Inspection on 29/06/07 for Oldbury Grange Nursing Home

This inspection was carried out on 29th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Oldbury Grange Nursing Home 16/03/09

Oldbury Grange Nursing Home 12/02/08

Oldbury Grange Nursing Home 26/02/07

Oldbury Grange Nursing Home 07/12/05

Oldbury Grange Nursing Home 23/06/05

Oldbury Grange Nursing Home 27/01/05

Oldbury Grange Nursing Home 06/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Oldbury Grange Nursing Home Oldbury Road Hartshill Nuneaton Warwickshire CV10 0TJ Lead Inspector Jean Thomas Unannounced Inspection 29th June 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.V338897.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.V338897.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 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.V338897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th February 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 were in the range £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, chiropody or hairdressing. Oldbury Grange Nursing Home DS0000004403.V338897.R01.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 residents 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. This was a key unannounced inspection visit, which addresses 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 visit to the care home took place on Friday 29th June 2007, commencing at 08:00am and concluding at 18:15pm. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. Three people living at the home 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’ and where evidence of the care provided is matched to outcomes for residents. A tour of the building and several bedrooms was made and observations at a mealtime. The inspector had the opportunity to meet a number of the residents by visiting them in their rooms and spending time in communal lounges and dining areas and talked to several of them about their experience of the home. A number of residents had cognitive impairments and some were frail and found it difficult to engage in conversation. General observations of working practices and staff interaction with the people living at the home were included in the inspection process. We talked to five staff members, the manager and matron and at the end of the inspection; feedback was given to the manager. 14 comment cards were sent to residents and 14 to their relatives or representatives. At the time of writing the report, six residents and six relatives had responded. An audit of residents’ surveys showed general service satisfaction. Comments made on the day of the visit showed that most residents like the food and were satisfied with their accommodation. Some staff are considered ‘better than others’ and residents do not feel they are given lifestyle choices such as when to get up, when to go to bed or when to have a bath. Residents lack stimulation and would like the opportunity to participate in activities suited to their needs. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 6 Surveys completed by relatives or representatives showed general satisfaction with the service. Staff are perceived as kind and caring and relatives or representatives are kept informed of any changes. This report uses information and evidence gathered during the key inspection process, which involved a visit to the home and looking at a range of other information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The inspection visit showed that health and safety was not well managed and three immediate requirement notices were issued to bring about the changes needed to safeguard residents. The details have been included in the report. Since the last key inspection visit to the service on February 26th 2007, there have been no complaints made to the Commission for Social Care Inspection (CSCI). Three complaints have been made directly to the service. The most recent complaint was received on May 8th 2007 and was made by a visitor who was concerned about how their relative had sustained a tissue wound and experienced what was described as a severe episode of diarrhoea. The manager reported that the complaint was investigated and was not upheld. The complainant was satisfied with the outcome and felt that the issues had been resolved. During the last key inspection visit, the matron told us there had been an allegation of suspected abuse by a carer to a resident. An investigation into the allegation of abuse and the conduct of a senior staff member was conducted in accordance with the local arrangements for safeguarding vulnerable adults. Both staff members were suspended without prejudice while an internal disciplinary investigation was carried out. The allegation was not upheld and the staff members reinstated. At the time of the key inspection visit, there were forty-one people being accommodated at the care home and the manager and matron were present for most of the inspection. The inspector would like to thank residents and staff for their cooperation and hospitality during the inspection visit. What the service does well: People moving into the home are encouraged to personalise their rooms and can bring small items of furniture into the home with them. Visiting is flexible and takes into account the needs and expressed wishes of the residents. Residents have access to a range of health care services and treatments as they would if living in their own home in the community. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 7 The home provides a varied and nutritious menu and the accommodation is well maintained. What has improved since the last inspection? What they could do better: There a number of improvements needed to make sure that all the people who use the service have positive outcomes. Information held in care plans has improved but gaps in care planning and recording may result in unmet needs. Risk assessments must be carried out paying particular attention to the prevention of falls and the use of bed rails. So that the home can be sure, any action necessary to reduce the risks to residents is taken. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 8 The activities programme should be reviewed and further developed so that residents are given more opportunities for stimulation through leisure and recreational activities, which match their cultural preference. Where possible the views of residents should be sought and taken into account when planning activities. All newly employed staff must undergo a full induction programme to ensure they fully understand their role and are able to meet the needs of the residents in a safe and appropriate manner. Rigorous staff recruitment policies and procedures must be in place and used to safeguard residents. Risk assessments must be carried out for the staff employed before the outcome of a Criminal Record Bureau (CRB) disclosure or checks made against the Protection of Vulnerable Adult (POVA) register were known. The outcome of the risk assessment must be used to safeguard residents. An annual quality audit seeking the views and opinions of residents, their relatives and other stakeholders must be carried out and an internal audit used to address any gaps in service delivery. A copy of the findings should be distributed to stake holders and a copy displayed in the home. The kitchen and the equipment used for food preparation must be kept clean so the residents are not at risk of cross contamination. Fire doors must not be wedged open unless authorisation to do so has been secured from the fire officer so that in the event of fire residents are not placed at risk. Residents must not be left for long periods without being offered a drink and resident should be offered a drink when they get up in the morning. 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.V338897.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.V338897.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): 3 Quality in this outcome area is good. People who are considering moving into the care home have their needs assessed so they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. Standard 6 is not included in this judgement, as the home does not provide intermediate care. EVIDENCE: People considering moving into the accommodation have their care needs assessed before deciding whether to move in for a trial period. Social Services carry out a Care Management Assessment and the Primary Care Trust assess the needs of people requiring nursing care. People who are self-funding and without a Care Management or Nursing Assessment have their care needs assessed by the manager. The manager talked about the assessment process and said she visits people who are considering moving into the home and talks to them about their needs Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 11 so that she can be sure the home is able to meet their needs before they decide whether to move into the home. Three residents’ personal record files were chosen for closer examination and for use in case tracking. Two residents had been at the home for some time and one resident had recently moved into the home. Examination of documentation held in respect of the three residents showed they had their care needs assessed before moving into the home. Information held on the initial care assessments includes previous medical history, a brief life history and details of any previous or current hobbies, interests and any religious needs. The records belonging to the person who had most recently moved into the home showed that a range of information had been secured including the person’s next of kin, GP and advocacy arrangements. The information held about the individuals’ care needs was supplied by Health and Community Care Services (HCCS) and was informative and considered sufficient to determine whether the individuals’ needs could be met by the home. A separate assessment record was completed by staff at the home and reflected the information already provided by the HCCS. The home’s assessment documentation does not include any of the details of the visit to the person who is considering moving into the home. For example, the date and time of when the visit took place and what was agreed. There was no evidence of consultation with the prospective resident or if appropriate their relatives or representatives. This is necessary for making sure that the views and opinions of the person considering using the service are heard, documented and taken into account when planning the person’s care. On arrival at the home, the person’s weight was checked and recorded, and nutritional and moving and handling risk assessments were carried out. Each resident had a care plan. Two residents spoken with confirmed that someone had visited them before they moved into the home and that they had been given the opportunity to visit to have a look round before making a decision as to whether to move into the home. Residents could not remember who had visited them or whether it was someone from the home. Both residents said they had chosen not to visit preferring instead to be guided by the views of relatives who visited on their behalf. One resident said, My granddaughter arranged the placement at the home. The last key inspection visit to the service showed shortfalls in the pre admission assessment process as records were not always maintained, dated and signed by the person completing the information. This inspection found that shortfalls had not been fully addressed and in the absence of a Care Management Assessment, work to improve the assessment and recording Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 12 process is ongoing. The manager said she would make sure that in the absence of assessment documentation supplied by other agencies the home would endeavour to secure the information needed to determine whether the person’s needs could be met. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 13 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 poor. Residents are treated respectfully and have a care plan but the absence of effective care monitoring may result in unmet needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three care plans looked at contained information to enable staff to meet health and social care needs. Standardised documentation is used in the care planning process. Care needs are noted but details of the type and level of support required is not always recorded. For example, the first care plan states “wears pads incontinent of urine, two carers to change pad” but failed to identify whether the person was continent of faeces or include the arrangements for toileting, which is necessary if one of the aims is to promote continence. The care plan identified the need for half hourly night checks but did not state why the checks were considered necessary. Monitoring records identified the need to check blood sugar levels four times a day each Tuesday and Friday. Daily records showed that blood sugar levels were being carried out four times a day seven days a week. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 14 A pressure relieving risk assessment identified the need for regular repositioning. Observations in the resident’s room showed that a repositioning chart is not always used to monitor movements and necessary for making sure, the resident is not left for long periods in any one position and therefore increasing the risk of developing pressure sores. Bowel monitoring records had not been completed since June 20th 2007 (nine days) and no reference to either of these activities was made in the resident’s daily monitoring records therefore staff could not be sure residents’ needs were being met or their health and safety compromised. The second care plan showed the resident was at ‘high risk of falling’ and although a falls risk assessment had been carried out, the outcome failed to identify effective measures needed to minimise the risk. For example, the care plan identified the need for supervision but did not explain how this was to be managed. Observations during the inspection visit showed the individual was left for long periods without the supervision they were assessed as needing. Effective strategies for minimising the risk of falls was discussed with the manager and the use of a pressure alarm mat identified as an option for the resident who presented as being at risk. The care plan had not been updated to reflect a number of recent falls. Information showed that management had concluded that the persons needs could no longer be met and a request to Community and Health Care Services for a care need’s assessment had been made so that alternative accommodation where the individual’s needs would be met could be identified. The care plan showed that the individual was prone to urine infections and severe constipation but failed to provide the information needed by staff to show how this was to be managed other than for “staff to take her to the toilet frequently.” The resident was assessed, as having vascular dementia and the information supplied in the Care Management Assessment showed how communication should be managed. This information was transferred to the care plan for use by the staff. The care plan showed that ‘on a good day’ the person was able to interact with the staff. There was no life history, which could have been used to engage the resident and encourage positive interaction and reminiscence therapy. The care plan or monitoring records held in respect of the resident failed to show how the resident’s psychological health was being monitored or any preventative or restorative care provided. Risk assessments were carried out for activities that may pose as a risk to the resident for example, moving and handling, nutrition and pressure sores. An Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 15 audit of risk assessments held in respect of the three residents’ case tracked showed gaps in the information. For example, the ‘ Patient Handling Assessment’ belonging to one resident included, stands but unable to walk The resident was asked about their experiences of the home and said they were unable to stand and the staff used a hoist to transfer them from the bed to the chair. Information held on care plans and monitoring records showed that residents had access to a range of health care services as they would if living in their own home in the community. Including GPs, optician, dental health checks and chiropodist. It became evident during the inspection visit that a number of residents are registered with a local GP who is also the owner of the home. Records showed regular reviews of care plans but there was very little documented information to show whether care plans required revising and updating and in some instances, care needs had changed but individual plans had not been updated to reflect the changes. The last key inspection visit found that syringes used for artificial feeding referred to as ‘PEG feeding’ were dated but had not been changed for 10 days and therefore increasing the risk of any infection. Syringes used as part of this process were looked at during this inspection visit and showed that syringes were being changed according to the advice provided by the manufacturer. Medication held by the home and administered to residents by staff was stored in a secure medicine trolley. In response to shortfalls identified during the last inspection visit, it was noted that the clinic door and medicine trolley were locked when not in use. The management of three residents’ medication was looked at. The medication records showed that most of the medicine administered was signed but there were three gaps on one of the records read so the home could not be sure whether or not medication had been administered. The last inspection visit showed that medication no longer in use was being held in the medicine trolley. The manager reported that medication no longer in use was returned to the pharmacy. The controlled medication was checked and showed that medication records accurately reflected the quantity of medication held. In response to shortfalls identified during the last inspection visit, the home no longer held medication for people who had left the home. There is a medication fridge and the temperature is recorded daily. The fridge held eye drops, which were dated when opened to ensure they were discarded 28 days after opening. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 16 Medication records belonging to one resident showed that the nurse had not signed a handwritten prescription on the medication record and the quantity of medication held was not recorded. Therefore, it was not possible to carry out an audit. This shortfall was outstanding from the last inspection visit. Throughout the duration of the inspection visit staff are observed treating residents with respect. Personal care was provided in private and staff were observed assisting residents to transfer in a dignified and respectful manner. When using the hoist the staff member explained the process to the resident and the staff moved at a pace conducive to the needs of the resident. To ensure privacy and respect are promoted the practice of expecting residents in a double room to share a commode is unacceptable. Residents should have their own commode or one resident could use a commode and one resident could use the toilet in the ensuite facility. The individual needs of residents should be identified in the care plan and the staff should make sure individual needs are met in a respectful and dignified manner. Observations during a tour of the premises showed the residents could if they chose have their own telephone in their room. Mail addressed to residents was held in a box in the reception area of the home for collection by relatives. Examination of the care plans of the residents identified for case tracking failed to show that consultation had occurred and agreement with the individual that their relatives or representative would collect their mail. A number of residents reported that they found staff generally kind and helpful and felt some staff members were more helpful than others. When asked what was meant by this one resident reported some of them rush you and another resident said I dont say much I just let them get on with it. One resident said they had positive experiences and if they were unhappy with the actions of a staff member, then they would make them aware. Comments on a survey received from visitor showed that having been in hospital a resident returned to the home with pressure sores. Staff kept the visitor informed of their relative’s condition and the tissue wounds have almost healed. Residents generally looked well presented and were wearing suitable clothing although one resident spoken with said she was ‘cold’. The inspector brought this to the attention of a staff member who gave the resident with a blanket. It was also noted the resident had dirty fingernails. This was brought to the attention of the manager who immediately asked a staff member to clean the resident’s nails. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 17 One resident spoken to said she did not always have a shower when she requested one and told the inspector she recently had to wait three weeks for a shower. The manager said a book was used to record when each resident had a bath and she was sure residents had a bath when they wanted one. These records were not looked at during the visit. A further resident spoken to said they usually had a wash in bed and the staff were always available to provide the support they needed. Comments noted include The staff are good. Comments noted on a survey from a relative include the nursing staff are particularly good. They are always ready to talk about my mum’s health or any concerns I may have. Most of the carers have taken time to get to know my mum as a person and take the time to chat to her. If all the carers were as good as the best carers are I would be very happy. One or two need to be told to take more time and not to rush the residents. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 18 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. Food is nutritious and open visiting arrangements encourage regular contact with relatives and friends. Social, and recreational activities do not meet the needs or expectations of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an open visiting policy that takes into account the individual needs and wishes of residents. Three residents spoken to confirmed visiting is flexible and said visitors were made to feel welcome. Residents said they could meet with visitors in the communal lounge or in the privacy of their own room. Information supplied by the home showed that visitors could stay for a meal if they chose. Three residents spoken to said they were encouraged to bring personal possessions with them and were not aware of any restrictions. The home has a designated activities worker who is available for three hours a day Monday to Friday and there is a basic programme of activities for groups and individuals. There is bingo for which residents are charged two pounds to play, exercise to music, sing-a-longs individual chats and activities with residents who prefer to remain in their room. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 19 Very little information is recorded about activities such as who participates or the outcomes for people engaged in any events. The activities programme was displayed in the reception area the home and may not be visible to the residents who spend their time sitting in the communal lounge. There is an absence of suitable and meaningful activities more especially for people with cognitive impairments who have little or nothing to do. The activities worker attended training in the provision of activities for older people but has not attended training in specialist dementia care. A number of residents spoken to were asked for their views and opinions of the activities provided by the home and comments noted include: its boring here, theres nothing to do and it would be nice if we could get out more. Comments on a resident’s survey showed that activities were not available and a resident reported that they once participated in activities three years ago we made paper chains at Christmas. A visitor who completed the survey on behalf of a family member made the following comment I am concerned by the lack of activities and stimulation that is in place. On the majority of occasions I visit, the residents are all sat around the outside perimeter of the lounge and nothing is happening. The residents’ highlight seems to be being taken to lunch at 11:30 which is incredibly early. Information supplied by the home and before the visit to the service showed that, a number of residents had been on a recent trip to Cadbury world. One resident talked about the local facilities and said that a local shop visited the home monthly and supplied items such as toiletries for residents to purchase. A hairdresser visits monthly and provides services at the home. Two residents spoken to talked about daily life in the home which one described as boring.” Other comments noted include, some staff are not very good and everything will look good when people are here but its all put on. xxx very nice always baths me. A number of other residents also made positive comments about the same named worker. Information supplied by the home before the inspection visit showed that a monthly church service is held at the home and is open for anyone to attend. Comments noted on one resident’s survey include I like the church services very much. The care plan of one of the resident’s case tracked showed they enjoyed playing cards, concerts, listening to music, radio and looking at magazines. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 20 Documentation held failed to show whether they had been given the opportunity to pursue their hobbies and interests. On the day of the inspection visit, there were no activities observed and the majority of residents spent their time sitting in the communal lounges. There was little or no interaction between residents and most residents were observed spending time sleeping. There were some staff interactions but staff members were generally busy and the interactions were not always engaging. Although the main lounge offers scenic, views over the countryside residents’ chairs were positioned in a circle around the room and most had their back to the windows and did not benefit from their surroundings. On arrival at the home nine residents were sitting in the communal lounge on the ground floor. All but two of these residents were asleep in the chair. Staff were seen supporting other residents to get up. Two residents spoken to said they were up early one since 6am and who said they did not like getting up so early. A further resident was unsure of the time she had got up but said, “It was early.” Residents’ spoken with did not feel they could choose when to get up and waited for the staff to arrive, as this indicated it was time to get up. Both residents said they had not been offered a drink since waking up. A further resident spoken to said their mouth was dry and they would like a drink. This information was giving to a staff member who supplied the resident with some juice. Residents spoken with were asked about the arrangements for supper. On said she had a drink and a biscuit before going to bed a further resident said they had not eaten since tea time the day before and a third resident said they couldn’t remember whether they had anything to eat or drink before retiring. Observations before breakfast in the communal lounge showed that at 08:50am residents had a jug of orange juice placed on a table positioned in front of them. At approximately 9:30am and after breakfast residents were offered a cup of tea. The arrangements for offering residents an early morning cup of tea was discussed with the matron who after talking to staff said that a number of dirty cups had been left out by the night staff and she felt sure residents would have been offered a cup of tea when they got up. The absence of regular snack meals or drinks place residents at risk of not having their nutritional needs met and of becoming dehydrated. Breakfast was transported from the kitchen to the ground floor lounge on a trolley. Residents’ remained in their chairs and had their meal served on a small table positioned in front of the chair. A table was placed in front of each resident’s chair when they got up and remained there throughout the duration of the inspection only to be removed when taking the resident to the toilet or in some instances to the dining room for a meal. Such practices are Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 21 considered institutional and in some instances used as a barrier to prevent the individual from exercising their right to freedom of movement and should therefore be discouraged. Residents were offered a choice of cereal or porridge and toast. A small number of residents also had cooked breakfast. The main meal of the day was served in the dining room on the lower ground floor. A number of residents were being cared for in bed and had their meals in their room while others chose to remain in the communal lounge on the ground floor. On the day the inspection visit fish and chips, egg and chips or jacket potato, cheese and beans were offered to residents. Liquidised, soft and diabetic diets were provided for people with specialist dietary needs. Observations showed that meals looked attractive and appetising. A number of residents needed support to eat their food. Observations in the communal lounge showed that support was generally provided in a sensitive and caring manner. It was noted that a staff member failed to engage the resident she was supporting. Another staff member encouraged the resident to eat their food and talked to them about daily life activities. This generated a positive response from the resident who had a good relationship with the staff member. Three residents spoken to confirmed they were offered alternatives and expressed the view that the food supplied was generally good. Opportunity was taken to visit the kitchen to look at the arrangements for the provision of meals and talk to the cook about any specialist dietary needs. Observations in the kitchen showed some concerns about the lack of cleanliness in the kitchen and the details have been included under the Environment outcome group of the report. A range of provisions including fresh and frozen foods were held. Menus showed that residents are offered a varied and nutritious diet. The cook said there were no restrictions and residents could have what they chose. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 22 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 18 Quality in this outcome area is adequate. Residents have access to the information they need to complain and know who to talk to if they have any concerns but are not confident that complaints would be taken seriously. Staff members are trained and understand how to recognise and respond to any allegations of potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although information about how to complain was displayed in the reception area of the home it was difficult to see and did not include timescales for responding to complaints or details of external agencies such as Community Health and Social Care Services and who provide funding for some of the residents. The complaints records were read and showed that since the last key inspection visit there were three complaints made to the home. The most recent complaint was received on May 8th 2007 and was made by a relative who was concerned about how their relative had sustained a tissue wound and had what was described as a severe episode of diarrhoea. The manager said the complaint was investigated and not upheld. The manager reported that the complainant felt the issues raised had been resolved. Comments included on a survey received from a relative showed that they had raised concerns when some items went missing from a resident’s room. The concern was reported and an investigation carried out. The relative was informed of the outcome and the items were never found. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 23 At the time of the last key inspection visit, the matron informed us of an allegation of suspected abuse by a carer to a resident. An investigation into the allegation of abuse by staff member and the conduct of a senior staff member has been carried out in accordance with the local arrangements for safeguarding vulnerable adults. Both workers were suspended without prejudice while an internal disciplinary investigation was carried out. The allegation was not upheld and both workers were reinstated. A number of residents’ spoken with and those surveyed said they would know who to go to with their any concerns or complaints. Two residents said they did not feel able to make a complaint and one resident said, “it would not make any difference.” Shortfalls in the home’s policies and procedures for reporting and management of allegations or suspicions of abuse identified during the last key inspection have not been addressed. The home does not have documents related to ‘ No Secrets’ or the process of reporting staff to the Protection of Vulnerable Adult (PoVA) register. The allegation of possible abuse referred to in the report was reported in line with local and national policies of allegations but the absence of clear guidance could result in any allegations not being appropriately managed. A number of staff spoken to gave examples of what actions may constitute abuse and how to recognise possible abuse. Most staff spoken to reported that they had attended training in safeguarding vulnerable adults. Two staff said they had completed a learning log as part of their National Vocational Qualification (NVQ). Staff members all said they would report any concerns to the manager or the matron. The manager reported that 10 care assistants are take part in a distance learning course on safeguarding vulnerable adults. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 24 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): 19,22,24 and 26 Quality in this outcome area is poor. Some areas of the home are not kept clean and residents are at risk of infection or cross contamination. Residents have access to the equipment they need but are at risk of injury. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The room of three residents identified the case tracking were among the rooms visited. Rooms were clean and comfortable and one resident being cared for in bed had easy access to the call alarm. Each room was sufficiently equipped to meet the needs of the resident. For example a resident requiring a hoist to enable them to transfer from the bed to the chair was being cared for in an adjustable height bed and a pressure relieving mattress was in place to reduce the risk of pressure sores. The bedrooms were comfortable with personal touches such as photographs and ornaments on show. They were clean with no evidence of odours. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 25 The last key inspection showed that sinks in communal and private toilet areas were not properly cleaned. A number of sinks were looked at and were found to be clean. One room visited was a double room. Privacy screening was available and the manager reported that the dividing curtain rail that was broken during our last visit to the service had been repaired so that privacy was assured. Observations during a visit to the room of one of the residents case tracked showed bed rails had been fitted. Information held in the resident’s personal record file showed that a risk assessment had not been carried out and the resident was therefore at risk of entrapment. The manager talked about the use of bed rails and reported that a number of residents had bed rails fitted and risk assessments had not been carried. This resulted in an immediate requirement notice being issued to make sure risk assessments were carried out for all the residents who had bed rails fitted so that their health and safety was assured. On arrival at the home, there was an odour noted in the first floor lounge, which appeared to disappear during the day. The environment was generally well maintained. The home has a large lounge on the first floor with a conservatory and a smaller lounge with dining room downstairs. Unlike the lounge on the first floor, the dining room has limited natural light and what is considered inadequate electric light fittings. Residents with a visual impairment may find the environment is not suited to their needs. The manager reported that she planned to have the light shades removed and cleaned and hoped this would enhance the lighting. The laundry is situated downstairs and is accessible to residents. There were two washing machines (both with a sluice facility) and a tumble dryer. The laundry person was wearing suitable gloves and used red disposable bags for soiled laundry. This made sure there was no contact between clean and soiled laundry and reduced the risk of infection or cross contamination. Liquid soap and paper hand towels were available in the laundry. Two residents spoken with said they were generally satisfied with the laundry service. One resident said they often felt frustrated when personal items took a long time or failed to be returned. The manager talked about the programme of renewal and redecoration and reported that future work will include new carpets in corridors and bedrooms and the passenger lift is to be revamped and upgraded. In response to shortfalls identified during the last key inspection visit. The manager reported that an audit of beds had been carried out to see which Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 26 needed replacing and in response to the audit a number of new beds had been purchased. Since the last key inspection visit in February 2007 the outside of the property has been repainted. The manager reported that she was considering replacing one of the washing machines with a new and more suitable model. Two staff spoken with said they used disposable gloves when providing personal care and were aware of the need for regular hand washing to reduce the risk of any infection. Three residents spoken to confirmed that staff wore gloves when supporting them with washing, dressing and toileting. Observations during the inspection visit showed staff wearing disposable gloves. Staff also wore aprons when serving food. Opportunity was taken to look at the arrangements for storing food and cleaning the kitchen. The food fridge held a number of items that were appropriately covered. Large catering containers of branston pickle and mayonnaise had been opened but the date of opening was not recorded. Therefore, the staff could not be sure products were being consumed within the timescale identified by the manufacturer. A cleaning schedule was looked at and records held showed days when the schedule had not been signed by the staff to show cleaning tasks had been completed. For example, gaps included 10 days during May 2007. Observations in the kitchen showed regular cleaning was not being carried out as there was food and other debris left on the floor under equipment, at the back of the kitchen doors and around the skirting boards. Grease at the back of the deep fat fryer was considered to be in excess of what would expect given the fryer was used twice on the day on the inspection visit. A hot trolley had food spillage on the doors and shelves and the microwave oven was greasy and food spillage evident. This was discussed with the manager who then visited the kitchen and was concerned to find that staff were not completing the cleaning schedule and demonstrated a commitment to making sure the kitchen was thoroughly cleaned within 48 hours. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 27 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 poor. Residents’ benefit from having their needs met by sufficient numbers of experienced and competent staff but the absence of rigorous staff recruitment practices fails to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager reported that the usual staff complement in the mornings comprised of the matron, two qualified nurses (RGN) and six care assistants. In the afternoons, there are two nurses and six care assistants and a nurse and three care assistants at night. The home also employs a deputy matron, cook and assistant cook, two laundry staff, and two domestic assistants. The manager said she planned to recruit an administrator. As the care home also provides nursing care a qualified nurse is on duty at all times. The inspection found there were sufficient numbers of staff available to manage the kitchen, laundry and cleaning tasks. The matron reported that agency staff were not used and staff employed at the home covered any gaps identified on the rota. Four staff spoken to said that there were generally sufficient staff available but when staff were absent through ill-health or holidays it was sometimes difficult and they had experienced shortages. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 28 A number of residents were asked about the staffing arrangements and those who were able to express a view generally felt there were sufficient numbers of staff available. An audit of surveys returned by residents and their relatives also showed there were generally sufficient staff available. Comments noted include “ I think there is usually enough staff but it would be nice to have more. Comments noted on surveys completed by relatives include xx xxxxxx is very independent and often reluctant to ask for help. Most of the staff are very good at picking up if there is something he needs but a few seem very rushed to him so sometimes it doesnt ask and “The staff are very approachable and have a good relationship with my mother. On the occasions when I have raised concerns they have responded well and advised me of any outcome.” Of the 28 care assistants, employed 18 are qualified to National Vocational Qualification (NVQ) level two in health and social care or equivalent and a further five are working towards achieving the award. A number of staff are undertaking a customer care learning unit as part of an NVQ. 10 care assistants are currently undertaking palliative care training and information supplied by the home before the inspection visit showed that 50 of staff have achieved a level two certificate in Dementia Awareness. Nurses have the opportunity to attend training appropriate to their role. For example: two nurses are to attend training on infection control in July 2007 and four are to attend male catheterisation training in October 2007. The recruitment records of the two most recently appointed staff members were looked at and showed that a photocopy of a Criminal Record Bureau disclosure carried out by a previous employer was held. The manager had not carried out appropriate security checks necessary to safeguard residents and staff were confirmed in post before the outcome of CRB disclosures and checks against the Protection of Vulnerable Adults (PoVA) were known. Shortfalls in staff recruitment practices were also identified during the last key inspection visit and improvements necessary to safeguard residents have not been implemented. In response to the shortfall identified during this visit an immediate requirement notice instructing the manager not to employ staff before the outcome of appropriate security checks were known and to submit applications in respect of the two named workers. Risk assessments must be carried out and the outcome used to safeguard residents. Documentation held also showed that any gaps in employment history were not explored and in one instance, only one reference secured. Although one Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 29 worker was previously employed in a similar capacity, no verification of the reason why they had ceased to work with vulnerable adults had been sought. The absence of rigorous staff recruitment practices place the safety and security vulnerable adults at risk. Information held showed that new workers complete an induction checklist, which is dated and held the signature of the person carrying out the induction. The information did not include what was discussed or identify learning needs. The manager reported that new staff work alongside an experienced staff member until they are assessed as competent but they are not supernumerary as they are included in the number of staff on duty. The manager said that as staff always worked in pairs the new staff member would be working with someone who was experienced and competent and therefore she did not feel it was necessary not to include the new worker on the rota. Records of any shadowing were not held. Two staff spoken to said they had access to training and were keen to explore any opportunities made available to them. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 30 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 and 38 Quality in this outcome area is poor. The manager is experienced and qualified but shortfalls in health and safety management do not promote residents’ safety. Residents’ benefit from having their needs met by staff who are supervised. Quality assurance monitoring is not taken seriously or used to improve the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is experienced and holds a Registered General Nurse qualification and the Registered Manager’s Award and continues to update her knowledge and skills by attending training courses relevant to her role such as Dementia Awareness. The manger is responsible for the environment and maintenance of the home and a matron who is a qualified nurse 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. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 31 Comments noted on one residents survey include management team very approachable. The inspection found that the manager and matron were not fully familiar with all aspects of the homes management and had difficulty locating some of the information and documentation required for the purpose of inspection. The inspection showed that health and safety in the home was not always well managed. For example, fire doors leading into the kitchen and laundry room, which should be kept shut, were wedged open. The inspector raised concerns about this and further observations during the inspection showed the fire doors into the kitchen had been wedged open again. An immediate requirement notice was issued to make sure the fire doors were not wedged open unless the manager had secured confirmation from the fire safety officer that to do so did not place residents at risk. From looking at training records and talking to staff it was evident that staff attended a range of health and safety training such as moving and handling, infection control, food hygiene and first aid. We obtain information before inspection visits to the service. This information includes confirmation that all necessary policies and procedures are in place and are up-to-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Information and documentation supplied by the home showed that the most recent staff fire drill/practice took place at the home on January 31st 2007. The last key inspection visit to the service showed that quality assurance monitoring was poor. The manager talked about a quality monitoring system and said surveys should have been sent to relatives and to residents who the home felt were able to respond. Some surveys were seen but were not dated. There was no evidence to suggest that an audit of responses had been carried out and any shortfalls in the service identified and used to improve services. The manager said surveys should have gone out in June 2007 but had been delayed and would be sent out shortly. The manager reported that the activities organiser held residents’ meetings and records of the meetings were not held. Two residents spoken to were not aware of residents’ meetings taking place. One staff member said she thought meetings took place but was unsure of when they occurred. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 32 The Annual Quality Insurance Assessment (AQAA) document received from the service did not include information about how the home monitored or planned to monitor the delivery of services. The manager reported that staff supervision took place and it was anticipated that staff members would each receive supervision six times a year. The manager, matron and deputy manager supervised the staff. Three staff spoken to reported they had received supervision. Staff supervision records were read and confirmed this occurred. Information supplied by the home showed that most residents’ have money held by the home for safekeeping. Money is stored safely and securely and records of all financial transactions are held. Money being held on behalf of residents is not well managed. For example, the monies and financial records held on behalf of two of the residents identified for case tracking showed a resident should have a balance of £86.00 and not £89.95 as was seen. The second resident should have £18.50 and not £17.10 as was seen. Records of transactions are held that individual receipts are not retained for some services purchased on behalf of the resident such as hairdressing and chiropody. Records of financial transactions also showed that a number of residents regularly withdrew two pounds to play bingo and there was no documentary evidence confirming the resident had authorised the withdrawal. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 1 X 2 X 1 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 1 3 X 1 Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 35 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 OP7 Regulation 13(4)(b) and (c) Requirement Care plans must accurately reflect the care needs of the residents and give clear guidance to the staff so that they are aware of what is required and of what has been agreed. Any health care monitoring records assessed as necessary must be completed and used to make sure the needs of the resident are being met. Where a resident is assessed, as being at risk of falling then a thorough risk, assessment must be carried out and the outcome used to inform care planning. So that the home can be sure that, any action deemed as necessary is identified and implemented to reduce any potential risk to the residents’ health, safety and welfare. 2. OP8 12 Timescale of 15/03/07 not met Residents must have the support they need to meet their personal hygiene needs. This must include bathing and nail care. So that residents’ health and welfare is maintained and they are not placed at risk of neglect. The nurse must sign all DS0000004403.V338897.R01.S.doc Timescale for action 30/06/07 05/08/08 3. OP9 13(2) 30/06/07 Page 36 Oldbury Grange Nursing Home Version 5.2 handwritten prescriptions on the medication records and make sure that the quantity of medication is clearly recorded. 4. OP9 13(2) Timescale of 15/03/07 not met Medication records must 05/08/07 document the administration of medication to a resident in order to ensure the health and welfare of residents taking medication are safeguarded. Arrangements must be made for 31/08/07 residents to have the opportunity to engage in a programme of activities that is suited to their individual needs and abilities. So that residents have the opportunity to participate in meaningful and therapeutic activities that are engaging, stimulating and promote and maintain independence in so far as residents are willing or able. Residents must be offered regular snack meals and drinks this must include a drink when they get up in the morning. So that the home can be sure, nutritional needs are being met and residents not at risk of becoming dehydrated. The home’s policy and procedure for safeguarding adults must be revised to take into account the Community Health and Social Care Services procedures and the Department of Health guidance, No Secrets. So that the residents can be sure that management are aware of the local arrangements for responding to allegations of abuse or mistreatment and any investigations carried out not compromised and evidence Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 37 5. OP12 16.2(n) 6. OP15 16(2) 05/08/07 7. OP18 13(6) 30/06/07 contaminated. 8. OP22 13(4)(c) Timescale of 15/03/07 not met The manager must make sure that bed rails are not fitted before: • A detailed assessment has been carried out by someone who is appropriately qualified and trained • Adequate training has been undertaken to assess the risks to the bed user • Bed rails are identified as being compatible with the bed and must be fitted properly • All appropriate health and safety checks are carried out to include a regular maintenance schedule to check wear on the bed rails. So the home can be sure, the residents are not placed at risk of falls or entrapment. 9. OP26 13(3) Timescale of 31/03/07 not met Effective procedures must be in place to reduce the risk of infection or cross contamination so that residents are not placed at risk. To include: making sure that the kitchen and the equipment used for food preparation and storage are kept clean and in good order. Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. To include: • The outcome of a Criminal Record Bureau (CRB) disclosure or checks against the Protection of Vulnerable Adult PoVA) register • Two written references, including where applicable, a DS0000004403.V338897.R01.S.doc 30/06/07 05/08/07 10. OP29 19 Schedule 2 30/06/07 Oldbury Grange Nursing Home Version 5.2 Page 38 • reference relating to the person’s last period of employment, which involved work with vulnerable adults of not less than three months duration A full employment history, together with a satisfactory written explanation of any gaps in employment. So that the home’s staff recruitment practices safeguard residents. A risk assessment must be carried out for those staff employed and where the outcome of security checks is not known and appropriate action taken to ensure the continued safety of residents. A copy of the risk assessment must be forwarded to the commission. Timescale of 28/02/07 not met A system for evaluating the quality of the service provided must be introduced and maintained and include consultation with residents their representatives and other stakeholders so that management are aware of and can respond to any shortfalls identified in the service provision. Timescale of 31/03/07 not met Rigorous procedures much be introduced to ensure monies being held on behalf of residents is safeguarded. This is to include retaining individual receipts for items purchased on the residents’ Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 39 11. OP33 24 30/06/07 12. OP35 17 Schedule 4 05/08/07 behalf. Where possible the resident should be encouraged to sign confirming authorisation of any withdrawals and where this is not possible, two signatures secured to confirm the transaction. Regular audits must be carried out to make sure any discrepancies are identified and responded to appropriately. So that residents are safeguarded and not placed at risk of financial abuse. The standards of health and 30/06/07 safety management within the home must be improved. So that residents can be sure that the home is being managed in their best interests and their health, safety and welfare is given the highest priority. This must include making sure that fire doors are not wedged open. 13. OP38 13(4)(c) 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 OP8 Good Practice Recommendations Care plan and monitoring records should include how the resident’s psychological health was being monitored or any preventative or restorative care provided. Residents should not feel rushed by the staff who are supporting them to meet their needs. Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 40 2. OP10 Staff should make sure residents are suitably dressed and are not left feeling cold. In order to promote respect and dignity residents sharing a double room should not be expected to use the same commode. Information about how residents’ mail is to be managed should be included on the individual’s care plan and should show that consultation has taken place and agreement reached. Staff with responsibility for planning activities should be trained in the provision of specialist dementia care so that they are aware of how to identify residents’ needs and can provide appropriate social and mental stimulation. A planned programme of person centred activities for people with dementia or other cognitive impairments should be introduced so that residents have opportunity to maintain life skills and benefit form having quality care that reflects their individual needs. Residents should be consulted about a programme of activities that takes into account individual and group needs. Details of planned activities should be displayed in the home so that residents are aware of what is planned for the day and can plan their time accordingly. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. The work already started on developing life stories and histories should continue so that staff are aware of cultural diversity and lifestyles and can make sure residents needs are met. Residents should be given the opportunity to go out into the garden or make visits to service and facilities in the local community. The staff practice of placing tables in front of the residents’ chairs and only removing them when supporting residents to go to the toilet or in some instances to the dining room for a meal. Such practices are considered institutional and can be seen as a barrier that prevents the individual from exercising their right to freedom of movement and should therefore be discouraged. Staff should engage residents when supporting them to eat their food so that meal times are a more pleasurable DS0000004403.V338897.R01.S.doc Version 5.2 Page 41 3. OP12 4. OP14 5. OP15 Oldbury Grange Nursing Home experience and residents can look forward to spending some quality time with a care worker. Foods such as Branstone pickle and Mayonnaise that have been opened and stored in the fridge should have the date recorded of when the item was opened so that staff can make sure, residents are not offered foods that may be contaminated and which may place them at risk of infection. Information displayed in the home about how to complain should be revised so that anyone choosing to complain about the service can be confident that complaints are taken seriously. The staff-training matrix should be up dated to accurately identify training attended so that the home can more easily identify staff training needs. The staff induction procedure should include details of any training supplied and a record should be held of any shadowing of an experienced and qualified worker that occurs so that residents can be sure their needs are being met by suitably trained and experienced staff. The induction process should also be used identify any further training or learning needs, and the information used to inform the home’s staff development strategy. New staff should be supernumerary so that the home can be sure residents’ needs are being met by appropriate numbers of experienced and qualified staff. Clear lines of accountability should be established within the home so that management can be sure residents’ needs are being met. A record of residents’ meetings should be held and include: the date, time and duration of the meeting. The agenda items and the names of those in attendance. The outcome of the meetings should be used to further develop the service. 6. OP16 7. OP30 8. 9. OP31 OP33 Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection West Midlands Regional Office 1st Floor Ladywood House 45-56 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. Extracts may not be used or reproduced without the express permission of CSCI Oldbury Grange Nursing Home DS0000004403.V338897.R01.S.doc Version 5.2 Page 43 - 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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