Inspection on 14/08/07 for Middletown Grange

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Middletown Grange 11/08/08

Middletown Grange 26/04/06

Middletown Grange 08/11/05

Middletown Grange 08/06/05

Middletown Grange 26/01/05

Middletown Grange 06/09/04

Middletown Grange 09/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton 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 Middletown Grange Middletown Hailey Witney OX29 9UB Lead Inspector Delia Styles Unannounced Inspection 14th August 2007 10:15 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 DS0000040174.V345441.R02.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. DS0000040174.V345441.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middletown Grange Address Middletown Hailey Witney OX29 9UB 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) 01993 700396 01993 775704 middletowngrange@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Karen Welch Care Home with nursing 56 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places DS0000040174.V345441.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. From time to time people over the age of 60 may be accommodated. The home may accommodate one service user within the category LD(E). 26th April 2006 Date of last inspection Brief Description of the Service: Middletown Grange is situated in a village location approximately 4 miles from the market town of Witney. The home is registered to provide care for up to 56 residents and is owned by Barchester Healthcare Limited. The home provides care for residents with nursing needs, and care and support for people living with dementia. There are 7 places used by the NHS Primary Care Trust for the intermediate care of individuals discharged from hospital awaiting return to their home. There are two spacious lounges, a conservatory and a separate dining room on the ground floor, with bedrooms on the ground and first floors. The first floor Memory Lane – also has its own lounges and dining room. An extensive building and refurbishment programme was completed in 2007 and included new kitchen and laundry facilities and a separate unit for the intermediate care service users. Recreational and social activities are provided and there is a large enclosed front garden. The home’s current scale of charges range from £563 to £900 per week. DS0000040174.V345441.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10.15 am and was in the service for 8.5 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager in the home’s Annual Qualtiy Asssurance Assessment (AQAA) that all homes are requried to complete each year, and any other information that CSCI has received about the home since the last inspection. The inspector saw all areas of the home and looked at a sample of the records and documents relating to the care of the residents. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires (comment cards) sent out for the Commission. Two comment cards were received from relatives, two from residents and two from health and social care professionals. There were a total of 54 residents on the day of the inspection, including nine residents from another local residential and nursing home who had to be moved here following extensive flood damage. The inspector thanks all the residents, visitors and staff for their assistance with the inspection process. What the service does well: The programme of extensive building work and refurbishment was completed in March 2007. The home provides an attractive, clean and safe place for residents. Residents feel well cared for by the staff, and all comments about the staff were very complimentary. Comments included about what the home does well included: ‘care and consideration to patients’; ‘does its best to treat my mother with dignity’. Residents enjoy the range of activities provided, and appreciate the qualities of the activities organiser. The general manager of the home, Ms Keren Welch, has been in post for 18 months providing continuity in management of the home for residents and staff. DS0000040174.V345441.R02.S.doc Version 5.2 Page 6 Residents’ families and representatives say that the home communicates well with them about any important issues affecting their loved ones. What has improved since the last inspection? What they could do better: Residents’ care records and updating of these when their care needs change, should be improved, so that the home can show to what extent the care given has improved the resident’s quality of life and wellbeing; or if not, what changes in the prescribed care have been made. In particular, where visiting specialist advisors have suggested changes in the way in which a resident is cared for, their care plan should show whether staff have followed the most recent guidance, for example, in care of wounds and the nutritional risk assessment and care for residents. DS0000040174.V345441.R02.S.doc Version 5.2 Page 7 Improvements should be made to the home’s records relating to staff recruitment to show evidence of individuals suitability to work in the care service and to provide a clear audit trail of the process by which people are recruited. Records of any complaints or concerns raised by residents and their representatives should show that complaints are dealt with in a timely and effective way, so that people are confident that their concerns have been looked into and actions taken to resolve them. Residents and relatives’ comments showed that there is concern about the number of staff available to provide the care needed by residents. The general manager said that there are plans to increase the numbers of staff as more residents come to live here. The increasing care needs of residents and people admitted to the intermediate care unit, show that the staffing levels and skill mix should be reviewed and amended to make sure that there are always sufficient staff to meet the residents’ assessed care needs. 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. DS0000040174.V345441.R02.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 DS0000040174.V345441.R02.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. People’s needs are assessed prior to admission of the individual so that the home can be confident that the placement is appropriate and will meet the resident’s care needs. The pre-admission assessment process for people admitted to the short stay intermediate unit should be reviewed to ensure that the home’s staff are always aware of the nursing and medical needs of prospective service users before they are admitted and can be confident that the home can meet those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Head of Care, a registered nurse from the care home, assesses all individuals before they come to stay at Middletown Grange. Pre-admission information usually includes information from family or friends, health professionals or social workers. DS0000040174.V345441.R02.S.doc Version 5.2 Page 10 For those coming from hospital to the care home for intermediate care before returning home, a member of the Primary Care Team carries out the assessment, and to make sure that all the needs can be met, discusses the arrangements with the home’s general manager and Head of Care before the individual is admitted. The inspector noted that the care needs assessment of a recently–admitted intermediate care service user was incomplete and it appeared that a GP had not agreed to take over the person’s medical care before their transfer from a local hospital. The home has an agreed protocol that includes the signed acceptance of a GP to provide medical care for prospective intermediate care service users prior to accepting their admission to the home. The inspector discussed this with the general manager and Head of Care. The agreed protocol should be reviewed and the multi-disciplinary team reminded of the system to ensure that the home’s staff have all the relevant information and support from professional colleagues before accepting new admissions. The registered manager must be able to confirm that they can provide the number and skill mix of staff to meet the assessed needs of people receiving intermediate care. DS0000040174.V345441.R02.S.doc Version 5.2 Page 11 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 adequate. Overall, the health care needs of residents are met with evidence of good multi disciplinary working taking place. The care planning system needs further improvement to adequately provide staff with the information they need to satisfactorily meet residents’ care needs and to demonstrate that care is monitored and evaluated effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector assessed the detail of four residents’ care records. The home is in the process of updating residents’ care plans and care records that are held in individual folders in the nurses’ station offices. The care records for the nine service users admitted from another care home were not included in the sample looked at by the inspector, as service users are cared for by staff from that home and their care records are maintained separately by those staff. The care records viewed contained detailed assessment for the dependency and risk factor scores, such as risk of pressure-related skin damage (‘pressure DS0000040174.V345441.R02.S.doc Version 5.2 Page 12 sores/ulcers’) and malnutrition. There was evidence of input from specialist health and nursing care practitioners where residents have particular health care needs. However, there were not always care plans or up to date records about some specific aspects of care needed by the resident. For example, someone assessed as at significant risk of malnutrition (and who had a low body weight) and sacral skin damage, did not have care plans detailing how their nutrition or wound care were to be addressed. It was not apparent whether the instruction ‘refer to a dietician’ dated April 2007, had been followed up. A clinical psychologist had assessed a resident but the suggestions made about how staff could improve their communication and interventions with this person had not been transferred to their care plans. There was no evaluation of to what extent, if any, staff interventions had improved the condition of these residents. The Head of Care acknowledged that some care records were not up to date and said that there was insufficient time for staff to manage this along with the practical care needed by residents, many of whom are very dependent. However, Head of Care pointed out that the home does not use agency staff and the staff have a detailed verbal handover at the beginning of their shifts, so that they are kept up to date about any changes in residents’ condition and care needs. In one of the care plans looked at there was a good example of the life history of a resident who is no longer able to communicate themselves, and signed by a family member. The manager asked the resident’s permission to show the inspector their ‘life story’ book that included photos and descriptions of their work, family and friends. The life storybooks are a valuable way for staff to be able to understand residents’ former interests and lifestyle, and helps staff to acknowledge, support and develop their daily social life and activities in and around the home. The care records for people admitted to the intermediate care unit are less detailed because of the focus on their physical rehabilitation and short length of time in the unit before they are discharged to their own homes. The inspector looked at the care records for a service user recently admitted. This person had extensive and complex health care needs and the manager and Head of Care had delayed their admission until more information about the person’s care needs could be provided by the hospital discharging them. The inspector spoke to a physiotherapist involved with the intermediate care residents, who was satisfied with the care of the individuals at the home. DS0000040174.V345441.R02.S.doc Version 5.2 Page 13 One health care professional responded to the CSCI comment card; his or her responses indicated that the assessment arrangements, monitoring and attention to the health care needs of residents, and skills and experience of staff to support individuals’ social and health care needs are ‘usually’ satisfactory. However, this person also felt that there should be ‘more staff available to manage clients with dementia’. Another health care professional considered there are too few nurses to manage the care of frail elderly patients. This professional is not satisfied with the way in which the home communicates and works with them and is not satisfied with the overall care provided to residents in the home. Two residents who completed the commissions survey questionnaires indicated that they considered they ‘always’ receive the care and support they need and that this is ‘usually’ the case for their medical care. The inspector looked at the system in place for managing residents’ medication in the home. Medication, including controlled drugs, is appropriately recorded at the home, and a contract is in place regarding the safe disposal of drugs. The inspector noted that medications were being given out by a nurse at approximately 10.30 am and queried whether these were ‘morning’ medications and whether there was sufficient spacing of ‘drug rounds’, if lunchtime medications were due at 12.30. Nurses spoken with said that they are careful to ensure that medications required to be given evenly spaced throughout a 24 hour period (for example, anti-Parkinsonism medication, analgesics and antibiotics) are recorded and given to adhere to the prescription instructions. Residents’ medication administration record (MAR) charts seen were correctly completed and showed that residents had received their prescribed medication. Some charts had handwritten amendments written by staff on the verbal instruction of the doctor. It is best practice to request the doctor to check and countersign any changes to the MAR chart in person and preferably within 24 hours of any verbal instruction being made and/or to faxinate the new instructions. If this is not possible, the nurse taking the message to amend the MAR sheet should have a second nurse check and countersign his/her entry. This provides an additional safeguard against medication errors with possible ill effects for residents. Residents said that staff treat them with respect, and that their privacy is respected and this was evident to the inspector when she observed how staff spoke to and assisted residents. DS0000040174.V345441.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good Residents have opportunities to take part in a variety of interesting activities within the home and community that generally meet their individual needs and preferences and improve their quality of life. The food in the home is good and meals are balanced, nutritious and cater for the dietary needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a varied activities programme organised by an experienced and activities co-ordinator. One of the ground floor sitting rooms is equipped for activities such as arts and craftwork with residents. In addition to any group activities, the activities worker tries to spend some individual time with those residents who are unable or do not wish to join a larger group. Residents are involved in the planning of various activities and outings and the programme is very flexible to meet the needs of residents on a day-to-day basis. There are few opportunities for social events and organised activities in the evenings and weekends. Two residents told the inspector that the evenings were boring with just the T.V or reading to occupy them, and few residents who were able to hold a conversation with them. The manager said that an additional activities worker had been appointed so this will enable the frequency and variety of activities to be extended. The manager also DS0000040174.V345441.R02.S.doc Version 5.2 Page 15 acknowledged in the AQAA document, that care staff need to be more involved and confident in arranging recreational and social times with residents at times when the activities co-ordinators are not available. Several staff told the inspector that there were too few care staff to help residents to get ready for organised activities in the home and trips out. Residents care records (profiles) seen by the inspector included ‘life stories’ that indicate residents’ likes and dislikes (if they are unable to communicate these themselves). The activities organiser records the resident’s participation in activities and social events on an activity record sheet in their notes and undertakes a monthly review of these. The first floor is called ‘Memory Lane’ and accommodates people living with dementia. There are a number of pictures and objects familiar residents around the corridors and sitting rooms – old style radios, pictures of old farm equipment and tractors etc. A dresser with numerous drawers in it is used by residents to collect and ‘tidy’ away objects and articles they pick up as they move around the corridors. The manager stated in the AQAA return that, with the completion of landscaping, raised garden beds and a footpath around the grounds there would be more opportunities for meaningful outdoor activities such as gardening. Other improvements planned are to introduce music therapy and massage for residents. The home has its own minibus allowing a limited number of residents trips out to Witney, local garden centres and other places of interest. One resident spoke of her particular enjoyment of trips to a local antiques centre. The inspector joined residents for lunch in the ground floor dining room. The layout of the dining area and the timing of meals has been changed recently. The current arrangement of dining tables was cramped and did not allow easy movement for staff and residents to and from the tables or for staff to sit by residents if they need help with eating their meals. The home has a part-time hostess and prepares tables for lunch and assists residents. This person was not on duty on the day of the inspection and the manager laid tables and assisted a resident with their meal. Residents spoken with enjoyed their meal and said that the food was usually very good. The menu was on display in the corridor outside the dining area. Main course choices were sausages in onion gravy or vegetable lasagne, followed by a lemon meringue pie with cream or ice cream, or yogurt. Tea and coffee was served after the meal. The home has staff from a very wide range of different ethnic backgrounds. By contrast, the majority of residents are white, British and Christian. The DS0000040174.V345441.R02.S.doc Version 5.2 Page 16 home encourages positive approaches to equality and diversity, by using ethnicity to share experiences, for example, celebrating different national holidays, religious and feast days, by having food and drink choices representing the various nations. The home plans to extend this by having a monthly ‘Kulture Korner’ which demonstrates clothing, pictures and other cultural items from around the world, and inviting residents to take part in some cooking of ethnic dishes. From other evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. DS0000040174.V345441.R02.S.doc Version 5.2 Page 17 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 & 18 Quality in this outcome area is adequate. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. However, formal processed need to be further developed so that the home’s procedures are understood, consistently applied and can be audited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is freely available to all residents, and residents who responded to the Commission’s comment cards said that they knew who to speak to if they were unhappy with their care. Two residents told the inspector that they knew who to complain to within the home, and were confident that their concerns would be taken seriously. The inspector looked at the homes complaints record. This included copies of correspondence to a complainant and indicated that the person’s concerns had been investigated and the outcome shared with the complainant. However, the timescales and outcomes had not been dated to show that the home had responded within the timescale stated in the homes own complaints procedure. It was not clear whether the complainant was satisfied with the outcome, or whether staff had been informed about the nature of the complaint and any action they may need to take to prevent a recurrence. The manager states in the AQAA return that care is monitored to prevent complaints and to help staff understand their role. However, the inspector DS0000040174.V345441.R02.S.doc Version 5.2 Page 18 considered that it was not clear from the homes records whether nursing and care staff are aware of the process for bringing any ‘informal’ verbal concerns or complaints to the attention of managers so that residents and their relatives can be confident that their concerns have been heard and will be looked into. Since the last inspection concerns have been brought to the attention of the Commission by two social care professionals: one about the assessment of a service user’s personal needs and one in relation to meeting the physical and emotional needs of a client. They have been advised to put their concerns in writing to the home manager. The home has policies regarding the safeguarding adults and the manager was aware of the local procedures to investigate any concerns. Staff have initial training on the safeguarding of adults at induction and annual training updates are provided. DS0000040174.V345441.R02.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is excellent. Since the last inspection the programme of extensive new building and refurbishment has been completed and now provides residents with very attractive, clean and comfortable accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, an extensive programme of rebuilding and refurbishment has been completed. This has improved the environment for residents by upgrading most rooms to include en-suite facilities, new assisted bath and shower facilities, and replacing soft furnishings and chairs and redecorating. The kitchen and laundry are new and meet current environmental health standards. New emergency call bell, fire alarm, phone and computer systems have improved the technical security and responses to residents. DS0000040174.V345441.R02.S.doc Version 5.2 Page 20 The intermediate care beds are now in a separate area on the ground floor, with a sitting room and adapted kitchen and area for physiotherapy. Access to the home is by electronic keypad and the grounds are safe for all the residents. The inspector noted that the front door to the home sticks preventing visitors or residents opening it: this should be adjusted. On the morning of the inspection, a tradesman, visitor and the inspector gained entry into the home without being noticed by staff because the receptionist was not available and the door was not locked. There was a potential for unauthorised people to access residents’ rooms and property. Staff should be alert to times when the reception area is not staffed and should activate the front door electronic keypad to protect residents’ privacy and security. The home was clean and mainly odour free. Residents’ comment cards showed that the home is ‘always’ or ‘usually’ clean and fresh. One area smelled unpleasant and the manager explained that the new sluice room equipment had not yet been commissioned and was not yet in use. The inspector strongly recommends that the home has functioning sluice disinfector equipment in order to reduce the risk of infection in the home. Staff have supplies of protective gloves and aprons, liquid soap and disposable towels for their use to reduce the risk of cross infection. The inspector noted that there were no engaged/vacant indicators on bathroom doors and recommends that there is some means of showing staff and residents when the bathrooms and toilets are in use to protect residents’ privacy and dignity. DS0000040174.V345441.R02.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is adequate. Staffing numbers and skill mix do not always meet the assessed care needs of residents in the home and must be reviewed to improve the match of suitably qualified staff and ensure residents receive consistent care. The arrangements for the induction training and supervision of staff are satisfactory. Progress is being made to improve the staff training programme that will have a positive effect on residents’ care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As identified in previous sections of this reports, comment cards sent out on behalf of the Commission, comments made to the inspector by staff and visitors on the day of the inspection, and the inspector’s own observations during the inspection, indicate that residents’ care needs are not consistently met by the number and skill mix of staff on duty. On the first floor (Memory Lane) during the morning there was 1 RN and 5 care staff looking after 19 residents who have dementia. During the afternoon and evening, staffing numbers remained the same for the ground floor (1 RN and 3 care staff) and for Memory Lane, there was 1 RN and 4 care staff. Overnight, there are 2 RNs and 3 carers for the whole home. DS0000040174.V345441.R02.S.doc Version 5.2 Page 22 The manager said that from the first week of August the staffing numbers would be increased on the frail elderly ground floor unit to provide an additional care staff member throughout the day. When full (on the day of the inspection, the home had 2 vacancies, excluding the 9 places used by temporary residents from another care home) the manager said staffing levels for the ground floor would be further increased to a total of 2 RNs and 4 care staff during the day. Also the night staffing will be increased to provide 2 RNs and 4 carers for the whole home. Nine residents who were transferred from their flooded care home have been accommodated in new rooms on the first floor and are looked after by a separate staff team from their own care home. During the day the inspector noted that several residents were left in their wheelchairs sitting at dining tables for at least half an hour after the meal had ended. Several of these residents were confused and calling for staff help. There were too few staff available to assist residents to and from the toilet and then to their rooms or a comfortable easy chair in the lounge/conservatory area. There were no staff available to residents in the communal areas of the ground floor for long periods because staff were busy seeing to the physical needs of residents in their own rooms. Similar concerns were raised in the last inspection report. The manager and head of care said that the care needs of people admitted to the intermediate care unit are more complex than when the unit first opened. The Head of Care said that more time is required by her or another RN to oversee the admission and discharge process for intermediate short-stay service users and to monitor their nursing and clinical care needs. The manager must undertake a review of the staffing levels, skill mix and deployment of staff to ensure that residents care needs are met. The AQAA information shows that 3 of the current 16 care assistants have achieved National Vocational Qualification (NVQ) Level 2 in care. Ten of the care assistants are qualified general nurses in their own country of origin and 2 are registered midwives. A further 8 staff are working towards an NVQ 3 in dementia care qualification. All new staff attend corporate induction, which is completed within six weeks of starting work. All staff have personal development plans, and staff training is well organised by the manager. The inspector saw the recruitment files of three staff members. There was evidence that the correct screening checks and references had been received prior to starting new staff in employment. However, there was some missing information such as copies of letters of job offers, job descriptions and signed DS0000040174.V345441.R02.S.doc Version 5.2 Page 23 contracts. The staff files could be improved by maintaining an audit check list to show when information had been requested and supplied by applicants. DS0000040174.V345441.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. The management and administration team for the home are relatively new and are still establishing their respective roles and responsibilities. Further development is needed to ensure that the aims and philosophy of care for residents are effectively delivered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The general manager for the home, Ms Keren Welch, has now been in post for 18 months. She has successfully completed the process to become the registered manager for the home. She has a Diploma in Health and Social Care, a certificate in equality and diversity, and an award in care of people living with dementia. She is studying for her Registered Manager (NVQ Level 4) award and to become the moving and handling trainer for the home. DS0000040174.V345441.R02.S.doc Version 5.2 Page 25 A Head of Care, who is a registered nurse, has been appointed to oversee and supervise the nursing care of residents in the home and liaise with the general manager. The Head of Care has approximately 16 hours per week as supernumerary (that is, not included in the number of staff who provide direct care to residents) to carry out assessments of prospective residents and provide support and supervision to nurses and care staff. A receptionist and finance administrator have also been appointed in the past 12 months to complete the management and administration team. The home is part of a large company that provides additional staff advice, support and resources. Relatives or representatives manage relatives’ personal money, and residents are invoiced for additional expenditure such as chiropody or hairdressing. The company’s quality assurance system includes regular visits by the hospitality manager to oversee quality issues about food, the laundry service and the environment. There are regular quarterly residents meetings and questionnaires are sent out annually to residents, relatives and other representatives to complete to give their views about the homes services. The home has a safe working practice policy and provides training for staff on safety topics. A named staff member is responsible for health and safety and a health and safety committee meets regularly. All the appropriate checks are carried out regarding fire precautions, and contracts for the maintenance of equipment are in place and are carried out regularly. The inspector observed 2 instances of poor moving and handling by 2 staff members when transferring residents, on their own, from wheelchairs to armchairs in the conservatory area of the home. This was discussed with the general manager who said she would remind staff of the importance of using the safe recommended moving and handling techniques to protect residents and staff from unnecessary injury. From the comments received in writing and during the inspection, and from her own observations, the inspector considers that more work is needed to improve staff skill and deployment in order to achieve the home’s stated aims and philosophy of care for residents. DS0000040174.V345441.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 3 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 2 X 3 X 3 X X 2 DS0000040174.V345441.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP27 Regulation 18 Requirement Review the staffing numbers and skill mix to ensure that there are suitably qualified, competent and experienced staff to meet the health and welfare of service users. Timescale for action 26/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The care needs of service users admitted for intermediate care should be fully assessed and the local protocol agreed with the PCT should be adhered to so that the home can assure service users that it can meet their assessed care needs. Care plans should be sufficiently detailed to inform the staff of the actions needed to meet residents’ care needs and should be reviewed and evaluated to describe the extent to which prescribed care has met residents’ assessed care needs and preferences. Good practice guidance should be followed and the doctor requested to countersign any hand written amendments DS0000040174.V345441.R02.S.doc Version 5.2 Page 28 2. OP7 3. OP9 4. 5. 6. OP10 OP15 OP16 7. 8. 9. OP19 OP26 OP29 10. OP38 made by the homes staff to MAR charts following the doctors’ instruction. If this is not possible the nurse who received the instruction and made the amendment should have a second staff member check and countersign the MAR chart. Review the signage on bathroom/wc doors to protect residents’ privacy and dignity when using these facilities. Consider changing the use/layout of the ground floor dining area to improve space and access for residents and staff assisting them at meal times. Improve the recording of complaints and concerns to demonstrate that the home has a consistent and effective complaints management procedure and to enable effective auditing of complaints so that future practice can be emended. Ensue the privacy and security of residents by monitoring access to the home. Adjustments should be made to the front door to ensure it opens and closes freely. Ensure that the sluice disinfector units are functioning correctly to clean and disinfect contaminated equipment. Improve the standard of recording in staff files to provide an audit trail and evidence of a rigorous and consistent process for staff recruitment and appointment. Ensure that all staff adhere to safe moving and handling practices to reduce the risk of injury to residents and themselves. DS0000040174.V345441.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000040174.V345441.R02.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!