Inspection on 24/09/09 for Pirton Grange Nursing Home

This inspection was carried out on 24th September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pirton Grange Nursing Home 04/06/09

Pirton Grange Nursing Home 09/12/08

Pirton Grange Nursing Home 17/04/08

Pirton Grange Nursing Home 12/09/07

Pirton Grange Nursing Home 20/09/06

Pirton Grange Nursing Home 19/01/06

Pirton Grange Nursing Home 15/07/05

Pirton Grange Nursing Home 30/09/04

Pirton Grange Nursing Home 14/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Pirton Grange Nursing Home The Grange Pirton Grange Nursing Home Pirton Wadborough Worcestershire WR8 9EF zero star poor service 04/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Christine Potter Date: 2 4 0 9 2 0 0 9 Information about the care home Name of care home: Address: Pirton Grange Nursing Home The Grange Pirton Grange Nursing Home Pirton Wadborough Worcestershire WR8 9EF 01905821544 01905821257 admin@pirtongrange.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Pirton Grange Limited care home 58 Number of places (if applicable): Under 65 Over 65 0 0 0 0 past or present alcohol dependence past or present drug dependence dementia mental disorder, excluding learning disability or dementia Conditions of registration: 58 58 58 58 The maximum number of service users to be accommodated is 58. The registered person 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 to the home are within the following categories: Dementia (DE) 58 Mental Disorder, excluding leaning disability or demetia (MD) 58 Past or present drug dependent (D) 58 Past or present alcohol dependent (A) 58 Date of last inspection 0 4 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 14 Brief description of the care home Pirton Grange has extended the home and provided a purpose built unit. The original home is a heritage listed building and is in the process of being 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 people with mobility problems to mobilise throughout the home. The new unit provides accommodation for people in single en - suite bedrooms which are well equipped for people with physical disabilities. In addition to the bedrooms the home provides lounge and dining room, and specialist bathing facilities. The spacious landscaped gardens are accessible for people to 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 Huntingdons 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 part pf the European Care Group who have other homes throughout the country. The home have appointed an acting manager who is applying for registration with the Care Quality Commission. Information about the fees are 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. Care Homes for Adults (18-65 years) Page 3 of 14 What we found: This unannounced random inspection of Pirton Grange nursing home was carried out on the 24th September 2009. The reason for the inspection was to review the homes progress and compliance with the requirements and the statutory notices made following the last key inspection on the 4th June 2009. The number of residents being accommodated were 27 on the day of the inspection, and we met Mr Murphy, Mr Smith, Mr Hartenfield who was appointed in August to be the home manager, and J Bright. We spoke to managers, nurses and care staff, reviewed care records, staff records and medication. We found that the home had made progress with some of the requirements and statutory notices, however a code b notice was issued and evidence photocopied in respect of conflicting information provided about the residents by staff and the individuals care documentation. Choice of Home: No standards from this section were assessed at this inspection. Mr Murphy informed us that there have been no new admissions to the home since January 2009, and that the home would not admit new people until the senior management were confident that the home was stable and able to meet peoples assessed health, welfare and psychological needs. We were informed that a new pre - admission assessment has been developed to provide a full assessment of peoples health, welfare and psychological needs. Individual Needs and Choices: During the random inspection on the 24th September we observed that the residents on the three units were either in the lounges, outside in the garden or in their bedrooms. The activities organiser told us that some people were going swimming later that day. The televisions were on in the lounges and we saw a few people watching the television. There were staff available in the lounges and the garden, staff were observed in peoples bedrooms engaging one carer was reading to a resident. Staff were seen actively engaging with the residents for example playing cards, or assisting in the group activity which was being held in the garden. We looked at the care records for two people as part of the case tracking. We were informed by the clinical lead that all the care plans had either or were in the process of being audited by a manager from another home belonging to the organisation. The care files have been segregated into colour coded sections to assist with finding relevant information and details about the individual and their assessed health care needs. Much of the old paperwork had been filed to assist in condensing the information. A day and night care summary has been completed to assist the staff reference important information quickly about the persons abilities. The new manager also informed us that the service was receiving a training session about the advantages of computerised care plans for the home to consider. We asked staff members about each individual residents health care needs and were Care Homes for Adults (18-65 years) Page 4 of 14 provided with conflicting information to the information in the care records. For example we were told that a person was immobile and staff had to do everything for them. The care plan for this person showed inconsistencies with the information and the assessments which had been undertaken. The risk assessment for safe moving and handling developed February 2009 had been updated monthly recorded that the person could stand with two staff members. The day care summary recorded gait and poor posture requires two carers/physiotherapists and handling belt for all transfers. The person had also been assessed as being nutritionally at risk, the care plan stated: Requires assistance with all meals/fluid intake. The care plan directions was for a high calorie diet/soft food only Given this information we were concerned to see on the individuals weight monitoring charts for August 19th 2009 a 4.7Kg weight loss with a message stating to re-weigh this person the next day. However on the 24/09/09 this had not been actioned and neither had the evaluation for nutrition identified this potential weight loss and recorded condition remains unchanged The nutritional risk assessment had not been updated and the directives in the persons care plan had not been followed for weight loss which stated advise the GP, dietitian and family. The person was weighed during the inspection and the weight loss was less significant The food and fluid charts for this person showed gaps for Tuesday and Wednesday 22nd and 23rd where tea should have been recorded. The last entry for bowel action was recorded 11/09/09, again this had not been further investigated. The records for personal care also had gaps where nothing had been entered for several days. The nurse told us that this person is usually assisted with personal care by the night staff as they prefer to get up early, this information was not included in the individuals care record. We looked at the care records for the second person. We discussed their health and welfare needs with staff and was advised that this person is becoming more withdrawn and sleeping a lot of the time. This information had not been updated in their care plan. We found inconsistencies in the care documentation to what we were told by the staff. We were informed that the individual was continent however the daily charts recorded wet pad changed, wet or dry. Staff were unsure about the necessity for this. This persons weight had been stable until July 2009, no record available for August or September or a reason why the weight had not been completed. It was also noted that the nurses had failed to develop a care plan for the persons acute needs for an injury sustained following an accident in the home. A code b notice was issued and evidence to support the above was photocopied at the inspection. We discussed dignity issues with the clinical lead for a person with a catheter bag clearly visible, we were informed that this had been highlighted and it staff were respecting the individuals wishes about choice of clothes. The home has recently accessed specialist support for physiotherapy, speech therapy, and occupational therapy, and have provided them with an equipped treatment room to use. We spoke to two therapists during the inspection and they explained what they were doing and how they were working with the staff as part of training and best practice. They were also assisting in developing risk assessment for the staff to follow. Lifestyle: We spoke to the activities organiser who told us that their had been a significant improvement in the home in the recent months and they were pleased with the support provision for activities. We saw people in the lounges watching television. Many people were participating in the group activity in the garden with the staff, and appeared to be Care Homes for Adults (18-65 years) Page 5 of 14 enjoying the music. Activities are now available for the people living in the home for the seven day week. Staff were seen engaging with people individually either in the bedroom or the lounges. Personal Support: The home have contracted a pharmacy technician to assist them in ensuring that issues around medication are safely. We spoke to this person and were advised that the medication room had been cleared out and the food supplements were now being stored separately. They have separated the medication to a trolley to be used for each unit to simplify the system for nurses. They had also liaised with the supplying pharmacy about ways to improve the system to assist the staff in ensuring people receive their medication correctly. The home have met with the local doctor and requested that they have a weekly visit to review the residents and the prescriptions for medication to be completed by the one surgery, which again should assist the staff in medication audits. Since the last Key inspection the home have moved the controlled drug cupboard. It was discussed that the requirement was to replace the cupboard as this was not the correct standard for storing controlled medication. The temperature of the treatment rooms was warm, the pharmacist confirmed that that was the reason feeds had been removed and staff were recording the room temperature daily average 28 degrees. We were told that they looking to place an air conditioning unit in here We noted one error where the amount of medication received had not been recorded on the persons medication administration record. Concerns, Complaints and Protection: No standards from this section were assessed at this inspection. Environment: Since the last key inspection the owners have made further financial investment into the home. Some areas have been decorated and the usage of some rooms changed. A staff room has been provided, a family room for relatives to book and use when they visit which has a large flat screen television and the home are going to provide facilities for them to make drinks. A therapy room for the visiting therapists to use, room for the doctor, and a room for the pharmacist. However the environment remains clinical with little evidence of personalisation and suitability for the people living there. At the time of the visit all areas were observed to be clean and tidy and no odours were evident in any part of the home. Staffing: We were informed that there were 27 people living in the home on the day of the visit. Care Homes for Adults (18-65 years) Page 6 of 14 The home is split into four units and each unit is staffed separately. Currently the staffing levels are two nurses plus a team leader with 16 care assistants on days (this includes support staff for activities) Night duty there are two nurses and six carers. The duty rota confirmed that these levels were planned for the seven days We looked at the staff duty rota for the home and theses showed a shortfall at weekends we were told that this had been covered by agency staff. We were told by the clinical lead that the home is currently trying to recruit two nurses for days and a nurses for nights. We looked at the training records for the staff which have been developed into a matrix. This still shows that not all staff working at the home are up to date with the mandatory training and specialist training, but appreciate that with the loss of records this is not accurately up to date. To ensure the health and welfare needs of people living in the home are met all nurses and carers must be assessed as possessing the correct skills and competencies to meet the residents health and welfare needs safely at all times. Conduct and Management of the Home: These standards were not fully assessed at this inspection. There has been inconsistent management for Pirton Grange since December 2008. We were introduced to the new manager who commenced at Pirton Grange in August 2009. Due to the recent rapid turnover of managers in the home, stability and continuity have been impaired. This has a negative effect on people who use the service as they can not be confident that the home has a stable and permanent person who is committed to the people using the service and the development of standards with the home (which directly influence and affect peoples quality of life). What the care home does well: What they could do better: Person centred care plans and ensure that all staff working at the home have the knowledge and understanding about the peoples health and welfare needs to ensure that the individuals health and welfare needs are not compromised. Care Homes for Adults (18-65 years) Page 7 of 14 Pirton Grange have been without a consistent manager which has had a negative in pact on the people who use the service and staff working at the home. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 The pre-admission process must be made more robust to ensure that only people whose care needs can be met are admitted to the home. The wellbeing of people using and potentially using the service will be safeguarded. 30/04/2009 2 6 12 Care plans must reflect the 04/09/2009 individuals needs and preferences, and show how the service will meet their changing needs and goals by involving individuals in the creation of their care plan. Personalised care plans show how the service is enabling people to make decisons and be involved in their own care and support. 3 20 13 The purchase and installation 26/02/2009 of a Controlled Drug cabinet that complies with the Misuse of Drugs safe custody Regulations 1973 is required. It must be reserved for the storage of Controlled Drugs only. This is to ensure that all controlled drugs are stored Care Homes for Adults (18-65 years) Page 9 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action correctly 4 32 18(1)a Staff must attend 30/09/2008 appropriate 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. this standard was not met at this inspection 5 33 18 The home must show that the staff have the necessary knowledge, skills and competencies to meet the assessed needs of people using the service. Peoples health care needs are safeguarded. 30/04/2009 Care Homes for Adults (18-65 years) Page 10 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The pre-admission process must be made more robust to ensure that only people whose care needs can be met are admitted to the home. To ensure that people using the service will be safeguarded. Not assessed 24/09/09 30/10/2009 2 6 12 Reg 12(1) (a) care plans should be comprehensive and reflective of the individuals care needs. To promote and ensure proper health and welfare of the people living in the home. 24/09/09 some improvement with the format not fully met this requirement 12/10/2009 3 8 16 Reg 16(2)(m)(n) The service 16/10/2009 must consult and enable people using the service to maintain and develop appropriate social, Page 11 of 14 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action emotional, communication and independent living skills, and take part in fulfilling and meaningful activities, as part of their daily routines and interaction with family, friends and wider community. To enable people using the service to maintain an appropriate and fulfilling lifestyle inside and outside the home. 4 9 12 When a risk is identified to a 12/10/2009 persons health, safety or wellbeing, a risk assessment must be completed that provides clear guidance and insruction to the staff about minimising the potential risk. 24/09/09 weight loss not investigated to safegaurd the health and welfare of people living in the home. 24/09/09 some improvement noted requirement not fully met 5 39 24 Reg 24 (1) (a) (b) 16/10/2009 The home should establish and maintain a system for reviewing the quality of care and service provision in a format suited to the needs of the people using the service. to ensure that the views of people using the service are being listened to. Care Homes for Adults (18-65 years) Page 12 of 14 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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