CARE HOMES FOR OLDER PEOPLE
Oldbury Grange Nursing and Residential Home Oldbury Road Oldbury Bridgnorth, Shropshire WV16 5HA Lead Inspector
Patricia Scott Unannounced 24 June 2005 10:00
th 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 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. Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Oldbury Grange Nursing and Residential Home Address Oldbury Road Oldbury Bridgnorth Shropshire WV16 5HA 01746 766616 01746 768741 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Shropshire Private Care Limited Caroline Susan Weston Care home with Nursing (N) 55 Category(ies) of 45 x Old age, not falling within any other registration, with number category (OP) of places 10 x Dementia (DE) Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 30th June 1999. 2. 3. The home may accommodate a maximum of 55 service users. The home may accommodate a maximum of 10 persons with dementia, the remainder being persons who are over 65 years of age whose needs do not fall into any other category. Date of last inspection 7th October 2004 Brief Description of the Service: Oldbury Grange is a large country style house converted and extended to include the addition of a single story purpose-built wing. Mrs Caroline Weston manages the Home on a day-to-day basis. It is owned by Shropshire Private Care Ltd., the Directors being, Mr & Mrs C Gillie and their three Daughters, Mrs J Core, Mrs M Harding and Mrs A Wray. The Company also owns Bradeney House in Worfield. Oldbury Grange is registered to provide accommodation for 55 Older People covering personal care for 34 persons, including 10 EMI (Elderly Mentally Ill) and nursing care for 21 persons. However, at the time of the Inspection 53 bed spaces were in operational use, as two bedrooms previously designated ‘shared’ were being used for ‘single’ accommodation. Nursing care services are provided in the single story wing, whilst the original building is used to provide care for Service Users requiring ‘residential’ care. Service Users with dementia are cared for in both sections of the Home dependent on their assessmed needs. Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 24th June 2005 and commenced at 10.00. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s objectives to be able to meet service user requirements and expectations were being met. Outcomes from the previous inspection and CSCI’s risk assessment of the home were taken into account to determine the core standards focused on and depth of inspection this time. The Commission does not currently have any concerns regarding this home. What the service does well: What has improved since the last inspection?
The requirement made at the previous inspection of 7/10/04 to improve the provision of social activities in the home has been achieved. An activity coordinator had been recruited who has since left her employment and the post
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 6 has been advertised again. The manager reported that staff have become more involved in leisure activities which was seen happening during the inspection. There are regular events taking place as well has planned outings. Mrs Weston also spoke of an interest to develop staff in their role as activity providers and will endeavour to provide training in this area. The requirement to allow the manager more supernumerary time in order to discharge her duties as registered manager has also been acted upon. Mrs Weston stated that she has at least 3 and sometimes 4 days a week to fulfil her role. Over 50 of care staff now have their NVQ 2 in care. The manager has achieved her NVQ 4 in management. What they could do better:
Staff clearly work well together as a team and the manager stated that yearly appraisals are due. However, to ensure that staff have the opportunity for individual discussion about their performance and personal development with the manager or delegated supervisor the home still needs to put in place formal supervision carried out at least 6 times a year and keep a record on file. Some supervision takes the form of on-the-job clinical observation which if recorded could count towards a supervision session. Employers should ensure that all employees who are responsible for selecting, fitting and checking bed rails have received appropriate training. Other staff, such as care assistants and support workers who make beds and help service users in and out of bed, also may remove and replace bed rails. These employees should be given information and instruction in the correct fitting and adjustment of bed rails. This topic was discussed with the manager and that she should include the management of this area in the general maintenance of equipment records, health and safety audits and training in the home. Implementation of this would improve health and safety for both service users and staff. Four of the communal bathrooms are carpeted. In such areas the recommendation is to use hard flooring. The manager stated that these are in the near term plan for refurbishment. It is strongly recommended that this be completed as soon as possible. It is acknowledged that these areas are regularly cleaned. It was considered that the privacy and dignity of service users at Oldbury Grange were being promoted as far as possible by staff approaches and practices. However, the style of 4 doors does not afford complete privacy of a
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 7 service user within their bedroom. The Company should move to a programme of replacing these. Under the regulations homes must demonstrate that they are conducting the service provision with “due care, competency and skill”. It is a requirement where organisations employ a registered manager and are not as such involved in the day to day management of the home that they conduct a monthly unannounced visit to the home and produce a monthly report that is given to the manager and a copy sent to CSCI. 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. Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 standard(s) 1,3 The home provides an up to date statement of purpose and service users guide that is clearly written so that prospective service users have the information they need to make an informed choice about where to live. Pre-admission needs assessments are thorough ensuring that service users who move into the home are assured that their needs will be met. EVIDENCE: A service user confirmed that she had been asked about herself and her life history prior to being admitted to the home. The statement of purpose and service users guide are available in service users’ rooms. The information provides details of needs assessment to be conducted prior to admission and examination of care plans in the office confirmed that this process had been carried out by a person who is trained to do so.
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 standard(s) 7,8,10 The health needs of service users are very well attended to with evidence of good liaison with other health care professionals thus, service users can be assured of appropriate treatment of their health problems. Personal care support in the home is provided in such a way as to promote and protect service users’ privacy, dignity and independence in their daily life as well as at the end of life. There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. EVIDENCE: The care of 4 service users was case tracked. Care plans were seen and where appropriate they were spoken with and their bedrooms seen. Of particular note was the feedback to a service user who was having his blood sugar level monitored by staff. An explanation was given as to why it was happening and after the event he was fully informed of the result. The staff
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 11 member had also recorded it in the care plan straight after. This service user was spoken with and confirmed that staff keep him informed about all aspects of his care. He gave some details of his care needs that matched with the plan of care seen. Another service user who was asleep at the time of my visit was seen to be nursed in bed. Her care plan detailed assessment of nutritional needs and care to be given and that liaison with the GP had taken place for referral to the dietician. Nutritional supplements were seen on her table. Bed rails were in use and consent from the relative for their use was on file. (see summary). This person also had management for her pain relief but there was not a care plan for this. The manager agreed that this should be implemented. She looked comfortable and pain free. Another service user had a specific plan to inform staff of how she should be assisted to move. She confirmed that this always happens as it should and that staff are very knowledgeable and kind. Service users spoken with other than those case tracked were complimentary about the staff that care for them. Although staff practice provides service users with privacy the environment falls short of this regarding 4 bedroom doors. (see environment and summary) Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 standard(s) 12,13 The routines of daily living and activities are flexible and varied so that service users lifestyle experienced matches their preferences for recreation. Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. EVIDENCE: There is no imposition of rules or routines within the home. A service user commented that he had wanted to spend some of the morning in his room and that staff had been respectful of this. He stated that staff had popped in from time to time and that he had never been left for long periods. Service users with dementia can move within the home and gardens and are not confined to any part of the home. Some were having their nails done, others were sitting talking to staff whilst doing a jigsaw puzzle. There have been more trips out lately including a canal trip which had been enjoyed by many service users. Pictures were on display on the notice board. The home has accessed the community bus service that takes 2 wheelchairs. Staff have attended a dementia course but they also wish to access training to provide activities for people with dementia. A notice of events is displayed on the board and resident meetings are held to discuss aspects of life in the home.
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 standard(s) These standards were not assessed at this inspection EVIDENCE: Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 standard(s) 19 The standard of the environment within this home is very good providing service users with an attractive and homely place to live. EVIDENCE: A tour of the premises showed that the home offers a clean comfortable environment and has equipment to deal with the needs of dependent service users e.g. hoists, hand rails, assisted bathrooms. Four communal bathrooms have carpet flooring. There is a potential here to harbour bacteria from accidental soiling of urine and faeces. The garden areas are safe and accessible to all. A ground floor bathroom was being used to store a lot of equipment. This is a hazard to service users who may walk into the room. The manager reported that the toilet is still used by service users, in which case the room should be maintained in a safe order.
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 15 The manager stated that four bedroom doors have squares of glass in the door panel that can be obscured by a curtain. Some could be seen through and so there is the potential for any person whether visitor or staff to see into these rooms and therefore privacy is not afforded. The home should consider replacing these doors as a move to improve service users privacy of their personal space. Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not fully assessed at this inspection EVIDENCE: Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,38 The registered manager is qualified, competent and experienced to run the home which is done so in the best interests of service users who benefit from her ethos and leadership. The manager fully understands her duties regarding health and safety thus ensuring that staff and service users are at low risk of harm. EVIDENCE: Safety checks are carried out as seen in fire records and hot water testing. Accident records are maintained with monthly audits taking place. The manager possesses all the relevant qualification required within the standards. Discussions demonstrated that she continues to strive for excellence and find innovative ways to provide a good the service to those that live in and are involved in the home be it service users, visitors, relatives, in-house staff and outside health care professionals, etc.
Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 18 Where the home is owned by an organisation one of the directors of the service not associated with the day to day running of the home should conduct unannounced visits and produce a report under Regulation 26. The manager stated that this does not occur at present. Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 N/A 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 N/A 15 N/A
COMPLAINTS AND PROTECTION 2 N/A N/A N/A N/A N/A N/A N/A STAFFING Standard No Score 27 N/A 28 N/A 29 N/A 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A x x x x x x x x Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? 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 10 Regulation 23(2)(e) Requirement Timescale for action 3/1/06 2. 19 13(4)(a) 3. 37,38 26 To commence a programme of replacing 4 bedroom doors to ensure service users have private accommodation. To ensure that all parts of the Immediate home to which service users have access are so far as reasonably practicable free from hazards to their safety The responsible Individual or one 9/8/05 of the partners musty visit the home unannounced each month and prepare a report for the manager and CSCI as to the conduct of the home. 4. 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. 2. 3. Refer to Standard 8 26 8,38 Good Practice Recommendations Introduce care plans for pain management where relevant Replace floor covering in the 4 carpeted bathrooms as soon as possible. Be mindful of Regulation 18(1)(a). Provide training appropriate for staff who who are responsible for selecting,
E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 21 Oldbury Grange Nursing and Residential Home 4. 37 fitting/using and checking bed rails Include maintenance of bed rails in the records for routine checks of equipment and health and safety audits. Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 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 Oldbury Grange Nursing and Residential Home E56 E01 S22259 Oldbury Grange N RH V235333 UI 240605 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
