Inspection on 01/03/07 for Ogwell Grange Care Home

This inspection was carried out on 1st March 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

Ogwell Grange Care Home 16/02/06

Ogwell Grange Care Home 10/08/05

Ogwell Grange Care Home 17/01/05

Ogwell Grange Care Home 08/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ogwell Grange Care Home Rectory Road East Ogwell Newton Abbot Devon TQ12 6AH Lead Inspector Megan Walker Unannounced Inspection 10:00 1st March 2007 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 Ogwell Grange Care Home DS0000032352.V325180.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. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ogwell Grange Care Home Address Rectory Road East Ogwell Newton Abbot Devon TQ12 6AH 01626 354576 F/P 01626 354576 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) Ogwell Grange Ltd Sylvia Betty Kay Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for max 20 (OP) Registered for max 20 DE (E) residents 65 years and over Date of last inspection 16th February 2006 Brief Description of the Service: Ogwell Grange is registered as a Care Home that offers personal care for up to 20 (twenty) people who are of retirement age, some of whom may have a memory problem. Ogwell Grange does not provide intermediate care and it is not registered to provide nursing care. Ogwell Grange is in the village of East Ogwell, a short distance from the market town of Newton Abbot in South Devon. The home is a listed building and was a rectory that has been used as a residential care home since late 1994. Ogwell Grange is a large, detached, stone built construction within its own grounds that offers uninterrupted countryside views from many of the rooms across to Dartmoor National Park on the horizon. Accommodation at Ogwell Grange comprises of 14 (fourteen) single rooms and 3 (three) double rooms all with en-suite facilities, a large lounge and also a large separate dining room. There is also an assisted bath in a communal bathroom and a separate “wet room” for those people who prefer to have a shower. The home has been adapted over the years to meet the needs of the people who live there. This includes the provision of a small shaft lift that goes from the ground to the first floor and a stair lift to the mid landing serving the mezzanine floor. The wellmaintained grounds are easily accessible for residents and their visitors to enjoy. The current fees range from £363.00 to £420.00 per week. Hairdresser and chiropodist charges are additional as are toiletries, papers and magazines, and any other sundry items residents may wish to purchase. This information was given to CSCI in the Pre-Inspection Questionnaire dated January 2007. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection of this service. The fieldwork visit for this inspection took place on Thursday 1st March 2007 between 10h00 and 17h30 and was an unannounced visit by two inspectors. It included talking to residents and staff in the home, observation of interactions between staff and residents, and residents with residents, a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The Registered Manager, Mrs Sylvia Kay, was present at the time of this visit. Part of the time was spent talking with her about the day-to-day routines, as well as the management of the home. In addition other information used to inform this inspection: • The Pre-inspection Questionnaire completed by the Registered Manager. • The previous two inspection reports • All other information relating to Ogwell Grange received by CSCI since the last inspection. Of approximately 40 Comments’ Cards and Surveys sent out, CSCI received back – • 7 Residents “Have Your Say About Ogwell Grange” Care Homes Surveys • 4 “Relatives/Visitors” Comment Cards • 9 Care Workers Surveys • 0 General Practitioner (G.P.) • 0 Health/Social Care Professional in contact with the home Also the Commission for Social Care Inspection (CSCI) received 9 other letters from relatives of residents, the vicar who regularly visits the home, and an independent contractor who comes into the home once a month to assist with activities for the residents. These were all apparently written at the request of the Registered Manager. An Immediate Requirement concerning fire safety was made at the time of this visit and the fire safety and rescue service was later informed of this. There are additional seven requirements and six “Good Practice” recommendations were made as a consequence of the inspection. What the service does well: Ogwell Grange offers comfortable accommodation in pleasant, tranquil surroundings. Both the property and the grounds are well maintained. Residents may personalise their bedrooms. A contracted laundry service provides residents with well-laundered bed linen and towels. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 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 Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4,5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents have sufficient information available to them about the home and are appropriately assessed before moving into the home. EVIDENCE: A resident who returned a survey to CSCI confirmed that they had received a copy of the Resident’s Guide prior to moving into the home. A detailed Resident’s Guide with some historical background to the premises as well as the service being offered at Ogwell Grange was seen during this visit. One resident who returned a survey to CSCI wrote that they had received a contract when they first moved into the home however “No new contract since home changed ownership.” Inspection of a random selection of residents’ care Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 9 files found an inconsistency with contracts. More recent residents had a contract with the current Registered Provider however those people who were already living at Ogwell Grange when the home was sold still had contracts with the previous owners. One file had only a contract with a local authority. Subsequent to this visit the Registered Provider has forwarded evidence to CSCI of up to date contracts for all residents. A resident who has been living at the home since 2002 confirmed that they had had two visits to the home prior to moving in. Another resident said that they had been able to visit the home before deciding to move in. In other circumstances residents’ families had been to visit the home. The assessments of care needs inspected were comprehensive although for those people who were already living at Ogwell Grange when the home was sold there was no evidence of pre-assessments having been completed. A pre-assessment was seen on a file of a more recent resident to the home. Prospective residents receive a verbal confirmation that their assessed needs can be met within the home. There was no evidence on any of the care files inspected to show that written confirmation outlining what was being offered had been sent to either the prospective resident and/or their family/representative. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are appropriately met. However for some residents, their emotional and social needs are at risk of being compromised by poor care practices. EVIDENCE: Inspection of residents’ individual care files found that they each had an assessment of health care need. This included mental and physical health, behaviour and dietary needs. Medical appointments, district nurse visits and any assistance that an individual required for reasons of physical and/or mental health was also recorded. There was some evidence that residents had contributed towards their care planning. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 11 Observation during this visit, and reading various documents as well as staff comments in surveys returned to CSCI, found that the Registered Manager has a innate sense of personal pride in appearance of both the residents and the home. Inspection of the bathing rota, for example, showed that staff were expected to assist residents with cutting their fingernails. Staff were also expected to check each residents’ drawers once a month to ensure that there were no odd socks, socks or tights with holes in them, and to tidy drawers. Comments from staff surveys included: “Individual care of residents is very high. I enjoy making them look good and feel special by co-ordinating clothes, applying make-up, jewellery and manicures, perfume, styling hair.” “Hair dressing and good grooming provided, in which the manager is very particular on that.” A relative who returned a survey to CSCI wrote about the irregularity of eye drops being given to a resident and also that staff did not assist with a hearing aid, “Every week X complains about not having medication regularly... Also it would help everyone if someone could help X to put in the hearing aid each morning. This would make a great difference as X could communicate with others.” The Registered Manager, subsequent to this visit, stated that every effort was made to ensure that residents are offered their medication at the required time. The home’s system for administering medicines was examined. Medicines were securely stored in a locked cabinet in the office. A locked refrigerator was available for medicines requiring cool storage. No controlled drugs were in use at the time of this visit. Secure storage was available for a resident who administers her own medication. However, there was no risk assessment in place for this resident concerning self-medication. Homely remedies were in use in the home. A list of these medications was seen but an appropriately qualified professional had not approved this. Subsequent to this visit, the Registered Manager has shown CSCI a copy of a signed letter of approval from the pharmacy that supplies the home’s medicines. A monitored dosage system was in use in the home in which tablets are supplied to the home by the Pharmacy in pre-packed dosages. Some shortfalls were found in recording. A single signature on each sheet denoted the receipt of medication rather than a signature and confirmed quantity for each medicine received. One dose of medicine remained in a cartridge in spite of having been signed for as administered. Signatures were missing for some doses of medicine that had been administered. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 12 Prescribed skin creams were being used for residents other than those for whom they had been prescribed. Staff had attended a training course for the administration of medicines on 1st February 2007. Seven certificates of attendance were seen. Those staff that administer medicines were listed and samples of their signatures were available for inspection. During this visit seven matters of serious concern regarding residents’ privacy and dignity were found: 1. During a tour of the premises there was no evidence of screens being provided for residents who share a bedroom. 2. A woman and a man who had no relationship to one another shared one bedroom. There was no evidence of informed consent between the two residents, or written agreement from either resident on their individual care plan. In subsequent discussion the Registered Provider stated that this arrangement was agreed with relatives and the CSCI. The CSCI has no written record of this. There was no screen provided in this room. The Registered Manager, when asked, did not think that a screen was necessary because of the position of the beds (they were at an angle to each other due to the structure of the room), and also because apparently one of these two residents got up early. 3. Some residents have been given “sleep suits” to wear at night. There was no evidence on these residents’ care files of risk assessment, consent or clear records of a multi-disciplinary decision showing why this form of clothing was in use. 4. The staff handover book had a recent message to all staff written by the Registered manager that “incontinent residents are to sit on vinyl chairs” because two chairs had been “completely ruined”. 5. After lunch and before residents had a hot drink to conclude the meal, two residents wished to leave the dining room. Staff prevented them from doing so by instructing them to “sit down and you can go after your drinks”. One resident who continued to try to leave the room was told that they were “being silly”, and “when you sit down I’ll bring you your drink.” 6. A cream was left in a shower room clearly labelled with the resident’s name and intimate personal information about its application. 7. The staff handbook contained detailed information about individual residents’ health and care needs. Ogwell Grange Care Home DS0000032352.V325180.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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents who are mobile and mentally well find the lifestyle experience in the home matches their expectations and preferences and satisfies their interests and needs. EVIDENCE: Residents who returned a survey to CSCI wrote: “Since living here [Ogwell Grange] I feel I have improved. I have support with my care, I have gained weight and I enjoy the company and activities.” “I enjoy all the activities and outings especially tea at The Grand Hotel. Recently we had a moor land trip and a tour of our new Asda.” Two relatives wrote in letters to CSCI: “I’ve visited on different days and times, there is always something going on, they’re either doing exercises, quizzes or being entertained.” Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 14 “Their [Ogwell Grange] regular entertainment programme culminating in a Christmas programme all through December is varied and thoroughly enjoyed by residents and is open to family members should they wish to join in.” Throughout the day of this visit all the residents were seen sitting in the lounge. After lunch the atmosphere in the lounge was lively amongst a group of residents whilst they awaited the visit of an external activities co-ordinator who comes into the home once a month. On this occasion residents were able to enjoy an hour of music and poetry. One resident expressed a preference to do go elsewhere during this period of time. In the staff office there was a list of various activities that take place in the home throughout the week. The Registered Manager said that the residents were offered a variety of activities during the day and she considered that this provided them with a better quality of life. A local vicar was at the home in the morning offering a service of Holy Communion. This was held in the dining room and the Registered Manager confirmed that this happened twice a month. In a later conversation with the vicar and the Registered Manager it was apparent that the vicar has an active role in the daily life of the care home. The Registered Manager regarded him as very supportive to both residents and staff, and gave examples of care and support that he had offered during times of emotional need. The Resident Guide is clear about the home’s links with the local Church of England church and prospective residents would be aware that Ogwell Grange is a faith based that is, Christian, home. Residents who were asked said that the food was good. On the day of this visit lunch was stew and dumplings. The cook explained that vegetarian products were bought in for residents who did not eat meat (she had vegetable quiches on this occasion), and desserts for those residents who had diabetes. The cook explained that should a resident require a pureed diet then she would puree each item of food separately to serve it attractively. She also commented that this was important for the individual to experience different tastes rather than a mush of mixed puree. The daily menu was displayed on a board in the main hallway. The cook said that any resident who didn’t like what was being offered as the meal of the day could come and see her to ask for something else. Lists of individual residents’ likes and dislikes, and preferences for drinks, e.g. coffee with no sugar, were pinned up in the kitchen. Ogwell Grange Care Home DS0000032352.V325180.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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives and friends can feel confident that any complaints or concerns will be listened to, taken seriously and acted upon. EVIDENCE: The Complaints Procedure for the home was seen displayed in the hallway, near the kitchen. Since the last inspection CSCI has not received any complaints about the home although a relative raised a concern about there only being one member of staff on duty at night – “It seems quite pressured for one person at night.” The Registered Manager explained that there was only person on duty at night and that she was on call as she lives in a house in the grounds of the care home. A fold-up bed was seen stored on the landing and the Registered Manager explained that this was occasionally used if a staff member was on a “sleeping” duty. The home’s own complaints record showed that there had been no complaints though there had been one “suggestion” regarding seating for residents. This had been followed up with the recent provision of new chairs in the lounge. In January all staff had attended a two-hour training session on “Safeguarding Vulnerable Adults”, run by a private company at the home. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 16 Inspection of a random selection of staff files found that recruitment of staff was not a robust procedure. [SEE Staffing.] Ogwell Grange Care Home DS0000032352.V325180.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, 20, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and safety measures need to be put in place to ensure the environment does not put residents at risk. EVIDENCE: A tour of the premises found that residents’ rooms were personalised to suit their individual preferences. There were freestanding electric heaters in some of the bedrooms that were too hot to touch. The Registered Manager explained that these were provided at residents’ requests if they were cold. On the day of this visit the heating was on and the building was very warm. The Registered Manager was advised during this visit that heaters should be fixed to prevent injuries to residents or staff, and to prevent a risk of fire, should the heaters be accidentally knocked over. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 18 At the time of this visit workmen from a roofing company were repairing a flat roof that was causing an ongoing problem, including to the fire exit door on the first floor. (This was found to be swollen due to rain seeping into it. It was therefore stuck and required brute force to open it. Immediately outside the fire door was a large pool of water, also caused by the rain, causing a potential hazard in case of an emergency evacuation.) The Registered Provider explained that the repair work by the roofing company should resolve this so it would not be a problem in the future. The fire exit door on the ground floor was also found to be stiff to open and when opened it was catching on a doorway canopy. The fire door from the stairs to the landing was blocked open with a large wooden doorstop. This door also required attention to the door clasp that was stiff and did not glide into place without manual assistance. The fire door to bedroom 4 was sticking on the carpet and this prevented automatic closure. Wedges were found holding open the lounge, dining room, and other rooms around the home. An Immediate Requirement was issued at the time of this visit that door wedges and any other object must not be used to block open any doors. It was also brought to the Registered Manager’s attention that the home’s risk assessment for fire safety specified that door wedges were not to be used in the home. This information was forwarded to the local Fire and Rescue Service. Since this visit the Registered Provider has responded in writing to CSCI. He stated that door closures had been fitted to the lounge, dining room and two bedrooms. Also the fire doors had been eased so they open and shut without force. The Pre-Inspection Questionnaire under “Any changes since the last inspection” listed that eight armchairs had been replaced in the lounge. A relative who wrote to CSCI noted from observation that “not always enough chairs in the lounge for residents possibly due to day care clients,” The Registered Manager said that this matter had also been raised with her and additional armchairs had been provided for residents’ use. On the day of this visit there were twenty residents living at the home and there was seating available for up to twenty people in the lounge. Two bedrooms were found to have the doorknob fitted back to front, i.e., the lock was on the hallway side of the door. This was brought to the attention of the Registered Manager during this visit. Two rooms were fitted with linoleum, at the request of the occupants’ families. The Registered Manager said that carpets would be fitted when these rooms became vacant. Infection control measures were inspected during this visit. It was found that there was a potential risk of cross-infection as numerous skin creams were found in residents’ rooms and a shower room. One was found to be out of date. Many were found to be unlabelled or labelled with the name of another Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 19 resident. Alcohol hand gel was available in the home’s foyer, lounge and other parts of the home for use by staff and visitors. The staff room toilet seat was misaligned and the hot tap was stiff to open. There was a paper hand towel dispenser and a communal hand towel provided for staff to use. All portable electrical items around the home were in date with portable appliance electrical testing safety stickers signed and dated on them. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a low turn over of staff and a staff team that enjoys working at Ogwell Grange. EVIDENCE: Inspection of a random selection of staff files found that there were lots of legally required employment checks missing. The Registered Manager explained that all the staff that worked at the home prior to its present owner had not been issued with new contracts nor had there been any further employment checks undertaken. This meant that on the files of those staff working at the care home when the current provider bought it, there were no application forms, no written references, no record of previous employment. One file had a Criminal Records Bureau (CRB) check i.e. police check, for the person named on it to work at another care home. There was evidence of a staff training programme and several courses had been arranged for staff to attend during January and February of this year. Staff interviewed during the inspection confirmed this. These included, for all staff, Manual Handling, Dementia Care and Safeguarding Vulnerable Adults. Fourteen staff had attended a course on Basic First Aid and eleven staff had apparently attended a half-day course on Handling and Administration of Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 21 Medication. Only seven certificates were available for inspection at the time of this visit. A relative in the “Have Your Say” survey raised a concern about night staff cover. This was also a comment made by staff in their Care Workers Surveys. The Registered Manager explained that there was only one person on duty at night and they were expected to carry a portable telephone with them at all times. She also stated that with the level of activities provided during the day, the majority of residents were tired and slept well at night. The staff member on duty apparently checked each resident every two hours throughout the night. This staff member additionally had ironing and other “small chores” to do during the night as well as assist residents to bed. Discussion with the Registered Manager about staffing levels during the day and evening found that she was considering introducing an extra staff member on to the rota for the evening, from 17h00 until 21h00. There was a trial planned for four weeks in the near future whilst the Registered Manager was on holiday. There would therefore be three care staff on duty during a period of time when residents are more vulnerable and likely to fall. Nearly half of the current residents choose to go to bed between 21hh00 and 23h00, sitting in the lounge for the evening. It was unconfirmed how many of these residents would require assistance to get ready for and/or get into bed. The Registered Manager explained that with the present rota of two staff on duty during the evening, only one care assistant may go to the kitchen at any one time to ensure that there was always a care assistant nearby to assist residents if required. It was again unconfirmed the expectations of care assistants if more than one resident wished to go to bed at the same time, and if they each needed assistance, particularly after 21h00 when the night care assistant was working alone. There was a discrepancy amongst staff about the arrangement of the rota, that it was inconsistent and a feeling that there was favouritism towards some staff members. Inspection of the staff rotas for the four weeks from 23rd December 2006 to 19th January 2007 provided by the Registered Manager with the preInspection material, found that generally staffing levels during the day were good with six staff including a cook and a cleaner on duty in the mornings, and three in the afternoon. This included weekends. Out of the eighteen staff listed only four regularly work twelve-hour shifts and two of these staff were responsible for cleaning on some of their shifts. From the rotas provided staff had worked the same days each week with little change. There was no evidence that any staff member had exceeded the European Work Directive of working forty-eight hours including overtime in any seven-day period. There was no evidence of any changes to these rotas, for example, staff sickness. The rota listed eighteen staff excluding the Registered Manager. This does not correspond with the Pre-Inspection Questionnaire completed for the same period and lists fourteen staff. Further more, the staff shown on the rota as Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 22 being responsible for medication each morning and each afternoon are not all listed on the Pre-Inspection Questionnaire as being responsible for administering medication. However, the Registered Manager stated that eleven staff had received training in administering medicines and seven certificates confirming this training arrived during the inspection. During a tour of the premises a fold-up bed was seen stored on the landing. The Registered Manager explained that on occasions, usually weekends, a member of staff was employed as a “sleeper”, that is, a second night carer who could sleep on duty and be woken by the “waker” in event of an emergency. This member of staff was expected to sleep either on the landing or in the dining room; there is no provision of separate staff sleeping accommodation within the home. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 23 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, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager is popular with residents, their families and staff. Certain aspects of residents’ health, safety and welfare are compromised so put them at risk. EVIDENCE: Surveys returned and letters sent to CSCI by residents and their families and other visitors to the home conveyed a high level of regard and respect for the Registered Manager, Mrs Sylvia Kay, for example, Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 24 “Sylvia Kay manages the home with her team of care assistants… Outside professionals are welcomed in to attend to residents’ hair, foot and medical needs.” “Sylvia has a very positive attitude to her work.” “I like everything here. I like staff here. We are happy and laughing. I love Sylvia.” The bed linen and towels are sent to an external laundry contractor. The home does not have a sluice and there was not any evidence of a policy dealing with soiled clothing. When asked the Registered Manager said that badly soiled clothing were thrown away with relatives’ permission, and that residents’ families were then sent an invoice or asked to provide replacement clothing. She explained that the final decision to throw away clothing was taken by her, not by individual staff members. It would be disposed of as clinical waste. There was no evidence of how this was explained to residents; particularly those with dementia care needs that may not understand the apparent loss to them of certain items of clothing. There was a discrepancy amongst staff about the arrangement of the rota, that it was inconsistent and a feeling that there was favouritism towards some staff members. The rota listed eighteen staff excluding the Registered Manager however this does not correspond with the Pre-Inspection Questionnaire completed during this period that lists fourteen staff. Furthermore, the staff shown on the rota as being responsible for medication each morning and each afternoon are not all listed on the Pre-Inspection Questionnaire as being responsible for administering medication. However, the Registered Manager stated that eleven staff had received training in administering medicines and seven certificates confirming this training arrived during the inspection. The Registered Manager said that staff meetings were held about three times a year, usually before/after an important event such as Christmas and the home’s summer fete. No minutes were available for inspection however the Registered Manager confirmed that these were kept elsewhere not at the home. The Registered Manager stated that neither the management nor staff of the home had any involvement in residents’ finances other than small amounts of cash held in trust. A sample of records concerning these cash amounts was examined. The records were supported by receipts but had not been updated for over three weeks. The staff interviewed described the staff supervision system as “informal” and that the Registered Manager was “available” and “approachable”. There was no evidence of formal staff supervision records on staff files inspected although Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 25 there were some annual self-appraisals. The Registered Manager confirmed during this visit that she would endeavour to set up regular recorded supervision with all staff. One of the home’s domestic staff confirmed that there is a lockable cupboard for all cleaning equipment and hazardous substances used in the home. She also explained that there was an outstanding order for new buckets to replace those seen being used. The buckets had a labelling system to ensure that different buckets were used to clean different areas. Inspection of the maintenance records and information provided in the PreInspection Questionnaire showed that all the necessary checks were in date and completed regularly as required. There was an environmental health inspection on 22nd February 2007. The report of that visit had several requirements and recommendations relating to the kitchen that needed attention for the protection of residents. This report also included contacting an Environmental Health Officer about “Safer Food, Better Business”, the Food Standards Agency changes to legislation in January 2006. CSCI has been advised as required by regulation of death of residents. The Pre-Inspection Questionnaire listed four admissions to an Accident and Emergency Department in the past twelve months. CSCI was not notified about any of these admissions. The Registered Provider subsequently explained that this was due to his misunderstanding about notification of death, illnesses and other events as required by Regulation 37 of The Care Home Regulations 2001. Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement “13 Further requirements as to health and welfare (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. “ In particular: • When medication is administered to residents it must be clearly recorded. • The receipt of medicines must be confirmed in the Medicines Administration record by entering the amount and a signature against each medicine received. • Prescribed skin creams must only be used for those residents for whom they were intended. I.e. the person whose name is on the prescription label on the product. • Any resident who chooses to administer their own Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 28 Timescale for action 01/04/07 2 OP10 12 (4a) medication must be assessed for any risk this may present and action taken to minimise any identified risk. “12 Health and welfare of service users (4) The registered person shall make suitable arrangements to ensure that the care home is conducted – (a) in a manner which respects the privacy and dignity of service users; (b) with due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of service users.” In particular: (1) Where residents share a room, screens are provided to ensure that their privacy is not compromised when personal care is being given or at any other time. (2) Care plans must show evidence of informed consent and written agreement from each resident or their advocate that each resident has chosen to share a room. The care plan must also show clearly how such a decision was made, by whom, and with regard to person-centred care, how sharing a room is beneficial to each individual. 01/04/07 Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 29 (3) (4) (5) (6) Care plans must show clearly the reasons for using sleep suits at night, assessments for use of sleep suits, and written consent from the resident or an advocate on behalf of the resident if they are unable to give informed consent themselves. There must also be clear evidence on the care plan to show that use of such clothing is not restricting liberty of movement or compromising the individual’s dignity by limiting their freedom of choice. The Registered Manager must review the home’s current practice of managing continence and take action to ensure that residents’ dignity is not being compromised. All staff must be trained and reminded about the importance of treating all residents, regardless of their disability (including mental health), with respect at all times. Staff must ensure when they assist residents with personal care in a communal bathroom, that any prescribed creams are returned to the person’s room and put away so the person’s privacy and dignity is not compromised. Version 5.2 Page 30 Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc 3 OP19 13 (4a.c) “The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated” 01/04/07 4 OP19 4 All freestanding heaters used within the care home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. 14/03/07 “23 Fitness of premises (4) Subject to paragraph (4A) the registered person shall after consultation with the fire and rescue authority – (a) take adequate precautions against the risk of fire, including the provision of suitable fire equipment; (b) provide adequate means of escape; (c) make adequate arrangements – (iii) for the evacuation, in the event of a fire, of all persons in the care home and safe placement of service users;” (iv) for reviewing fire precautions, and testing fire equipment, at suitable intervals; Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 31 • Doors must not be wedged or held open with anything other than an automatic fire safety guard. Doors must not be blocked open with any other object, e.g. stool. All rooms must be assessed as part of the home’s fire risk assessment. If the risk assessment shows that the door of a room is preferred open, appropriate fire safety automatic door closures that comply with the home’s fire alarm system must be fitted. Action must be taken to minimise any other risks identified during the assessment of rooms for fire hazards. Fire exit doors must be capable of being opened without force. Fire exits must be kept clear at all times. Corridors, hallways and landings leading to fire exits must be kept clear at all times. Fire exits must be checked regularly as part of the home’s fire equipment maintenance programme. NB: An Immediate Requirement concerning fire safety matters that required immediate attention was issued at the time of this inspection. This was followed by a letter from CSCI to the Registered Provider, about other urgent matters if fire safety. The Registered Provider has confirmed in writing to CSCI that it has been met within the timescale given. 5 OP27 18 (1a) “18 Staffing (1) the registered person shall, having regard to DS0000032352.V325180.R01.S.doc 01/04/07 Ogwell Grange Care Home Version 5.2 Page 32 the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; The Registered Provider must assess the current practice of having only one care worker on duty in the care home after 21h00 until 08h00 for any risk it presents to residents, and take action to minimise any identified risk. “Schedule 2 INFORMATION AND DOCUMENTS IN RESPECT OF PERSONS CARRYING ON, MANAGING OR WORKING IN A CARE HOME. 6 OP29 Sch. 2 01/06/07 7 OP37 17 The Registered Provider must operate a thorough and robust recruitment procedure based on equal opportunities and ensuring the protection of people who use the service. Evidence of this will be via a clear audit trail of information kept on individual staff files. The Registered Provider must 01/06/07 ensure that all records and documents specified in Schedules 3 and 4 are kept in a care home; that they are kept up DS0000032352.V325180.R01.S.doc Version 5.2 Page 33 Ogwell Grange Care Home 8 OP38 37 to date and in good order. 37 Notification of death, illness and other events The Registered Person must inform CSCI of any incident that affects the health, safety and welfare of the residents. 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations The Registered Provider should make sure that each resident has a contract stating the services and facilities provided for her/him at the home by the current Registered Provider. The Registered Provider should write to prospective residents confirming that they can be accommodated at the home and that their pre-assessed needs can be met at the home. Residents and/or their representative should be involved in drawing up and reviewing their individual care plan. The Registered Provider should provide a choice of main courses at lunchtime and review regularly residents’ preferences for breakfast and drinks. The Registered Provider should consult with the relevant agencies to ensure safe working practices including food hygiene and infection control. 2 OP4 3 4 5 OP7 OP15 OP38 Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Devon Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Ogwell Grange Care Home DS0000032352.V325180.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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