Inspection on 29/12/05 for Mandeville Grange

This inspection was carried out on 29th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mandeville Grange 04/02/10

Mandeville Grange 23/10/09

Mandeville Grange 11/11/08

Mandeville Grange 23/11/06

Mandeville Grange 28/09/05

Mandeville Grange 14/03/05

Mandeville Grange 10/08/04

Mandeville Grange 28/01/04

Mandeville Grange 21/01/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Mandeville Grange 201-203 Wendover Road Aylesbury Buckinghamshire HP219PB Lead Inspector Mr Guy Horwood Unannounced Inspection 29th December 2005 12:10 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 Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 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. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mandeville Grange Address 201-203 Wendover Road Aylesbury Buckinghamshire HP219PB 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) 01296435320 Mr A.S. Dhot Mrs S.K. Dhot Mrs Minerva Patti Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. General Nursing Care ( age 50 plus including one 39 plus) Date of last inspection 28th September 2005 Brief Description of the Service: Mandeville Grange Nursing Home is situated on the outskirts of Aylesbury Town, which provides a variety of shops and other local amenities. The Home provides Nursing care for up to thirty-one Service Users, who are accommodated on two floors of the building. All floors are accessible by stairs, a passenger lift or stair-lift. Qualified Nurses and Carers staff the Home. The Manager is a suitably qualified Nurse; in addition to managing Mandeville Grange she also manages The Gables Nursing Home, (also owned by the proprietors) which is situated approximately five minutes from Mandeville Grange. This is possible through the employment of two capable and supportive Deputies. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Mandeville Grange Nursing Home, carried out on the 29th December 2005 between 12.10pm and 13.30pm. The lead inspector was Mr Guy Horwood, who was accompanied by Mrs Sue Smith, (Inspector). The inspectors were met by the homes deputy manager, Mrs Angela Huxley, upon arrival at the home. The inspection consisted of meeting with residents and staff, witnessing staff care practices, viewing some care records and touring the premises. The inspectors found staff polite and courteous, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspectors would especially like to thank the residents for their time and for allowing the inspectors into their home. What the service does well: Residents described staff as “very good”, “kind”, “very nice girls”, and were said to “look after me well” by one resident. The home was described by a resident as being a “Home from Home”, and in one residents opinion scored “100 ”. Residents appeared well cared for by a caring and kind group of staff. Care plans are maintained and up to date and reflect residents care needs in the majority of cases. Staff liase with healthcare professionals external to the home where required. Meals are of a good quality and resident’s receive a varied and wholesome selection of meals, taking into account their tastes and choices. The home was suitably heated at the time of inspection. The home appeared clean and tidy, and no offensive odours were noted, a testament to the hard work of the homes house keeping staff. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 7 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 Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this visit. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 Staff appear to be caring and residents appear to be well cared for. Care plans are working documents, are up to date and subject to regular review. However, where assessments highlight a significant care need, e.g., the risk of developing pressure ulcers, care plans must reflect how this care need is to be addressed by staff. Frail elderly residents at risk of developing pressure ulcers may benefit from the provision of pressure relieving cushions. Residents have access to healthcare professionals external to the home to ensure that their healthcare needs are met. EVIDENCE: On arrival at the home a number of residents were seated in the lounge area with lap tables, and others were making their way to the dining area in preparation for lunch. Residents appeared well cared for and to be dressed in clean and co-ordinating clothing. The home felt comfortably warm throughout. Those residents seated in the lounge area had blankets over their knees. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 10 Glasses, where worn, appeared clean, nails were trimmed and some ladies hands had been moisturised with creams. Two care plans were viewed, and both were found to be up to date, well maintained and subject to review. Admission assessments were informative and care plans well written. Assessments as to tissue viability and moving and handling were present, complete and up to date. In one care plan the resident had been identified as of a high risk of developing pressure ulcers through the use of a tissue viability tool. Subsequently the care records identified the provision of a pressure-relieving mattress, yet no care plan was in place laying out the care to be delivered by staff pertinent to the prevention of pressure ulcers. The deputy manager stated that the home has some airflow pressure-relieving mattresses, and one of these was seen in use during the tour of the premises. Residents seated in the lounge area appeared frail and were not seen to change position or mobilise during the visit. In the lounge area only 1 pressure-relieving cushion was noted in use for the 11 residents present. It is strongly recommended that the home purchase a number of pressure relieving cushions for general use for frail elderly residents at risk of developing pressure ulcers, to be used in conjunction with regular programmes of encouraging residents to change position and/or mobilise where possible. The deputy manager stated that consultation with a local PCT wound care specialist nurse had taken place with regards to a residents care. Care plans recorded visits by General Practitioner’s and other healthcare professionals. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 At the time of this visit the home does not have an activities organiser, or sufficient staff to cover the provision of activities, and therefore does not provide sufficient activities in relation to residents leisure and social interests. It is anticipated that with the employment of an activities organiser, which the providers are currently seeking to employ, this issue will be addressed. Meals are of a high standard, incorporate the dietary needs, likes and requests of residents and therefore provide residents with appealing meals and meal choices. EVIDENCE: A radio in the lounge was playing, although this was tuned to a “pop music” radio station. Some residents were reading the day’s newspaper, one was being visited by a physiotherapist and some were chatting with each other. A resident expressed the desire to go on holiday or to go out on a bus trip for a day in the summer. The resident said that they were unable to get out much and said that this made them sad. The resident said that this had been discussed with staff, but she had been told that getting out as she described might be difficult. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 12 It is anticipated that with the employment of a new activities organiser this issue will be reviewed, and in the meantime that the homes manager will take on board these comments and investigate further. Drinks were to hand for most residents, and jugs of water and squash were situated in the lounge. Those residents in bedrooms had cold drinks to hand. Hot drinks were served to residents during the visit. The day’s meal was seen being served and appeared and smelt very nice. Meals were well presented, including soft meals, and were covered prior to serving. Where staff were witnessed to assist residents with meals, this appeared to be done in a caring manner with staff taking their time. The homes cook had prepared a home made quiche and home made tomato soup for the resident’s supper. Again these appeared very nice. The inspectors sampled some homemade mince pies, which were tasty! During the visit, evidence was seen of an alternative to the main meal being served to a resident. Residents spoken with said they frequently discussed meal choices with the cook, who was able to incorporate dietary needs and personal choice into the menus or on an individual basis. Receipts for deliveries from a local butcher and for the supply of dry ingredients were seen, and these appeared to show a variety of good quality products being purchased for the home. A number of residents were asked as to their opinion of the food they received, and all comments were positive including that “the food is excellent” and that the recent Christmas day dinner had been “very nice”. The deputy manager said that information regarding nutrition and the assessment of residents with regards to their nutritional needs had recently been investigated and was to be introduced into care plans shortly. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25,26. The home was warm, clean and tidy, and no offensive odours were noted. A number of furnishings within the home are becoming worn and in need of replacement. These areas of poor maintenance, and the apparent lack of a programme of replacement of furnishings, detract from the otherwise homely and pleasant environment provided at the home. EVIDENCE: Residents spoken with in bedrooms had call bells at hand to summons staff when required. Vanity units and furnishings were noted as chipped and worn and in need of either repair or replacement. At the time of the visit the home appeared clean and tidy, and no offensive odours were noted. Residents spoken with commend housekeeping staff on their work to maintain the cleanliness of the home. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 15 Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staff may not always be present in sufficient numbers to meet residents social and leisure needs. EVIDENCE: At the time of the visit the home appeared to have staff in sufficient numbers to meet residents care needs, although a resident commented that staff did not always answer the nurse call bell promptly. Other residents commented that they could not go outside of the home due to not enough staff being available to take them out. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38. Confidential records holding residents details of a sensitive nature are not always stored securely. The absence of radiator covers presents a potential risk to the health and safety of residents. The failure of some doors to close to their stops and staff holding doors open by inappropriate means has the potential to place residents, staff and visitors at risk. The storage of hoists in corridors presents a potential risk to the health and safety of persons within the home. EVIDENCE: Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 18 A resident was spoken with in his bedroom. Whilst in this resident’s bedroom it was noted that the radiator was extremely hot to the touch and was not fitted with a cover of any kind. The resident, who’s room it was, possessed a walking frame to assist with his mobility, which it transpired he used for transferring from one seat to another. After viewing this residents care plan it came to light that he had recently suffered a fall whilst trying to mobilise unsupervised, and the care plan identified a potential risk of falling out of his bed. In light of the potential risk of falls associated with this resident, an immediate requirement was served to cover his radiator with a low surface temperature cover. A second resident spoken with who had a history of falls and walked short distances supervised by staff and with a frame, was also in a bedroom with an uncovered radiator. Throughout the visit the inspectors noted a number of radiators in bedrooms and corridors that were not fitted with covers and were extremely hot to the touch. At previous inspections the registered persons have stated that those radiators identified as being of a high risk to the health and safety of residents would be fitted with low surface temperature covers. In light of the apparent failure in this process associated with the resident described above, the inspector has no option other than to require the covering of all radiators within the home with low surface temperature covers. Through later discussion with the homes owners, they stated that they had taken measures prior to the inspectors visit to deal with this issue and were in the process of fitting said covers within the home. This action on the part of the providers is welcomed. The deputy manager stated that information had recently been acquired relating to falls in the elderly and was to be incorporated into staff training and care plans in the near future. Records were noted as stored securely within the first floor “treatment room”. However, during the visit, care records holding information of a sensitive and confidential nature were found in the main corridor on a windowsill. The deputy manager stated that these records were usually stored securely in the nurse’s office. A number of bedroom doors were noted to fail to close to their stops, this included doors to bedrooms 5, 6, 8, 9 and 11. The door to bedroom 1 was found held open with a walking frame. The door to bedroom 12 was unable to be closed due to a missing closure. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 19 A “Dorgard” hold open device was noted in use on the kitchen door. Due to this being a high risk area with regards to fire safety, it is strongly recommended that the manager contact the fire safety officer to discuss whether this device is suited for use on the kitchen door. A hoist had been stored in the corridor of the first floor. This presented an obstruction and hazard within the corridor as it was opposite a fire alarm point and extinguisher along a fire escape route. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X 2 2 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 2 2 Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 OP38OP25( 5) OP38OP25( 5) Regulation 13(4) Requirement Immediate Requirement served 29/12/05: The radiator in room 17 is to be fitted with a low surface temperature cover. Low surface temperature covers are to be fitted to all radiators within the home. This process is to be guided on a risk assessment basis, with those radiators presenting the highest risk to residents being covered first. A programme for the repair and replacement of worn, tired and dishevelled furnishings, including vanity units, is to be commenced, with an action plan of this programme to be provided to the Commission. Care records of a confidential nature are to be kept securely within the home. Doors are not to be held open unless with a device approved by the fire officer. Doors must be able to close to their stops. A routine programme of maintenance with regards to this issue is to be DS0000019240.V273967.R01.S.doc Timescale for action 01/02/06 2 13(4) 01/01/07 3 OP19 23(2) 01/03/06 4 5 6 OP37 OP38 OP38 17 23(4)(c) 13(4) 29/12/05 29/12/05 01/04/06 Mandeville Grange Version 5.0 Page 22 commenced with appropriate records kept. 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 3 Refer to Standard OP8 OP12 OP38 Good Practice Recommendations It is recommended that pressure-relieving cushions be purchased for use with residents at risk of developing pressure ulcers. Staff are to enquire as to residents preferences as to the music played in communal areas. It is strongly recommended that a fire safety officer from Bucks Fire and Rescue Service be consulted as to the use of the “Dorgard” hold open device on the kitchen door. Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 Mandeville Grange DS0000019240.V273967.R01.S.doc Version 5.0 Page 24 - 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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