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Inspection on 17/04/08 for Pirton Grange Nursing Home

Also see our care home review for Pirton Grange Nursing Home for more information

This inspection was carried out on 17th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents are actively encouraged and supported to maintain family contact. It provides some residents with a varied choice of social activities including holidays. Residents are provided with a varied choice of food, which is well presented and more than sufficient in the amount offered. Comments from residents and relatives received during the inspection included: "my only complaint is too much food" "the food is very good" "the meals always look nice and --- always enjoys the food". The nurses and staff spoken with during the inspection were enthusiastic about their role, and provided a detailed knowledge and understanding about the residents needs. Positive comments received from the residents and relatives about the staff included: "staff are always polite and respectful" "staff are willing" The procedure for residents monies maintained in the home is robust and safe.

What has improved since the last inspection?

Since the last inspection the service has prioritised on completing the new building Orchard Way. With this the staff have tried to minimise the effects of the building work for the residents. A new pre-admission process has been introduced since the last inspection.

What the care home could do better:

Following the home`s last key inspection in September 2007, we received a high number of complaints and concerns about the service (for details see complaint`s section of this report). Given the serious nature of the complaints we decided to complete a key inspection to ascertain compliance with the National Minimal Standards. Following the inspection it appears that for someresidents the home are meeting their needs very well. For the residents with more complex needs there appears to be gaps in the process. The care plans and other relevant documents should be more person centred in a format suited for the individual`s needs. Training for all staff in specialised areas to ensure that they are up to date with the latest guidance and good practise to meet the needs of the residents. The environment issues will go when the residents are transferred into the new building, however the health and safety issues highlighted through the inspection and received complaints should have been addressed. Given the complaints referred to communication issues, the service should develop a system to ensure that any messages or information received about the residents is conveyed to all the relevant people. This includes the information from the pre-admission assessment being included in the resident`s plan of care. The home should not accept residents into the home who they cannot meet there needs totally. The home should review the choice of activities and social interaction for the more dependant residents, and ensure that their plans of care provide information for staff. The home should ensure that all staff follow their infection control policies, this includes the management of prescribed topical creams, and disposal of used gloves. All complaints either by the home or referred via other authorities should be included in the homes complaint`s register and provide clear details of how the complaint was investigated and by whom, and clear outcome for the investigation. The complaints policy should also be available for the residents in a format suited to their needs. For all new staff recruited the home must ensure a Criminal Records Bureau disclosure (CRB) is received before they start working at the home.

CARE HOME ADULTS 18-65 Pirton Grange Nursing Home The Grange Pirton Wadborough Worcestershire WR8 9EF Lead Inspector Chris Potter Key Unannounced Inspection 17th April & 1st May 2008 09:15 Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 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 Pirton Grange Nursing Home DS0000004133.V364222.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 Adults 18-65. 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. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pirton Grange Nursing Home Address The Grange Pirton Wadborough Worcestershire WR8 9EF 01905 821544 01905 821257 admin@pirtongrange.co.uk 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) Pirton Grange Limited Sharon Joels – acting manager Care Home 34 Category(ies) of Physical disability (34), Physical disability over registration, with number 65 years of age (34) of places Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is primarily for people with a physical disability, but may also accommodate people with an associated mental disorder. The home may also accommodate 2 named persons over the age of 65 years whose needs fall within category OP. 12th September 2007 Date of last inspection Brief Description of the Service: Pirton Grange is in the process of moving into its new purpose built home “Orchard Way”. The existing home is a heritage listed building and will then be modernised and upgraded. Pirton grange is situated near the village of Pirton in beautiful countryside south of Worcestershire. The home is two storeys with a lift to assist residents to mobilise throughout the home. All residents are accommodated in single en – suite bedrooms which are specially equipped for there use. In addition to the bedrooms the home provides lounges, dining room, and specialist bathing facilities. The spacious landscaped gardens are accessible for the residents use and provide a pleasant outlook from the home. The home provides 24-hour nursing care for people under the age of 65 years. There assessed health needs include Huntingdon’s Disease, Acquired Brain Injuries and other physical and mental health problems. People can be accommodated on long term and short term placements. Information regarding the home can be obtained from the Statement of Purpose and the Service Users’ Guide, which are available in the home. The home is owned by the European Care Group who owns other homes throughout the country. The home is without a registered manager at the moment, the acting manager is Sharon Joels who is a first level nurse and is in the process of undertaking the Registered Manager’s Award. Information about the fees is not included in the Service User Guide, for up to date information about the fees please contact the home direct as the fees are based on individual needs and assessments. Additional charges are made for cigarettes and holidays abroad. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 5 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 the service experience adequate quality outcomes. This was Pirton Grange’s unannounced key inspection, and was undertaken on the 17th of April 2008 and the 1st of May 2008. Two inspectors were present for both days, and included a pharmacist specialist who inspected the homes’ management of medication. The inspection lasted a total of 20 hours. Both the manager and deputy manager were on duty and assisted throughout the inspection. On the days of the inspection the home was caring for 31 and 30 residents (respectively). A key inspection is where we look at a wide range of areas. To help us plan for the inspection we looked at pre-inspection information requested earlier in the year, this included the Annual Quality Assurance Assessment (AQAA). The inspection included a tour of the home, concentrating primarily on communal areas and facilities. The care documents of four residents were viewed, and included care plans, daily notes, risk assessments and some accident records. Other documents seen included medication records, some service records and some staffing records. The focus of inspections undertaken by the CSCI is upon outcomes for people and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practise and focuses on aspects of service provision that need further development. Feedback received prior to the inspection, and from residents and relatives at the time of the inspection was varied. Comments included: • • • • • • • • • “I cannot think how Pirton Grange gained the Inspectorate’s approval” “I can’t thank them enough they are all wonderful” “The lift is always breaking, and then I can’t go out, I would like to go out more” “The food is very good, the only problem we have too much food” “I like it here and all the staff are friendly” “The communication is poor and not all requests are passed on” “Staff are always polite and respectful” “Staff are willing” and (The) “food is very good” We would like to thank staff and residents for their co-operation and hospitality. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Following the home’s last key inspection in September 2007, we received a high number of complaints and concerns about the service (for details see complaint’s section of this report). Given the serious nature of the complaints we decided to complete a key inspection to ascertain compliance with the National Minimal Standards. Following the inspection it appears that for some Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 7 residents the home are meeting their needs very well. For the residents with more complex needs there appears to be gaps in the process. The care plans and other relevant documents should be more person centred in a format suited for the individual’s needs. Training for all staff in specialised areas to ensure that they are up to date with the latest guidance and good practise to meet the needs of the residents. The environment issues will go when the residents are transferred into the new building, however the health and safety issues highlighted through the inspection and received complaints should have been addressed. Given the complaints referred to communication issues, the service should develop a system to ensure that any messages or information received about the residents is conveyed to all the relevant people. This includes the information from the pre-admission assessment being included in the resident’s plan of care. The home should not accept residents into the home who they cannot meet there needs totally. The home should review the choice of activities and social interaction for the more dependant residents, and ensure that their plans of care provide information for staff. The home should ensure that all staff follow their infection control policies, this includes the management of prescribed topical creams, and disposal of used gloves. All complaints either by the home or referred via other authorities should be included in the homes complaint’s register and provide clear details of how the complaint was investigated and by whom, and clear outcome for the investigation. The complaints policy should also be available for the residents in a format suited to their needs. For all new staff recruited the home must ensure a Criminal Records Bureau disclosure (CRB) is received before they start working at 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. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 2 Quality in this outcome area is adequate. Information is provided to assist people with their choice of home. To further assist people the information should be available in alternative formats and reviewed at least annually. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide are both available on request from the home. The Statement of Purpose and Service User Guide provides information about the home’s facilities and the specialised care that Pirton Grange offers. At present, the Service User Guide is only available to individuals in a standard format. It was recommended that the home review the Service User Guide, and develop a format that is more suited to the needs and comprehension of their residents. The Statement of Purpose and Service User Guide should be reviewed and updated at least annually. The copies available at the inspection were dated Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 10 July 2005. The complaint’s policy within the documents should be personalised to reflect Pirton Grange’s procedure. Relatives spoken to confirm that they had received a range of information about the services provided, and were fully informed. Residents spoken to were unsure whether they had seen the information and felt that the home had been chosen for them. Comments included: • • • • • • “All staff are polite and respectful”, “I can’t thank them enough they are all wonderful”, “ I like it here and all the staff are friendly”, “The communication is poor and not all requests are passed on”, “Staff are always polite and respectful” and “Staff are willing”. Prior to accepting residents into the home, a care needs assessment is completed. The care needs assessment is usually undertaken by the acting manager to ensure that the home can meet the individual’s needs. Samples of four residents’ care documents were examined and all contained a completed care needs assessment. Generally, the care needs assessment contained comprehensive assessments including the pre- admission assessment. However for one resident, the person responsible for undertaking the assessment had not signed the assessment document. The home should ensure that the nurse undertaking the assessment signs the pre-admission assessment. It was noted that some of the information in the pre-admission assessment had not been included in the resident’s care plan. A person’s request about their night time care had not been included in their care plan. A complaint received from a resident who had a short stay at the home gave clear information about how the home had failed to meet their needs. The complaint is still under investigation by the home, so the outcome is not yet known. The home’s AQAA completed earlier in the year stated that they were going to review their assessment tool, which had been done. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 Quality in this outcome area is adequate. For the majority of individual’s involved in making decisions about their lives and play an active role in planning the care and support they receive the service is meeting their expectations. However for residents’ with complex needs and who are unable to express their choice their expectations are not totally met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pirton Grange understands the rights of individuals to take control of their lives and to make their own decisions and choices. In practice this is not demonstrated for all the residents. Some staff have a limited understanding of how to do this effectively. There is evidence that some individuals are involved in decision-making about the home, such as day-to-day living and social activities. Residents’ care plans need to be more person-centred in their Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 12 approach, and include more information about each resident’s likes, dislikes and preferences for example, what time they like to get up and what time they like to go to bed. This information will assist all staff in getting to know the residents. One resident spoken with during the inspection felt that some residents were given more opportunities in relation to going out, and they felt that they were not consulted about the day-to-day running of the home. The care records for four residents were reviewed during the inspection. The care records clearly showed that some residents and their representatives were consulted about the care provided. On discussion with a relative it was felt that information is not always communicated and passed on to all staff. The deputy manager had completed a new format of care documentation for a resident, which included a life history with photographs. This was commended, and hopefully this standard will be implemented for all residents. The care records show that appropriate risk assessments were being completed, and included the action being taken to minimise the risk once it had been identified. The care records showed that the plans were not always being followed or updated to reflect the change in the care provision. This was evidenced from a resident’s wound care plan, where the staff were not following the guidance for changing the wound dressing. The daily entries showed different dressings to those specified on the wound care plan. For more acute episodes, a care plan had not always been implemented. For example, a resident with diarrhoea had no plan of care developed to address this acute healthcare need. For another resident, their pre-admission assessment cites under “sleep”, “needs assistance to move at night”. A care plan had not been developed. Under “religion” for another resident, it stated; “likes to go to Church”. This had not been included in their care plan. Comments about the care included: • • • • • • “Not totally happy with the care”, (I) “ visit daily to check on things, staff do not listen or follow instructions properly”, “Communication is poor at times and messages do not get passed on”, “All staff are polite and respectful”, “Fairly prompt response to the call bell so (I) feel that the staffing levels are adequate” and “Some staff are very willing”. On the days of the inspection, the home had a higher ratio of male residents being accommodated in proportion to the number of female residents. All residents’ wishes in relation to the gender of carers providing personal care Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 13 were being respected. This information was included in the residents care records, and a record of who delivered the care included. The home’s AQAA showed the home provide a holistic and person-centred approach for residents, and plans to improve this area include the development of a more in-depth structure for risk assessments before people move into the home. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate Some residents’ benefit from having access to a range of social and therapeutic activities suited to their needs and choices. Relatives are free to visit at any time. A varied and nutritious diet ensures nutritional needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs dedicated staff responsible for activities and therapies. An activities organiser is employed covering 40 hours each week, and this provision is based on flexibility and the needs of residents. A reflexologist provides treatment for residents at no additional cost, and the home also contracts to provide physiotherapy input. A beauty therapist visits weekly on Wednesdays. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 15 The home aims to provide a varied program of activities, and has formed a residents’ committee and a relatives’ committee - Friends of Pirton - to assist with fundraising events. The varied responses taken from the home’s quality assurance questionnaire indicates that the home is not meeting the needs of all the residents. Three out of the twelve completed questionnaires were quite negative, and recorded the fact that some residents felt that they; (a) (b) (c) Were not given enough privacy, Would like more activities and Did not feel that they were treated equally. It was recommended that the home develops and implements an action plan to improve service delivery and outcomes for people using the service. The acting manager described some of the activities and social outings which some of the residents participate in. On the days of the inspection, a small group of residents had gone out for the day to the Cotswold Country Park. Holidays for the residents are being organised by the home. The more dependent residents are going on a local holiday for a few days to a specially adapted barn. Other holidays arranged for residents include a caravan holiday in Breen, and a couple of residents are going abroad accompanied by staff. One resident discussed how they spend their days at Pirton Grange. They have a computer in their room, which is broken at the moment so they are unable to access the Internet. We were told that they were looking forward to going out more but given that the lift breaks down fairly regularly; this is a problem for them and restricts their movements. The home does not provide regular religious services for the residents. Some residents do visit the local church for special events. The home’s chef is a Chaplin and provides a service for some of the residents on a Sunday. The home welcomes visitors, and refreshments are available for them. Visitors confirmed that they were made to feel welcome by the staff. Since the last inspection the home has appointed a new chef, who has reviewed and updated all the menus to ensure that the residents’ dietary needs are being met. A meal was observed being served in the dining room, and the residents were being assisted appropriately. A variety of aids were in use to assist and promote each individual’s independence. The carers were observed sitting down with the residents to feed them. The lunch being served was shepherds pie and vegetables, which appeared appetising. Comments from residents Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 16 and relatives was most complimentary about the quality of food provided and included: • “The food is very good”, • “We have too much food”, and • “Good food”. All residents have a nutritional risk assessment in place, which monitors their weight and specifies whether nutritional supplements are necessary. The care plans reviewed evidenced that the assessments were being updated monthly. The home’s AQAA stated that the home’s plans for the next 12 months were to look at; organising daily activities for every day living, accessing external facilities for furthering education, accessing opportunities for residents to undertake voluntary work and the possibility of sourcing some paid employment opportunities. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is adequate The home has a good policy for the management and administration of medication, by not adhering to that policy can place people who use the service at a potential risk. For the majority of people who use the service have their emotional and physical needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA specifies plans for the next 12 months, which includes introducing annual interim health checks i.e. blood tests and accessing more specialist professional training externally, or within the company. A medication procedure was available (dated April 2008), which was specific to the medication management within the service. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 18 There was evidence to suggest that the service is able to undertake a check on people’s medication. For example, we saw that the dates of opening of medication in boxed containers were recorded and any balances of medication were recorded and carried forward onto a new medicine record chart. This is seen as good practice, which would help in checking that medication had been administered as prescribed by a doctor. Two people’s medication were checked and, although the majority of the checks were accurate, it was, therefore disappointing that two random checks undertaken did not evidence that medication had been administered as prescribed. Medication seen was secured and locked away safely in a new larger medication storage room. Only medication that was in current use was stored in the trolley, which made it easy to locate individual people’s medication. Some medication, which requires refrigeration, was seen stored in a refrigerator, however the maximum and minimum temperatures recorded were not set within the correct temperature range for safe medication storage. The correct arrangements were discussed with the manager during the inspection. Overall, people’s medication was stored in a safe and secure environment. The majority of the medicine records seen were well documented either with a signature for administration or with a code to explain why the medication was not administered. It was therefore; disappointing that one medicine chart was not completed correctly. The record for the administration of an anticonvulsant, which was to be administered ‘three times a day’, showed that on one day the medication had only been signed for administration in the morning. The second dose had not been administered and a reason given as ‘Morn meds given late’ and nothing documented for the third dose. We spoke to a member of staff who stated ‘sometimes he sleeps in late or goes out for a walk. I don’t know why the record shows only one administration’. This means that some of the medicine records were not always accurate and people who use the service were not safeguarded. Some people were prescribed medication to be given when required. For example, one person was prescribed a medicine to calm and control their behaviour when required ‘to help curb agitation’. The care plan did not contain written information to inform staff under what circumstances this medicine should be administered. The medicine records showed that staff had not administered the medication for sometime. We spoke to a member of staff who stated that the need for this medication would be reviewed with the doctor. The records show that staff were not able to follow any written guidance to administer the medication, however staff spoken to had a good understanding of when the medication was needed to ensure that the health and welfare of people were safeguarded. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 19 In one resident’s bedroom, prescribed topical medication was in excess of the recommended date of opening of one month. The cream was dated April 2006. Other topical creams in bedrooms were observed with no date of opening. In the last 12 months, the home has reported two medication errors relating to controlled drug administration and an additional medication administration error. The training records identified that the nurses’ had not received refresher training since April 2005. Nursing staff within the home have access to a Huntington’s specialist for advice and information. The care plans for residents with Huntington’s provided detailed information about the illness. It was further recommended that the staff should also have some specific training to further assist them in meeting the needs of the residents. Infection control issues were raised during the course of the inspection, as used latex gloves had been disposed of inappropriately in the office bin and other open bins. This resulted in odours permeating around the home. In relation to specialist equipment, the geographical design and layout of the original home is not suited for meeting the needs of residents with complex healthcare needs – particularly as the original building has not been adapted for use as a care facility for people with complex nursing needs. For the majority of residents who use the service, it was found that the home meets their physical and emotional care needs. Comments received from other healthcare professionals and relatives of residents confirm this. However, from the complaints received by us since the last inspection, concerns regarding the health needs and emotional needs of the residents with more complex needs are held by people who have input into, and contact with the home (see complaints section). Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is adequate The people who use the service do not always feel that their complaints are listened to. Staff are aware of the home’s complaints and safeguarding policy, but do not always follow the procedures correctly, which can affect the complaint investigation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the first day of the inspection, the complaint’s policy reviewed did not reflect the home’s procedure. Following discussion the acting manager had raised this with the organisation, and confirmed that this was to be addressed. The current complaint’s procedure is available in the Service User Guide, but is not made available in suitable formats for the people who use the service. Since the last key inspection in September 2007, the police and healthcare professionals have reported six complaints to us. Three of those complaints were referred to “safeguarding” - which is a multi-agency procedure used to investigate concerns raised. The main issues identified through the complaints related to safety and protection of severely vulnerable residents in the home. The home was criticised for not following safeguarding procedures, which resulted in Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 21 authorities not being notified about issues raised. This affected the investigation process, and the outcome of the investigation was inconclusive. The staff did learn from this experience and followed their policy with the other concerns. The outcome for the other two safeguarding issues is not yet concluded. The findings will be included in the next inspection report. The complaints received included concerns about: • The health care of specific residents with Huntington’s disease. Concerns were raised about their weight loss, and how this had not been addressed. The home investigated this concern and concluded that their scales had not been working correctly. It was disappointing that the home had not identified this issue, and actioned it before having a complaint raised. How the home failed to meet the health care needs of residents with more complex needs. How a resident’s general appearance was not appropriate The disruptive behaviour of some of the residents, which allegedly affects their temperament. The home’s environment not being appropriate for the residents’ needs – with particular regard to health and safety issues. Staff do not have the specialised knowledge and understanding about the residents’ care needs. Staff not communicating the residents’ needs clearly, resulting in health care needs not being met. • • • • • • Some of the complaints have been addressed and the home have updated appropriate policies and procedures and shared the information with the appropriate authorities. The residents’ transfer into the purpose-built home (on the week commencing the 8th May 2008), will resolve the environmental issues. The new build is well equipped with appropriate aids and adaptations, which will further help staff to meet the residents’ healthcare needs. The home is co–operating with the investigations and providing the information requested. We spoke to a relative who had made a complaint. The person feels that communication with the home remains poor, and that changes requested only last for a couple of weeks before being disregarded. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 22 The home must also ensure that all complaints are recorded in their complaints register, and provide details of the investigation with the outcome. Given the number of complaints and safeguarding issues the home is being closely monitored by other agencies that commission care from the home. Staff spoken to were aware of safeguarding and confirmed that they would have no hesitation in reporting any concerns. The acting manager confirmed that training had been arranged for all staff to update their information. Induction training also includes guidance for the staff about safeguarding. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24 and 30 Quality in this outcome area is adequate The existing building is not well-suited for the needs of the residents, and a failure to maintain the building effectively, may present health and safety problems for the residents, relatives and staff. The new building is designed to meet the needs of the people who use it, and assist them with their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Given the transfer to the new building is imminent, the environmental issues were not fully assessed at this time. However a complaint received prior to the inspection raised concerns about health and safety issues, which were reviewed during the inspection. The same issues were identified during the inspection so the complaint is substantiated. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 24 It would be an expectation that the providers maintain the home to a standard that ensures any health and safety risks are minimised to protect residents, visitors and staff. Issues identified included: • • • • • • • • • An unguarded radiator in a communal area. A broken electrical socket. Easy access to a gas cylinder in the grounds, which needs to be protected. Floor lifting in some areas. CoSHH (Control of Substances Hazardous to Health) items not stored securely Soiled equipment on a resident’s bed. Used gloves disposed of in open waste bins. Odours permeating in parts of the home. Poor decorative order throughout. The original building is a period building, possessing poor lighting levels. The design and layout of the building does not enable staff to use specialist-lifting equipment in all areas. The residents’ bedrooms seen have been personalised to assist in reflecting their personality. Residents and relatives confirmed that they were looking forward to transferring to the new building. A resident when asked if they had any choice about their bedroom in the new building, stated that they had not been consulted. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,34,35 and 36 Quality in this outcome area is adequate. Staff are employed in sufficient numbers proportionate for the number of residents. To ensure that the home can meet all residents’ needs additional specialist training is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota’s reviewed confirmed that the home is providing staffing levels proportionate for the number of residents’. Residents and relatives confirmed that they felt that the staffing levels were satisfactory and staff responded promptly when the call bell was activated. “always respond promptly” The home employs 31 carers and of that number nine are senior carer’s. The home always has a registered nurse on duty, supported with carers. The acting manager is supernumerary to the duty rota. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 26 The home employs both male and female nurses and carers to assist the residents with their preference for care, which is included in the residents, care records. Opportunity was taken to examine three staff files, and to review the employment process undertaken by the home in order to gauge the level of safeguarding procedures operated during the recruitment process. The records of one staff member showed that the home had failed to seek a reference from the applicant’s most recent employer. Another staff file selected for examination possessed a reference from the applicant’s previous employer. However, the outcome from the reference was merely “okay” and no other reference had been sought. Records showed significant delays in requesting enhanced Criminal Record Bureau (CRB) disclosures for prospective employees. On a number of occasions, CRBs had not been requested until staff had been employed and working at the care home for a period of three to four months. This represents a potential risk to the safety of residents. The acting manager said there had been problems obtaining CRB’s for a period, and that this had now been resolved. The inspection found that all staff employed now have a CRB disclosure held on their personnel file. Training records identified gaps and not all staff are up to date with mandatory training. The majority of staff were in need of an annual update for moving and handling. No specialist training could be identified for the staff including challenging behaviour, Huntington’s and dementia. The home has met the standard of having over 50 of the care staff with NVQ level 2 in care. Two named staff are responsible for Infection control and tissue viability for the staff to refer for advise. All staff spoken to during the inspection were aware of their roles and responsibilities and confirmed that suitable training had been provided by the home. Staff confirmed that the home has regular staff meetings, which they find helpful. The minutes of staff meetings were examined during the inspection. Minutes of a meeting dated 25/02/08 were the most recent notes available. The records examined demonstrated that there were issues/friction between the night and day staff. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 37,38,39 and 42 Quality in this outcome area is adequate. To ensure that the people who use the service are protected the home should ensure that health and safety policies are followed. Staff have clear defined roles and generally the people who use the service are aware of their roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 28 The home appointed an acting manager over 12 months ago and the acting manager has still not completed the registration process. The importance of completing this was discussed at the inspection. The acting manager is a registered nurse, and has worked at Pirton Grange for many years, as a carer prior to completing her nursing qualification. She is in the process of undertaking the Registered Manager’s Award (RMA) having completed two units. A deputy manager has also been appointed to assist with the management and organisation of the home. Staff spoken with during the inspection confirmed that the manager and deputy manager were both supportive and approachable. The home has a staff supervision procedure in place the last recorded dates for staff supervision were 27th November 2007. Insurance cover for the home is displayed in the entrance area of the home. The fire records for the home were reviewed and there was a gap, the reason for this was that the maintenance person had left. The information was later provided by e-mail to confirm that the tests had been completed. The majority of residents manage their own finances and personal allowances. The home does not have any responsibility for the residents’ finances. They hold some personal allowances for some of the residents. These are kept in individual folders receipts are given when money is used, only the trained staff have access to this money. Two staff are required to sign money out for the residents. The results from the most recent quality audit were available. This provided no indication that the results or negative comments had been investigated or followed up. Three out of the twelve completed surveys made a negative comment. The 2008 responses three out of twelve completed surveys gave negative feedback. The AQAA was completed earlier in the year for the key inspection in September 2007, so was not requested for this inspection. Some of the improvements for the next 12 months had been initiated. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 2 2 X X 2 X Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 YA16 Regulation 23(2)(e) Requirement The manager must ensure privacy is promoted by fitting an approved locking device to bedroom doors. Timescale for action 01/05/08 2 YA20 13 (2) 3 YA22 22 4 YA24 13 Service users are transferring to new accommodation and in accordance with current CSCI guidance this requirement has been removed. Medication administration 16/06/08 records must document what has been administered in order to ensure that the people who use the service are safeguarded. So that service users can be 16/06/08 confident complaints are taken seriously, the home must follow the agreed procedures for investigating and responding to complaints. Provide and implement an 01/05/08 ongoing redecoration program to enhance the home’s appearance. Service users are transferring to new accommodation and in accordance with current CSCI guidance this Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 31 5 YA30 13(3) requirement has been removed. To reduce the risk of infection and/or cross contamination staff must be appropriately trained in infection control and staff work practises in the home must undertaken in accordance with recognised good infection control practises and procedures. 16/06/08 6 YA32 7 YA37 This includes ensuring that used disposable gloves are disposed of safely and appropriately. 18(1)a Staff must attend appropriate 30/09/08 training so that they are able to demonstrate they have the knowledge, skills and confidence needed to ensure residents’ health and emotional needs are met. Section 11 The acting manager must ensure 30/06/08 an application for registration with the Commission for Social Care Inspection is completed and returned. This will promote service users’ confidence in the home’s management arrangements and ensure compliance with the Care Standards Act 2000. 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 Refer to Standard YA1 YA2 Good Practice Recommendations The home should further develop the Statement of Purpose and Service User Guide to promote a greater ease of understanding for people who use the service. To assist in ensuring residents’ health and emotional needs are met, information from each pre-admission assessment should be included within each individual resident’s care DS0000004133.V364222.R01.S.doc Version 5.2 Page 32 Pirton Grange Nursing Home 3 4 5 6 YA6 YA11 YA12 YA18 7 YA20 8 YA20 9 YA20 10 YA39 record. To further assist people who use the service, care plans need to have a more person-centred approach, which is suited to their individual needs and requirements. To ensure residents’ spiritual needs are met, a review and evaluation of religious services and spiritual opportunities available should be undertaken by the home. The home should ensure care plans support residents in achieving opportunities to participate in emotionally fulfilling activities. Residents’ care plans should reflect their expressed wishes. For example, preferred times for getting up in the morning and retiring at night and their preference(s) for clothes, baths and showers. A system should be introduced which proves that medication is stored at a safe temperature. This helps to ensure that people who use the service are protected from harm. A system should be introduced to ensure accurate medicine audits are performed. This will ensure that people who use the service are given medication in accordance with the directions of their General Practitioner. A written protocol should be available which explains to staff the procedure(s) to be undertaken to safely manage agitated or aggressive behaviour(s). This should include details for the administration of medication prescribed ‘when required’ for the management of aggressive behaviour. The home should ensure that feedback from the annual quality surveys is used to improve service delivery for people who use the service. Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Pirton Grange Nursing Home DS0000004133.V364222.R01.S.doc Version 5.2 Page 34 - 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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