Inspection on 16/06/08 for Littleport Grange

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Adequate service.

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 18/12/07

Littleport Grange 13/09/07

Littleport Grange 15/01/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Littleport Grange Grange Lane Ely Road Littleport Ely Cambridgeshire CB6 1HW Lead Inspector Lesley Richardson Unannounced Inspection 16th June 2008 11:00 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.V368032.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.V368032.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.V368032.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 18th December 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 £487.00 and £660.00 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.V368032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection of this service and it took place over 8 hours and 50 minutes as an unannounced visit to the premises. 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. One requirement from the last inspection has been met and one requirement has not been met. There has been one further requirements and no recommendations made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment and from returned surveys was also used in this report. Fourteen surveys were returned from people who live at the home, and three were returned from visitors to the home. We didn’t receive any surveys from staff members. What the service does well: The home is a large converted building with an extension at the rear of the building and it is situated in its own grounds. There are three different lounge areas on the ground floor, plus another two on the first floor for people to use if they wish. There is a choice of main meals each day and staff members stay with people who need help to eat. Assessments are completed before people move into the home. This means the home can make sure they have enough staff with the correct training to care for particular needs before the person moves in. Health care professionals: Family and friends can visit at any time during the day and people at the home said they are made welcome and can talk in private if they want to. The are kept informed of any issues that happen and one person visiting the home said, “I was phoned 4 times by different members of staff to tell me Mum had fallen in her room. And when I went to visit I was met by a carer who also informed me Mum had fallen”. People like the activities at the home. They have a happy hour, physical activities, and quizzes and bingo that are arranged by the activities coordinator. They say there is plenty to do during the week, but it is a little quiet at weekends and they would like to go out more often. People also said they Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 6 can choose when they do things, like getting up and going to bed, and what they have to eat. 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 and the home does something about them. This means 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. New staff members have training when they first start working at the home. All staff members have moving and handling, fire awareness and other health and safety training updated every year. This makes sure they know how to safely move people and what to do in a fire. Other training, such as medication administration and safeguarding adults, is also given to make sure staff know what they should do and how to do it safely. Records are kept to show money kept by the home on behalf of people living there. This means that there is information to show when money is spent and what it is spent on, so that people can feel safe in having the home take care of it. Health and safety checks are completed and the results are written down as a record. What has improved since the last inspection? What they could do better: Care plans are written to show staff members how to care for people’s needs, but they don’t contain enough information for staff to be able to do that properly. There aren’t enough details about the equipment staff should be using, how they should be sitting people up or why they might not be able to do this properly. When new information is obtained, such as recommendations from a dietician, this isn’t written into the care plan and isn’t always passed on to other parts of the home who should be told. When records are kept to show the amount of food someone has eaten, this isn’t written clearly enough or with enough detail for people to know whether the person is getting enough nutrition. Staff members are polite and courteous with people but they don’t always think about what they are doing or saying. For example, even though one man complained about being wheeled over a bump in the corridor and the staff Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 7 member apologised, she didn’t tell him there was another bump coming up or slow down to go over it. One visitor to the home told us, “I also find it belittling to hear staff carers/RNs saying to some of the older ladies, “What a good girl” when they take their medicine or eat all their meals”. At the inspection in January this year we found staff members were using one tin of a drink thickener for lots of people, when each person who is prescribed it should have their own tin. This was still happening at this inspection. Another person had a tin of this thickener in her room, even though it had originally been prescribed for someone else. To use items prescribed for one person in the treatment of another is unacceptable practice. We also found that two prescribed creams were still being kept in people’s rooms without risk assessments being completed. We have removed the requirement as both these creams are considered cosmetic rather than medicinal, but risk assessments must still be completed to make sure everything that can be done to reduce the risk of possible harm to people can be done. 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.V368032.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.V368032.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 adequate. Not enough information is obtained about people before they live at the home, which means staff may not be able to care for them fully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An assessment is completed before people move into the home. Further assessments are obtained from health and social care teams and provide additional information so the home is able to say whether it has the staff with the skills and experience to properly care for someone moving in. We looked at the care records for two people who had moved into the home since the last inspection. The pre-admission information for both people showed there was little detail obtained, which would make it difficult for care staff to know how needs were being met and how people like to be cared for. For example, both people have sensory impairment, but neither pre-admission assessment shows how the visual impairment limits one person’s ability to do things for themselves, or how the other person is able to communicate what they want. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. Littleport Grange DS0000024311.V368032.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, 10 and 11 Quality in this outcome area is adequate. Although care plans do not give enough guidance, most staff members know what they need to do to care for people in a way that causes them least distress. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most of the people who commented in surveys said they get the care and support they need from staff members and during the inspection people told us care staff are nice and are polite. We saw this during the inspection and that staff knock on doors before entering rooms. Two people wrote in surveys, “I am very happy with the care I receive here” and “I am very well looked after”. One of the people we spoke to during the inspection said she has regular carers who are very good. She needs help, but feels her needs and choices are met and her dignity is respected, and she does not feel rushed. 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 Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 11 information. Care plans for four people were looked at as part of this inspection. They show that each person has a plan that guides staff members in what they need to do to meet most of their identified needs. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. Although care plans give staff information, they are not always written for all identified needs or updated when needs change. Two of the care records we looked at were for people with nutritional needs and recent weight loss. The information in both main plans had not been updated with recommendations made by a visiting dietician. Although the information was written in reviews of the care plans, it had not been passed on to the kitchen staff so they could take the action they needed to. However, care records show that staff members had taken enough action to stop both of these people from losing more weight. Staff members do not always follow the guidance that is written in the care plan. One person’s plan tells staff he is able to eat by himself if staff are present and tell him what food is on the plate, where the plate is and where the food is. We talked to this person and he told us that staff members usually tell him the meal is there but what is on the plate or what they are going to give him next. We watched staff during the meal and this is exactly what happened. The reviews show he now needs staff to help him, but there is nothing to tell staff how much help he needs, what or if he is able to do anything for himself. We saw a staff member help this person at lunchtime and she did everything for him. We talked to staff members who said the person is no longer able to or doesn’t want to feed himself and so they do it for him. The plans in people’s rooms were more up to date, but still didn’t give staff specific advice about equipment they should use or what to do to make sure things are safe. For example, plans for helping one person to move didn’t mention the type and size of equipment to be used or that there are sometimes problems moving him. Staff members told us that they use a specific sling as they have found it puts less strain on the person’s legs and he is less aggressive because of it. This information is not recorded anywhere in his care records. Another person’s plan is vague about sitting her up for meals and drinks and simply says “appropriately”. This person should be sat as upright as possible to prevent choking. We talked to care staff who told us that because of a curve in her spine sitting this person upright at 90o would mean she would be bent forward. Again, care records show that there has been no detrimental effect from this, but the information in plans should be more detailed to make sure there is clear guidance for all staff. Care records that detail the amount and type of food that is eaten are not completed properly. Food charts give vague details, such as spoons or bowl of purée, but don’t give specific amounts or what purée or dessert consists of. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 12 Thirteen out of fourteen people returning surveys said they receive medical attention when they need it and comments from people at the home show this. There is information in care records to show health care professionals, such as specialist nurses, dieticians, sppech therapists, opticians and chiropodists are contacted for advice and treatment. As described above, not all the information is always passed on or written in plans, although this doesn’t always have a negative effect. People we spoke with during the inspection and received surveys from all said they get medical attention when the need it. We carried out a random inspection in January 2008 to look at whether improvements had been made to medication administration practice since the last key inspection. Many of the issues found at the key inspection in December 2007 had improved, although we found that some prescribed creams kept in people’s rooms did not have risk assessments and that drink thickener prescribed for one person was also used for other people. At this inspection the work to improve practice that we found at the random inspection has continued. Medication administration recording and practice is still at an acceptable level. However, we also found two different creams, sudocrem and aqueous cream, are still being kept in people’s rooms without risk assessments being completed. The senior nurse on duty said he wasn’t aware risk assessments were also needed for these prescribed creams. Because these creams are cosmetic in nature, rather than medicinal, we have decided the previous requirement has been met. However, risk assessments must still be completed for these creams to be kept in people’s rooms. We found a tub of ‘Thick-n-Easy’ drink thickener in one person’s room that had previously been prescribed to another person. Another tub of ‘Thick-n-Easy’ was again in communal use in a dining room during lunch, although there was no prescription label on the tub. To use items prescribed for one resident in the treatment of another is unacceptable practice and this requirement has not been met. We saw staff being polite to people during this inspection. However, there are examples above and in other sections of this report that show staff members do not always consider people while they help them or carry out their work. We saw one person being wheeled from the dining room after lunch and when he complained to the carer about going over a bump too fast she apologised. She didn’t make any attempt to slow down or tell the person when another bump was coming up and did not react when he again commented that it was uncomfortable going over bumps so fast. One visitor to the home made the following comment, “I also find it belittling to hear staff carers/RNs saying to some of the older ladies, “What a good girl” when they take their medicine or eat all their meals”. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 13 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. A range of activities are offered and people are able to make basic choices, but these are not always person centred and do not always look at people as individuals. 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 ‘happy hour’ and exercises provided by Sports for All, as well as bingo and quizzes with the co-ordinator. Links have been made with the local community to provide reminiscence opportunities for people as many come from the local area. An activities programme is printed and a copy is available to people in the home. People returning surveys said they have enough activities and things to do, and during the inspection people said they like the happy hour but there is little to do at weekends and they miss going out in the bus. We talked to the activities co-ordinator who gave a good idea of the activities that are available, but also said there is no transport for trips and she doesn’t have enough time to spend with people who are not able to leave their rooms. However, there is little information in care records about people’s individual interests and what Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 14 they like to do, or even how they like to be cared for. One visitor to the home said, “I have never seen anyone just spending five minutes with a resident talking about life in general or what the resident may have done or can remember what they have done”. People are able to make everyday choices about when to get up and go to bed, how to spend their days, whether that is in their own room, in the main lounge/dining area or participating in activities. Two of the three visitors who returned surveys said their relatives are able to choose what they do and how they do it. People told us during the inspection they are able to choose an alternative meal if there is nothing on the menu they like. The home has an open visiting policy and people can have visitors at any time of the day. Two of the visitors returning surveys said the home helped people keep in touch and they all said they are kept up to date with issues concerning that person. One comment from a visitor said, “I was phoned 4 times by different members of staff to tell me Mum had fallen in her room. And when I went to visit I was met by a carer who also informed me Mum had fallen”. The main meal is served at lunchtime and alternatives are available on the menu and by request. We saw lunch being served in the main dining room and consisted of steak & kidney pie, mash & vegetables (carrots & cauliflower) and gravy, followed by dessert. Food was served appropriately in a relaxed and unhurried way. Drinks were offered throughout the meal. About three quarters of people usually like the meals that are provided, and a comment from one person was, “kitchen will always provide an alternative to menu”. Not everyone is happy with the meals and we were told that there should be more variety of meat, that tea would be better if there was more choice and another person commented they would like more fresh fruit. Although staff were courteous and attentive, they didn’t always ask people if they wanted gravy before pouring it onto their meal, or explain what the person was to eat if they were helping them. We also saw some staff members talking to each other over the heads of people eating meals. One person said he didn’t want to eat the meat but was told by the carer he had to. We looked at the care records of one person who relies on staff to help her eat and has lost weight because of her poor appetite and memory. There was no information in her care records to tell staff what her favourite foods are or whether there is anything she really likes. We talked to a member of the office staff about this problem who said she regularly saw a someone who knew this person before she came into the home. She said she had never known to ask about food preferences but would do this to see if there was anything the person at the home would particularly like to eat. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 15 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 good. Complaints and safeguarding issues are taken seriously, which means people are able to raise concerns and know they will be acted upon. 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 29 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. Thirteen of the fourteen people who returned surveys said they know who to speak to if they have any concerns, and eleven of the fourteen said they know how to make a complaint. Twelve of them said staff listen to and act on what they are saying. The visitors also said they know how to make a complaint. 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. There have been three safeguarding investigations since the last inspection. All staff have received training in safeguarding vulnerable adults and when we spoke with staff members during the inspection they all listed this as part of the training they had completed. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 16 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. Renovation and redecoration means the home is generally a pleasant place to live, but not everyone is able to sit in communal areas in comfort. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large renovated country house with an extension, which is set in it’s own attractive gardens. The general décor within the home is satisfactory, and it was clean and tidy, with no offensive smells. Nearly everyone returning surveys said the home is usually clean and tidy and people at the home said the home is clean. One person said, “very limited eyesight but think it ‘feels’ clean and fresh”. The head of care told us there is an ongoing maintenance and redecoration programme. There were a number of issues that people raised in the returned surveys and during the inspection. Two people said there is a problem with getting clothes Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 17 returned from the laundry and another person said there can be some nasty smells in the home and wondered if a change of flooring would help in this. In one of the surveys one person said the windows could do with an extra clean on the outside. When we looked at this we also saw that the window ledges were peeling and flaking paint. While we were walking around the home we saw a number of carpets that were becoming worn and stained, particularly in the extension part of the home. In the AQAA the home has already identified it is something they need to think about replacing. Although they don’t pose a health and safety hazard at the present, they should be replaced before they do become a health and safety issue. We saw a lot of people in one main communal area sitting in wheelchairs rather than armchairs. We spoke with two people who were sitting in wheelchairs, one said she was uncomfortable in it and the other person said she had a comfortable chair in her room but there wasn’t one downstairs for her. She has to stay in a wheelchair that is uncomfortable and too small as it is difficult to get through doorways with a wider wheelchair. A staff member said some people have wrong sized chairs, but that people are asked if they want to sit in armchairs and that there is enough equipment to do this. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 18 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. Organisation of staffing numbers does not give people living at the home the opportunity to continue living as they are able. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New staff members are given induction training, which includes mandatory health and safety training. Most staff members at the home have received required health and safety training, including medication training for all staff giving medication. Information provided shows almost 30 of non-qualified care staff have a NVQ at level 2 or above. Most people who returned surveys said staff members are available when they are needed and that they get the care and support they need. However, one person said, “would like to be up by 10:30 at the latest, also can wait a long time for bell to be answered in evening, usually around shift change over”. People we spoke to during the inspection also said there are not always enough staff on duty. Two comments were, “wouldn’t want to upset them, take ages to come back to you – seem to disappear for ages” and “waiting for attention in the afternoon”. During the inspection we saw 5 or 6 care staff going for a break together, leaving only one or two staff members visibly available in the large communal areas at the front of the building at 5 o’clock in the afternoon. Relatives told us, “I have on numerous occasions gone in to Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 19 visit only to find 3-4 members of staff running round the home trying to do missing staff’s jobs as well as their own”. When we spoke to staff they said that agency staff are not used to cover sickness or leave. They said staffing levels are not high enough and staff do not have the time to maintain independence and are only able to meet basic needs. A number of comments by staff members referred to the need to get everyone up by 11am, and that night staff start getting people up at 6am in order to try to accomplish this. They told us they have 15-20 minutes to help each person complete their personal hygiene and get dressed. There were also comments about the division between different staff members, with some nursing staff not always helping with physical care. We also noticed that care staff have little information about social needs and how to meet these and that it is not considered part of their role. The staff rota is quite difficult to read, but showed there are usually between 13 and 14 staff members on duty in the morning, giving a ratio of about 1:5. This drops to 7-9 in the evening and drops again to between 6 and 7 at night, although the rota showed that some nights there are only 3 staff members on duty. One person living at the home said, “night staff particularly low numbers”. Although there is a big drop in staffing levels between the morning and evening shifts, staffing numbers alone cannot be the sole contributing factor to people not having enough time to maintain their independence. The home is a large house with a three storey extension, significant numbers of staff go on breaks together leaving very few staff available, and it appears there is a reluctance for some staff to complete work that they don’t consider part of their role even though they are able to do it. Recruitment records for two recently employed staff members were looked at. These show that all the required checks were obtained before the new staff members started working at the home. However, not all the required information is obtained. One person had only written the years she had been employed, which doesn’t show whether there were gaps in employment. This had not been looked at by the home and there was no written explanation. This same person had two satisfactory references but one was a personal reference that had been obtained from a current staff member at the home. All required information must be obtained so the home can be sure they are employing people who are safe to work with vulnerable people. As there was an improvement at the last key inspection in this area a requirement will not be made as we expected the home to be able to improve again. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 20 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, 36 and 38 Quality in this outcome area is adequate. Checks and servicing of equipment is carried out at required intervals, and people are asked their opinion of the home, but people living at the home must be included for it to run in their interests. 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. An annual quality assurance survey is carried out, which obtains the views of relatives of people at the home, staff and stakeholders in the community. It doesn’t contain any views of people living in the home. The last survey was Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 21 carried out in July and August 2007 and the report includes a list of actions that need to be taken in response to the survey. Information provided before the inspection says there are monthly residents meetings and a bi-monthly newsletter to all residents that lets them know what has happened in response to issues they have talked about. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did this within the time we asked for it. The home has given us most of the information we asked for although there are a few sections that are not completed or have little information in them. Money is kept by the home on behalf of people living there; access can be gained through the administrator who maintains an accounting system for credits and withdrawals. The records for two people were looked at and found to tally with the money available for these people. People living at the home are also able to keep money with them, if they wish. Staff files show that staff members receive supervision every 2-3 months and staff members we spoke to also said they had supervision. We also saw that new staff members have a person who they shadow and who supervises their work before the Criminal Records Bureau check is issued. Information provided before this inspection shows equipment, like hoists, lifts and fire-fighting equipment has been serviced or tested as recommended by the manufacturer. We looked at fire equipment around the home, this has been tested within the last 12 months. Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 22 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 23 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(2)(c) Timescale for action Care plans must be revised when 31/08/08 there is a change in needs and how these are to be met. This is to make sure staff have the most appropriate guidance and people’s needs are met properly. Items prescribed for each resident must not be retained and/or used for the treatment of others. This will protect residents and ensure they receive only the items prescribed for them. This requirement had a timescale of 29/02/08, which have not been met. Enforcement action is now being considered. 31/08/08 Requirement 1. OP9 13(2) Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Littleport Grange DS0000024311.V368032.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team 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. 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