CARE HOMES FOR OLDER PEOPLE
Neville Grange Resource Centre Queens Road Saltaire Shipley BD18 4SJ Lead Inspector
Carol Haj-Najafi Unannounced Inspection 23rd November 2005 09:45 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 Neville Grange Resource Centre DS0000033532.V266007.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. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Neville Grange Resource Centre Address Queens Road Saltaire Shipley BD18 4SJ 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) 01274 593399 City of Bradford Metropolitan District Council Department of Social Services Mr Roy Wilks Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (2) of places Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07 June 2005 Brief Description of the Service: Neville Grange is a local authority resource centre that provides a variety of services to older people. They offer long term and short term care, respite care and intermediate care. They also offer day care provision, which is not part of the registered service. The home is registered to provide personal care for up to 35 older people. It is situated in the village of Saltaire, which is an urban area of Bradford, and locally known as the doorstep of the world heritage site. Accommodation is provided on two floors and is offered in a combination of twenty-seven single and four double rooms. The first floor is accessed by a passenger lift. The home is divided into four separate units, two provide long term care, one respite, and one intermediate care. There is an enclosed courtyard, which offers service users a place where they can sit and socialise in a congenial setting.It is within easy reach of many local amenities including shops, post office, and a main bus route, and is close to Shipley Town Centre.St Peters church and churches of all other denominations are in close proximity.Parking to this facility is quite limited. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection between 09.45am and 3.45pm. The purpose of the inspection was to ensure the home was operating and being managed to a satisfactory standard. I spoke to thirteen service users, one visitor, five staff, including the deputy manager. I also looked around the home. Records were inspected including care plans, assessments, accident reports, financial records and complaints investigation records. Feedback was given to the deputy manager at the end of the inspection. The registered manager discussed the arrangements for keeping staff records at the home the day after the inspection. What the service does well: What has improved since the last inspection?
Records about service users are much more organised. A new care planning system has been introduced. Each service user has more information recorded in the plan of care, this provides clear guidance on how each person’s needs should be met. More assessments have been completed to help prevent service users from developing pressure sores or becoming malnourished. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 6 Bradford social services looks after finances for some service users, they now receive individual statements that tell them how much they have in the account. 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. Neville Grange Resource Centre DS0000033532.V266007.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 Neville Grange Resource Centre DS0000033532.V266007.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): 1, 2 & 6 The pre admission assessment process is good. Service users receive a guide which gives them information about the home, however, they do not receive a contract when they move into the home. The intermediate care unit is good, and service users benefit from a wellorganised and co-ordinated service. EVIDENCE: The home has produced a new service user guide and statement of purpose. The documents give good detailed information about the home. Two service users that recently moved into the home said they had seen the documents and thought they had provided them with useful information. They also said they were enjoying living at the home. A meeting was held to confirm the placement was suitable but this had not been recorded. The home arranged a visit from a specialist worker to assess how special needs could be met. Contracts are issued to long stay service users from Bradford social services headquarters although these are not issued at the point of admission and do not include the current range of fees or the room to be occupied. Respite care and intermediate care service users are not issued with contracts. Everyone
Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 9 should receive a statement when they move into the home so they are aware of the conditions that apply at the beginning of their stay. These shortfalls have been identified as requirements at the last five inspections. I looked around the intermediate care unit and ate lunch with three service users. All service users were pleased with the standard of care and level of support they were given. The unit has clear objectives and the reason for all admissions are defined. The deputy manager and staff were familiar with the objectives and explained how the unit operates. Each service user had a plan of care, risk assessments and individual programmes. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Care plans and risk assessments have improved and these are now more personalised and organised. However, there were gaps in how some needs should be met. EVIDENCE: The last inspection identified that more information should be included in care plans and some risks to residents had not been properly assessed. A new care planning system has been introduced. Each service user has a range of assessments, a service user plan, a night checklist and a bath and weight chart. The new system is good and better organised. I looked at four service users’ care records. Generally, plans of care contained good information about each service user. Service users are involved in devising and reviewing the plans. Staff have completed assessments for each service user. Some nutrition and pressure assessments identified areas of risk. However, there was no record of how these needs should be met. One service user had had an area of broken
Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 11 skin, which had recently healed. A relevant assessment or plan of care had not been completed. The service user had not been weighed since admission in September. One service user had fallen out of bed, an accident form was filled in but again an assessment or plan of care had not been completed. Service users were able to confirm that staff had taken appropriate action but this information was not recorded. Medication records were looked at. Most records are printed by the pharmacy but some records were hand written. On one hand written sheet the medication was written up twice, although there was no indication the medication had been administered twice it was confusing. Another sheet had the type of medication written up but the strength of the medication was not recorded and staff were not able to confirm the strength of the medication that was being administered. The deputy manager said both entries did not comply with the home’s medication policy. Two signatures for hand written entries would reduce the likelihood of errors. All staff that administer medication are completing a distance learning medication course. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 12 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): 14 Service users are clearly very happy and feel they have control over their lives. EVIDENCE: I spoke to thirteen service users. All of the service users were complimentary about the home. Many praised the staff and the standard of care, a sample of these, from service users are as follows; ‘a super home and super staff, it’s very nice here, they are marvellous, they ask me how I like things done, it’s like a five star hotel, they let you do things slowly, it’s very good, the best around’. Service users confirmed that they are able to choose when to go to bed and what they want to watch on TV. One service user, who was there for a week’s respite stay, brought their parrot with them. Staff spoke about promoting choice and gave examples. These included meal options, entertainment, clothing and activities. Some service users have telephones in their rooms, others can access a portable payphone. Neville Grange Resource Centre DS0000033532.V266007.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): 16 & 18 Service users are comfortable in discussing and reporting concerns. An appropriate complaint’s procedure is in place. Service users are safeguarded from abuse. EVIDENCE: Service users were asked ‘what they would do if they were unhappy about something in the home’. They said they would discuss it with the manager or staff. Two complaints have been received during the past twelve months, these have been thoroughly investigated and reports of the investigations are kept in the complaint’s file. A summary of the complaint’s procedure is included in the service user guide and displayed in the home. All staff have attended adult protection training, which was facilitated by Bradford social services. Staff were familiar with the procedure for reporting concerns or any allegations of abuse. Neville Grange Resource Centre DS0000033532.V266007.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, 20, 21, 22, 23, 24, 25 & 26 The home is very pleasant and service users are comfortable living there. Although the home does not meet the standard in relation to providing smoke free sitting rooms, steps have been taken to address this and the problem should soon be resolved. EVIDENCE: I visited all four units during my inspection. Each unit was clean, tidy and well maintained. Service users in all units said they were happy with the home. Service users that live at the home have personalised their rooms. Bedding and carpets were reasonable quality. Each bedroom has a built in wardrobe and drawer unit. There is equipment in the home that helps people with independence. The home is pleasantly decorated. The entrance and corridors were being decorated the weekend after the inspection. On the day of the inspection, one lounge was quite smoky. It has been identified at a previous inspection that the smoking arrangement should be
Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 15 reviewed, as two units do not provide smoke free lounges. A smoking room has been identified but some building work needs to be completed before this can be used. Plans have been agreed and the home is waiting for the work to commence. Neville Grange Resource Centre DS0000033532.V266007.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): 28, 29 & 30 The staff team have worked hard to achieve their NVQ awards, and have a good understanding of ‘good care practice’. The home operates a satisfactory recruitment process. EVIDENCE: The majority of care staff have completed NVQ level 2. Twelve staff have finished the award and three staff are in the process of completing it. One is completing level 3 and the deputy manager is completing the registered manager’s award. At present only one night staff has NVQ level 2. The deputy manager discussed the recruitment process that is co-ordinated centrally. The process includes full documentation checks and equal opportunities. The registered manager said recruitment records are held in the home, although these were not looked at during the visit. A shortfall in fire safety training was identified at the last inspection. Two fire safety courses have been arranged for 29 November. Neville Grange Resource Centre DS0000033532.V266007.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): 31, 33, 35 & 37 The registered manager is qualified and competent to manage the home. Some systems are in place to check the quality of the home but a formal survey would capture a wider range of service users and relatives views. Service users are not receiving the full amount of interest on their savings that they would receive if their savings were held in a bank or building society, therefore they are losing out financially. EVIDENCE: The registered manager has been in post for eight years. He is a qualified RMN and has completed the registered manager’s award. He also has other relevant management and social care qualifications. Staff confirmed there were clear management structures in place. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 18 Each unit holds service user meetings approximately every two months. The meetings are recorded and there was evidence that service users can put forward ideas and suggestions. Visits by a manager of another home and an independent person, to make sure the home is running properly are carried out once a month. These are called Regulation 26 visits. Positive findings and suggestions for improvements are put forward. Reports from the visits are kept in the home and sent to the CSCI. The deputy manager said quality surveys to find out service users views about the home have been completed in the past but these have not been done for some time. Mainly, service users or relatives are responsible for managing individual finances. Bradford Social Services is the corporate appointee those service users who need assistance with finances. Service users who have savings with Bradford Social Services do not receive any interest for the first £500; this does not comply with the care homes regulations or guidance published by the Commission for Social Care Inspection. Individual statements are issued to service users. All transactions are recorded and receipted; service users sign for monies received. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 19 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 3 2 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 X 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X 3 X Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 Requirement The registered person must ensure that all service users, at the point of admission, are issued with a statement of terms and conditions. (Timescales of 30/09/05, 31/03/05, 31/10/04 & 31/10/03 not met) The registered person must ensure the bedroom to be occupied and current charges are included within the statement of terms and conditions. (Timescales of 30/09/05, 31/03/05, 31/10/04 & 31/10/03 not met) The registered manager must ensure plans of care are recorded for risks that have been identified through the assessment process. In order to make sure the administration of medication is safe, all handwritten MAR (Medication Administration Records) must be checked and countersigned by a second person. The registered manager must ensure all staff receive fire
DS0000033532.V266007.R01.S.doc Timescale for action 31/01/05 2. OP2 5 31/01/05 3. OP7 15 31/12/05 4. OP9 13 (2) 31/12/05 5. OP30 23 30/11/05 Neville Grange Resource Centre Version 5.0 Page 21 6. OP35 20 training. (Timescale of 31/07/05 not met) The registered provider must demonstrate how each individual service user will receive any interest applicable to their individual savings. (Timescale of 30/09/05 not met) 31/01/05 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 OP33 Good Practice Recommendations The registered manager should carry out periodic surveys that provide service users with an opportunity to express their views about the home. Neville Grange Resource Centre DS0000033532.V266007.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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