user was taken outside in a wheelchair and was given a fleece jacket to wear. However, the garment didn’t belong to the service user but was for communal use and given to any service user wishing to go out into the garden. Two thirds of the service users or people responding to the CSCI questionnaire on behalf of service users said they receive the care and support they need. Service users were also complimentary about the staff and the care they received during the inspection. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Social activities provide stimulation and interest for people living in the home, and visits from relatives and friends ensure continued social contact. But, as service users are not consulted about their interests, individual preferences may not be catered for. EVIDENCE: An activities coordinator is employed at the home and a variety of entertainment is available for service users. One person said there are things to do during the day, and another person said that although she prefers to spend time alone, she knows there are activities for other people. However, there was no information in service users care records to show what their social interests are or how care staff can enable service users to maintain these. All of the service users or people responding to the CSCI questionnaire on behalf of service users said there are always activities that they can take part in. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 17 The home has an open visiting policy; relatives and visitors are welcome and able to visit service users in private or in communal areas around the home. One person said she has plenty of visitors and is taken out by them and another person said she is visited by her daughter who brings her fresh fruit. Everybody that responded to the relatives and visitors questionnaire said they are made welcome at the home at any time, they can visit in private if they wish and the home keeps them informed about their relative. There are a number of examples throughout this report where service users have been denied the opportunity to make a choice about how they would like care carried out or whether they would like something different to what is provided by the home. Over 90 of people responding to the relatives/visitors questionnaire said they are consulted on decisions about their relative. It is important that service users who cannot make decisions for themselves have an advocate that is able to do this for them. However, it is also important to note that if this result is indicative of most service users relatives, the home may be denying capable service users the opportunity to make their own decisions. A main meal was served during the inspection and provided service users with a variety of food groups. There are two dining rooms in the home, one for service users who are able to eat independently and one for people who need help to eat their meal. Staff members sit with those people who need help with eating and many people were wearing cloth tabards to protect their clothing. However, many service users were drinking from plastic beakers with a spouted lid, even though some were seen easily managing porcelain plates. If the use of these beakers is for health and safety reasons this must be supported by individual risk assessments, of which none were seen in care records. If service users are able to manage plates it is questionable, therefore, that a plastic beaker of hot tea without a handle would be safer than a porcelain cup with a handle. 83 of the service users or people responding to the CSCI questionnaire on behalf of service users said they always or usually like the meals at the home. People who live at the home also said this during the inspection. Only one person said they only like the food provided sometimes. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Systems for the protection of vulnerable adults do not ensure staff members have appropriate guidance and service users are safe. EVIDENCE: The manager said the home has received one complaint in the last 12 months. Documentation relating to how this complaint was investigated, the outcome and action taken was looked at. This was completed within the appropriate timeframe, although the response was long and gave a lot of detailed medical information. However, 45 of relatives responding to the CSCI questionnaire said they had made a complaint. One relative said she had made a verbal complaint, which had been dealt with and she has not had the need to complain again. She said the manager made her aware of the complaints procedure. The manager said verbal complaints are not recorded as they are generally dealt with immediately. Two people at the home said they would know who to speak to if they were unhappy about something, and one of these people said she would tell someone “pretty quick” if she was not happy. All of the service users or people responding to the CSCI questionnaire on behalf of service users said they knew who to speak to if they weren’t happy about something and how to make a complaint. Two thirds also said staff members listen and act on what they say. 64 of relatives and visitors to the home who responded to the questionnaire said they knew how to make a complaint. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 19 The home has referred one person for inclusion on the Protection of Vulnerable Adult register and the employee was dismissed. This was the appropriate response from the home, although the local adult protection team was not notified for 11 days and CSCI was not notified until 3½ after the incident. By which time the home had conducted it’s own investigation and disciplinary proceedings. This does not follow local adult protection guidelines. Concerns raised by a number of different sources, primarily regarding poor care practices, have resulted in an adult protection investigation, which is still being dealt with. Staff records indicate new staff members attend a protection from abuse training session in the form of a questionnaire and answer booklet. This form of training is generally not adequate as it does not give staff members the opportunity to practice what they have been taught or ask questions. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 20 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, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of décor within this home is adequate and in some areas does not present as a homely and comfortable environment for service users to live. EVIDENCE: Littleport Grange is an adapted large detached house, with a purpose build extension at the rear of the property, and situated in it’s own grounds. Service users accommodation is located on three floors, which can be accessed by a number of staircases or passenger lifts throughout the building. While the general décor in the home was acceptable, there were some carpeted areas on stair landings and in service users rooms that were stained and dirty. Containers for the disposal of soiled incontinence pads are placed at various locations around the home, some outside service users bedrooms, although not all of these had lids attached and some had not been used correctly to Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 21 reduce unpleasant odours escaping from them or preventing the contents from being seen or inappropriately accessed. All of the service users or people responding to the CSCI questionnaire on behalf of service users said the home was always or usually clean and fresh. Storage location of specialist equipment should be considered and more suitable areas found. Wheelchairs, walking frames and packets of incontinence pads were stored in an external courtyard. The wheelchairs and walking frames were exposed to the elements, although the incontinence pads were under cover. The manager said wheelchairs and walking frames are dried before use if they have become wet. However, the life expectancy and safety of these pieces of equipment will reduce if not cared for appropriately. Incontinence pads and equipment was also seen in the large seating area off the foyer. This is not acceptable, and it suggests service users with incontinence needs may have these met in this communal area. A recent Health and Safety Executive inspection identified inadequate number of hoists for the number of service users that require assistance with transfers using this method. The manager said at the random inspection in November 2006 that 2 new hoists had been purchased and another one was on order. Service users rooms are personalised and they are able to bring their own furniture into the home if they wish. One person said she prefers to spend time on her own and her room reflects the time she has spent on it. Not all service users rooms were as pleasant; two people who were still in bed when the inspectors visited (one person stays in bed) had rooms with unpleasant odours, although the one person who was able to communicate did not appear to be aware of the smell. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in staff training, although this still does not ensure service users are cared for by staff with the knowledge to ensure their safety or meet care needs. Not all vetting and recruitment checks are carried out, leaving service users at risk. EVIDENCE: The files of two recently employed staff were examined. Most of the required checks and documents had been obtained or applied for prior to both staff members starting work at the home. However, there was no photograph or any form of identification in one person’s file. Obtaining proof of identification and a recent photograph ensures the person applying for the position is the person working in the position. There has been an improvement in the amount of training staff members receive. Staff records indicate moving and handling training has been recently updated, and the use of a hoist during the inspection to transfer one person appeared to be correctly completed. However, this training evidently does not include suitable places to use the hoist, as has been mentioned in a previous section. Information provided prior to the inspection indicates that some mandatory health and safety training may be in the form of a questionnaire Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 23 and answer format only. This type of training alone is generally not adequate, as it does not give staff members to practice what they have been taught or to ask questions. The manager provided information that shows approximately 20 of non-nursing care staff have a national vocational qualification at level 2 or above. Staffing levels on the day of inspection were adequate, and the home had more than one registered nurse on duty. All of the service users or people responding to the CSCI questionnaire on behalf of service users said staff members were available when they were needed. 82 of people responding to the relatives/visitors questionnaire felt there are adequate numbers of staff at the home, although the remaining number thought staffing levels at weekends were not always sufficient, and especially at weekends it took too long for call bells to be answered. Staff members were seen standing around the walls of one lounge room, talking to each other rather than interacting with service users. One person visiting the home confirmed this is often the case. Two service users responding to the questionnaire said not all staff members are able to understand or act on what is said by service users. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 24 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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems for service user and their representative’s consultation is limited and only goes a short way to ensuring the home is run in their best interests. Systems for managing service users money are not enough to ensure financial safety. EVIDENCE: The manager is a nurse and is registered with the Nursing and Midwifery Council. Although this is the case, the manager gave an example of outdated care practice following the random inspection in November 2006. This suggests she may not keep up with current good practice in all areas. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 25 The home asked 14 people living at the home their views in a service user satisfaction survey. The manager said the results identified issues, such as the need for more fresh fruit, and the appropriate action was taken. However, one service user said in the CSCI questionnaire that they would like more choice and more fresh fruit. The views of service users representatives were not obtained, but the manager said she has an open door policy and comments are welcome. The home must make a greater effort to obtain the views of all service users and their representatives. The report from the survey was not available during the inspection, which means service users and their representatives to also do not have access to the report. Quality audits of the home and regulation 26 visits are completed by the operations manager, although only 2 reports, dated February and October 2006 were available during the inspection. Service users who do not wish to or are unable to look after their own money can have small amounts kept at the home, which is administered by the home. Records for money kept on behalf of three service users was seen. Money was kept in an envelope, together with any relevant receipts, and credits, debits and the balance were written on the front of each envelope. However, the balance for one person was incorrect and although the administrator was able to give an explanation about the missing money, there were no receipts for the purchases made or total spent in that transaction. There were no signatures for debits to accounts. This is poor bookkeeping practice and leaves service users at risk of financial abuse. Information supplied before the inspection shows health and safety maintenance and servicing checks are completed as required. The manager and handy man confirmed all taps have mixer valves to guarantee low temperatures. The home’s policy states water outlets should be tested regularly with a hot water temperature range between 33 and 43oc. Hot water temperatures were checked during the inspection as the last record seen was dated August 2006 and showed one shower temperature of 49oc. The shower temperature was checked during the inspection and was within the desired temperature range, but there were no records of immersion temperatures available. Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 26 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X 2 X X X 2 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 2 X 1 X 1 X X 2 Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 27 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 RQN Regulation Requirement Timescale for action 28/02/07 2 OP7 3 OP7 4 OP8 5 OP8 CSA 2000 The home must not admit Section 24 service users with conditions for which the home is not registered to care for. 13(7), (8) Restraint of any kind must not be used unless it is the only means of securing the welfare of that person. Records must be kept of the circumstances and nature of any restraint used. 15(2)(c) The registered person must revise the service user’s plan. The plan must reflect changes to identified needs and how these are to be met. (Previous timescale of 25/11/06 not met.) 13(1)(b) The registered person must make arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. (Previous timescale of 20/11/06 not met.) 17(2) The registered person must maintain in the care home the records specified in Schedule 4. Records of the food provided for DS0000024311.V328190.R01.S.doc 28/02/07 15/03/07 28/02/07 28/02/07 Littleport Grange Version 5.2 Page 28 6 OP9 12(1) 13(2) service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. (Previous timescale of 20/11/06 not met.) The registered person must ensure that medication is only administered to residents from correctly labelled and identifiable containers which are supplied and labelled for them An immediate requirement notice was served. The registered person must ensure that medication is only administered as prescribed and special instructions for use are adhered to. An immediate requirement notice was served. The registered person must ensure that medication is not left unattended in communal areas. An immediate requirement notice was served. The registered person must ensure that medication is disposed of promptly if no longer prescribed and not retained for future use. The registered person must ensure that a record is kept of medicines disposed of so that a complete audit trail exists. The registered person must ensure that medicines controlled under the Misuse of Drugs Act 1971 are stored in accordance with the Act and associated Regulations. DS0000024311.V328190.R01.S.doc 16/01/07 7 OP9 12(1) 13(2) 16/01/07 8 OP9 13(2) 16/01/07 9 OP9 13(2) 15/02/07 10 OP9 13(2) 15/02/07 11 OP9 13(2) 28/02/07 Littleport Grange Version 5.2 Page 29 12 OP9 13(2) 13 OP10 12(4)(a) 14 OP12 16(2)(m), (n) 15 OP14 12(2) 16 17 OP16 OP18 17(2) Schedule 4(11) 13(6) 18 OP19 13(4) 19 OP26 16(2)(k) 20 OP29 19 The registered person must ensure that a record is kept of the temperature of the medication storage room to ensure a suitable environment exists. The registered person must make suitable arrangements to ensure that the care home is conducted in a manner that respects the privacy and dignity of service users. (Previous timescale of 20/11/06 not met.) The registered person must consult service users about their social interests. (Previous timescale of 25/11/06 not met.) Service users must be enabled to make choices about how they would like to receive personal and health care. A record must be kept of all complaints made and the action taken. The registered person must make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must ensure that all parts of the home to which service users have access are free from hazards to their safety. Soiled waste stored in disposal bins must not be accessible. Arrangements must be made to keep the care home free from offensive odours and for the suitable disposal of general and clinical waste. The registered person must not employ a person to work at the care home unless the appropriate checks have been completed. (This is in relation to DS0000024311.V328190.R01.S.doc 28/02/07 28/02/07 15/03/07 28/02/07 28/02/07 28/02/07 15/03/07 28/02/07 28/02/07 Littleport Grange Version 5.2 Page 30 21 OP33 24(5) 22 OP35 17(2) Schedule 4(9)(a) proof of ID and photograph of prospective employee being obtained.) (Previous timescale of 07/011/06 not met.) The registered person must enable all service users and their representatives to give their views about the home. Accurate records must be kept for the receipt, return or use of service users money. 31/03/07 28/02/07 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 OP9 OP9 Good Practice Recommendations The registered person should consider the need for handwritten changes or additions to medication records to be signed and dated by the person making the entry. The registered person should consider the need to have sight of the original signed prescription, before it is dispensed and that a copy is retained in order to validate the prescriber’s instructions. Storage areas for equipment should ensure the equipment is not at risk of damage and service user safety is not compromised. Staffing levels should reviewed to ensure service users care is not reduced at weekends. There should be a minimum ratio of 50 non nursing care staff with a NVQ at level 2 or above. Staff training methods should be reviewed to ensure that this does not take the form of questionnaire and answers only. The quality assurance report should be made available to service users and their representatives. Records kept for service users money should be signed by two people for auditing purposes and accountability. 3 4 5 6 7 8 OP22 OP27 OP28 OP30 OP33 OP35 Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 31 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 © 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 Littleport Grange DS0000024311.V328190.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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