Inspection on 15/08/07 for Morris Grange Nursing Home

This inspection was carried out on 15th 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

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Morris Grange Nursing Home Great North Road Middleton Tyas Richmond North Yorkshire DL10 6NX Lead Inspector Anne Prankitt Unannounced Inspection 15th August 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morris Grange Nursing Home DS0000069571.V335858.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. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morris Grange Nursing Home Address Great North Road Middleton Tyas Richmond North Yorkshire DL10 6NX 01748 826266 01748 824074 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) Grange Property Holdings Limited Mr James Ferris Care Home 71 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (54) of places Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE The maximum number of service users who can be accommodated is: 71 N/A 2. Date of last inspection Brief Description of the Service: Morris Grange is a one-storey nursing home situated in large grounds in a rural position off the A1 trunk road near Richmond. There is parking provision at the front of the home. It is divided into two adjoining units. It is registered to provide nursing care, and care for people with dementia. The Commission received confirmation on 30 April 2007 that the current weekly fees range from £317 to £512. Hairdressing, except for permanent waves, is paid for by the provider. Additional charges are made for individual newspapers, and outgoing telephone calls. Bedrooms are fitted with telephone sockets, and service users can have a private telephone. Some of the bedrooms have a private conservatory. There are also communal conservatory facilities. A brochure about the home is sent out whenever an enquiry is made. Information about the home is also given to people within the service users’ guide and Statement of Purpose. The inspection report will be available for those who wish to look at it. There has been a change of ownership since the last key inspection. The home is now owned by Grange Property Holdings Limited. They have appointed a new manager who is now registered with the Commission for Social Care Inspection. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the newly appointed registered manager, Mr Jimmy Ferris, returned a Pre Inspection Questionnaire, which provided information about Morris Grange Nursing Home. Surveys were sent to a selection of people who live at the home, their families, and some visiting professionals. A record has also been kept about what has been happening at the home since it became newly registered. During the site visit, discussion took place with some of the people who live at the home, so that their views about the service could be sought. Time was also spent looking at some documents, making a general tour of the communal areas and viewing a sample of private accommodation. Some people who live at the home are more able to express their views than others, so time was also spent observing the general care given where appropriate, and of the approach and attitude of staff towards the people who live there. The site visit took approximately nine hours to complete. The overall general response from the surveys, which was very positive, was fed back to the registered manager. Any negative points made were also discussed with him. All responses were treated anonymously. All of the information gathered was used to form a judgement about the service that Morris Grange offers to the people who live there. The registered manager and his deputy were available throughout the day. They were provided with feedback at the end of the site visit. What the service does well: People who are thinking of living at the home have their needs assessed before they are offered a place. This helps to check that the home will be able to meet them. People’s needs are written down in their care plan. This helps staff to provide care in a consistent way. Relatives’ comments were generally very positive, and included: ‘I am very satisfied with the care. My relative has improved’, ‘I think the care home does really well’, ‘The emphasis is on high grade caring and this is maintained at all times’, ‘Nursing care is of an excellent standard’. One health professional commented ‘First class nursing care’. People are given choices in their daily lives, and flexibility, so that they can continue to enjoy their own routine wherever possible. One person said ‘It’s just like being at home. I can have a shower when I want, and the staff give Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 6 me choice’. Another said that staff help them to remain an individual. ‘I have telephone, music, visitors when I want, the daily newspaper delivered, and the use of the home’s bus which gets me out’. Visitors are made welcome into the home. This helps people to maintain contact with their families and friends. People are confident that they will be listened to if they complain. Staff know their responsibilities in passing on any concerns which affect the safety and vulnerability of people. There is a staff training programme in progress which is looking at areas where further training is needed so that people get good safe care. The registered manager and his deputy want to make sure that the home is a good place for people to live in. What has improved since the last inspection? What they could do better: The ways in which people’s views are sought could be improved upon when deciding how the home should be run, so that they know that their views are being taken into account. The environmental health officer could be contacted to seek their advice about the provision of fly screens in the kitchen, and to make sure that he is happy with the improvements that have been made in the kitchen service. The cracked floor covering in the laundry could be repaired so that it is easy to keep clean, and the risk from infection reduced to a minimum. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 7 The fire officer could be asked to check that the improvements being made to the systems meet with current legislation, and properly protect the people who live at the home. Training for staff in all areas of safe working practice could be updated to make sure that they are providing care in the safest possible way. The way that ‘when required’ medication is monitored and recorded could be improved, so that it is clear which people are able to tell staff when it is required, and which are not. 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. Morris Grange Nursing Home DS0000069571.V335858.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 Morris Grange Nursing Home DS0000069571.V335858.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 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Specially appointed staff always try to meet people before they are admitted to the home, when they collect information and carry out an assessment about their needs. Information is also collected from other professionals, such as hospital staff and care managers. This helps staff to check that the home will be able to meet these needs properly. People and their relatives are also offered the opportunity to look round the home if they wish, so that they can see what it is like. This helps them to make more informed decisions about whether they want to live there. In addition to the care that the home could previously provide, it is now also registered to provide care for up to ten people with dementia, but who do not have nursing needs. These people will be accommodated in the main part of Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 10 the building. As yet there has been nobody admitted who falls into this category of care. But the registered manager has made sure that twelve staff have received extra training in dementia care, so that they are better equipped to meet these people’s needs should they be admitted in the future. The home will accept referrals from the rapid response team, who send their own team of physiotherapy and occupational therapy staff to the home in order to carry out an assessment. These placements are ‘spot purchased’. There are no beds at the home which are block purchased by the Primary Care Trust, who pay for the initial two weeks of care for people admitted under these arrangements. It is General Practitioners who mainly make the initial referral to the rapid response team. The referrals are regarded as ‘transitional’ placements, when people receive a period of assessment during which it would be decided whether or not they require intermediate care. Should this be the case, then the person would be transferred to an ‘independent living scheme’ placement where they would receive proper intense input which is not provided by the home. Intermediate care is not provided. Morris Grange Nursing Home DS0000069571.V335858.R01.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 People who use the service experience good quality outcomes in this area. People’s care is generally well planned and delivered. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Each person has a care plan which explains what their needs are, and whether there are any risks involved in their care. Equipment is available to help maintain people’s health, such as pressure relieving equipment and special beds. The care plans seen included information to help staff understand people’s social and emotional needs, as well as general care needs, such as how people should be helped to maintain continence. The plans were of good quality, person centred, and reviewed regularly. This helps to make sure that people are treated as individuals. This was evident on the day of the site visit, when a person was reviewed by the General Practitioner because staff had noted that they seemed to be in pain. Their care was adjusted accordingly. People’s named nurse keeps their care plans under review. Staff explained that they tell people and their relatives who the named nurse is, and that they try to introduce themselves to people when they are first admitted. One member of care staff said how they always try to give care according to people’s Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 12 wishes. One care plan discussed with the deputy manager was quickly changed to reflect current need where there were some anomalies, which could have resulted in the care needed being misunderstood. The plans identified that the advice of professionals is asked for when needed. The overwhelming majority of relatives spoke very favourably about the home: ‘I am very satisfied with the care. My relative has improved’, I think the care home does really well’, ‘The emphasis is on high grade caring and this is maintained at all times’, ‘Nursing care is of an excellent standard’. One health professional commented ‘First class nursing care’. The medication kept by the home was generally well managed. Systems are now checked weekly to make sure that there are no errors occurring which could be detrimental for the people whose medication staff look after. The records seen were well kept and up to date. Where people choose to look after their own medication, the staff monitor any risks to them regularly. They also keep a record of the medication that they are taking, so that the information can be passed on in the case of emergencies. However, the way that ‘when required’ medication is recorded by staff could be improved upon, especially where a decision has been made by them that the person receiving the medication does not have the capacity to explain whether or not they are in pain. Morris Grange Nursing Home DS0000069571.V335858.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 People who use the service experience good quality outcomes in this area. People can maintain important contacts with their family and friends, and care is taken to help them meet their social needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There is now an activities person working full time at the home. People appreciate her input, and she was organising both group and individual activities on the day of the site visit. This will help to make people’s lives more interesting. A staff member on the dementia unit commented that the activities organiser had made a big difference to people’s social input. She explained how people who stay in their rooms are offered one to one activities such as foot massage, nail care and music. A relative commented: ‘…….. has improved dramatically since the activities person was put into place’. Representatives from three religious denominations visit the home regularly to assist in meeting people’s spiritual needs, and the home has a contact who they would approach should they need to locate any other clerics of other denominations should people with more diverse spiritual needs be admitted. Since the new owners took over, they have provided transport, which can accommodate wheelchairs, so that people who live at the home can benefit Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 14 from trips out. As the home is set in isolated surroundings, this will be positive for the people who live there. One staff member explained that nobody is excluded, and everyone who lives at the home has the opportunity to go on trips where their health allows. People can have visitors at any time. They were pleased that they were welcomed into the home, and that there were no restrictions placed upon where they could have their visit. Staff were seen welcoming people into the home during the day. The routine on the day of the site visit appeared quite relaxed. Staff said that this is how they tried to work, so that the routine could be flexible. People spoken with were very happy about the flexibility in the routine, which they said allowed them to rise and retire when they wished. They felt that their personal choices were considered by staff. One person said ‘It’s just like being at home. I can have a shower when I want, and the staff give me choice’. Another said that staff help them to remain an individual. ‘I have telephone, music, visitors when I want, the daily newspaper delivered, and the use of the home’s bus which gets me out’. People enjoy the food at the home. They get a choice of menu at each mealtime, and are offered three meals and supper each day. Food is available over a twenty four hour period. The only complaint was that sometimes people get too much food. The chef asks people each day what they would like to eat. By doing this, he has an idea about what is popular and what, if any, changes need to be made to the menu to satisfy people’s likes and dislikes. One person commented: ‘On the odd occasion I don’t like the menu the chef always provides me with a special treat.’ The chef was satisfied that presently he has sufficient budget to provide people with good quality meals, and choice of menu. The dietician visits people on request, and the registered manager has asked her about the menu generally, so that he can be satisfied that it is properly balanced and nutritious. The staff give the chef information so that he knows whose meals need to be fortified, or who has special dietary needs. The kitchen records have been updated in line with the ‘Safer Food, Better Business’ guidelines, as recommended by the environmental health officer. This will help to make sure that people get food which has been safely stored, cooked and served in premises which are fit for purpose. There are three separate dining areas. Staff are available to help people in each area when needed. People can also eat in the privacy of their own room if they choose to. People appeared to enjoy their meal. Morris Grange Nursing Home DS0000069571.V335858.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 People who use the service experience good quality outcomes in this area. People are protected by a staff team who will act appropriately on concerns brought to their attention. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There have been no complaints made to the home since the new owners took over. The complaints procedure was displayed at various points around the home so that people could see how their complaint would be handled. Staff were very clear about their responsibilities in passing on complaints without fail to the management. People spoken with thought that their complaints would be dealt with by the management to their satisfaction. A relative said ‘Jimmy (the registered manager) is very visible. I would go to him if I had a problem’. There has been one anonymous concern raised with the Commission for Social Care Inspection which was referred to social services and discussed as a group with the home. The referrer provided very limited information to help the management at the home resolve the issues raised, which were around poor state of equipment, an abundance of flies and ants in rooms, and also that people’s pain was ignored. Despite the lack of information provided, it was evident at the site visit that the management have tried their best to resolve any issues raised. All staff have attended a meeting where the issues were discussed. This will help to protect people from harm. Evidence gathered at the site visit however suggested that people were being properly looked after. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 16 All staff spoken with knew that they must report anything to the management where they thought that people had been wrongly treated, and they knew that they could not keep this information to themselves in such instances. The management were also very clear about their responsibilities in reporting such matters to the local authority so that they could be investigated without delay. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. The planned or completed improvements to the environment will be of benefit to the people who live at the home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The building is separated into two areas. It overlooks large grounds which are currently being upgraded, to include areas where people will be able to enjoy their surroundings in safety. Some relatives commented that they were pleased that this work, which they believed to be overdue, was underway. One relative commented; ‘ My relative gets out into the fresh air now. They get taken out in their wheelchair’. Main Area This area is divided into separate wings. Some corridors are wide, allowing easy access for those with motorised scooters. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 18 There are five bedrooms which are not currently registered because they need to be refurbished to a better standard before they can be used by people who choose to live at the home. They are currently being used for storage purposes. The communal sitting and dining areas were being decorated at the time of the site visit. It is also planned that individual bedrooms will be decorated as required as part of a rolling programme of works. This will make the environment more pleasant for people. People’s bedrooms are individualised, and contain personal belongings. Many of the bedrooms in this area of the home have their own conservatory area, which people can use as their own private sitting area. One person said ‘I like my room with the view of the countryside’. A new ‘walk in’ shower room has also been created. This gives people extra choice. One person did not have access to their call bell when in bed because the room had been reorganised. This was discussed with the person concerned to see whether any changes needed to be made whilst they occupied the room. It was decide that they would be transferred to a different room where access would be easier. Staff need to take this into consideration on future admissions. The Dementia Unit The registered manager has plans to make the communal bathroom more bright and airy for people. Aids to help with orientation have been provided, including a board which is changed daily to reflect the day, date and weather. A large clock has also been provided. A small kitchen is also planned, so that staff have better access to running water for people’s drinks, without having to leave the unit. The new owners have bought some new beds, specialist mattresses and new wheelchairs as part of their plans for improvement. They are currently discussing the provision of an additional hoist. There are good systems in the laundry for managing infection control. Clear details are provided about anybody whose laundry needs to be handled carefully. But the laundress said that care staff make sure that soiled lined is delivered in special bags, and that she is provided with protective clothing. She was satisfied with the range of equipment that she had been provided with, and people’s clothes looked well care for. The laundry floor covering is beginning to crack. This will make it more difficult to keep clean, and could increase the risk of cross infection. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. Staff are provided with training to help them provide good care. Further attention to detail during the recruitment process, and planned update in all areas of mandatory training, will provide additional safeguards for the people who live there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: It was generally felt that there were enough staff to met people’s needs, although comment was made that extra staff each afternoon would benefit those people who live on the dementia unit, so that more one to one time could be spent with them. The registered manager is already considering this, and will review the staffing levels again when the unit becomes full. Although it could not be avoided, it was unfortunate that on the day of the site visit, two out of three staff working in the dementia unit were agency staff. This situation should be avoided wherever possible so that people get good continuity of care. However one staff member had worked on the unit before, and so knew something of people’s preferred routine. The agency staff spoken with explained that they had been given a mini induction before they started caring for people on the unit. This included information about the fire procedure and also rules about moving and handling. They were satisfied that this, together with individual information available in people’s rooms about their preferred routine, helped make sure that they gave the right care. The Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 20 trained staff member was available at all times, and was careful to oversee the agency staffs’ work. The registered manager, who is relatively new in post, has already made links with a local training organisation, so that he can enrol on a suitable management course. He has also made enquiries so that the National Vocational Qualification training for care staff can continue. This will help maintain a well trained workforce who provide the correct care for people. He is now looking at the training needs of staff. Twelve staff have recently completed dementia awareness training. A trained staff member said that they are also given opportunities to update their professional skills. Two recruitment files were looked at. In each case the police check and references had been obtained before staff had been allowed to provide care to people. This helps to keep people safe from unsuitable workers. The registered manager should make sure that they get a reference from the previous employer for new staff, or explore why they have not been put forward as referees. This was not the case in one file, although the deputy manager explained that in this situation, such a reference would be difficult to obtain. New staff undergo an in house period if induction, which is then underpinned with induction training provided by a training specialist, and which meets with current induction standards. This helps to make sure that new staff know what is expected of them in providing good safe care. As well as ongoing daily supervision, staff receive formal supervision three times each year. Staff think about what they would like to discuss before the session taken place. This helps to keep supervision focussed, which should benefit the people who live at the home. A record is kept of what is discussed. Mandatory training is not yet up to speed, but the registered manager and his deputy are in the process of addressing any shortfalls. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. The home is run by an enthusiastic manager and deputy, whose aim it is to make the home a better place for the people who live there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The majority of people spoke very positively about the new owners and management arrangements at the home. Staff comments included ‘Brilliant – the company are quicker to respond, and are getting the resources that we need quickly’. ‘I have met the area manager and I felt listened to’. A relative commented ‘There have been a good deal of improvements since new owners have taken over. They are giving families more information about amenities and social events’. The registered manager feels supported by the company for whom he works. He is extremely enthusiastic, and wants to make the home better for the Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 22 people who live there. He is in the early stages of seeking their views, and those of their relatives. Surveys have not yet been sent out to ask the views of people who live at the home, their representatives, and visiting professionals involved in their care. However, he is clear about how he intends to develop this further, so that the home is run taking into account people’s views. Staff commented about the new registered manager ‘Jimmy is OK. He is very approachable’. They explained how he gives time for both the people who live at the home and also their relatives. Another said that ‘there have been changes for the better’. He has however already set up a number of audits around the home to help to make sure that each area is properly run. The administrator, in the absence of anyone else being willing and able, collects the pension for one person, and keeps a record of their weekly personal allowances on their behalf. The money held could be reconciled with the records kept. Everyone else’s finances are managed by themselves, or a representative. Systems are in place to make sure that the in house maintenance checks are carried out regularly. These include the weekly check of the fire alarm system, bed rails and hot water temperatures. The records showed that the hot water temperatures in one bedroom, which was vacant, far exceeded that which is considered safe. But the registered manager had not been made aware of the problem. The temperature was checked on the day of the site visit and was now too cold. It was agreed that the registered manager should discuss with the maintenance man what information he needs to pass onto him so that such matters can be addressed without delay. This will help to protect people from unnecessary risk. Larger maintenance and services jobs are carried out by outside contractors, and there were records available to show that these had been kept up to date. This helps to protect people. The registered manager should however check with the owners of the Liquid Paraffin Gas (LPG) tanks which supply the home, as to how regularly they should be serviced, so that he is able to monitor that this is done. The company has taken action to upgrade the fire system at the home so that it gives extra protection in the case of fire. A risk assessment has been completed by a fire specialist. It would be good practice to now liaise with the fire authority so that the owners can be assured that no further action is required on their part in keeping people safe from the risk of fire. The registered manager has agreed to do this. The registered manager said that the works required in the kitchen by the Environmental Health officer have been completed, but that he intends to invite him back to check that he is satisfied with the action taken. There were no fly screens in the kitchen at this site visit. Advice must be sought from the Environmental Health officer about this matter, as the home is situated Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 23 amongst farmland, and flies can be prolific, although they did not pose a problem on the day. A contract is set up with the pest control team so that any problems can be sorted out quickly. Certificates were awaited for the Portable Appliance Tests which have recently been completed, and there were some services coming up for renewal, including the fixed wiring, emergency call bells and gas cooker appliance test. However, the registered manager was aware of these and stated that they were in hand, or due to be organised. This will help to keep the premises well maintained and safe for the people who live there. Staff have completed training in moving and handling and fire safety. The registered manager now needs to check that outstanding training in infection control and food hygiene, is completed. He also needs to complete a risk assessment to check that people have access to staff with appropriate skills in first aid, so that their health can be maintained in emergencies. Where he finds gaps, training must be provided. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 24 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 3 8 3 9 2 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 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 OP30 OP38 Regulation 13 Requirement All staff must receive training where appropriate in the following areas: • • Infection control Food Hygiene Timescale for action 30/09/07 So that people living in the home can be well protected from unnecessary risk. 2 OP30 OP38 13 A risk assessment must be completed to check what level of first aid training is required by staff at the home so that people can be assured that they will be given the proper first aid attention in emergencies. The risk assessment should consider • • • the needs of service users how likely it is that first aid will be needed what kind of first aid is likely to be needed. 30/08/07 Where a risk assessment is not completed, there must be a qualified first aider on the premises at all times. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 26 3 OP33 24 The quality assurance systems at 31/10/07 the home must be developed further so that people can be sure that any changes made reflect their views and are in their best interests. 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 OP9 Good Practice Recommendations Where people are able to tell staff when they need their ‘when required’ (prn) medication, this should be recorded in the care plan. The medication records should then be signed when the medication is actually administered. Where the person is not able to decide, and staff are making a decision on their behalf about whether or not they need their medication, then the home should record on each occasion why the medication has, or has not, been administered. 2 3 OP26 OP29 The laundry floor covering should be repaired or replaced to reduce any possible risk from infection. In order to protect people fully, a reference from the previous employer for new staff should always be obtained. Where this is not possible, the problem should be discussed, explored and recorded, including as to how the decision has arisen that sufficient evidence about their past employment history has been obtained. It should be clear what maintenance faults should be passed onto the registered manager so that such matters can be addressed without delay. This will help to protect people from unnecessary risk. The owners of the Liquid Paraffin Gas (LPG) tanks which supply the home should be consulted as to how regularly they will be servicing their equipment, so it can be assured Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 27 4 OP38 that is being kept safe and well maintained. The fire office should be invited to visit the home to check that he is satisfied that fire safety systems that have recently been improved upon, and the fire safety risk assessment which has recently been produced, properly protects people from the risk from fire. The environmental health officer should be invited to visit the home to check that the improvements made to the kitchen area meet with current regulation, and properly protect the people that it serves. They should be consulted to see whether fly screens are required in the kitchen area to reduce the risk from contaminated food. Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Morris Grange Nursing Home DS0000069571.V335858.R01.S.doc Version 5.2 Page 29 - 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!