Inspection on 05/04/09 for Osmaston Grange Care Centre

This inspection was carried out on 5th April 2009.

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

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 16/06/08

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 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Osmaston Grange Care Centre 5 - 7 Chesterfield Road Belper Derbyshire DE56 1FD Lead Inspector Janet Morrow Unannounced Inspection 5th and 6th April 2009 11:30 DS0000070160.V374918.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Osmaston Grange Care Centre DS0000070160.V374918.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.V374918.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 16th June 2008 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 a 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.V374918.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 April 2009 stated that the fees ranged from £414.75 - £519.75 per week. Details of previous inspection reports can be found in the office at the home and on the Care Quality Commission’s for website: www.cqc.org.uk Osmaston Grange Care Centre DS0000070160.V374918.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. This inspection visit was unannounced and took place over two days for a total of 13.25 hours. One hour was spent observing the care given to people in the dementia unit. The care of one person was then looked at in depth when comparisons with the observations were made with the home’s records and the knowledge of the care staff. In addition, the care of two people in the residential part of the home and one person in the nursing was also looked at in detail. Care records and staff records and a sample of policies and procedures were examined. Eight members of staff, seventeen people living in the home, two visiting professionals and seven relatives were spoken with. One visiting professional and two relatives were contacted by telephone following the inspection visit. The manager, deputy manager and the responsible individual were also spoken with during the visit. A partial tour of the premises was undertaken. Quality assurance surveys undertaken by the home were examined. Two staff surveys were also received and relatives’ surveys were received. Written information was supplied by the home following the inspection visit. What the service does well: There was a core group of staff who had worked at the home for a number of years that helped to ensure consistency of care. Staff gave positive feedback about the management arrangements and stated that they worked together well as a team and had the right support and guidance to enable them to do their jobs. 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.V374918.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: Although some alterations to terms and conditions of residence (contracts) had been made, not all people in the home or their representatives were aware of this and not all have had a contract. Terms and conditions of residence must state the breakdown of fees to include nursing, personal care and accommodation costs and how these are to be paid so that people living in the home and their representatives are clear about payment arrangements. This is outstanding form the previous inspection visit in June 2008. The responsible individual must ensure that complaints and requests are responded to as outlined in the internal complaint policy and procedure. Staffing hours must be kept under continuous review, particularly in the dementia unit, to ensure that there are always sufficient staff on duty to meet peoples’ needs. This must include domestic staff. The home must ensure that there are sufficient staff on duty with an up to date First Aid qualification. Peoples’ financial records should always correspond accurately with the amount of cash held. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Osmaston Grange Care Centre DS0000070160.V374918.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.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued issues regarding contracts and fees do not ensure that people living in the home have sufficient information to make informed decisions. EVIDENCE: The written information provided by the home stated that the statement of purpose was available for inspection within the home. This was seen on display in the entrance. Contracts, in particular for those people receiving nursing care, were also problematic. One relative spoken with had raised queries regarding the contract and stated they had not received a response to a query regarding the nursing care element of the fee. One file examined in the nursing unit did not Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 11 have a contract and those in the residential unit did not have one or had one from the previous responsible individual. A query raised since the last inspection visit in June 2008 also concerned the lack of a contract and lack of clarity about payment details. The issue regarding contracts was raised with the responsible individual during the inspection visit. Although the company had its own contract, not everyone in the home had received one. A sample contract was examined and although it referred to the breakdown of fees into nursing, personal care and accommodation costs as legally required by the Care Homes Regulations 2001, it did not actually state what these were and no contract was available during the visit that had this information specified on it. Four peoples’ care files were examined, two from the residential unit, one from the dementia unit and one from the nursing unit 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. Two visiting professionals spoken with did not raise concerns regarding the care provided and felt peoples’ needs were met. Osmaston Grange Care Centre DS0000070160.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs were met and the care of people living in the home was planned and given in a way that respected individuality. EVIDENCE: Four 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 nutritional risk had been identified there was an eating and drinking plan available that stated to encourage the person to eat and to offer regular snacks and where pressure sore risk assessments indicated that a monthly re-assessment was needed, this was being carried out. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 13 A life history and social care plan was available on all files and on the dementia unit staff were starting to compile ‘memory books’ that included information about a persons’ history and their past interests and lifestyle. All four care plans seen were reviewed on a monthly basis. Both staff surveys responded that they were ‘always’ given up to date information about peoples’ needs and one commented that ‘care plans are up to date and all information is included in them’. An internal survey seen from a relative commented that they were ‘pleased with the care so far’. Access to health care professionals such as opticians, General Practitioners and hospital out-patient departments was facilitated and recorded in the files seen. A visiting professional spoken with said that problems identified by staff had been addressed following professional advice, although there was room for improvement in some areas such as addressing continence issues and use of equipment. An internal survey completed by a visiting professional commented that they had ‘no concerns this year’. There was a programme in place for the servicing of wheelchairs. However, it was observed that some wheelchairs had no footrests and one person was seen being pushed holding their feet off the floor, even though footrests were available. These were then utilised when the staff member concerned realised they were being observed. Similar issues with the use of wheelchairs had been raised at the previous inspection in June 2008. Although notices were visible around the home advising staff not to use wheelchairs without footrests, this was not being adhered to consistently. 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 three 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 assisting with the lunch-time meal, playing games and having conversations. Requests for assistance were responded to promptly. No staff interactions were negative, with care and assistance being provided in a sensitive manner. However, it was noted that people able to communicate well received more attention than those who were quieter. Privacy and dignity was upheld and people living at the home were observed to have warm relationships with staff. Relatives interviewed confirmed this and described the staff as ‘really kind’, ‘nice’ and ‘very good’. A visiting professional spoken with described staff as ‘welcoming’ and the care as ‘good’. Ten peoples’ medication administration record (MAR) charts were examined to check the accuracy of the recording. This showed that records were accurate, Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 14 with signatures in place for medicines dispensed. However, on the residential unit two people were not signing handwritten medication administration record (MAR) charts to ensure they were accurate. Three peoples’ MAR charts were then examined in more detail and were completed accurately. Storage of medicines was satisfactory and medicines were within their expiry date. The temperatures of the medication refrigerators were being recorded and were within safe limits. However, the storage room in the residential unit was very warm and there was no accurate recording of its temperature. The records of controlled drugs were examined in the residential and nursing units and accurately corresponded with the medicines held. Two people were signing the record. Temazepam was stored under controlled conditions. Secure storage facilities were available. The manager was undertaking regular monitoring of recording on MAR charts and taking action if any discrepancies were found. This had helped maintain improvements in medication administration recording since the last inspection in June 2008. The written information supplied by the home stated that all staff involved in administering medication had ‘undertaken appropriate training to ensure they are competent to do so’. Osmaston Grange Care Centre DS0000070160.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities, meals and contact with the community were well-managed, which enhanced peoples’ quality of life. EVIDENCE: People living in the home and their relatives spoken with confirmed that that the routines of the home were flexible and it was observed that people had the choice of whether or not to participate in activities. The written information supplied by the home stated that ‘routines are flexible, resident based’. Detailed information was maintained on individuals’ past history and likes and dislikes, which were incorporated into their social care plan. People were observed pursing their own interests such as reading and doing jigsaws. A boat trip was being organised for the summer and one person spoken with stated that they went out with friends each week. Two people Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 16 expressed disappointment that there was no longer a minibus and said outings were less frequent as a result. One person said they were ‘bored’. The home maintained its Christian ethos and the written information supplied by the home stated that there was ‘communion once a month and a service every Sunday afternoon’. It also stated that additional staff hours had been allocated to arrange activities. The observation in the dementia unit showed that a range of recreational options were available to people; for example, staff were observed chatting with individuals and playing games. However, one of the games seen appeared to be a child’s game that was not appropriate for adults. 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. Most people spoken with also said they enjoyed their meals and stated that they were offered alternatives if they did not like what was on offer. However, two people did not always like what was on offer and said that their preferences were not always catered for. A relative spoken with also confirmed this. Menus were examined in the residential unit and showed that nutritional options were available and staff spoken with were aware of dietary requirements. The observation in the dementia unit showed that everyone enjoyed the food and one person said ‘I like my dinners’ and described the food as ‘good’. The manager was aware of who to contact for an advocacy service and stated that one person in the home currently had an advocate. However, the staff on the relevant unit were not aware that anyone had an advocate. Osmaston Grange Care Centre DS0000070160.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of response to complaints did not always ensure peoples’ concerns were listened to objectively or dealt with promptly. EVIDENCE: The complaints procedure was examined and stated that complaints would be investigated within twenty-eight days. This was confirmed on the written information supplied by the home. The complaints record was examined and showed that two complaints had been received at the home since the last inspection visit in June 2008. It was clear from the record what action had been taken to address them and whether the complainant was satisfied with the outcome. However, the written information supplied by the home stated that there were four received in the last twelve months. However, there had been four concerns brought to the attention of the Care Quality Commission (previously the Commission for Social Care Inspection) since the previous inspection visit in June 2008. These were similar in content, being primarily about lack of staff and no contracts or contact with the new responsible individual, as well as specific individual issues related to equipment not working. The responsible individual had only recently addressed some of Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 18 these issues, such as staffing, but others, particularly regarding contracts, were still outstanding. A recent staff meeting held in March 2009 documented a lack of domestic staff at weekends, which had also been highlighted in complaints going back to September 2008. Two relatives spoken with stated that they did not have a contract. One said they had written about this but had not received a response. Another relative said they had had no contact with the responsible individual and were not aware of the company address or how to contact them. The information displayed in the home in the statement of purpose was also out of date and gave the previous responsible individuals’ contact details. One relative spoken with said they had made a request for equipment to be provided and had had a verbal response but nothing in writing and that it took twelve months to sort out their request. A safeguarding adults policy was in place and the home had a copy of the Derby and Derbyshire Local Authority Social Services safeguarding adults procedures. The manager was able to demonstrate that she was aware of her responsibilities in reporting any allegations. There had been no allegations reported since the last inspection in June 2008. Staff spoken with were aware of their responsibilities to report any allegations and confirmed that safeguarding training took place. Training records confirmed it had occurred in December 2008 and March 2009. However, one senior member of staff had not undertaken the training. Osmaston Grange Care Centre DS0000070160.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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. The responsible individual stated that new cleaning equipment had been purchased to assist domestic staff. The courtyard area in the dementia unit was being improved and staff were in the process of developing a sensory garden. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 20 Fittings and furnishing were of good quality. The written information supplied by the home stated that new carpets had been supplied in fifteen bedrooms in the residential unit and that the dining room had been decorated. Bathrooms and toilets were viewed in the nursing and dementia unit. They were clean and hygienic. Recent complaints received at the Commission stated that there were no cleaning staff at the weekends and this had had an adverse effect on the cleanliness of the home. At the time of the inspection visit, cleaning staff were available at weekends, although the manager said that this had been a problem on some occasions. However, she stated that this had been rectified and there were now regular cleaning staff on duty at the weekends and a further member of domestic staff had been agreed for the dementia unit. The laundry in the nursing and dementia unit 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 knew how to control the spread of infection and confirmed that there was always a plentiful supply of protective equipment such as gloves and aprons. Osmaston Grange Care Centre DS0000070160.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of staff at weekends had compromised the quality of care at key times. EVIDENCE: The staff rota for 30th March 2009 – 12th April 2009 was examined. This showed that there were three care staff and one nurse on duty in the nursing unit for the morning and afternoon shifts, two care staff in the dementia unit for the morning and afternoon shifts and five care staff in the residential unit on both shifts. The complaints received by the Care Quality Commission (previously the Commission for Social Care Inspection) since the last inspection in June 2008 stated that there were insufficient staff, particularly at weekends, and this was discussed with the lead nurse, manager and owner. They confirmed that there had been occasions when it was difficult to get a nurse for the night shift due to recruitment problems and cleaning staff at weekends in the nursing and dementia unit. A staff meeting held on 30th March 2009 also made reference to a lack of domestic staff at weekends in the residential part of the home and in Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 22 the dementia unit at weekends. The manager confirmed that one member of domestic staff was currently available for the nursing and dementia unit and that a further member of domestic staff had been agreed for the dementia unit. An additional nurse was in the process of being recruited and existing staff were covering nursing shifts. However, there were no laundry staff at the weekend in the residential unit. A relative spoken with said there were insufficient staff and it was always ‘rush, rush, rush’, which upset the person living in the home. Another said there was sometimes a long wait for the door to be answered when visiting. One member of staff described the morning shift in the residential unit as ‘busy’. Feedback on internal satisfaction surveys also highlighted potential staffing problems. Seven of the nine surveys seen from relatives responded that there were not enough staff, although they said they were satisfied with the care provided. One commented that ‘more staff would be a bonus’ and another said there were ‘definitely not enough staff’. Another said ‘the dementia unit would benefit from more staff’. The number of staff on the dementia unit was discussed with staff and management. Staff in the unit felt that two staff per day shift was sufficient given the needs of people currently accommodated. A visiting professional commented that there had been staffing problems, and although this was now better, the staff on the dementia unit would have ‘difficulty coping’ if anyone was admitted who had more intense needs. The observation showed that the atmosphere in the unit was calm and staff were coping with peoples’ needs without prolonged waiting times for assistance. However, this must be kept under continuous review as two staff for fourteen people is the lowest possible minimum. One staff survey responded that there were ‘usually’ enough staff on duty and the other responded that there ‘always’ were and commented that ‘when holidays are taken staff pull together’. The written information supplied by the home stated that the home operated a ‘thorough recruitment procedure’. Four staff files were examined for recruitment information. This showed that a proper recruitment process was in place and that all the information required by the Care Homes Regulations 2001 was in place, including Criminal Record Bureau (CRB) checks, identity information, two written references and Protection of Vulnerable Adults (POVA) First checks. One person’s verification of fitness to practise had recently expired but the manager confirmed during the inspection visit that this was still valid. The written information supplied by the home stated that twenty-nine of fortytwo staff had achieved a National Vocational Qualification at level 2 or above. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 23 The home was therefore meeting the target of having 50 of staff qualified to level 2 or above. Staff spoken with confirmed that mandatory health and safety training took place as well as course relating directly to care. Training certificates showed that courses on administering medication, pressure sore prevention, palliative care and dealing with challenging behaviour had taken place in 2008. Training planned for 2009 included dementia, tissue viability, the Mental Capacity Act and nutrition and well-being. In addition, the lead nurse provided teaching sessions in clinical procedures for nursing staff. Both staff surveys received responded that they received training relevant to their role and to help understand individual needs. One survey commented ‘training courses are ongoing and always there for us’. Osmaston Grange Care Centre DS0000070160.V374918.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed and health and safety needs were addressed which ensured that peoples’ interests were safeguarded. EVIDENCE: The manager was well qualified and experienced to run the residential part of the home. She had achieved a National Vocational Qualification (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 Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 25 old age. There was also a lead nurse in place on the nursing unit to ensure that there were clinical managerial arrangements in place. An administrator had been appointed to assist with the running of the home and this had proved to be beneficial and allowed the manager more time for specific managerial duties. The manager was developing quality assurance systems, which included a month by month account of the home’s development. A quality assurance policy was in place that said there would be meeting every six months for people living in the home and satisfaction questionnaires would be sent out annually. A business plan for 2009-2010 was also in place. The manager was undertaking audits to check the quality of some aspects of the home; for example, an audit of care plans had taken place in January 2009 and medication audits were also taking place. Plans examined for 2009 indicated that redecoration of the reception area in the residential unit was planned and also detailed entertainments and activities that were due to take place. It also confirmed staff training that was booked for the future. A staff meeting had also been held in March 2009 and the written information supplied by the home stated that staff meetings were now being held more often. It also stated that the home intended to have ‘more frequent residents’ meetings’. A survey had been sent to relatives and visiting professionals in November and December 2008. The responses seen were mixed, with comments about insufficient staff, which are referred to in the staffing section of the report, and comments that improvements could be made in communication and ‘attention to detail could be better’. Other comments seen were ‘warm and friendly home’ and ‘staff have been so good’. There was a system in place for dealing with peoples’ personal finances. Eight peoples’ records were examined across the three units and were generally in order with receipts available with the following exceptions; one persons’ record had an extra £10 in their account that was not accounted for and another had £1 over. The manager explained that the latter was due to lack of change at the time of the transaction but there was no clear explanation of why the other account had money available that was not accounted for. Another account was 30 pence short according to the record. The manager said that a bank account was in the process of being set up for people living in the home. Health and safety issues were generally addressed. A random sample of maintenance records showed that the electrical wiring was checked in 2007, fire fighting equipment in December 2008, gas safety in January 2009 and emergency lighting in May 2008. The written information supplied by the home also confirmed this. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 26 Training information showed that mandatory staff training in health and safety areas such as fire safety, food hygiene, infection control and moving and handling took place. Staff spoken with confirmed that this training took place. However, there was no record to show that first aid training had taken place in the last twelve months. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 17 X 18 3 3 X X X 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 3 X 2 X X 2 Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 01/08/08, and although some improvements have been made, it is not fully met. Timescale extended to 01/06/09. 2. OP16 22 (3) Complaints and requests must always be responded to as outlined in the internal complaint policy and procedure. This is to ensure that peoples’ concerns are listened to and acted on. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 29 Timescale for action 01/06/09 01/06/09 3. OP27 18(1) (a) Staffing hours must be kept under continuous review to ensure that there are sufficient staff at key times to meet peoples care needs. This must included domestic staff. This is to ensure that there are sufficient staff to meet individuals’ needs and that the cleanliness of the home is maintained. 01/08/09 4. OP38 13 (4) The home must ensure that there are sufficient staff on duty with an up to date First Aid qualification. This is to ensure that emergencies are dealt with appropriately. 01/07/09 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. 2. 3. 4. 5. Refer to Standard OP9 OP9 OP12 OP15 OP22 Good Practice Recommendations Two people should sign and date handwritten medication administration record (MAR) charts. The temperature of the medication storage room in the residential unit should be monitored to ensure it is safe. Activities in use ion the home should always be ageappropriate. Greater attention should be given to individuals’ food preferences to ensure they have meals that they enjoy. Wheelchairs should always have footplates available for use. DS0000070160.V374918.R01.S.doc Version 5.2 Page 30 Osmaston Grange Care Centre 6. OP35 Peoples’ financial records should always correspond accurately with the cash held. Osmaston Grange Care Centre DS0000070160.V374918.R01.S.doc Version 5.2 Page 31 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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