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Inspection on 26/02/07 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 26th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The general day to day care of residents is good. The care staff know each resident well and are able to meet their needs. Residents spoken to state: `The staff help you although they are always busy` `Staff are very kind` `The nurses are very good` `The staff know what I need and manage that well` There is a variety of training for staff in a number of areas related to the care of the residents. Over 50% of care staff have achieve a National Vocational Qualification to at least Level II in Care. Residents` personal monies are properly managed and they are protected from financial abuse.

What has improved since the last inspection?

The corridors have been re-painted and look clean and attractive.

What the care home could do better:

There are many improvements needed in the service to ensure that the outcomes for service users are good. Pre-admission paperwork must be completed and the potential resident visited where possible to ensure that their needs can be met by the home. The residents where possible must be consulted about their care and the care plans must reflect the current needs of the residents and be up dated as required. Issues related to controlling infection must be addressed such as: a) Changing syringes used for artificial feeding as recommended b) Ensuring that there are suitable hand washing facilities in the laundry c) Toilets and bathrooms are properly cleaned especially the hand basins. Medication management and ensuring that medication is always locked must be addressed to ensure the safety of the residents. The registered manager must ensure that complaints are fully understood by staff and information must be readily available for residents and relatives to enable them to make concerns and complaints known. The registered provider must ensure that all staff fully understand the areas that are considered abusive behaviour and their role in reporting incidents or suspicions of abuse, therefore protecting the residents. The employment procedure is poor and the registered manager must ensure that this is addressed so that all employees are considered safe to work with vulnerable adults. All staff that are newly employed must undergo a full induction programme to ensure that they fully understand their role and are able to meet the needs of the residents in a safe and appropriate manner.The unpleasant smells in the entrance area, lounge and some bedrooms must be dealt with as this makes the environment uncomfortable to live in. Residents, relatives and staff must be involved in quality assessing the service provided and this information should be made public.

CARE HOMES FOR OLDER PEOPLE Oldbury Grange Nursing Home Oldbury Road Hartshill Nuneaton Warwickshire CV10 0TJ Lead Inspector Mrs Suzette Farrelly Key Unannounced Inspection 26th February 2007 08.00 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.V323799.R02.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.V323799.R02.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 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.V323799.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 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. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The inspection visit was unannounced and took place on Monday 26th February 2007 and started at 8:00 am and finished at 5.50pm. During the inspection three residents were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. An inspection of the environment was undertaken, and records were sampled, including staff employment and training, health and safety, staff rotas, complaints and fire records. Three staff were spoken with concerning their experience of working at this service and their understanding of their role. One student nurse was spoken with regarding her placement and support. A meal was eaten with the residents at lunchtime and general discussion took place with the residents sitting at the same table. A further four residents throughout the visit were spoken with regarding their experiences of living at this home. Observation of working practices and staff interaction with service users was undertaken. Information from the Pre- Inspection Questionnaire has also been incorporated into this report. Residents or relatives returned no comments cards to us. The Inspector would like to thank staff and service users’ for their cooperation. What the service does well: The general day to day care of residents is good. The care staff know each resident well and are able to meet their needs. Residents spoken to state: ‘The staff help you although they are always busy’ ‘Staff are very kind’ ‘The nurses are very good’ Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 6 ‘The staff know what I need and manage that well’ There is a variety of training for staff in a number of areas related to the care of the residents. Over 50 of care staff have achieve a National Vocational Qualification to at least Level II in Care. Residents’ personal monies are properly managed and they are protected from financial abuse. What has improved since the last inspection? What they could do better: There are many improvements needed in the service to ensure that the outcomes for service users are good. Pre-admission paperwork must be completed and the potential resident visited where possible to ensure that their needs can be met by the home. The residents where possible must be consulted about their care and the care plans must reflect the current needs of the residents and be up dated as required. Issues related to controlling infection must be addressed such as: a) Changing syringes used for artificial feeding as recommended b) Ensuring that there are suitable hand washing facilities in the laundry c) Toilets and bathrooms are properly cleaned especially the hand basins. Medication management and ensuring that medication is always locked must be addressed to ensure the safety of the residents. The registered manager must ensure that complaints are fully understood by staff and information must be readily available for residents and relatives to enable them to make concerns and complaints known. The registered provider must ensure that all staff fully understand the areas that are considered abusive behaviour and their role in reporting incidents or suspicions of abuse, therefore protecting the residents. The employment procedure is poor and the registered manager must ensure that this is addressed so that all employees are considered safe to work with vulnerable adults. All staff that are newly employed must undergo a full induction programme to ensure that they fully understand their role and are able to meet the needs of the residents in a safe and appropriate manner. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 7 The unpleasant smells in the entrance area, lounge and some bedrooms must be dealt with as this makes the environment uncomfortable to live in. Residents, relatives and staff must be involved in quality assessing the service provided and this information should be made public. 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.V323799.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 was not inspected, as this service does not have intermediate care. Quality in this outcome area is adequate. There is insufficient information available prior to admission for this service to be able to demonstrate that all needs have been fully assessed and can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three resident profiles were examined. One resident’s pre-assessment form was completed, however this had limited information and was not dated or signed to indicate when and who it was completed by. There was a further assessment, for this resident, dated 25/03/06 that was more complete and contained both the resident’s capabilities and where assistance was required. A further resident was admitted from another care home and this service had faxed over their care plans and information about this residents needs and capabilities. There was no evidence to suggest that anyone from this service Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 10 visited the resident to ensure the accuracy of the information or to meet the resident before admission. The final profile examined indicated that a resident admitted for respite care and discharged on the day of the visit did not have any pre-admission information. The staff stated that this resident had been in the home before on a number of occasions, however current information was not available. Social service assessments were available for two of the residents records examined and two social service contracts were seen. Two separate residents spoken to stated that their families had decided on the admission to this service and they were both happy with the admission. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. The care of residents is good however poor record keeping and management of medication compromises this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three profiles were examined. Assessments and care plans are kept in separate folders for each resident and these can be found in their bedrooms. Daily recording is kept separately together in a general folder. It was noted that there is limited correlation between the daily records and the care prescribed by the nurses. In one daily record it was written on many occasions ‘ Slept well’ and ‘Maintains independence during the day’. This type of daily recording would not assist with evaluation of care prescribed. Other records seen had more information related to nursing interventions and daily activities. The risk assessments for the three residents case tracked were up dated monthly and the care plans contained suitable information in relation to the Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 12 outcome of the risk assessments giving the care staff direction on care to be given. One resident case tracked had information in their care plan about the use of ‘bed rail’ to prevent falls at night, when visiting this resident’s room it was noted that there were no bed rail bumpers to prevent injury. On further discussion with the qualified nurse and a care staff it was apparent that there was confusion. The qualified nurse stated that the bed rails were used but the carer thought they were not. This could result in inconsistency of care and possible accidents. The care plan of one resident, who has artificial feeding referred to as PEG feeding, had not been up dated. The care plan described the amount of liquid feed the resident should have in a 24-hour period, however the dietician visited on 01/02/07 and increased the amount of liquid feed. This was because of slow consistent weight loss. When visiting this resident it was noted that the correct amount of liquid feed is being given and the qualified nurse was aware of the new treatment. The syringes used as part of this process were dated and had not been changed for ten days; this could increase the risk of infection. One resident case tracked had developed a large sore to their sacrum within two weeks of admission to the home. The staff had photographed the process of the healing of this area and there are clear records of treatment, the frequency of treatment and outcomes. Visits from the GPs’ are clearly recorded with reasons for the visit, conclusion, and changes in medication. Other records of visits by the chiropodist, optician and dentist were not available in the residents’ profiles and could not be located during this visit. On arriving at the home it was seen that the clinic room was open and the medicine trolley was also open, no staff were in the immediate area, this could result in medication being taken from the trolley by residents, staff or visitors. The qualified nurse explained that there had been an emergency and had forgotten to close the clinic door. An audit of five resident’s medications was conducted. The Medication Administration Records (MARs) were signed and there were no gaps. Four of the MARs seen had been hand written and signed by the qualified nurse. The quantity of medication received was not always recorded; therefore checking that medication is administered as prescribed would be impossible. The controlled medication was checked and it was found that medication for three residents who had left the home were still available. The records for the Temazepam were not available, as these had been filed with the residents’ Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 13 records. It was not possible to check and ensure that all the medication in the controlled medication cupboard were correct. On resident had Fludrocortisone 0.1 mg in the medicine trolley that was no longer required, the qualified nurse said this should have been returned. There is a medication fridge, the temperature is recorded daily and is with in suitable range to store medication. This fridge held only eye drops during this visit; none had been dated when open to ensure that they are discarded after 28 days of opening. Residents are treated with respect and the care staff were seen to refer to residents by their preferred name. Personal care and assistance was given in privacy and staff were discreet and took care to ensure that resident were given time to assist in all daily activities. It was seen that the curtain rail of the dividing curtain in one shared room was broken and the curtain could not be closed, this would deny dignity and privacy for both residents sharing this room. The registered manager stated that she was aware of this and that the maintenance person had been informed. Five residents were spoken to at length and said: ‘The staff help you although they are always busy’ ‘The staff are OK and help me when needed’ ‘The staff are very kind and the nurses are very good’ Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. Residents’ lifestyle experiences are partly met by the activities and daily choices they are given, this is compromised by a lack of consultation and equipment to assist residents to make choices. Relatives are made welcome and can visit at any reasonable time, which increase the good experience of residents living in this service. The main meal has variety but second choice and teatime meal is repetitive reducing the choice and varied experience of eating. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This service employed an activity organiser in December 2006; this person has no previous experience in this role but has begun to develop a variety of activities. Unfortunately on the day of the visit she was not at work but came in to discuss her role. The activity organiser works Monday to Friday from 9:15 am to 11:15 am and has developed a basic programme of activities for groups and individuals. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 15 There is bingo, alphabet quizzes, exercise to music, sing-a-longs and individual chats, and activities with residents who prefer to stay in their rooms. On Thursdays the hairdresser visits and the activity organiser gives residents a basic manicure. This is enjoyed by a number of the ladies. Very basic records are maintained individually for each resident and a daily account of activities is also maintained. These would be more useful if they contained more in depth information of the residents’ activities and participation and subjects discussed. One resident stated that she is bored sometimes, but enjoys watching television another resident said that they enjoyed bingo. There are no resident meetings and the service has not held resident meetings for some time. It is advised that this would assist the service to discuss such things as activities and outings with the residents and record their wishes. There are no restrictions on visiting the home and visitors are always made welcome. No visitors were seen during this visit but two residents spoken to say their loved ones are always made welcome. The local Church have a service on a Thursday at the home for all those who wish to attend and there is a mobile shop that visit approximately six weekly. There have been various trips outside the service; in the summer, the residents enjoyed a barge trip. One resident said that they enjoyed this trip and would like to do this again. Christmas shopping and a visit to the Black Country Museum has also taken place. The new activity organiser stated that she is exploring suitable outings for the residents to consider. The registered manager felt that the activity organiser could be delegated the job of organising resident meetings in the near future. The cook was seen discussing the day’s choices with residents in the morning. It was confirmed through discussion that the cook asks each resident who is able to eat and make the choice what he or she would like to eat. The inspector ate the midday meal with the residents in the dining room. The meal was mashed potatoes, garden peas, and sausages with banana and custard or ice cream for sweet. The main meal choice was baked potatoes with a variety of fillings. It was noted that the choice does not vary. It is recommended that the service consult with the residents to determine the type of food they would like and consider other alternatives to the main meal. The dining room is spacious and most residents, who are able, eat in the dining room. The qualified nurse explained that the residents could choose if they wish to eat in the lounge or their bedrooms. Each table was laid with a Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 16 tablecloth, centre decoration and condiments, however the meal was served with gravy, at no time were residents given the choice on the amount and whether they wanted gravy. All residents were given a jug of juice and a plastic cup at breakfast time and staff filled these cups and encouraged the resident to drink throughout the day. Tea was also offered at regular intervals. Fluid balance charts and food intake charts were also available, although the quantity taken was not recorded in the daily records of those examined. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. Although staff are fully aware of their role in managing complaints and dealing with suspicion and allegations of abuse the policies and procedures do not reflect this, which could result in poor management of the above. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have received two complaints related to theft of items from residents. This was discussed during the inspection and the registered manager was unaware of these concerns. We will give further information to be given to the service to enable them to investigate further. A senior carer described her actions in the event that a resident or relative raised a concern or complaint; however neither the carer nor the deputy matron could find the standardised form for recording concerns and complaints. Two residents said they would tell the carers or the nurse if they were worried or concerned. The matron reported an allegation of suspected abuse by a carer to a resident to us, this is still being investigated and further information will be sent when available. A discussion regarding abuse was undertaken with a senior carer, carer and the domestic, all demonstrated a good understanding of the areas of abuse and actions to be taken in the event of suspected or witnessed abuse. It was Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 18 also evidence through documentation that training in protection of vulnerable adults and abuse, was undertaken by some staff in January 2006. The policies and procedures for the reporting and management of allegations or suspicions of abuse were incomplete and require further information to reflect the local social service procedures. This was discussed with the registered manager who stated that this would be updated. The home does not have documents related to ‘No Secrets’ or the process of reporting staff to the Protection of Vulnerable Adults (POVA) list. This lack of clear information could result in poorly managed investigations and reporting of abuse; however recent reporting was in line with local and national policies. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 19 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, 24, 25, 26 Quality in this outcome area is adequate. The residents live in a well maintained and pleasant home that is compromised by the disorganisation and unpleasant smells. The infection control in the home is adequate some practices may compromise this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On entering the building there was an unpleasant smell that remained for the duration of the visit. The registered manager explained that carpets were to be replaced when the finances were available. It is advised that the reason for this unpleasant smell is located and suitable cleaning is undertaken to try to eliminate this. The immediate entrance area appeared untidy and unwelcoming; this was pointed out and the registered manager dealt with this immediately. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 20 Five bedrooms were viewed; three from residents case tracked and two others including two double rooms. These rooms had evidence that residents are given the opportunity to personalise their space. It was seen that the curtain rail in one of the double rooms was damaged and the curtain could not be closed compromising the privacy and dignity of both residents. The first bed in this room had a very badly damaged bed base where the material was torn in numerous areas. In a further room the bed rail bumpers were on an unoccupied bed, and the occupied bed required them. The qualified nurse instructed a carer to rectify this. The home has a large lounge on the first floor with a conservatory and a smaller lounge with dining room downstairs. The upstairs lounge had an unpleasant smell that remained for the duration of the visit. It was noticed that both the lounge areas were generally untidy with bric-a-brac and flowers left on surfaces without thought, various items such as games, soft toys and magazines were in areas that residents would not be able to easily access. The slabs on the patio have been re-laid and are now even to minimise the risk of trips and falls. The communal toilets and bathrooms have been redecorated and were seen to be clean and tidy. All sluice rooms were locked. The registered manager pointed out that all the corridors have been decorated, these areas looked bright and clean. There is sufficient light throughout the home. The staff room fridge is not working correctly, it was explained that a new fridge is to be delivered this week. The laundry is situated downstairs and inaccessible to residents. There are two washing machines and a tumble drier. The laundry person has suitable gloves and disposable bags for soiled laundry. There was no evidence of liquid soap and paper hand towels to ensure good infection control. The registered manager stated that this would be rectified the following day. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area adequate. There is sufficient well-trained staff on duty to meet the needs of the residents. The employment records are disorganised and all checks required for employment are not always completed to ensure that the employee is safe to work with vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is sufficient suitably trained staff on duty at all times. The home also accommodates student nurse training, a student nurse was spoken to and stated that she had learnt a lot at the home and was enjoying her placement. The home does not use agency staff at this time; gaps in the roster are covered by overtime from staff employed by the home. 7.30 – 2.30 (morning) 2.30 – 9-30 (afternoon) 9.30 – 7.30 (nights) 2 nurses 2 nurses 1 nurse 1 senior carer 1 senior carer 4-5 care staff 4 care staff 2 carers There is the registered manager, the matron and a deputy matron. Each person has a specific role in relation to the management of this service. The registered manager looks after the environment and maintenance of the service, the matron ensures that there is sufficient staffing and that suitable Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 22 training is available, and the deputy matron is responsible for health and safety issues including the correct procedures for moving and handling. There are sufficient staff to manage the kitchen, and laundry. The cleanliness of the home is adequate however; there are areas that require deeper cleaning such as toilet sinks, carpets, and some bedrooms. The home employs designated domestic staff. Three staff records were seen of staff recently employed. These were incomplete and disorganised. Criminal Record Bureau (CRB) Checks and Protection of Vulnerable Adult (POVA) checks are not sent for prior to employment. The registered manager had also not requested POVAfirst checks, which ensures that the new employee is safe to work with vulnerable adults. Some references were dated the same as the application form suggesting that the carer brought these with them. There is no evidence that the registered manager checked to ensure these were genuine. A folder containing the CRB checks for all staff was disorganised and the registered manager had difficulty locating evidence of checks requested. Staff records of employees no longer working for the home were laying on the floor and not in secure storage. There was no evidence of induction and one newly employed member of staff stated that the induction had taken ‘about an hour’. The registered manager must ensure that there is suitable induction for all staff employed and that this is managed appropriately and completed with in a reasonable time frame. Sixteen care staff have a National Vocational Qualification to at least level II in Care, which exceeds the recommended 50 . Many staff have also attend a variety of training since January 2007 covering Equality and Diversity; Vulnerable Adults; Loss and Bereavement; Effective Hand Hygiene and Fire Training. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. The management is not organised and there is insufficient consultation with residents, relatives and staff to ensure that improvements in the service are made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is responsible for the environment and maintenance of the home, and there is a Matron who is a qualified nurse who manages the clinical areas and is responsible for training all staff. The deputy matron who is also a qualified nurse is responsible for health and safety. Through discussion and examination of records it was apparent that some areas of responsibility are not appropriately delegated and the deputy matron and registered manager could not answer all questions regarding the management of staff and the home. It is important that the managers are aware of what is Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 24 occurring to ensure that all residents are cared for, their needs met, and staff are aware of their roles and responsibilities. The quality assurance system is poor; there are monthly staff meetings where issues related to the home, and care is discussed. Resident and relative meetings do not occur and there was no evidence to demonstrate that they are consulted about the quality of the service provided. Staff receive supervision and the file was examined. It was seen that this does not occur six times a year for all care staff. The deputy manager stated that the process was time consuming and that at times it was difficult to fit in with the daily routine of the home. Ways to deal with this were discussed at the time. The home manages residents’ personal monies. Two records were checked and found to be correct and contain all receipts for monies spent. The home does not act as an advocate for residents in regards to their personal finances. The registered manager stated that some refurbishment had occurred since the last inspection and it was planned to replace the hall carpets and decorate some bedrooms date for this had not been agreed. Three staff spoken to stated that they felt supported by the management. One carer felt that the care practices had improved and there was a better choice of meals, however more moving and handling equipment would be useful such as slide sheets and at times the numbers of staff were not enough to enable staff to spend quality time with the residents. The health and safety of the home is maintained and a selection of certificates and records were seen this confirmed that the home ensures that all equipment is safe and in good working order. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 25 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 2 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 1 X 3 2 X 3 Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 26 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 OP3 Regulation 14(1) Requirement The registered manager must ensure that a comprehensive pre admission assessment is completed for each prospective resident. Records of this assessment must be maintained, dated and signed by the person completing the information. Timescale for action 15/03/07 2. OP7 14(2) 3. OP7 15(1) 4. OP7 15(2)(c) (Outstanding since 23 June 2005) The registered manager must 15/03/07 ensure that risk assessments are completed and reflect the current needs of the residents. The registered manager must 15/03/07 ensure that the care plans contain the correct information in sufficient detail to ensure that the residents receive consistent and the right care. The registered manager must 31/03/07 ensure that there is documentary evidence (where possible) to demonstrate that residents are involved in the care planning process. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 27 5. OP7 15(2)(b) 6. OP8 13(3) 7. OP8 13(7) 8. OP9 13(2) 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP9 13(2) 13. OP14 12(3) The registered manager must ensure that the evaluation of care prescribed reflects the care given and if it is working. The registered manager must ensure that syringes used for residents with PEG feeds are changed according to advice from the dietician. The registered manager must ensure that risk assessments for the use of bed rails are clearly recorded and full safety checks are completed. The registered manager must ensure that the clinic door and medicine trolley are locked at all times when not in use. The registered manager must ensure that medication no longer in use is removed from the medicine trolley and returned to the pharmacy. The registered manager must ensure that all eye drops are dated when opened to ensure that they are discarded after 28 days. The registered manager must ensure that the nurse signs all handwritten prescriptions on the MAR charts and the quantity of medication is clearly recorded. The registered manager must ensure that any controlled drugs no longer prescribed are returned to the pharmacy at the earliest opportunity. The registered provider must ensure that all residents are given choice concerning their daily lives. Various ways of doing this must be developed. 15/03/07 28/02/07 31/03/07 28/02/07 28/02/07 28/02/07 15/03/07 28/02/07 31/03/07 Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 28 14. OP16 22(5) 15. OP18 13(6) 16. OP18 13(6) 17. OP18 13(6) 18. OP19 23(2)(b) 19 OP24 16(1)(c) 20 OP25 23(2)(d) 21 OP26 16(2)(k) 22. OP26 16(2)(j) The registered provider must ensure that all residents, relatives and staff are fully aware of the complaints procedure and where the forms for recording a complaint are located. The registered provider must ensure that all staff are fully aware of the policies and procedures related to the protection of vulnerable adults. The registered provider must ensure that all staff are fully aware of what constitutes abuse and the whistle blowing policy. The registered provider must ensure that the policies and procedures for the Protection of Vulnerable adults are in line with local protocol. The registered manager must ensure that equipment and furnishing in the home are in good repair and suitable for its use. The registered manager must ensure that dividing curtains in shared rooms are in good repair and maintain the privacy and dignity of the residents. The registered manager must ensure that the communal environment is tidy and comfortable for residents enabling them to access items in these areas. The registered manager must ensure that unpleasant smells in communal and private areas of the home are eliminated and actions are put into place to manage these in the future. The registered manager must ensure that there is liquid soap and paper hand towels in the laundry to ensure good infection control. DS0000004403.V323799.R02.S.doc 31/03/07 31/03/07 15/03/07 15/03/07 30/04/07 28/02/07 31/03/07 15/03/07 28/02/07 Oldbury Grange Nursing Home Version 5.2 Page 29 23. OP26 16(2)(j) 24. OP29 16(2) 25. OP29 19(4)(c) 26. OP30 18(1)(c)(i ) 24 27. OP33 28. OP36 18(2)(a) The registered manager must ensure that all sinks in communal and private toilet areas are cleaned properly. The registered provider must ensure that Criminal record Bureau Checks with Protection of Vulnerable Adult checks are applied for and a POVAfirst has been received before employment. The registered manager must ensure that all references are genuine. References brought to the home by the employee must be checked out. The registered manager must ensure that all staff have a full induction into the home, their role and care. The registered manager must ensure that there is a suitable quality assurance system that includes residents, relatives, staff and other involved in the service. The registered manager must assess the supervision process and ensure that all care staff receive supervision six times a year. 15/03/07 28/02/07 28/02/07 15/03/07 31/03/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations The inspector recommends that the staff-training matrix be up dated to accurately identify training attended. Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oldbury Grange Nursing Home DS0000004403.V323799.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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