Inspection on 22/10/07 for Osmaston Grange Care Centre

This inspection was carried out on 22nd October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Osmaston Grange Care Centre 05/04/09

Osmaston Grange Care Centre 16/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Osmaston Grange Care Centre 5 - 7 Chesterfield Road Belper Derbyshire DE56 1FD Lead Inspector Janet Morrow Key Unannounced Inspection 22nd October 2007 10:30 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.V348699.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.V348699.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.V348699.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 This a new service and is the first key inspection. 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 residents 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. All residents have access to a well-set out garden area. Osmaston Grange Care Centre DS0000070160.V348699.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 November 2007 stated that the fees ranged from £333– £600 per week. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over three days for a total of 14.5 hours. A second inspector assisted on the nursing unit on the second day for two hours. Care records, staff records, maintenance records and a sample of policies and procedures were examined. A partial tour of the building was made. Five members of staff, the manager and deputy manager were spoken with. Ten of thirty-seven residents currently accommodated in the older residential building and four residents in the nursing unit were spoken with; three visiting professionals and three relatives were spoken with. One relative and two visiting professionals were contacted by telephone following the inspection visit. Residents’ surveys were received after the inspection visit. Two hours were spent observing the care given to residents in the lounge in the dementia unit. A short inspection visit was undertaken in August 2007 as result of a safeguarding adults query and the findings from this visit will be referred to in this report. Written information supplied by the home informed the inspection process. 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 with a pleasant garden area. Residents and families were encouraged to personalise their rooms with their own possessions. The observation showed that the majority of communication with residents in the dementia unit demonstrated an understanding of individual needs. Residents enjoyed the meals provided by the home. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Recruitment procedures had not improved and there were some serious gaps in recruitment information such as lack of confirmation of fitness to practise for qualified staff and lack of references, which had the potential to place residents at risk of harm. This was raised as an issue at the previous inspection visit in August 2007 and an immediate requirement notice was therefore issued to commence the process of rectifying this. There were inadequate management arrangements for clinical supervision of qualified staff and several lead nurses had been in post since the operation of the nursing unit. Inexperienced staff were sometimes in charge in the nursing unit. This must be reviewed in order to ensure care needs are fully met and residents are in safe hands. Falls risk assessments and actions to address any risks must be in place in care records in all the units of the home. Care records must contain sufficient detail for staff to understand what care need to take place and to ensure residents’ needs are fully met. Terms and conditions of residence must state the breakdown of fees and how these are to be paid so that residents and their representatives are clear about payment arrangements. Medication procedures need further improvement to ensure that handwritten medication administration record (MAR) charts are signed and dated by two people and the temperatures of the medication refrigerator are recorded on a daily basis. Infection control procedures could be improved by ensuring all staff, including domestic staff, have received training in this area and by the use of the ‘Essential Steps’ guidance issued by the Department of Health to assess infection control procedures. There needs to be additional staff training in the following areas: fire safety, infection control, safeguarding adults, palliative care and dementia care. Induction training for nurses must also be established. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 8 All staff must receive regular supervision to ensure that they receive proper support and advice. A review of staffing should be undertaken to ensure that there is continuity of care and that use of agency staff minimises disruption to residents. Visiting professionals should be surveyed as part of quality assurance processes. Odour should be eliminated in identified areas in the home. 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.V348699.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.V348699.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): 2, 3 and 4. Standard 6 is not applicable as the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of some assessment information had the potential for the home to fail to meet needs and inadequate information in terms and conditions of residence did not ensure that prospective residents had all the information they needed to make an informed choice about moving into the home. EVIDENCE: Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 11 Six residents’ care files were examined 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 and pressure sores as well as a general moving and handling assessment. However, falls risk assessments were not routinely available in the residential part of the home. This was raised as an issue at the previous inspection visit in August 2007. When brought to the attention of the deputy manager during the visit, this was rectified. The information available established that the home was able to meet residents’ needs and relatives interviewed also confirmed that needs were met. One relative stated that their had been a ‘very big improvement’ in the condition of their relative since admission to the home. Terms and conditions of residence (contract) were seen in two files examined in the nursing unit. Neither had a breakdown of the fees into accommodation, personal care and nursing care, as required by the Care Homes Regulations 2001. Two relatives spoken with stated that they were unclear about how the free nursing care element of the fees was reimbursed and one had not received a response from the owner when they had sent in a written query. Osmaston Grange Care Centre DS0000070160.V348699.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. Lack of experienced staff, insufficient recording on care plans and clinical arrangements had the potential for care needs not to be met. EVIDENCE: Six residents’ care files were examined and all had a care plan in place that set out how residents’ needs were being met, including health and social needs. However, there were some inconsistencies in the recording on care plans with some having sufficient detail and others having missing information. Two files on the nursing unit had relevant information on specific care needs; for example, on one file an assessment by a speech and language therapist was in place and there were charts recording when repositioning took place to prevent pressure sores. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 13 However, on other files in the residential unit, where risks were identified there was insufficient information about the action taken to minimise risks to residents. For example, in one file a tissue viability risk assessment indicated that monthly re-assessments were needed but there was no further documentation to show this had occurred and in another file the recording regarding a dressing was unclear. Other files showed that pressure relieving equipment was in place for those at risk of pressure sores and visiting professionals spoken with stated that response to pressure sores in the residential part of the home had improved and all relevant equipment was now in place. Access to health care professionals such as opticians, General Practitioners and hospital out-patient departments was facilitated and recorded. There had been a recent enquiry regarding standard of care within the nursing unit of the home that had resulted in action being taken by the Local Authority. This had raised concerns about the quality of care offered to terminally ill residents and also the prevention and treatment of pressure sores and wounds. The manager stated that the home was not currently admitting people where palliative care was identified as the main need and that training in palliative care was booked for later in the year. Inexperienced staff were sometimes in charge of shifts on the nursing unit and there was a lack of clarity about the supervisory and support arrangements for these staff. The District Nursing team had given advice regarding pressure sore prevention and training had been offered. However, only two members of staff had attended this training. Visiting professionals had assisted in making satisfactory arrangements for the use of pressure relieving equipment. The observation carried out in the dementia unit looked specifically for indications of residents’ well-being and/or distress, level of engagement with activities or objects and type of staff interaction and observed three residents closely. During the period of observation, there was no evidence of residents’ being distressed and some staff were proactive in engaging with residents in a positive manner, such as offering drinks and having a conversation. Requests for assistance were responded to promptly. Eleven medication administration record (MAR) charts were examined in the residential unit for accuracy of recording. This showed that there had been improvement since the last visit in August 2007, with a total of five gaps on four charts. Three medication administration record (MAR) charts were then examined in more detail and two were completed accurately. All three had all the medication in stock that was required. On the nursing unit, all the medication administration record (MAR) charts were examined and showed that there were two gaps over the fifteen Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 14 examined. Codes were used and had an explanation of what it meant. Two charts were examined in more detail and were found to be accurate. However, two people were not consistently signing handwritten charts. The medication refrigerators’ temperatures on the residential and nursing unit were within safe limits. Although a system for recording temperatures was in place, this was not being adhered to consistently and there were several days were no temperature was recorded. Eye drops stored in the refrigerator were labelled with date of opening. The record of controlled drugs was examined. Although the record corresponded with the medicines in stock, there was an anomaly in the record of Temazepam, which was being stored under controlled conditions. This showed a tablet in the blister pack on a day when it had been signed for as given. The home was asked to provide an explanation of this following the inspection visit. They were also asked to provide a copy of the record of medicines returned to the pharmacy as this was not available at the time of the inspection visit and the register showed that the home still had medicines in stock, although the resident concerned had gone into hospital. Osmaston Grange Care Centre DS0000070160.V348699.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 good. This judgement has been made using available evidence including a visit to this service. Activities, meals and contact with the community were well managed, which enhanced residents’ daily lives. EVIDENCE: Residents spoken with stated that they had their own routines and had choice in how they spent their day. Activities were arranged on a regular basis; for example, there were fortnightly exercise sessions, monthly entertainment occurred and there were outings in the summer, such as trips to the seaside and boat trips. Some residents were also involved in running a small shop selling snacks, sweets and toiletries. Those residents 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.V348699.R01.S.doc Version 5.2 Page 16 Although trips out occurred, one resident was disappointed that they were not able to go out as much as they would like, as they needed to be accompanied for safety reasons. Those relatives and visitors spoken with stated that they were able to visit at any time and were made to feel welcome. Residents 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 residents; for example, two members of staff were observed playing a game with two residents and one also received a manicure. Another resident was offered a choice of film to watch. The menus were on display outside the dining rooms and showed that a choice was always available and that the food offered was nutritious. There were few special diets, apart from diabetic. The kitchen staff spoken with were aware of who had special dietary needs. Food stocks were good and fresh fruit was available. The dining areas were pleasant and bright and tables were well laid with napkins and condiments. The serving of the lunchtime meal was observed in the dementia unit and residents were offered choices and appropriate assistance to eat. The manager was aware of how to obtain an advocate if necessary but stated that no one in the home currently had one. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 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 were in place. However, further staff training would ensure that residents were more adequately 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 been informed of one complaint received by the Local Authority and had undertaken an inspection visit as a result of this enquiry. The complaints record on the nursing unit was seen and there were no complaints recorded. The annual quality assurance assessment information stated that five complaints had been received in the home in total over the last twelve months and that two had been upheld. Residents and two relatives spoken with stated that they would take any concern to the provider or manager and were confident of a courteous response. However, one relative who had raised a query (not a complaint) had not received a response to their written enquiry. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 18 A safeguarding adults policy was in place and the home had a copy of the up to date Derby and Derbyshire Local Authority Social Services safeguarding adults procedures. In discussion, 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 July 2007 and had resulted in an additional inspection visit in August 2007 and action being taken by the Local Authority. Staff spoken with were aware of their responsibilities to report any allegations but not all had done specific training on safeguarding adults. The last recorded course seen in staff training records was October 2006, although some staff stated they had undertaken training on this as part of their National Vocational Qualification training. However, the written information supplied by the home stated that safeguarding training had taken place in 2007. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 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 residents had comfortable and homely accommodation. EVIDENCE: The home was clean, tidy and well maintained at the time of the inspection visit. However, there was a mild odour in one bedroom that staff were aware of and were doing their best to eradicate it. Fittings and furnishing were of good quality. There was an ongoing programme of maintenance. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 20 Residents spoken with were pleased with their bedrooms and they were personalised with their own possessions. Three residents’ 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 resident had no lockable storage space. Two residents spoken with had their own telephone line. Communal space included a small quiet room that was used by visitors and for religious meetings. 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. Residents spoken with stated that their laundry was dealt with well. Not all staff spoken with knew where to find information on the Control of Substances Hazardous to Health (COSHH). They were aware of infection control procedures, such as special disposal bags and use of gloves and aprons. However, one member of staff spoken with had not undertaken infection control training. The written information supplied by the home stated that they had not used the ‘Essential Steps’ guidance issued by the Department of Health to assess infection control procedures. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were shortfalls in staff recruitment information that meant residents were not fully safeguarded. There were occasions when insufficient staff and the use of agency staff had the potential to compromise consistency of care. EVIDENCE: The staffing rota in the nursing unit was examined for the weeks 15th October – 4th November 2007. 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. This was verified on the day of the inspection visit. The inspection visit undertaken in August 2007 identified that inexperienced staff had been working on the dementia unit alone at night. This was discussed with the manager who stated that this now did not occur and all staff working in the unit at night had prior experience in care work. There were several occasions when the home used agency staff to fulfil the rota. The written information supplied by the home stated that this had occurred on twenty-three nursing shifts during the previous three months. Discussion with staff showed that generally there were enough people on duty Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 22 to meet needs and shifts were not operating with insufficient cover. However, it was identified that there was sometimes a problem with skill mix when different staff were on duty. One relative spoken with stated that they felt there were a lot of different staff in the unit and was concerned that ‘there was no-one to guide them’. The written information supplied by the home stated that there was 55 of staff with a National Vocational Qualification at level 2 and a further eight members of staff were undertaking the training. There were also three staff undertaking the level 4 training. The home was therefore meeting the target of having 50 of staff qualified to level 2 or above. There was a training programme in place that covered mandatory health and safety training. However, not all staff were up to date with this training. One member of staff spoken with had not undertaken fire training and another had not done infection control training. There was also no clear induction training for nurses other than the essentials of the home such as locating essential information and shadowing staff for two days. Training applicable to care was also undertaken. However, not all staff had undertaken dementia training although four key staff were doing a distance learning course with a local college; not all staff had undertaken safeguarding training; palliative care training had not yet been undertaken although it was arranged for November. The written information supplied by the home stated that sessions in tissue viability, wound care and catheter care were planned. One staff member spoken with had completed study days on diabetes. Five staff files were examined, three in the residential unit and two on the nursing unit. This identified that there were shortfalls in recruitment information and the home was therefore not meeting its legal obligations under the Care Homes Regulations 2001. Three files did not have two written references, one had an incomplete employment history and there was no verification of fitness to practise for nursing staff. Lack of two written references was raised as an issue at the inspection visit in August 2007 and an immediate requirement notice was therefore issued to commence the process of rectifying these shortfalls. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a lack of clarity about management arrangements, particularly for the nursing unit, which meant the home was not always run in residents’ interests. 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 Manager’s award in 2005. In discussion, the manager was able to demonstrate that she was familiar with the diseases of old age. However, she was not a qualified nurse and the lack of a nurse manager for the nursing unit had had a Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 24 negative impact for residents and staff. The owners had arranged for a nurse to take the clinical lead but there had been several changes to the lead nurse during the short period that the nursing unit had been operating. The recent enquiry in July 2007 that been through safeguarding procedures had identified that newly qualified staff felt unsupported and staff spoken with stated that supervision arrangements were ad hoc and informal. This is a matter of concern as the enquiry was related to clinical issues. The owner and manager did not appear to have a clear understanding of their responsibilities in relation to the operation of a nursing unit and had made some errors that had the potential to impact negatively on residents; for example; • the employment of newly qualified staff and staff without a general nurse qualification who would be working as the only nurse on shift on some occasions had the potential to compromise care; • insufficient recruitment practices and failure to check personal identification numbers (PIN) for fitness to practise meant residents were not fully safeguarded; • no clear induction programme for nurses had the potential to compromise care • lack of detail on terms and conditions (contracts) for residents with nursing needs meant there was a lack of information to make an informed choice about the home. Supervision of staff appeared to be ad hoc, particularly on the nursing and dementia unit. Supervision records were available for some staff in the residential unit for October 2007 but none were seen in staff files in the nursing unit. The owner stated that any queries in relation to clinical issues would be dealt with by the lead nurse, who would be available by phone for other members of staff. If the lead nurse was not available, then staff called each other or NHS Direct for support. Staff spoken with confirmed this arrangement. There did not appear to be any specific supervision or support arrangements in place for the lead nurse in relation to clinical issues. Lack of supervision for staff was raised as an issue at the inspection visit in August 2007. A system was in place to assure the quality of the service and a quality assurance plan was seen for 2007. This covered plans to gain feedback from residents’ meetings and to discuss social activities, staff development and prompt dealings with complaints. A survey had been undertaken and satisfaction with the service was generally good with comments such as ‘everything seems to be satisfactory’. Letters of thanks dated August 2007 were also seen and stated that the residents was ‘very happy with the care’ and another letter dated March 2007 stated that ‘the obvious benefit shown by her general demeanour is fantastic’. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 25 The proprietor was available on a daily basis and residents spoken with stated that he was ‘approachable’ and responsive to suggestions. However, there had been no feedback received from visiting professionals. A previous visit to the residential unit in April 2007 established that there was a system to manage residents’ personal finances and that no issues were raised. The information needed to do a full check on residents finance was not available during this inspection visit as the owner was on leave. Health and safety issues were addressed. The written information supplied by the home stated that portable electrical appliances had been checked in March 2007, fire equipment in March 2007, the lift in August 2007 and gas appliances in April 2007. Mandatory staff training in health and safety areas such as, first aid, fire safety, infection control and moving and handling was listed in the written information provided by the home as being undertaken during the year. Staff spoken with confirmed that they had access to this on a regular basis. However, one member of staff spoken with had not done any infection control training and another had not done any fire training. A fire drill took place on the new unit during the inspection visit. Osmaston Grange Care Centre DS0000070160.V348699.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 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? FIRST KEY INSPECTION 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 – 6) 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. 2. OP3 12 (1) (a) & 13 (4) (c) A falls risk assessment must be completed for all residents to identify and address any risks. Previous timescale of 01/10/07 not met. Timescale extended. All care plans must contain sufficient detail to ensure clarity on what needs to take place to meet care needs. 01/12/07 Timescale for action 01/12/07 3. OP7 15 (1) 01/12/07 Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 28 4. OP8 12 (1) (b) The nursing unit must be conducted in a way that promotes and makes proper provision for the care and treatment of residents, in that there must be adequate arrangements for clinical supervision and advice for nursing staff. The temperatures of the medication refrigerator must be recorded daily to ensure safe storage. All staff must receive training in safeguarding adults to ensure residents are safe. All staff must receive training in infection control to ensure residents’ safety. Recruitment procedures must include all information as specified in Schedule 2 of the Care Homes Regulations 2001 to ensure residents safety and to meet legal requirements. This must include full employment histories, verification of fitness to practise for qualified staff and two written references. Immediate Induction training for all staff must be completed to ensure staff are familiar with the routines and expectations of the home and to ensure residents’ needs are met. All staff on the nursing unit must receive training in palliative care and all staff on the dementia unit must receive training in caring for people with dementia to ensure appropriate care is given DS0000070160.V348699.R01.S.doc 01/12/07 5. OP9 13 (2) 01/12/07 6. OP18 13 (6) 01/04/08 7. OP26 13 (3) 01/04/08 8. OP29 19 (1) (b) (i) & Schedule 2 26/10/07 9. OP30 18 (1) (c) (i) 01/12/07 10. OP30 18 (1) (c) (i) 01/04/08 Osmaston Grange Care Centre Version 5.2 Page 29 and staff are competent. 11. OP31 9 (2) (b) (i) The managerial arrangements of the home must specify the support available to the lead nurse and clarify arrangements for their supervision to ensure the home is run in residents’ best interests. All staff must receive regular supervision to ensure competent staff care for residents. All staff must receive mandatory training in health and safety issues such as infection control and fire safety to ensure the health and safety of residents and staff. 01/01/08 12. OP36 18 (2) 01/01/08 13. OP38 18 (2) & 13 (4) (c) 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Two people should sign and date handwritten medication administration record (MAR) charts to minimise risk of errors. Odour should be eliminated in identified areas. The home should use the Department of Health ‘Essential Steps’ guidance to assess their infection control procedures. All staff should be aware of the location of Control of Substances Hazardous to Health (COSHH) information. Staffing should be reviewed to ensure continuity of care and to minimise disruption to residents. DS0000070160.V348699.R01.S.doc Version 5.2 Page 30 2. 3. OP26 OP26 4. 5. OP26 OP27 Osmaston Grange Care Centre 6. OP33 Feedback from visiting professionals should be sought to assist with quality assurance processes. Osmaston Grange Care Centre DS0000070160.V348699.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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