CARE HOMES FOR OLDER PEOPLE
Littleport Grange Grange Lane Ely Road Littleport Ely Cambridgeshire CB6 1HW Lead Inspector
Lesley Richardson Unannounced Inspection 18th December 2007 10:40 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.V356808.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.V356808.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.V356808.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 13th September 2007 Brief Description of the Service: Littleport Grange is registered as a care home with nursing for up to 75 older people. Although the home is registered with 75 beds the home has chosen to accept only 66 people, so that they may be more comfortable. Accommodation is provided in a large detached property set in attractive and well-maintained grounds on the edge of the town of Littleport. There are local amenities within walking distance and the city of Ely is a short drive away. The house is on three floors made accessible by two lifts and stairs. There are a number of lounges and dining rooms available to residents. There are 58 single and four large double bedrooms, most with en-suite facilities. There are registered nurses on duty at all times as well as day care and night care assistants, administrators, cooks, housekeepers, bed makers, laundry workers, maintenance man, gardener and full time activities co-ordinator. Fees for the home range between £478.00 and £630.00 per week, a full range of fees is available from the home upon asking. The Commission for Social Care Inspection report is available in the manager’s office for people at the home or relatives and visitors to the home who wish to read it. Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of this service and it took place over 5 hours as an unannounced visit to the premises. There were two regulation inspectors and a specialist pharmacy inspector present during the inspection. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. Two requirements from the last inspection have not been met. There have been no further requirements and 2 recommendations made as a result of this inspection. Information obtained during a random inspection carried out between this inspection and the last key inspection in September 2007 has also been used in this report. This is a poor service. What the service does well: What has improved since the last inspection?
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 6 No out of date medication was found in the medication storage room and no residents had been left without prescribed medication. The way care records are written and the information that is written in them has got better. There is more information about people’s preferences and what they like and don’t like. For example, one person likes to read one particular paper during the week and a different one at the weekends and this is written in the care records. People living at the home are able to get the advice to health care professionals, like dieticians and speech and language therapists. This information is available in care records, although not always written out in full in care plans. During this inspection it was more obvious that people living at the home are able to choose when they go to bed, when they get up, where they sit, what they have to eat and what they do during the day. Staff are polite and usually ask people rather than give them limited options, although one staff member gave a person a drink without talking to him at all. Further improvement, therefore, is still needed. At the last inspection we found an area that was possibly a health and safety risk. This has improved at this inspection, although the bins used for soiled incontinence pads must be used properly so that they do not pose the safe risk. We carried out another inspection between the last key inspection and this one to check recruitment checks were being carried out on new staff properly. The home showed they had done this and are still doing all the checks needed to make sure new staff members are safe to work with vulnerable people. There is a system for people who want the home to hold money on their behalf, which means this is safe and money is always available when it is needed. Maintenance and service checks for equipment and systems in the home are carried out at the required intervals. A quality assurance survey has been carried out by the home, and they asked relatives, staff and stakeholders what they think. This includes an action plan for issues that have been brought up in the survey and shows what is being done. But there is nothing to show they asked anyone living at the home their opinion. If this is also available it must be included to show the home is being run in the interests of people living there. What they could do better:
People who use the service must be protected by having medication given to them as prescribed by their doctor and special instructions for medication must be followed so that the treatment is effective. The accuracy and quality of the
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 7 records of when medication is given to residents must be improved to show that they receive medication as prescribed. Even though there have been improvements in the way care records are written and the information contained in them, this must continue to make sure all staff have as much information about how to care for people as possible. Each person’s need for help stays the same at weekends as during the week, but staffing levels drop. Staffing levels, particularly at weekends, should be looked at to make sure people are able to get help when they want and need it. 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.V356808.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.V356808.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. The home has adequate information about people before they live there, which means they are able to make a decision about whether the person can be properly cared for before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager carries out assessments 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. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Although there have been improvements in written care records, poor practice in medication administration continues to put people living at the home at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A specialist pharmacist inspector examined practices and procedures for the safe handling and recording of medicines. The medication storage room is having building work done to accommodate changeover to blister packs planned for Jan 2008. New medication trolleys are in use. The storage was chaotic because of the building work, but no expired medication found. The quality and accuracy of records of medication prescribed and given to residents show some concern. There were a number of unexplained omissions in the records giving no clear indication of whether medication had been administered or not, and if not given, the reason why was not always recorded.
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 11 The quantity of medication left did not tally with the records. One resident was prescribed medication in a different dose on a Sunday from that taken on Mondays to Saturdays, but the record showed that the dose for the Sunday had been given on 3/12/07, which was a Monday. Special instructions for medication e.g. “take one hour before meals or on an empty stomach” or “take every 12 hours”, were not being followed. This means residents may not receive treatment that is effective. Medication for one resident prescribed “when required” was recorded as being given regularly every night. No residents has been left without medication for continued treatment. Where medication is prescribed in variable doses e.g. “one or two tablets”, the actual number given is not consistently recorded and creams and ointments have their administration recorded as a tick, not initialled to indicate who gave the treatment. This does not provide an accurate record of when medication is given or who by, and may result in residents receiving too much or too little medication. The medication round was observed at lunchtime and a bottle of medication was left unattended on top of the medication trolley in a corridor area off the dining room. This could result in the wrong person taking the medication. One resident stores a cream in her room. Their ability to safely hold and administer their medication and any risks to other people living in the home had not been assessed. This could be putting people in this home at an unnecessary risk and is against the homes medication handling procedures. Each person in the home has their own set of care plans that guide staff members in how to care for them. There are two sets of these records, so that a copy can always be kept in the person’s room and is easily available for information. Care plans 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. They also show individual preferences, like what times people like to get up and go to bed and what newspapers one person likes to read. There are still some things that are not clear enough in care plans and staff should make sure they are as clear as possible when they write them. For example, whether a person should be turned in bed if they have a high risk of developing pressure sores. Staff members were clear in their understanding of these individuals’ needs and why one person was not turned at night, although this was not clear from the care plan. Plans are reviewed monthly or more often and most changes in care trigger a change in the care plan. One person had been seen by his GP the day before this inspection, who had asked that he be given more drinks, although his care plan had not shown this. Again, staff were aware of this person’s need for extra drinks, but they must make sure any changes in care are written in the Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 12 care plan as soon as possible, so that anyone looking after the person is able to find up to date information. People living at the home have access to a range of health care professionals, including specialist nurses and medical advice, dieticians and speech and language therapists. Apart from the example in the previous paragraph where advice from a GP had not been written into the care plan, most information and advice from health care professionals does form part of care planning and how staff members should care for people. There was one incident, however, that shows even though this information is in care records, not all staff follow the advice. One staff member was seen giving a person a drink with the person was lying back in a recliner chair at less than a 45o angle. The information in this person’s care record (although not written into the care plan) tells staff that the person is ‘to be sitting up as close to 90o as possible’. Other staff members said the person should be sitting as upright as possible and it was easy to raise the back of the chair to this position. After talking to the manager about this issue, it has been decided this is an isolated incident and the general practice is as recommended by the speech and language therapist. Staff are polite towards people living at the home and all but one person spoke to everyone they approached in a respectful manner. However, one staff member, while not rude, helped a person to have a drink without saying one word to him. This task took approximately 5-10 minutes and the staff member departed to assist other people and did speak with them. The person receiving a drink has a care plan for communication needs, which tells staff they “must explain any procedures of care to be done”. This staff member did not treat this person with the dignity he deserves, although this again appeared to be an isolated incident. This has been discussed with the manager. Littleport Grange DS0000024311.V356808.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. Improvements by most staff mean people living at the home have choice and control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator who organises a programme of events and things for people to do. These include a ‘wine and biscuits’ afternoon and exercises provided by Sports for All, as well as bingo and quizzes with the co-ordinator. An activities programme is printed and a copy is given to everyone in the home. There is information in care records about people’s individual interests and what they like to do, like which paper they like to read. Relatives are able to visit when they want. One person’s relative said she is always made to feel welcome and is asked to stay to lunch when she visits. The home provides a different menu every day, containing 6 different main meals, from which people can choose what they would like to eat. Staff members sit with people who need help to eat.
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 14 People living at the home are usually able to choose their daily routine, although staffing levels at some times may make this less easy. People living at the home said there are sometimes not enough staff for them to get help when they need it. Examples where choice is not given, like the one in the previous section, are more isolated although the home must continue to make sure all staff members understand how to help people live how they would like. Littleport Grange DS0000024311.V356808.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 20 complaints in the last 12 months. This also now includes verbal complaints, which are recorded and looked at in the same way as written complaints. A relative visiting the home during the inspection said she is able to talk to the manager if she is not happy and her concerns have always been sorted out. 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. An incident of concern found at the last inspection has been investigated by the manager, who said it was not an adult protection concern, but had been recorded using incorrect wording. Littleport Grange DS0000024311.V356808.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 a pleasant and comfortable place to live, but some areas pose a health and safety risk to people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been some repair and renovation work at the home in the last year; the small dining room has been redecorated, flooring has been replaced in the ground floor corridors and the main communal area has also been redecorated. Most of the home was clean and tidy during the inspection, but it was noted that specific bins used for soiled incontinence pads were not maintained in sanitary or hygienic conditions. Bins in three communal toilets or bathrooms were seen to be overflowing and had not been closed properly, the outside of two bins were soiled. Other areas found at the last inspection have improved.
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 17 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. Improvements in recruitment checks mean new staff are safe to work with vulnerable people, but additional staffing levels are needed to make sure people are able to get help when they need it. 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. We carried out a short inspection in November 2007 to check if the home had complied with a statutory notice and requirement made at the last key inspection. Enough information had been obtained by the home to show they have met the notice and requirement. Recruitment records for three 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. Although there are fewer examples in this report that indicate staff numbers at the home are not high enough; people living at the home said it is often
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 18 difficult to get when it is needed. They said this is worse in the morning when staff are busy getting people up, and this is understandable, but weekends are also a problem as there are a lot fewer staff then. Low staffing levels at weekends also came up in the quality assurance survey carried out by the home in July and August 2007. A copy of the staffing rota was provided before this inspection and shows there are less staff on duty at weekends. However, individual need for help does not reduce at weekends and therefore staffing levels should be similar to weekdays. The manager said the home is actively recruiting new staff members and explained the processes for managing fluctuating staffing levels. Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. 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.V356808.R01.S.doc Version 5.2 Page 20 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. There are regular residents meetings and minutes are available. 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 four 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. Information provided before this inspection shows equipment, like hoists, lifts and fire-fighting equipment has been serviced or tested as recommended by the manufacturer. Records for fire drills and alarm testing were looked at and have been carried out. Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 3 Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement Medication must be administered safely, as prescribed and records for the receipt; administration (or non administration) of medicines must be accurate and complete. Medication must be administered in a way which ensures effective treatment. This is to make sure that residents receive the medicines prescribed for them. This is a repeated requirement. Previous timescale of 31/10/07 not met. 2 OP9 13(4) A documented risk assessment must be in place for all people who look after their own medication in order to minimise the risks to people in this service. This is a repeated requirement. Previous timescale of 31/10/07 not met.
Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 23 Timescale for action 21/01/08 21/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP33 Good Practice Recommendations Staffing levels should be similar for weekends as weekday shifts as individual needs do not reduce at weekends. Quality assurance survey reports should include the views of people living at the home as well as relatives, staff and stakeholders. Littleport Grange DS0000024311.V356808.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection 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
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