CARE HOMES FOR OLDER PEOPLE
Norton Grange 46 Tern Grove Kings Norton Birmingham B38 9DN Lead Inspector
Monica Heaselgrave Unannounced Inspection 29th March 2006 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Norton Grange Address 46 Tern Grove Kings Norton Birmingham B38 9DN 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) 0121 458 5292 0121 458 1143 Birmingham City Council (S) John Christopher Wilkins Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. That the home is registered to accommodate 20 people over 65 years who are in need of care for reasons of old age. Registration category will be 20 (OP) Those minimum staffing levels are maintained at 3 care staff throughout waking of 14.5 hours. Not consistently complied with. That additional to above minimum staffing levels there must be two waking night care staff. 15th August 2005 Date of last inspection Brief Description of the Service: Norton Grange is a care home, owned and managed by Birmingham City Council. It is located in a residential area of Birmingham, set back from a main road where public transport can be accessed. Shops and community facilities are not located near to the Home. The Home was a purpose built two-storey building. The top floor is now not used. Accommodation and care is provided on the ground floor. All bedrooms are for single occupancy, with toilets and bathrooms for communal use. Facilities are split into two units, each with a dining room and kitchen. There are separate lounge areas where people can choose to socialise. A separate corridor has the laundry, store rooms, staff room and office accommodation. There is a separate Asian Elders Day Centre operating from the Home, this has it’s own facilities. At the front of the Home there is a ramped access and parking space for a number of vehicles. To the rear and sides are garden areas, which are utilised by service users. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a four-hour period. A tour of some bedrooms and the communal areas was undertaken. A number of records were inspected to include care plans, staff rotas, staff meetings, service user meetings, daily records, service user finance records and the arrangements for the administration of medication. The inspector met a number of service users individually, others were observed. The assistant manager and members of the care staff team contributed to the inspection. The inspector had the pleasure of sharing the lunchtime meal with a group of service users. This is the second of two visits. Readers of the report are advised to read both reports in conjunction in order to obtain a fuller picture of the service. What the service does well:
Norton Grange continues to maintain good standards of care. There is a structured care planning process that has been developed further since the last inspection. This is detailed in the following section of the report. Health care arrangements are good. Concerns are acted upon quickly. The arrangements in place for the safe administration of medication, further enhance good practice in this area. There are robust procedures for responding to suspicion of abuse; ensuring service users are protected from people unsuitable to working with vulnerable people. There are systems in place to safeguard services users finances. Service users are supported in this area. Service users have access to safe and comfortable communal facilities. There are two units, with a choice of lounge and dining areas. These were comfortably furnished, clean and well maintained. There is room for indoor activities to take place. On the day of the visit service users were participating in making Easter art and crafts. There are ‘snug areas’ for service users to sit if they choose not to socialise in the main lounges. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 6 Outdoor space is accessible for those with wheelchairs. The grounds are well kept and have lawns and borders. Service users spoken with said they enjoy sitting out in warmer weather. Assisted bathing, toilet and washing facilities are situated on each unit, and within easy access of the communal areas. These facilities meet the needs of those service users who require staff assistance. Service users have their own bedrooms. These are single. Some service users showed the inspector their room. These were comfortably furnished. All rooms are lockable. Whilst below the national minimum standards for space, those service users spoken with, were happy with their own rooms. The staff team have the skills and training to ensure service users are in safe hands. The recruitment and selection process is thorough. This ensures service users are protected from anyone considered to be unsuitable to work with vulnerable adults. There are established quality assurance systems in place to enable service users to express their views, and affect the way the service is delivered. What has improved since the last inspection? What they could do better:
Minimum staff levels have not been consistently maintained. This could compromise meeting the needs of service users. The condition of registration must be complied with at all times. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 7 Visits by the registered provider must be supported by a written report. This is important in forming an opinion of the standard of care provided, and gives service users, staff and families the opportunity to give their views. There are some outstanding requirements relating to the building. The Registered Manager should advise the Commission on progress in this area. 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. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5, 6 Service users are provided with a contract, which gives information as to what to expect from the service. This ensures service users rights are protected. Prospective service users and their family have opportunities to visit and judge the suitability of the service for themselves. EVIDENCE: At the previous inspection in August 2005 three standards were assessed. One required a minor amendment to the Statement of Purpose. This has been updated to specify that toilet facilities are shared between both male and females, as this may influence some prospective service users choices about residing in the home. On admission each service user is provided with a written contract. These were seen on those files sampled. The contract provides information as to what is provided, fees payable, and information as to the rights and obligations of both the service user and the provider. Terms or conditions including period of notice are also explained.
Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 10 Prospective service users and their family or representative do have the opportunity to visit and decide if the facilities are suited to their needs. Records of these visits are maintained and used as part of the service users assessment information. This enables staff to have a fuller picture of the individuals needs which can be developed into a care plan tailored to meet their needs in a manner suited to them. One lady said, ”I liked the place when I saw it, and now I’m here I still like it”. Norton Grange does not provide intermediate care. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, 11 The arrangements for the management of medication are good, there are clear procedures supported with staff training that ensure medication is administered safely to service users. There are procedures in place that support the preferences of service users at the time of their death. EVIDENCE: Standards 7, 8, and 10 were assessed at the previous inspection. Two requirements were made. There has been further development in meeting the standard relating to care plans. At this inspection further development of care plans had commenced. These are being reviewed to ensure that they include specific details as to how the needs of service users are to be met. Particular attention to the choices, routines and how these are arrived at for those who suffer from dementia is being explored. The inspector was informed that staff received training in dementia.
Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 12 The agenda for the managers meeting in May 2006 includes exploring dementia and the type of activities or choices that service users can be assisted with. This will further enhance the care provided and ensure that goals or expectations are more measurable both for the service user, their family, and the staff team. This work continues. A request has been made to Capital and Building for partitioning to the toilets. The inspector was informed that a contractor visited in October 2005. During the inspection medication records and storage were examined. Staff had a good understanding of the residents medication needs. Training records indicated that staff had received accredited training in medicine safety. Medication records were in good order, and signed by staff who administer. A record of medication ordered and received was maintained, which enabled staff to monitor that correct medication was received prior to administering it to service users. Medication was seen to be stored securely. Service users care files were sampled and showed that, staff monitors the well being of service users on medication, and call the G.P. if concerns are evident. There is a system for the regular review of medication, ensuring the health care needs of service users are promoted. There is a good system in place to ensure that at the time of their death, service users and their families are assured that their choices and preferences are respected. Care files sampled showed that this information was explored and recorded. A policy to guide staff in this area was also seen. Staff training records showed training in bereavement had also been undertaken. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 There has been some progress in updating care plans, to ensure they reflect the choices of the service user. This will, on completion ensure as far as possible, that service users lifestyle matches their expectations. EVIDENCE: At the previous inspection these standards were assessed. Three requirements were made. Two of these have been assessed and are now met. At this inspection work had commenced on ensuring care plans accurately reflect the choices of the service user, and in particular, how the choices are arrived at specifically for those who suffer with dementia. The inspector noted that training in dementia has been undertaken. The assistant manager said that the management and staff team have developed strategies to explore the type of activities and measurable goals and how these can be reflected in care plans. This work continues. At the previous inspection, service users expressed dissatisfaction with the quality of their meals. The management team explored with service users their concerns, with a view to resolving them. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 14 At this inspection, the inspector was satisfied that the quality control measures in place are effective. Daily records were sampled of service users comments on the food. These are reviewed, every three months. A ‘comments and compliments’ system is also in place, where feedback is given to service users and the cook. There is a system in place for addressing these issues with the representatives of the provision. Service users did not articulate any concerns regarding their meals, a couple stated that, staff ask them regularly and that they can speak openly in service user meetings. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18 There are systems in place to ensure service users legal rights are protected. There are robust procedures to protect service users from abuse. EVIDENCE: At the previous inspection a requirement was made to review the needs of those service users who may require assistance to protect their privacy and dignity. The assistant manager confirmed that this area of care is being monitored, and that where an individual is in need of this support, the care plan has been adjusted. Discussion with service users did not highlight any further concerns regarding this matter. It would therefore appear that this has been resolved. The legal rights of service users are protected. Care files showed that pertinent information is recorded regarding service users legal status in relation to their finances. Where external advocates or persons with power of attorney are required, this was seen to be in place to protect the service users interests. Service users confirmed that they are enabled to take part in the voting process. Some have attended polling stations and some have utilised postal voting. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 16 There are robust procedures for responding to suspicion of abuse. Training records reflect training has been undertaken in this area. Staff spoken with had a good understanding of how to report concerns either to their seniors or to the Commission. There are systems in place to safeguard services users finances. An audit of money and those records maintained was undertaken and confirmed this. Some service users, are supported to manage or part manage their own finances, within a risk management framework. Comments from individual service users confirmed that they have access to their money, as they require it. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 22, 23, 24 Service users live in a well-maintained, safe and comfortable environment, which they enjoy. EVIDENCE: At the previous inspection four standards were assessed, one was met. Three requirements were made. At this inspection one requirement was met, the broken skylight window has been replaced. Requirements made in relation to replacing the windows throughout, has been raised with Capital and Building. The inspector was informed that the manager continues to await finances for this work to be carried out. The work necessary for altering radiators to enable service users to adjust their temperatures has also been raised. This remains ongoing.
Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 18 Service users have access to safe and comfortable communal facilities. There are two units, with a choice of lounge and dining areas. These were comfortably furnished, clean and well maintained. There are lots of plants, ornaments and personal touches throughout. There is room for indoor activities to take place. On the day of the visit service users were participating in making Easter art and crafts. There are ‘snug areas’ for service users to sit if they choose not to socialise in the main lounges. Outdoor space is accessible for those with wheelchairs. The grounds are well kept and have lawns and borders. Service users spoken with said they enjoy sitting out in warmer weather. Assisted bathing, toilet and washing facilities are situated on each unit, and within easy access of the communal areas. These facilities meet the needs of those service users who require staff assistance. They were clean, odour free and spacious. Aids and adaptations were seen to include hoists, emergency call system and hand grab rails, and these enable staff to support service users in a safe and suitable manner. The equipment seen was suited to meeting the needs of the service users. Service users have their own bedrooms. These are single. Some service users showed the inspector their room; these were furnished with a bed, chest of drawers, bedside cabinet, wardrobe, and a chair. All rooms are lockable. Whilst below the national minimum standards for space, those service users spoken with, were happy with their own rooms. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Minimum staffing levels are not consistently maintained. This could compromise the assessed needs of service users. The staff team are trained and competent in meeting the needs of service users. Recruitment procedures are robust, and provide adequate safeguards for service users. EVIDENCE: At the previous inspection two standards were assessed. A requirement was made in relation to maintaining minimum staffing levels. At this inspection rotas indicated that this has not been consistent. There has been some staff sickness, covered by casual or agency staff. Rotas need to be reviewed to ensure any gaps are covered. The home was at full capacity of 20 service users at the time of the visit, minimum staffing levels are required to ensure the safety and well being of all service users. The inspector was informed that an increase in the staffing assignment was awaited. Staff records were sampled and showed that 95 of the staff team have NVQ level 2 in care, and two managers have NVQ level 4.
Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 20 The care manager also has NVQ level 4. The staff team have the skills and training to ensure service users are in safe hands. Recruitment policies and procedures were assessed. The recruitment procedures were robust. Staff files sampled, showed that all had the required information. Police Checks or POVA 1st, (Protection Of Vulnerable Adults) checks, were evident, as were references, and proof of identity. The recruitment and selection process is carried out by the personnel department, and is thorough. This ensures service users are protected from anyone considered to be unsuitable to work with vulnerable adults. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 There are established quality assurance systems in place to enable service users to express their views, and affect the way the service is delivered. The arrangements for service users finances ensure that where able they can control their own money, or their interests are protected where they are unable to do this for themselves. EVIDENCE: At the previous inspection four standards were assessed. Three of these were met. One requirement was made which has now been met. At this inspection it was noted that there are platforms in which service users can contribute to the way the home is run, this included ‘service user meetings’, ‘quality audit meetings’, and daily ‘compliments and complaints’ which are utilised to seek service users views on various aspects of how the home is run.
Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 22 The manager has also commenced further development on care plans to demonstrate that service users can affect the service they receive, this will further enhance the quality control measures in place. Staff meetings and formal supervision are well established and provide a good sense of direction for staff in undertaking their role and responsibilities. On both inspection visits, staff members have been proactive in introducing the inspector, and supporting service users to ‘have their say’. The Occurrence book was viewed which confirmed that monthly regulation 26 visits are being undertaken. These are required in order that the registered provider can seek the views of service users and staff as to their opinions of the standard of care provided. However the last written report on file was dated a considerable time ago. This platform is an important aspect of the quality control measures, and must be complied with on a monthly, unannounced basis. There are systems in place to safeguard services users finances. An audit of money and those records maintained was undertaken and confirmed this. Some service users, are supported to manage or part manage their own finances, within a risk management framework. Comments from individual service users confirmed that they have access to their money, as they require it. Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 23 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 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 X 3 3 3 2 X STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X X Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 24 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 OP7 Regulation 15(1) Sch 3 Requirement The development of care plans to continue, with specific details as to how the service users’ needs are to be met, and how this is measured. The Registered Provider to update the Commission on progress in the partitioning of the toilets. Work to continue on ensuring Care plans reflect choices and how this information was gained. Work to continue on Care plans, to reflect where and how the information was gathered for those service users to be unable to demonstrate choices. The Registered Manager should advise the Commission on progress for the replacement of windows. Timescale to be agreed. This is an outstanding requirement from 08 July 2004. The Registered Manager should advise the Commission on progress for altering radiators to allow temperatures to be
DS0000033520.V279484.R01.S.doc Timescale for action 01/07/06 2 OP10 12(4)(a) 01/07/06 3 4 OP12 OP14 15(1) Sch 3 12(1)(a) 12(3) 01/07/06 01/07/06 5 OP19 23(2)(b) 01/07/06 6 OP25 23(2)(p) 01/07/06 Norton Grange Version 5.1 Page 25 adjusted by the service users. Timescale to be agreed. This is an outstanding requirement from 08 July 2004. The Registered Person must ensure the conditions of registration, in relation to staffing levels, are maintained. Regulation 26 reports must be available for inspection. 7 OP27 18(1)a CSA2000 Sec24 26(4)(c) 29/03/06 8 OP33 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Norton Grange DS0000033520.V279484.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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