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Inspection on 12/02/08 for Oldbury Grange Nursing Home

Also see our care home review for Oldbury Grange Nursing Home for more information

This inspection was carried out on 12th February 2008.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Comments received from relatives state that: "My mother has settled here well and we are very pleased with the care she is getting". "My father is always clean and well dressed and he is very happy with the food". These comments reflect generally the views of people using this service. Assessments provide comprehensive details of the health and personal care needs of people moving into the home. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care. Systems in place to record any complaint received were good and supported the home in ensuring that concerns received were appropriately investigated.

What has improved since the last inspection?

There have been a number of significant improvements made in the home, especially in high risk outcome areas. All requirements and recommendations made following the last key and random inspections had been addressed. The majority of which were fully met. The staff in the home are commended for working towards making these changes. These areas include: Care plans showed that the matron and nursing staff had made improvements by updating them and reviewing risk assessments. There was evidence that the health and well being of people followed through the case tracking process had been updated and changed as appropriate. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. The home has worked hard to improve the medicine management since the random inspection, which took place on 29th September 2007. All requirements issued had been fully met as well as all the recommendations. This was commended. Observations made by the expert by experience shows that good interaction was observed between staff and residents. A good variety of activities were evident, given the time available. The home has implemented internal audit processes to monitor the views of people using the service, care practices, medication procedures and care plans. The outcomes of audit reports were followed up the matron. These audits will help to ensure that the home is run in resident`s best interests.

CARE HOMES FOR OLDER PEOPLE Oldbury Grange Nursing Home Oldbury Road Hartshill Nuneaton Warwickshire CV10 0TJ Lead Inspector Yvette Delaney Unannounced Inspection 12th February 2008 09:00 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 Home DS0000004403.V358607.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. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oldbury Grange Nursing Home Address Oldbury Road Hartshill Nuneaton Warwickshire CV10 0TJ 02476 398889 02476 398881 shroprivatecare@tiscali.co.uk 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) Dr B Sidhu Mrs C Sidhu Charan Kanwal Sidhu Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2007 Brief Description of the Service: Oldbury Grange Nursing Home is situated in the Warwickshire countryside a short distance from Hartshill. Dr and Mrs Sidhu currently own the home. The home is registered to provide nursing care for 44 elderly people. The accommodation is purpose built with service user accommodation provided on two floors. Access to each floor is possible via passenger lift or stairs. Garden and patio areas are easily accessible to service users, including those that use wheelchairs. The accommodation provides excellent views over the local countryside. At the time of the inspection the fees charged range from £460.00 - £500.00 per week and payable usually in advance by either cheque, direct debit or standing order. The fees do not include newspapers, toiletries, and the services of a chiropodist, dentist, optician or hairdresser. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this home is 1 star; this means that the home provides adequate outcomes for the people who use the service. This was the second Key unannounced inspection of this year, which examines all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The unannounced inspection took place from 09:15 to 18:30 hours. Since the last in the inspection in July 2007, a random inspection was undertaken in November 2007. There was little or no evidence of improvement found during the random inspection. Following the random visit a letter of serious concern was forwarded to the owners of the home. Our expectation of this visit was that the home would have made improvements. This key inspection visit showed improvement in a number of key areas. It was evident that the manager, matron and other staff had made good progress in ensuring that Oldbury Grange nursing home is meeting the Care Home Regulations and National Minimum Standards of practice. This report uses information and evidence gathered during the key inspection process, which includes a visit to the home. Information examined and seen includes a Statement of Purpose and Service User Guide written by the home, the service history of the home, inspection activity details, a number of case files and information from other agencies and the general public. A pharmacist inspector undertook a full review of medication management within the home. The findings are included in this report. Four people who were staying at home were ‘case tracked’. This involves establishing an individuals experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on the outcomes for the resident. Tracking peoples care helps us to understand the day-to-day life of people who use the service. An ‘expert by experience’ accompanied the inspector on part of this visit. This is someone who has experience of care services themselves, due to having a member of their family in a care home. This person is actively involved with ‘Help the Aged’ and sits on a relative’s forum for an elderly person’s care home. The expert by experience takes the opportunity on the inspection visit to talk to residents, visiting families and staff. Findings in this report are also based on the persons’ observation of the interaction between people who live Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 6 in the home and staff. Their findings are also included in this report and used as evidence when deciding on the quality of service provided at the home. What the service does well: What has improved since the last inspection? There have been a number of significant improvements made in the home, especially in high risk outcome areas. All requirements and recommendations made following the last key and random inspections had been addressed. The majority of which were fully met. The staff in the home are commended for working towards making these changes. These areas include: Care plans showed that the matron and nursing staff had made improvements by updating them and reviewing risk assessments. There was evidence that the health and well being of people followed through the case tracking process had been updated and changed as appropriate. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. The home has worked hard to improve the medicine management since the random inspection, which took place on 29th September 2007. All requirements issued had been fully met as well as all the recommendations. This was commended. Observations made by the expert by experience shows that good interaction was observed between staff and residents. A good variety of activities were evident, given the time available. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 7 The home has implemented internal audit processes to monitor the views of people using the service, care practices, medication procedures and care plans. The outcomes of audit reports were followed up the matron. These audits will help to ensure that the home is run in resident’s best interests. What they could do better: Although there have been a significant reduction in the number of requirements made at this inspection there remains a number of areas where the home can make improvements. All staff must receive up to date training in respect of adult protection procedures and the prevention of abuse. This will ensure that people living in the home are protected from the risk of abuse. The heating in the home must be reviewed to ensure that the heating system is able to maintain appropriate temperatures in the home. This will keep residents warm and ensure their health and well being is maintained during periods of cold weather. Procedures must be in place to reduce the risk of infection or cross contamination in the home. Staff care practices need to be reviewed to support the control of odours in the home. This will protect people in the home from the risk of cross infection or contamination. Extractor fans in resident’s en suites, toilets and bathrooms need to be cleaned. This will ensure the health and well being of people who live in the home. Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. Two appropriate written references must be obtained for all staff. A full employment history, together with a satisfactory written explanation of any gaps in employment must be available. This will support the home’s staff recruitment practices safeguard people living in the home. The standards of health and safety management within the home must be improved. This will ensure that the home is kept free from hazards, which could put residents at risk from harm. Arrangements must be made for all staff to have up to date mandatory training. Appropriate dated records to confirm attendance must be retained in the home. This is to ensure that people in the home are protected from the risk of harm. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 8 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. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 9 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 Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 10 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 and 3. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. Information about Oldbury Grange needs to be updated to ensure people are given sufficient and current information about the home. This will allow people to make an informed decision about whether to stay at the home. People receive a comprehensive assessment of their care needs to ensure they can be met before admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide are available in resident’s bedrooms. Some of the information was noted to be out of date. Updating these documents will allow people to make an informed decision about whether they move into home. The expert by experience gave feedback on relatives that he had spoken to. One relative of a resident said that they were well informed when making a choice for a Home for her mother. Both sets of relatives spoken to were aware Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 11 of the procedures of the Home and had inspected the Home’s Service User Guide. There have been four new admissions to the home since our last inspection visit in November 2007. The pre-admission information for two of these residents was examined. Assessments provided details of the health and personal care needs of the two people. Information available includes mobility, history of falls and their medical history. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is adequate. Care plans show improvement and provide staff with clear guidance on all aspects of residents needs and this should result in appropriate care being given to residents. The staff had worked hard to improve the medicine management to a safe and good level. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, there were 34 elderly male and female people living in the home. One resident was in hospital and another was receiving respite care. We examined the care plans for two of the residents admitted to the home since the last inspection and two further residents requiring varied levels of care from nursing and care staff. Since the last inspection, the matron has taken steps to improve the care planning process within the home. Care plans read showed that the matron and nursing staff had made improvements by updating them and reviewing risk assessments. There was evidence that the health and well being of people followed through the case Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 13 tracking process had been updated and changed as appropriate. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. For example one care plan showed that a resident with pressure sores had appropriate documentation in place. Documentation available mapped the healing progress of the pressure sores. Care plan detailed dressings to be used and instructions were documented for staff on how often dressings should be renewed. A further resident reviewed through case tracking was receiving feed through a tube in their stomach (PEG). A care plan was available to inform staff on the care of the tube and surrounding skin area. Instructions were available to staff on the importance of keeping the person upright while feeding and making sure the resident’s mouth was kept clean and moist. These instructions help to prevent the risk of the person choking and lessen the risk of infection of the digestive tract due to a dirty mouth. The expert by experience said that relatives had said to him that they were made aware that they could be involved in developing their relative’s care plan and any subsequent reviews. Risk assessment had been reviewed and completed in all care plans examined. These include risks related to pressure areas, falls, mobility and nutrition. Baseline observations of residents of blood pressure, pulse, temperature and weight had been recorded on or as soon as possible following admission. This is good practice and would support staff when monitoring any deterioration or improvement in a persons well being. Entries in the resident health records and comments by people living in the home confirmed that they are supported in getting access to relevant health care professionals when needed. This includes access to GP, Chiropodist, Community Psychiatric Nurse and Optician. In the expert by experience persons feedback they were able to confirm that all residents have access to the Home’s GP. Visits from the Dentist are as necessary and at least once a year, the Chiropodist visits every six weeks and the Optician visits take place 6 or 7 times a year. The Hairdresser visits weekly and most residents use this service. On most occasions written entries in care plans had been signed dated and timed, omissions on providing this detail was mainly made by night staff. Nursing staff should be particularly aware of this, as this is a requirement under their professional code of conduct. This issue was discussed at the random inspection visit carried out in November 2007. One of the care plans examined showed that Tippex, (erasing fluid) had been used to obliterate a written entry. To maintain an accurate and informed audit trail on the day-to-day events of a residents daily life in the home written Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 14 entries should be scored through once and clearly initialled by the person making the entry. This includes entries written in error. The pharmacist inspection took place before the main inspection. It lasted just over two hours and the outcome was good. The home has worked hard to improve the medicine management since the random inspection, which took place on 29th September 2007. A warning letter was written due to the poor practice seen. All requirements issued had been fully met as well as all the recommendations. This was commended. The home has installed a good system to check all the prescriptions before dispensing and to check the medicines received into the home. The care plans had improved and the clinical needs of the residents were documented. Staff need to respond better to the changing clinical needs of the residents. For example, one resident’s diet was poor and nutritional supplements had been prescribed when they first came to live in the home. However, after living in the home for a while their appetite had improved and poor diet and risk of dehydration was no longer an issue but they still took regular nutritional supplements. Audits indicated that the majority of the medicines had been administered as prescribed and the nursing staff had accurately recorded what had happened. The managerial staff regularly undertake audits to check whether the staff administer and record the medicines correctly. The medication trolley’s used to transport and store the medicines were clean and all medicines kept in an ordered fashion which further reduces any risk of error and also reduced the length of time it takes to undertake the medication round. All Controlled Drug transactions were accurate. The separate Controlled Drug cabinet contained some items other than controlled drugs. This should be reserved solely for Controlled Drugs to reduce the number of people that have access to it. The nurse on duty had a limited ability to understand fully comments during the pharmacy inspection. Concern was raised that she may not be able to respond appropriately to residents with communication difficulties due to a lack of understanding of English. It was assured that English language lessons were being sought. This was raised at the last inspection. People living in the home were treated with respect and their dignity maintained; for example, personal care was provided in the privacy of residents’ own bedroom or bathroom with the door shut. Staff also spoke respectfully to residents. Working practices carried out by care staff was observed. It was evident that staff are knowledgeable about people in their care. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. Open visiting arrangements encourage regular contact with relatives and friends and food is nutritious. Social and recreational activities do not meet the full needs of all residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans examined showed that information regarding peoples preferences for their daily routine had been documented, such as the time they like to get up in the morning. People were heard to ask to go to their bedroom to rest after lunch and staff were observed to support residents forming their request. An activities coordinator has being employed in the home for two hours a day, working 09.15 am to 11.15 am, five days per week. This is good practice but the amount of time the coordinator could spend with residents to provide meaningful stimulation and cater for all residents was limited, due to some residents in the process of getting up for the day or having breakfast. Observations made by the expert by experience shows that good interaction was observed between staff and residents. Some residents were playing bingo Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 16 with two carers helping. A good variety of activities are evident, given the time available and some trips outside of the home are carried out. The activities co-ordinator is not aware of resident’s life histories but keeps a file, separate from the main file, of activities undertaken by residents. The file was examined and found to be reasonably up to date. The activities co-ordinator said that she visits room-bound residents. Residents are asked what they would like to do. Comments received from residents during the inspection include: “We do have an opportunity to suggest activities”. The Home has a mini-bus for residents use but it can only be used for people who are fully mobile. The activity co-ordinator says that she drives and takes 3 or 4 residents out at a time. Records were available to show peoples likes, dislikes, past and present hobbies and interests. A survey had been carried out to determine the ability of individual residents to take part in activities and their particular interest in various activities. The assessment looked at whether individual residents had any physical disabilities, which may affect the type of activities they are able to get involved in or identify the level of support required. The areas covered include physical disabilities, visual, hearing or speech impairment. Activities identified as being enjoyed by residents include cookery, knitting, singsongs, shopping and flower arranging. The home has started to write life histories for each resident. These are written with the involvement of the resident and their families. These will support staff to provide person centred care. An open visiting policy is practised. This helps to support residents to maintain links with their families and friends. Relatives and friends were seen to visit during the day of inspection. People visiting were willing to speak to the inspector and the expert by experience accompanying the inspector on this visit. The expert by experience said that conversations with families confirmed that relatives are aware they are able to visit at any reasonable time. Residents were seen to be taken to the toilet before lunch. Residents order lunch on the day and menus were on display in the dining room, two courses are available. There is a choice of two main courses and two puddings. Meals offered were pork, potatoes, cabbage, carrots and cauliflower the other main meal choice was a salad. The expert by experience and inspector had lunch with the residents. The expert by experience sat in the main dining room and the inspector in the lounge area. Lunch was served between 12.30 and 1.30pm. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 17 The observations of the expert by experience showed that care and patience was given to residents by two carers in the dining room. Some residents choose to eat in the main lounge and there was a further small lounge where others were being fed. The residents, the expert by experience shared a table with, seemed to enjoy the meal and said that the food was good. The serving of a soft food meal was demonstrated to the expert by experience and this served with the components of the meal placed separately. This will support residents to identify what they are eating and maintain an appetite if the meal is well presented. Some people needed prompting or encouragement to eat and others needed assistance to eat their meal. The manager had carried out a survey of food choices and an audit of practices carried out in the kitchen and dining room. Areas that had been identified for action had been reviewed to ensure that the action had been carried out and improvements made. This is good practice. The weekly menu was read and seemed varied. There is a three weekly cycle of menus. Although on the whole positive comments were received from residents about the meals served other comments received did include: “The food could be better”. “Not much variety.” The kitchen was very clean and tidy and the Cook was ready with lunch before all residents had reached the dining room. Afternoon drinks were served to residents after 2.30pm. Residents seemed appropriately dressed in the lounge on the day of the inspection. There is no “Relative’s Forum” for input from or on behalf of residents. This could be useful to feedback concerns or positive comments to the management team. The Matron said during the inspection that she has tried to set one up with little or no response from relatives. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 18 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 and 17 Quality in this outcome area is good. People have access to the information they need to complain and know who to talk to if they have any concerns. The adult protection procedure and staff awareness of the procedures reduces the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the reception area of the home. Copies are also available in the Service User Guide. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made include: The manager confirmed that two verbal complaints have been received by the home since the last inspection. The systems in place to record any complaint received was seen these showed that the concerns received by the home had been appropriately investigated. There have not been any complaints received by us. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. As requested at the last inspection copies of the local authority procedures were available in the home to be used alongside the home’s procedure. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 19 Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. Training records examined indicates that protection of vulnerable adults training had been received by staff in 2007. The exact date of attendance was not recorded. They have been no incidents referred to the adult protection team for further investigation. The expert by experience reported that he had not seen any evidence of abuse, verbal or otherwise on the day of inspection. Care and consideration by members of staff towards residents was evident at all times. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 20 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, 21, 22, 23, 24 and 26 Quality in this outcome area is adequate. The standard of the environment is generally well maintained providing a homely place to live. However, some practices do not ensure that the standards of hygiene are maintained and that people living in the home are cared for in a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector and expert by experience toured the home with the matron. The tour was to give the expert by experience the opportunity to view the home, as it was their first visit to the home. A number of the views expressed below are as seen through the eyes of the expert by experience but the outcomes were observed by both of us and the manager and matron involved in different stages of the tour. We noted the following: Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 21 Oldbury Grange is built on the side of a hill and has two levels. There is one lift and one main staircase serving the two floors. Carpets in the corridors had been changed recently but the general condition of the décor was seen to be in need of attention as this made the home look scruffy in some areas. At the west end of the home, the corridor was very cold and radiators were not on or working. This could affect the comfort and warmth of residents living in this part of the home. Bedrooms had dated furniture, worn looking carpets and looked on the small side, especially shared bedrooms. Some bedrooms have en-suites while others have bathrooms and toilets positioned near to bedrooms where they are easily accessible. The bathroom and toilet have special equipment, which can be used by people with varying levels of mobility. Some of the extractor fans were not operating in the en-suites and almost all were clogged up with dust. This would make the circulation of air in these rooms difficult and encourage odours to be retained in bedrooms and toilets. Bedrooms are personalised and residents are able to bring in their own possessions and items of furniture if desired. Some bedrooms visited were clean and tidy and furniture provided by the home was reasonable. Cleaning was being undertaken and not all bedrooms had been tended to by 10.30am. There was evidence of odours in some parts of the Home. Staff leaving dirty bed linen in bedrooms after helping residents to get up in the morning did not help to eliminate the odours. Empty rooms were not clean and in an unacceptable state to be demonstrated to potential users. An empty bedroom had not been cleaned well. Items of clothing, which includes a number of odd slippers, opened chocolates, sweets and drinks had been left in the room. Left unattended these items could attract vermin and the state of the room would not portray a good image for the care home. A trolley with clean linen was placed in the sluice room and the room left unlocked. The sluice room is a dirty area used to sluice items dirty with body fluids, such as urine or faeces. The room is also used to store some cleaning products. The furniture in the common areas was functional and appropriate with some recently introduced mobile chairs evident. During the tour, it was noted that a fire extinguisher was not securely attached to the wall. A vacuum cleaner had been left in the corridor. The electrical lead had been plugged into a socket in one of the bedrooms, trailed under the bedroom door and along the corridor. This presented a trip hazard for Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 22 residents, staff and visitors. The cleaners’ trolley containing various cleaning products was also left unattended in the corridor. This was accessible to residents while the servicing of rooms was being carried out. The random inspection in November 2007 identified that fire-resisting doors were being propped opened and access behind one fire exit door had been blocked. The manager and matron had taken steps to address these. Items had been cleared from the fire exit door. Advice had been requested from the fire service about obtaining appropriate fitted doorstops, which would close on activation of the fire alarm. A written response had been received by the home from the fire service and conditions to ensure the safe use of these devices given. The furniture in the common areas was functional and appropriate with some recently introduced mobile chairs evident. The main lounge, in two sections with a small conservatory off one end, was fitted out with a large television at one end, a music system with a radio. A second, smaller lounge on the floor below also had a television in it. There is well-equipped kitchen and on the day of the inspection the Cook was well organised with clean, tidy and ordered surfaces. There is a good wellorganised food store and two freezers and one fridge. Plated food was covered and opened food containers were sealed and date marked. The laundry was visited where the housekeeper was ironing and explained the process. Laundry is turned round in 24 hours, there are red bags for soiled linen, colours are washed separately from whites and resident’s clothing is marked with names or room numbers. There is a lost property box/rail. The expert by experience was told that washing continues through the night, which could be disturbing for some residents and affect their sleeping patterns. Comments received from residents about laundering of their clothes include: “Clothes get taken to laundry nightly, even when I want to wear that item again”. “I have lost items of clothing”. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 23 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 and 30 Quality in this outcome area is adequate. There is sufficient numbers of staff on duty to meet the needs of people living in the home. Mandatory and other training needs updating to make sure people are cared for by competent staff. Staff recruitment procedures need further improvement to ensure residents are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the matron, deputy manager, a nurse, five carers, a cook, kitchen assistant and housekeeper were working in the home. There were 33 residents present in the home each with varying levels of dependency. There was sufficient staff on duty on the day of inspection. Duty rotas examined showed that over a period of one month staffing levels had been maintained. Staff working in the home were observed to be caring and supportive to residents and positive comments are made about staff these include: Training records were available for examination. These showed that staff had completed a series of training in 2007, there was no indication of the date staff had attended the training. A training matrix showed that staff had attended moving and handling training in January 2008. It was difficult however, to Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 24 confirm that staff were up to date with mandatory training and training related to the care of people living in the home. Staff spoken with said that they had attended five training, moving and handling, cross infection. Nurses said that they had received training in male catheterisation. Some care staff have completed a National Vocational Qualification (NVQ) in care. The number of care staff that have completed the qualification is low. However, the home is working towards all care staff undertaking the qualification. Records show that four staff are currently undertaking NVQ level 2 in care. Limited information to confirm staff have received training does not help to support that staff are suitably trained and competent to provide care for people living in the care home. Information available on the induction process shows that it is linked to the common induction standards developed by the Skills for Care Council. A review of three staff files confirmed that recruitment practices for the home have improved. Staff files contained evidence of protection of vulnerable adults (PoVA) checks and Criminal Records (CRB) checks. However, information in files showed that that appropriate references are not always requested to ensure that staff are considered safe to work with residents living in the home. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is adequate. The person who has the required experience and qualifications manages the home. The welfare and well being of people are not consistently protected and safeguarded and could result in risk from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is one of the owners of the home. Mrs Sidhu is a registered nurse and is supported by a matron a registered nurse with 15 years experience of working in the home. Both people have attained the registered managers award. The matron is primarily responsible for the care practices in the home. The registered manager and is involved in the overall day-to-day management of the care home. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 26 The matron and owner are keen to make improvements and since the last inspection had taken actions to address some of the issues identified in the last report. Resident’s comments about the management team include: “I have no problem with the management”. The home has internal audit processes in place to monitor the views of people using the service, care practices and care plans. The outcomes of audit reports were seen. The matron had followed up the outcome of some of the audits carried out where specific action had been identified as needed to improve practices. These audits will help to ensure that the home is run in resident’s best interests. A quality assurance manual is available in the home but no evidence was seen to show that this had been implemented. Individual records are maintained for people where the home holds personal monies. Receipts were available to confirm expenditure detailed on individual accounts. The balance of money was found to be correct. There was a clear audit trail; two people undertake a monthly audit. This should ensure that peoples money is held safely. Health and safety and a maintenance checks had been carried out to ensure equipment was safe in full working order. Electrical equipment used in the home had been tested to ensure us it was safe to use and appropriately wired. Water temperatures checks had been recorded monthly and this assists in the prevention of people accidentally scolding themselves. Maintenance checks were completed on five systems and equipment. Staff supervision takes place in the home. Records available show that areas covered include appearance, observation of care practices, nursing procedures, personal care and training. Safe care practices were not observed at all times, care staff were observed lifting a resident by holding the person under their arms and a resident was moved in a wheelchair with ill fitting foot plates. These practices could result in injury to residents if not carried out appropriately and safely. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X 3 3 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 28 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. 2 Standard OP25 Regulation 23 Timescale for action The heating in the home must be 30/04/08 reviewed to ensure that the heating system is able to maintain appropriate temperatures in the home. This will keep residents warm and ensure their health and well being is maintained during periods of cold weather. 30/04/08 Procedures must be in place to reduce the risk of infection or cross contamination in the home. This must include: Improving staff practices to control odours in the home. Making sure bed linen is changed and taken to the laundry area in a timely manner. Clean linen and clothing should not be stored in the sluice room at any time. Extractor fans in resident’s en suites, toilets and bathrooms must be cleaned and a regular programme of cleaning maintained. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 29 Requirement 3 OP26 13(3) 4 OP29 19 Sch. 2 This will ensure the health and well being of people who live in the home. Sufficient information must be 30/04/08 obtained to determine the fitness of potential employees before they start working at the care home. To include: Two written references, including where applicable, a reference relating to the person’s last period of employment, which involved work with vulnerable adults. This will support the home’s staff recruitment practices safeguard people living in the home. Requirement outstanding from 31/12/07 The standards of health and safety management within the home must be improved. So that the home is kept free from hazards. Particular attention must be given to: The cleaner’s trolley must not be left unattended at any time. The electrical wire for the vacuum cleaner must not be trailed along the corridor and under bedroom doors. This will support resident’s protection from the risk of harm. Safe care practices related to moving and handling must be used at all times. This includes: When moving a resident from one chair to another. Staff must not lift residents or lift by holding people under their arms. 5 OP38 13(4)(c) 13/02/08 6 OP38 13(5) 13/04/08 Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 30 Residents must be transferred in wheelchairs safely. Footplates must fit the wheel chair they have been attached to. Risk assessments should be completed for residents who request not use footplates while being transferred in a wheelchair. These practices could result in injury to residents if not carried out appropriately and safely. Arrangements must be made for all staff to have up to date mandatory training. Appropriate dated records to confirm attendance must be retained in the home. This is to ensure that people in the home are protected from the risk of harm. 7 OP38 18, 13 30/04/08 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be updated and available in alternative formats. This will ensure prospective residents have all necessary information to enable them to make an informed decision about using the home. Staff should not use Tippex to erase written entries in resident’s files and care plans. This will ensure that a legible and effective audit trial is available to track the care given to people living in the home. Written entries in resident’s care files should be dated, timed and signed with the person’s signature. This will ensure that a legible and effective audit trial is available to DS0000004403.V358607.R01.S.doc Version 5.2 Page 31 2 OP7 3 OP7 Oldbury Grange Nursing Home 4 5 OP9 OP12 6 OP14 7 OP18 8 OP19 track the care given to people living in the home. It is recommended that the controlled drug cabinet it reserved for the storage of controlled drugs only to reduce the number of people that have access to it. Resources available, especially staffing levels to support activities in the home should be reviewed to ensure that all residents in the home can benefit from social, mental and physical stimulation. The home should consider if forming a relatives/residents forum, which would provide feedback on positive comments or concerns to the management team would be of best interest for people living in the home. Detailed training records should be available to confirm what training staff have received and on what date. This would ensure that people living in the home are receiving care from competent and qualified staff. Details and plans for ongoing refurbishment in the fabric of the home, updating of the décor and replacement of furniture should be maintained in the home. This will ensure that residents are living in a homely, attractive and well-maintained home environment. Oldbury Grange Nursing Home DS0000004403.V358607.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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