Inspection on 26/05/06 for Oldbury Grange Nursing And Residential Home

This inspection was carried out on 26th May 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oldbury Grange Nursing And... 10/02/10

Oldbury Grange Nursing And... 22/04/08

Oldbury Grange Nursing And... 06/03/06

Oldbury Grange Nursing And... 24/06/05

Oldbury Grange Nursing And... 07/10/04

Oldbury Grange Nursing And... 21/04/04

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

CARE HOMES FOR OLDER PEOPLE Oldbury Grange Nursing And Residential Home Oldbury Road Oldbury Bridgnorth Shropshire WV16 5HA Lead Inspector Keith Salmon Unannounced Inspection 26th May 2006 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oldbury Grange Nursing And Residential Home DS0000022259.V294070.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. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 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 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) Shropshire Private Care Limited Christine De Souza Care Home 55 Category(ies) of Dementia (10), Learning disability (1), Old age, registration, with number not falling within any other category (44) of places Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 30 June 1999. 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. The Home can accommodate one named service user under the age of 65 years The registered managers position is wholly supernumerary The deputy manager has one day allocated for supernumerary time 4. 5. 6. Date of last inspection 6th March 2006 Brief Description of the Service: Situated in the Oldbury area of Bridgnorth, Oldbury Grange is a large country style house converted and extended to include the addition of a single story purpose-built wing. Owned by Shropshire Private Care Ltd it is Registered to provide care for a maximum of 55 Older People, which may include up-to 21 persons requiring nursing care, up to 34 persons requiring ‘residential’ care, and 10 persons who with dementia (either nursing or residential). The original building is utilised for Residents requiring ‘residential’ care, and comprises a mix of single and double occupancy bedrooms with access via a passenger lift to the upper floor. Nursing care services are located in the single story wing and accommodation is provided in single bedrooms, with en-suite facilities. The gardens are well maintained and enjoy safe access for all for Residents. Fees charged range from a minimum of £330 per week up-to a maximum of £480 per week. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection was undertaken by one Inspector, commenced at 9:45am, lasted 5.0 hours, and concluded at 2.45 pm. Present was the Registered Manager, Mrs. Christine De Souza. Being the first Inspection of 2006/07 it centred on ‘Requirements’ cited at the previous Inspection, held in March 2006, plus all ‘Key’ National Minimum Standards. This Report is based on observations made during a tour of the Home, a review of Care Related Documentation, Staff Duty Rotas, Staff Personnel Files, Staff Training Files, plus a range of other documents/records reflecting the general operation of the Home. The Inspector also held 1:1 discussions with the Registered Manager, 6 Residents, 3 Visitors and several members of Staff. What the service does well: What has improved since the last inspection? The Home has improved the level of involvement from Residents and Relatives/Visitors enabling influence in areas such as leisure and social activities and menus. Improvements in the latter area have been further facilitated by a review of the deployment of Catering Staff, which provides cover over a greater part of the day. In addition to more effective use of available staff hours this has enabled greater flexibility in meeting Residents’ wishes with regard to the type of meals offered – particularly in respect of the ‘tea-time’ meal. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 6 A number of ‘Requirements,’ cited at the previous Inspection, relating to the following aspects of care have all been fully met:− − − − − − Changes to medicine administration practices Updating of the Complaints Procedure The use of wedges for keeping fire doors open to cease Issues relating to the use, and maintenance of wheelchairs The laying of more appropriate floor coverings in some toilets Safety checks on electrical appliances 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. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 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 Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. EVIDENCE: A review of 5 Residents’ Care Plans/Files, i.e. those relating to the two most recently admitted Residents plus 3 selected at random, demonstrated prospective Residents undergo appropriate care needs assessment which is conducted by the Manager or a suitably experienced deputy. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The model of Care Plan, utilised by the Home, is of a design, which is easy to read and comprehensive. Care provided by the Home is effective in meeting the Residents’ assessed care needs, and is delivered considerately and effectively. The approach of Staff in providing such care is good, with relationships between Residents and Staff being friendly and respectful. The storage, administration, and disposal of medicines are in accordance with accepted good practice. EVIDENCE: Five Residents’ Care Plans/Files were reviewed, i.e. those of the two most recently admitted Residents, plus 3 selected at random, as a component of ‘Case Tracking’. In addition, from observation and individual discussions with Residents and Relatives, it is clear they are treated in a considerate and respectful manner. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 10 At the previous Inspection two ‘Requirements’ were cited under the Standard covering the management of medicines, these being:1. “All medicines administered/non administered must be recorded immediately after the transaction with either a signature or a defined abbreviation in order to eliminate gaps in the administration record.” 2. “A dedicated fridge must be used for the storage of medication where they are required to be stored at a low temperature.” A thorough inspection of the medicine storage provision and medicine administration records demonstrated both these ‘Requirements’ to be fully met with all other medicine related practices meeting the guidelines of the Royal Pharmaceutical Society Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 11 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure opportunities are provided, which are consistent with Residents’ capabilities. The Home facilitates achievement of desired lifestyle through Residents conducting the pattern of their day as they wish, including contact with family and friends, and continuation of religious practices. There is a daily choice of attractive and nutritious meals. EVIDENCE: The Home now has a developing programme, comprising a variety of activities, planned and organised jointly by Residents and Staff. This was evidenced by Minutes of Meetings held between Residents, Visitors and Staff. A further improvement in the provision of leisure and social activities has been the appointment of a dedicated ‘Activities Co-ordinator’ employed for 3 hours on 3 days per week. In addition, the Inspector was informed a member of Nursing Staff is currently undertaking a course to gain a ‘Diploma in Seated Exercise Programmes’. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 12 A further innovation, introduced by the Manager shortly after taking up post, has been to hold a complete review of the deployment of Catering Staff with the aim of improving the overall quality of the ‘tea-time’ meal. This change involved the Kitchen Assistant moving to work from 10.30am - 5.30pm instead of 7.00am – 2.00pm, which has enabled provision of a wider range of freshly prepared snacks, the introduction of soups and the possibility of responding to direct requests by Residents. Evidence of the effectiveness of this new arrangement was found in comments made by Residents and Relatives who were fulsome in their praise of the change. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interests of Residents are protected through ready access to information relating to advocacy services and the Home’s Complaints Procedure. Staff are aware of their role in protecting Residents from abuse. EVIDENCE: Complaints Procedure details, which are included in the Service User Guide, and displayed prominently for the benefit of Visitors, have been amended so as to meet a ‘Requirement’ cited at the previous Inspection, i.e. − “The complaints procedure must include the contact details of Commission for Social Care Inspection” There are policies and procedures in place intended to provide protection for vulnerable people. These fully meet the requirements of this Standard and Staff Training Files confirmed the topic is covered both at induction and through on-going staff training. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home provides a safe, well-maintained environment with the gardens being easily accessible at all times of year. Specialist equipment, consistent with meeting the assessed care needs of Service Users and the demands of tasks carried out by Care Staff, is generally available and appropriately serviced and maintained. Generally, Residents live in ‘private’ accommodation, which meets their individual needs and capabilities. The cleanliness and general state of repair in all areas of the Home is good EVIDENCE: A tour of the premises, examination of maintenance records and discussion with the Manager, provided evidence of well-organised preventative maintenance practices, e.g. all bedrooms are subject to monthly application of a comprehensive checklist, including testing of water temperatures, and effective response to day-to-day maintenance issues. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 15 Specialist equipment, e.g. hoists, wheelchairs, stand-aids, was observed to be in good working order, and evidence of maintenance by qualified engineers was seen. At the previous Inspection a number of ‘Requirements’ were cited under Standards within ‘Environment’, all of which have been met:− “The use of wedges for keeping open fire doors must cease, where there is a need or a personal for a fire door to be kept open, and then the appropriate closure must be fitted linked to the fire alarm to close when the alarm is activated.” − “Regular maintenance checks are needed for the safe use of the wheelchairs.” − “Footrests must be on the wheelchairs and used. A risk assessment must be undertaken when there is an assessed need for the foot rests to be removed.” − “The carpets in the floor toilets must be replaced with a more suitable easily cleanable floor covering.” A Requirement in this area, which has not yet been met, is: − “All private accommodation doors must be fitted with a suitable door locking facility.” It is accepted many Residents do not wish to avail themselves of the facility by which they may lock their bedroom doors if they so wish – a fact confirmed directly to the Inspector by all those Residents engaged in conversation. However, the wishes of Residents who do wish to avail themselves of such a facility should be met, and with minimal delay. It is a ‘Requirement’ of this Inspection that:1. All Residents must be ‘risk assessed’ to determine suitability to have a key to the door of their bedroom, and, where appropriate, those wishing such a facility must be granted it. 2. To enable installation of locks to bedroom doors in future (where ‘risk assessment’ deems it appropriate) the Home must retain on the premises a minimum of two suitable door locks and be able to ensure fitting within two working days of such a request from the Resident for facility to lock their bedroom. It was noted at the previous Inspection two bathrooms were being revamped and redecorated. One was nearing completion with a few minor snagging items to be attended to, with work continuing on the other bathroom. It was observed at this Inspection that both bathrooms are still out of commission. It is a ‘Requirement’ of this Inspection that all necessary work is completed and both bathrooms is brought into use as soon as possible. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers on duty and skill-mix were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are now consistent with the safeguarding of Residents. The commitment of the Home to provide training for Care Staff is good, and in accordance with individual Staff Members’ learning needs. EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. These demonstrated Staffing numbers and skill-mix enable a service provision, which meets the care needs of the Service Users. A review of employment files for 5 members of Staff, i.e. those relating to the 2 most recently employed, plus 3 selected at random, provided evidence that employment practices are compliant with the Standard, and Schedule 2 of the Regulations. Examination of Staff Training Records evidenced Staff are subject to a thorough and relevant orientation/induction programme and comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’. This is followed, where necessary, by ‘specialist’ training, e.g. ‘Dementia Awareness and access to NVQ Training with attainment of NVQ Level 2 or higher currently running at 54 of Care Staff. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is benefiting from the input of an experienced and committed Manager. The ambience is warm, inclusive, and friendly. Operationally it appears well organised with the central purpose being ‘the best interests of Residents’. Lines of accountability are clearly defined and observed. The views of Residents and other interested parties are sought by the Home and acted upon. Service Users are safeguarded by the financial procedures operated in the Home. All Staff are subject to effective support with regular supervision, and appeared involved and happy in their work. Health and Safety Policies/Procedures/Practices were satisfactory. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 18 EVIDENCE: Having previously been employed at Oldbury Grange for many years as an RGN, Mrs. Christine De Souza has recently been approved by the CSCI as Registered Manager. A ‘Condition of Registration’ is, due to the Registered Manager working 28 hours per week, the Registered Manager must be ‘wholly supernumerary’ and the Deputy Manager must be ‘supernumerary at least one day per week’. Observation of the duty rota showed this to be as required. However, this arrangement is being reviewed by the management team with a view to possibly recommending to the Owners that the supernumerary time of the Deputy be increased to two days per week, and the Registered Manager’s working time increased to 32 hours per week. These changes combined would enable the Manager to work four longer (supernumerary) days per week thus facilitating the developing management task. Support for the Manager is evidenced by regular attendance at the Home by the Responsible Person, and monthly submission to CSCI of Regulation 26 visits. The Home manages cash for two Residents, whereby Relatives deposit these monies to cover for minor items of expenditure, e.g. shopping and hairdressing. These monies are maintained in accordance with the Standard. Financial records reviewed demonstrated appropriate records of transactions, including receipts and auditing practices, to be in order. Evidence of ‘quality assurance’ work being undertaken was seen, including questionnaires to Residents and Relatives/Visitors, and notes from regular meetings with Residents. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. Records are maintained for hot water supply to baths, and water tested during the Inspection was satisfactory. COSHH data sheets were up-to-date. A ‘Requirement’ from the previous Inspection that all portable electrical appliances must have an annual safety test has been met with written evidence observed. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 3 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 (2)(j) Requirement Timescale for action 31/07/06 2. OP24 23 (1)(a) Sch 1, 18 3. OP24 23 (1)(a) Sch 1, 18 All necessary works on the two bathrooms currently out of use must be completed and both bathrooms be brought back into use as soon as possible. All Residents must be ‘risk 31/07/06 assessed’ to determine suitability to have a key to the door of their bedroom, and, where appropriate, those wishing such a facility must be granted it. To enable installation of locks to 31/07/06 bedroom doors in future, where ‘risk assessment’ deems it appropriate, the Home must retain on the premises a minimum of two suitable door locks to ensure fitting within two working days of such a request. Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 21 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 Oldbury Grange Nursing And Residential Home DS0000022259.V294070.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate 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. 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