Inspection on 16/06/08 for Osmaston Grange Care Centre

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Osmaston Grange Care Centre 05/04/09

Osmaston Grange Care Centre 22/10/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Osmaston Grange Care Centre 5 - 7 Chesterfield Road Belper Derbyshire DE56 1FD Lead Inspector Janet Morrow Unannounced Inspection 08:30 16 and 18th June 2008 th 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 Osmaston Grange Care Centre DS0000070160.V366485.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. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Osmaston Grange Care Centre Address 5 - 7 Chesterfield Road Belper Derbyshire DE56 1FD 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) 01773 820980 01773 828536 Osmaston Grange Limited Mrs Judith Sissons Care Home 80 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (64) of places Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age - not falling within any other category - code OP. Dementia - Code DE 16 The maximum number of service users who can be accommodated is 80. The maximum number of nursing places is 20. Date of last inspection 22nd October 2007 2. Brief Description of the Service: Osmaston Grange care home is comprised of a two storey older building and a two storey purpose built building on the outskirts of Belper town centre. The home provides personal and social care for forty-four people aged sixty-five years and over, nursing care for up to twenty people and has sixteen places for people with dementia. It can therefore cater for eighty people in total. The older building is used for residential care for forty-four older people and the new build caters for people with nursing needs on the upper floor and for people with dementia on the lower floor. Osmaston Grange is Christian home and regular Christian meetings are held, although people can choose not to be involved in any religious activity. The older building has forty-two single bedrooms and one shared room; all rooms except one have en-suite facilities. The first floor is accessed by stairs and a passenger lift. There are two lounges and dining rooms on the ground floor. The new building has twenty single rooms all en-suite on the upper floor and sixteen single rooms, all en-suite, on the lower floor. There is access to a garden area. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 5 The home’s statement of purpose and service users guide sets out the care and services provided; a copy of the service user’s guide is issued to prospective residents or representative prior to admission. Information provided by the service in June 2008 stated that the fees ranged from £375 - £475 per week. Details of previous inspection reports can be found in the office at the home and on the Commission for Social Care Inspection’s website: www.csci.org.uk Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The home was in a period of transition, as a new owner had taken over the company at the beginning of May 2008 and was in the process of implementing changes. There had been some difficulties at the point of the sale with the telephone system being disconnected and a lack of information for people in the home and their relatives about the proceedings. This inspection visit was unannounced and took place over two days for a total of 15.25 hours. Care records, staff records and maintenance records were examined. A partial tour of the building was made. Eleven members of staff, the manager and deputy manager and owner were spoken with. Eleven people currently accommodated in the older residential building and six people in the nursing unit were spoken with; two visiting professionals and three sets of relatives were spoken with. One relative was contacted by telephone following the inspection visit. Two hours were spent observing the care given to people in the lounge in the dementia unit. A short inspection visit was undertaken in February 2008 to check compliance with requirements issued at the previous inspection visit in October 2007 and the findings from this visit will be referred to in this report. The home had not provided an annual quality assurance assessment prior to the inspection visit. What the service does well: Routines in the home were flexible and allowed for individual choice. Christian religious needs were well met with regular services, prayer meetings and bible study. The home was well maintained and comfortable. People living in the home were encouraged to personalise their rooms with their own possessions. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 7 The observation showed that the majority of communication with people in the dementia unit demonstrated an understanding of individual needs. What has improved since the last inspection? What they could do better: Medication procedures need to be improved to ensure greater consistency in the recording on medication administration record (MAR) charts, that the medication refrigerator temperatures are recorded and that controlled drugs records are accurate. The improvements noted at the inspection visit in February 2008 had not been maintained. Staffing hours across the home need to be reviewed, particularly in the nursing unit, to ensure that there are sufficient staff to meet peoples’ needs at busy times of the day. There must be greater efforts made to obtain two written references prior to staff commencing employment to ensure that the legal requirements of the Care Homes Regulations 2001 are met. Menus should be reviewed to address some of the adverse comments received about the meals. Care plans in the dementia unit must be reviewed to ensure that there is sufficient detail about life history and needs associated with dementia. Terms and conditions of residence must state the breakdown of fees and how these are to be paid so that people living in the home and their representatives are clear about payment arrangements. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 8 Arrangements for dealing with peoples’ personal money need improvement to ensure all money is properly accounted for and that there is a clear audit trail of money spent and received. Greater attention to peoples’ privacy and dignity is needed when they are in their rooms and when being moved and assisted. All staff should receive training on the Mental Capacity Act 2005 to ensure that they are familiar with its implications for care settings. The maintenance of the garden area should be improved to ensure weeds and long grass are dealt with. 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. Osmaston Grange Care Centre DS0000070160.V366485.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 Osmaston Grange Care Centre DS0000070160.V366485.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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient admission available to ensure that the home could meet individual needs. EVIDENCE: Six peoples’ care files were examined, two from each of the three units, and all had an assessment in place that gave sufficient information to establish that needs could be met. Where appropriate, information from the assessment and care management process was available. This information included risk assessments for nutrition, falls and pressure sores as well as a general moving and handling assessment. There had been no change to the terms and conditions of residence (contract) due to a new owner taking over the home, but in discussion the owner stated Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 11 that this was an area that he would review to ensure that the correct information, as required by Care Homes Regulations 2001, was included in contracts. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Inconsistencies in medication procedures and waiting times for assistance at key times had the potential for care needs not to be met. EVIDENCE: Six peoples’ care files were examined and all had a care plan in place that set out how individual needs were being met. This included interventions to minimise risks. For example, where a risk of pressure sores was identified on one file there was a care plan in place to address the risk, such as regular monitoring of skin condition and use of pressure relieving equipment; where a risk of falls was identified on one file, there was a mobility care plan that addressed the risk by stating supervision was required and mobility aids must be available. However, more detail on care plans in the dementia unit in relation to social needs, life history and interventions specifically related to the impact of Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 13 dementia was required to improve care and knowledge of individuals’ background. A visiting professional stated that people were ‘looked after well’ and that communication between staff and visiting professionals in the residential part of the home was ‘100 better’. Access to health care professionals such as opticians, General Practitioners and hospital out-patient departments was facilitated and recorded in the files seen. Opticians were visiting at the time of the inspection visit. The assistance available for people in the morning prior to and during breakfast appeared limited. One person spoken with said that they regularly waited over an hour in the lounge for their breakfast to be served. Another person was observed to sit for at least half an hour with their breakfast in front of them before any assistance was available and another person said that this was a regular occurrence. All staff spoken with on the nursing unit stated that there was insufficient time in the mornings to attend to peoples’ needs properly and that baths were not being given as often as they would like. Another person living in the home stated that they had not had a bath or shower for ten days and another stated that they felt ‘rushed’ first thing in the morning and did not always get the help they felt they needed. One relative commented that they had had ‘more help in the community’. The observation carried out in the dementia unit looked specifically for indications of peoples’ well-being and/or distress, level of engagement with activities or objects and type of staff interaction and observed four people closely. During the period of observation, there was no evidence of anyone being distressed and staff were proactive in engaging with people in a positive manner, such as offering drinks, organising a quiz, playing games and having a conversation. Requests for assistance were responded to promptly. However, it was noted that people able to communicate well received more attention than those who were quieter. Although privacy and dignity was generally respected and staff were described as ‘very nice’ and ‘very good’, there were some inconsistencies in practice. Staff were observed not to always knock on people’s doors and one person commented that this startled her, and staff were also seen to approach people from behind in wheelchairs and move them without explaining properly what they were doing. One person using a wheelchair did not have any footrests and had to lift their feet off the floor when being moved. A visiting professional spoken with stated that the dementia unit was ‘much better’ and there had been a ‘big improvement’ in the service offered. Fourteen medication administration record (MAR) charts were examined for accuracy of recording across the three units. Those seen on the residential unit Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 14 were accurate and recorded the amount of medication received and all medication was signed for as given or a code used to explain why it was not given. However, on the nursing unit three gaps on the charts were seen and two people were not always signing handwritten charts. Six charts were then looked at in more detail, two on each of the units. Those seen on the residential unit were signed accurately and corresponded with the dispensing system. However, on the nursing unit one person’s chart had one gap on one day for three medicines and one box of tablets had three tablets missing. On another person’s there was one gap on one day for one medicine and one weekly tablet missing that had yet to be administered and there was no supply of lactulose that was prescribed for them. On the dementia unit, paracetamol for one person was being administered from another person’s supply. On the nursing unit, the medication refrigerator temperatures were not being recorded on a daily basis. This had been raised as an issue at the previous inspection visits in both October 2007 and February 2008. Eye drops stored in the refrigerator were labelled with date of opening. The records of controlled drugs were examined on all three units. On the nursing and dementia unit, they were accurate and the amount of medicines stored corresponded with the written record. However, on the dementia unit, two people were not signing the record at the time of administration. The previous night’s record had only one signature and the person spoken with stated that as there was only one person on the unit at night, the second signature was being obtained at later stage. This is not safe practice as it means the medicines are not being checked at the time of administration. The controlled drugs register in the residential unit did not correspond with the amount of medicines in stock. There was less of one medicine and more of a second. However, the deputy manager showed other records that demonstrated what had occurred to these drugs e.g. in the ‘destroyed items’ record. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Dissatisfaction with meals affected the quality of life of people in the home. EVIDENCE: People spoken with stated that they had their own routines and had choice in how they spent their day. External musical entertainers visited and were enjoyed by people in the home. Some people expressed concern that there would be fewer outings as the home no longer had a minibus. However, the manager stated that she was looking into alternative arrangements for transport for outings. Those people wanting to pursue Christian religious activities were well catered for with weekly Bible study sessions and prayer meetings, and monthly communion services. There was a small room available for religious meetings. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 16 Those relatives and visitors spoken with stated that they were able to visit at any time and were made to feel welcome. People living in the home were able to have their own telephone line to keep in contact with family and friends if they wished. The observation in the dementia unit showed that a range of options were available to stimulate people; for example, one member of staff organised a quiz that people enjoyed and participated in and three others were playing games. Personal attention was also offered with one person having their hair done by a member of staff. The menus were on display outside the dining rooms and showed that a choice was always available and that the food offered was nutritious. The kitchen staff spoken with were aware of who had special dietary needs. Food stocks were good and fresh fruit was available for general consumption in the dining room, although one person commented that most people who had mobility problems were not able to get up and help themselves to the fruit. The dining areas were pleasant and bright and tables were well laid with napkins and condiments. However, feedback about the food from people living in the home was very mixed across the three units; it was described by some people as ‘adequate’, ‘no variety’, ‘too much pastry at teatimes, like junk food’, ‘the meat is tough’, ‘not enough fruit’ ‘ too soft’ and ‘no taste’. Others said it was ‘decent’, ‘alright’ and ‘good’ and one person said they ‘had not had a bad meal’ whilst living there. The serving of the breakfast and lunchtime meal was observed. There were choices available at breakfast and people were having cereal, toast and one person had bacon and egg. However, one person said that the main option remained much the same with cereal and toast being the choices and if you expressed a liking for one particular item, then you were given it everyday without being offered an alternative. People enjoyed the lunchtime meal on the second day of the inspection but said they weren’t aware that there was an alternative other than sausages if they did not like the dish on offer. One person commented that the alternative was ‘always sausages’, although menus stated otherwise. The comments made about the food and general observations about mealtimes indicated that a substantial group of people were not satisfied with the meals and that staff were not proactive in offering choices and ensuring that people knew the variety available on the menus. The manager was aware of how to obtain an advocate for someone if necessary and had recently familiarised herself with the Mental Capacity Act 2005 and its implications for care settings. However, there had been no training arranged for staff yet in this area. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 17 Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were handled objectively and safeguarding adults procedures and training ensured people were safeguarded. EVIDENCE: The home had a clear complaints procedure that stated complaints would be dealt with within twenty-eight days. The Commission for Social Care Inspection had not received any formal complaints although there had been two concerns about the sale of the home due to the lack of information made available to relatives. The complaints record at the home showed that there had been no written complaints received since the last inspection visit in October 2007 but that three verbal complaints had been received regarding laundry, the lack of phones following problems after the sale of the home and the lack of information about the sale. These were recorded in a separate book and showed the response given. A safeguarding adults policy was in place and the home had a copy of the Derby and Derbyshire Local Authority Social Services safeguarding adults Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 19 procedures. The manager was able to demonstrate that she was aware of her responsibilities in reporting any allegations. There had been one allegation of abuse that had gone through safeguarding procedures in April 2008 and had resulted in disciplinary action being taken by the home. Staff spoken with were aware of their responsibilities to report any allegations and confirmed that training took place. Training records in staff files showed that video training with an accompanying questionnaire had been undertaken in October 2007. Records of a staff meeting held in April 2008 stated that there was additional training due to be undertaken to enable three staff to provide basic training on safeguarding in the home. However, one member of staff spoken with stated that they had not yet done any safeguarding training. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well maintained, which ensured people living in the home had comfortable and homely accommodation. EVIDENCE: The home was clean, tidy and well maintained at the time of the inspection visit. There was no odour noted in any part of the building. Fittings and furnishing were of good quality. Some aspects of maintenance were taking longer than usual to repair as the home was waiting to employ a handyperson. A call bell in one room in the nursing unit was damaged and made it difficult for the individual concerned to Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 21 use. This was brought to the attention of the new owner who agreed to have it repaired the following day. People spoken with were pleased with their bedrooms and they were personalised with their own possessions. Three peoples’ bedrooms were viewed and two had all the items detailed in Standard 24; for example, lockable storage space, a lock on the door, two chairs and a table to sit at. However, one person said that the keys to their door had gone missing. One person spoken with had their own telephone line and said ‘I can phone my friends when I like’, which they felt made a difference to their lives. Communal space included a small quiet room that was used by visitors and for religious meetings. Equipment was generally well maintained but it was observed that some wheelchairs did not have footplates. The external garden areas of the home needed attention, as there were weeds growing between paving slabs and the grass was very overgrown. The laundry was viewed and there were two washing machines, both with a sluice wash facility, and two driers. There was one specific member of staff who was employed to deal with laundry. People spoken with stated that their laundry was dealt with well. Staff spoken with were aware of infection control procedures, such as special disposal bags and use of gloves and aprons and stated that information about anyone with an infection was always passed on. Infection control training was planned. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in staffing at key times adversely affected the quality of care provided. EVIDENCE: The staffing rota in the nursing unit was examined for the weeks 9th June – 22nd June 2008. This showed that there were three care staff for the morning and afternoon shift and two at night. There was one qualified nurse on duty on each shift and on three shifts the lead nurse was supernumerary to perform managerial functions. However, on the day of the inspection visit one nurse was on sick leave, which meant that the lead nurse was not available for any managerial functions. People living in the home, their relatives and staff spoken with highlighted difficulty with having sufficient time to assist people in the mornings and this was observed during the breakfast time period when there was little supervision available for people in the lounge for up to an hour. This meant that people were waiting for assistance to eat and drink. One person was sat at Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 23 the table for at least half an hour with their breakfast in front of them before assistance was available. The manager stated that sixteen of forty-six staff had achieved a National Vocational Qualification at level 2 or above and a further fifteen members of staff were undertaking the training. The home was therefore due to meet the target of having 50 of staff qualified to level 2 or above. In addition, there were also two staff undertaking the level 4 training and one undertaking the level 3 training. There was a training programme in place that covered mandatory health and safety training, although the home was still working towards making sure that all staff had undertaken the necessary courses. Training applicable to care was also undertaken, such as palliative care training and staff spoken with stated that ‘all the necessary courses’ were available. Information on the notice board stated that there were courses on tissue viability and dealing with challenging behaviour planned between May and September 2008. Five staff files were examined for recruitment information and showed that this had improved since the last inspection visits in October 2007 and February 2008, when serious shortfalls had been identified. All the files seen on this visit had all the information in place required by the Care Homes Regulations 2001, with the exception of one file that had only one reference. There was also a record of all nursing staffs’ verification of fitness to practise with expiry dates. However, a discrepancy on one file that was identified at the visit in February 2008 had not been checked out. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance processes and inadequate procedures for managing personal finances did not always ensure that the home was run in the best interests of people living in the home. EVIDENCE: The manager was well qualified and experienced to run the residential part of the home. She had achieved an NVQ in care to level 4 and also the Registered Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 25 Manager’s award in 2005. In discussion, the manager was able to demonstrate that she was familiar with the diseases of old age. There was also a lead nurse in place on the nursing unit to ensure that there were clinical managerial arrangements in place. Supervision records were available on staff files seen and showed that the most recent supervision had taken place in May 2008 for the staff concerned. The visit undertaken in February showed that there had been no formal clinical supervision arrangements put in place for the lead nurse but she stated that she obtained support when necessary from health professionals in the district nursing team and Primary Care Trust. There was also another senior nurse in the home who assisted in providing support to less experienced staff. The home had not provided an annual quality assurance assessment prior to the inspection visit. This meant it was difficult to fully assess quality assurance processes as there was no information available on how the home intended to improve. The new owner stated that he had a quality assurance system that would be implemented in due course and that this would include surveys of visiting professionals, relatives and people living at the home and regular visits from himself and area staff. The manger stated that an internal quality assurance survey had been sent out but that not all responses had yet been received. The nursing unit had not a properly established system for managing peoples’ finances. Although a receipt for one person’s money handed in was available, this was not dated and there was no system for recoding when money was taken out. This raises concerns, as there is no clear audit trail for personal money being brought in or taken out of the unit. Health and safety issues were generally addressed. A random sample of maintenance records showed that the hoists were checked in November 2007, fire alarms in May 2008 and portable electrical appliances in March 2008. Training information showed that mandatory staff training in health and safety areas such as first aid, fire safety, infection control and moving and handling took place and the new owner said that they had trainers in place who provided these courses. Staff spoken with confirmed that they had access to this on a regular basis. Fire safety training had taken place in January 2008 and night staff were included in this. Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 26 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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 3 X 3 Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5A (1,2) Requirement A statement must be made to the service user specifying the fees payable for the following: i) accommodation ii) nursing and iii) personal care. Where a nursing contribution is paid, a statement specifying the date of payment and amount of the nursing contribution must be given to the resident to their representative. This is to ensure that all parties are clear about the payment arrangements and charges. This requirement had a timescale of 01/03/08, which has not been met. Timescale extended to 01/08/08. 2. OP9 13 (2) The temperatures of the 18/06/08 medication refrigerator must be recorded daily to ensure safe storage. This requirement had a timescale of 01/03/08, which has not been met. Controlled drugs registers must DS0000070160.V366485.R01.S.doc Timescale for action 01/08/08 3. OP9 13 (2) 01/07/08 Page 28 Osmaston Grange Care Centre Version 5.2 always have two signatures when administering medicine to ensure they are administered safely and all medicines are accounted for. 4. OP9 13 (2) All medicines must be administered from containers labelled with the persons name to ensure that the person has the correct medicine and the correct dose. Medication administration record charts must always be signed accurately to ensure there is a clear audit trail of when medicines have been administered. Menus must be reviewed and people living in the home must be involved in this review to ensure that their preferences are taken into account and that they are fully aware of the options available. There must be a review of staffing hours to ensure that there are sufficient staff at key times to meet peoples care needs. Quality assurance processes must be fully implemented to ensure that the home improves its service. There must be proper system in place to ensure that peoples’ personal money is always accounted for and that there is a clear audit trail of money spent and received. 01/07/08 5. OP9 13 (2) 01/07/08 6. OP15 16 (2) (i) 01/09/08 7. OP27 18(1) (a) 01/08/08 8. OP33 24 (1) 01/09/09 9. OP35 17 (2) & Schedule 4 (9) 01/08/08 Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations Care plans in the dementia unit should always include social history and interventions to address the impact of dementia. Staff should always ensure peoples’ privacy and dignity by knocking on doors before entering and advising people what they are doing before moving or assisting them. All staff should receive training on the Mental Capacity Act 2005 to ensure that they are familiar with its implications for care settings. The garden area should be maintained to ensure there is a pleasant outdoor area for people to use. Wheelchairs should always have footplates available for use. There should always be two written references on staff recruitment files and any discrepancies in recruitment information should be addressed. Feedback from visiting professionals should be sought to assist with quality assurance processes. 2. OP10 3. OP14 4. 5. 6. OP19 OP22 OP29 7. OP33 Osmaston Grange Care Centre DS0000070160.V366485.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Osmaston Grange Care Centre DS0000070160.V366485.R01.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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