Inspection on 14/11/07 for Romford Grange Nursing Home

This inspection was carried out on 14th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Romford Grange Nursing Home 26/06/06

Romford Grange Nursing Home 19/12/05

Romford Grange Nursing Home 28/10/04

Romford Grange Nursing Home 29/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Romford Grange Nursing Home 144 Collier Row Lane Romford Essex RM5 3DU Lead Inspector Sean Healy Unannounced Inspection 14th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Romford Grange Nursing Home Address 144 Collier Row Lane Romford Essex RM5 3DU 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) 01708 755 185 01708 754 454 romfordgrange@schealthcare.co.uk Southern Cross Care Homes Limited Maureen O`Connor Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2006 Brief Description of the Service: Romford Grange is a purpose built care home with nursing situated in a residential area of Romford. It is within walking distance of local shops, and on several bus routes into Romford town centre. The home is registered for 41 older people, who need 24-hour nursing and personal care. There are bedrooms on the ground and upper floor, and a passenger lift that is wheelchair accessible. One of the bedrooms on the upper floor has been converted into a sensory room. There is a large, open plan, lounge and dining area on the ground floor, plus a smaller, similar purpose room, which is also used for meetings. The bedrooms are all single, but do not have ensuite toilets, so each room has a commode. There are bathrooms and toilets on both floors. A small patio area off the main lounge contains raised planted beds, and outdoor seating. Individual care planning is used to identify needs, and how these should be met. A hairdresser and a chiropodist visit on a regular basis. Southern Cross Ltd, which is a large private sector provider operate the home. The current scale of charges is £538.00 to £700.00 weekly. This includes a nursing contribution of £101.00 per week where nursing care is needed. The higher end of the scale is for privately funded residents who do not avail of the block contracting arrangements. Additional costs for items such as hairdressing, chiropody and newspapers etc. Information is made available to prospective residents via a Service Users Guide and Statement of Purpose. The providers emails address is: romfordgrange@schealthcare.co.uk Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place as a visit to the home on 14th November 2007 and ended on 23/11/07 following receipt of information regarding an adult protection issue and staff induction and supervision. The home provided an Annual Quality Audit Assessment (AQAA), which was also used to inform the inspection. The registered care manager facilitated the visit. I interviewed two nursing and care staff about their employment and understanding of job. In addition to this the activities co-ordinator, the housekeeper, the main cook, and the maintenance man spoke with me and discussed their job and the improvements needed. Four staff employment files were examined to check that they had been properly recruited, trained and supervised. A visiting Healthcare professional (health funded care assessor) who visits the home regularly to assess the quality of nursing care for individual residents gave her views. Comments from the boroughs quality performance team were also received and included. Two separate groups of relatives of residents spoke with me and contributed their views and experiences of the home. Three residents gave their views on the home and four residents files were examined including assessments and care plans. The inspection involved a tour of the premises and examination of a range of management documentation. The home currently has four vacancies What the service does well: Overall the residents and relatives are happy with the care and services the home provides. The home has a stable staff team and a good level of staff training is provided. Staff spoken to are happy working at the home. Recruitment practices are generally sound with the required checks being in place. Residents are happy with the activities and food provided at the home and they are comfortable with raising any concerns that they may have. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 6 The registered manager is very experienced and is in the home daily. There is good involvement from a range of healthcare professionals in provision of healthcare. What has improved since the last inspection? The information about the services that the home provides has been improved and all residents now have assessments of their care needs, which are being used now to develop effective care plans. Residents and their relatives are invited to be involved in care planning so that resident’s ideas and wishes can be included. The prevention of pressure sores, wound management, weight monitoring and promotion of continence and chiropody needs are now included in the care plans for residents. The checking in and the disposal of medication in now better managed, and good records are being kept. The arrangements for mealtimes have been discussed at residents and each residents care plan now includes their wishes about where and when they wish to eat. The home has asked residents for their views on the food and made adjustments to the menu in response to these views. There have been some improvements to the decoration of bathrooms with plans in place for further improvements (See what they could do better below) Work has also been done to improve the garden though it is difficult to assess the quality of this at this time of year. The fire equipment was checked and approved by the fire maintenance company in June 2007. The organisation of staff files has improved and they contain all the information required about staff recruitment induction and training. The home now regularly asks residents and their relatives for their views about how the home is managed, and all of the residents and relatives whom I spoke to said that they have been asked about the care plans, the food, and the decoration of their rooms, and said that activities are discussed and the manager is available to discuss any problems with. There is also an action plan showing what the home intends to do about any problems identified. The supervision of staff has improved and they now have the opportunity to regularly discuss their work with their manager. All staff I spoke to confirmed that it is happening. All policies and procedures have been updated and reflected details of the homes owners. Health and safety is now well managed. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 8 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 Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to enable them to choose whether to live at the home, and they have up-to-date contracts describing the service and costs. All residents have their needs assessed before moving into the home. Standard 6 is not applicable to this home. EVIDENCE: The home has a Statement of Purpose and Service Users’ Guide. These documents were seen to meet the required standard. There was a requirement at the last inspection for the home to ensure that the copy of the last inspection report be available to all residents. This is now happening and to residents and one visiting group of relatives said the new where this is kept and had seen it. The Statement of Purpose and Service User Guide were last updated in June 2006 and include the new provider, Southern Cross details. Both of these documents now reflect all of the information required to enable prospective residents to decide whether the home will meet their needs. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 10 Satisfactory contracts are in place, which outline the terms and conditions of residence. There was a recommendation made at the last inspection for the home to ensure that each resident has a copy of their contract or statement of terms and conditions. The manager said that all residents have now been given a copy and two residents and their family members confirmed that they had received copies. For residents files viewed showed very good details of the service provided and the fees charged. These included the reason why fees are higher for some residents and have been dated and signed by the resident and the homes management. Examination of for residents files showed that all of these residents had adequate assessments of their in the on file, which had been carried out prior to their admission to the home. These assessments included a resident personal profile, an admissions form outlining important details of care needed, family and friends and relevant professionals contact details, a physical and social assessment, and health care assessment, and a range of risk assessments relevant to the individual person. Risk assessments included management of pressure sores and tissue viability, mobility, falls, behavioural issues, and dietary/feeding issues. The assessment also included preferred activities and involvement from families and friends. The home does not provide intermediate care. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual care plans are prepared for residents and these are based on a single social services assessment. Residents are supported to access healthcare services but do not always facilitate best communications with other health professionals. Systems to manage medicines are satisfactory and improvements have been made. Resident’s rights are respected by the staff and they are treated with dignity and respect. EVIDENCE: There is a care planning system in place introduced by Southern Cross. This system gives guidance to staff on each record about how to carry out support tasks. Every resident has a care plan in place. Care plans are comprehensive, with good individual detail, and at the last inspection not all of the care needs identified in the assessments were included in the care plans for each resident, in particular psychological and social care plans were limited or not in place and some assessed physical care needs were missing from care plans. A requirement was made asking that all assessed care needs be included in Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 12 residents care plans. I looked at four care plans chosen randomly and found that these were complete and reflected the full range of assessed care needs. Therefore this requirement was met. Assessed care needs are now checked on admission to the home using a detailed assessment system developed by the registered provider, including a health and social profile of the resident and an admissions form to check that everything is in place before the resident comes to stay at the home. All four files examined showed that these were in place and discussion with two families, one of which had just gone through the admissions process verified that they had been fully included in the pre admission process. Care needs of the residents files examined included: family/friends and professionals contact details, physical care needs such as mobility support/osteoporosis/pressure wound management/dietary and eating support needs/continence management/diabetes/hypertension/and rheumatoid arthritis. Emotional support needs and behavioural support needs were also detailed in the care plans with some additional guidance for staff in how to provide support. Risk assessments were included in all four care plans and these matched the assessed care needs with some additional risks included in relation to living at the home. Risk assessments included: falls, maintaining a healthy diet and weight, fire related risks such as propping bedroom doors open, peg feed site infection and some risk of injury due to behavioural problems. There was good written evidence to show that care plans are now being reviewed monthly and the staff interviewed confirmed this. Daily notes are well maintained and these are linked to numbered care plans. Weekly progress reports are written and these were seen to report on the resident as a whole giving a better outline of their overall wellbeing. Care assistants working in the home write these reports. Relatives interviewed said that they found the home to communicate well with them and ask them for their views on the care provided. They said the manager is always available to discuss any ideas they have for improvements. As at the last inspection staff spoken to state that the nurses and the senior carers keep them informed regarding any changes to residents care plans. The staff spoken to be able to describe the plans for the residents whose care was case tracked. This shows that residents care needs would generally be met. The home has a good supply of specialist beds and the manager reports that the provider is very good at supplying these pieces of equipment when needed. The home provide care for residents with pressure sores, some of which were hospital acquired. Residents noted to have a high risk of pressure sores have the appropriate equipment in place. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 13 At the last inspection there was a requirement made asking that residents healthcare needs are assessed in relation to prevention of pressure sores, wound management, weight monitoring and the promotion of continence and chiropody. That report said the home needs to investigate why residents have developed pressure sores, with a view to reducing risks in future. The home has now included all of these areas in care plans for relevant residents and these show involvement from a visiting district nurse, a tissue viability nurse and continence advisor. There is a health funded care assessor who visits the home regularly monitoring resident’s care for those assessed as needing nursing care support. I spoke with her and she said that she finds the staff and management welcoming and open, and that she is provided with all of the information by the home to enable her to efficiently carry out her assessments. Her job involves examining care plans for up to four residents on each visit, and she finds care plans to be consistently good in relation to health care, and said that plans are up to date and are easy to read. She also confirmed that pressure sore and tissue viability management is now good, and that there is a general sense of wellbeing in the care provided and there is a good atmosphere in the home. However there is a concern that on repeated planned visits to the home, it has been difficult to find nursing staff who have the time to stay with her consistently throughout her visit as they are very busy, and this acts as a problem to getting the information needed efficiently and clearly. Given the intensive nature of the nursing care provided, it is important that these visits are well facilitated and the home must ensure that an appropriate member of staff is available to provide the information needed. (Refer to Requirement OP8) Records show good evidence of liaison with other healthcare professionals such as dietician etc. and their input was evident in the care plans. Records show that residents see the GP in a timely manner and they themselves commented that they receive the medical support that they needed. Evidence was also available that the community dentist visits the home, as does the chiropodist. There has been an increased rate of hospital admissions, which in itself is not a cause for concern, but the home does not at present have a system for overseeing the rates and causes of admission with a view to identifying problems and avoiding unnecessary admissions. The number of admissions increased substantially for the period January to September 2007 and when compared to the same period for 2006 the total number of admissions increased from four admissions to 14 admissions. The homes manager felt that there may be an issue with some GPs not attending the home often enough before arranging admission to hospital. Discussion with social services suggests that there may be an increased level of residents with higher nursing dependency levels being referred to nursing homes generally and this may also be impacting on Romford Granges admission rates. The home must put in place a system for monitoring trends and reasons for hospital admissions and regularly use this to report relevant issues or concerns Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 14 to Social services, the service commissioners, GPs and the organisations board of management. (Refer to Requirement OP8) The medication system at the home was inspected. The home uses a system provided by Boots pharmacy. There was a requirement made at the last inspection for the home to ensure better recording and checking of medication coming into the home and medication disposed of. This requirement is now met. Good records are kept of medication coming into the home delivered weekly by Boots Pharmacy. There is now a contacted agent for disposing of unused medication. New medication trolleys are being used and the night staff checks in the medications at weekends. The manger carries out a medication check monthly and qualified nursing staff solely are responsible for the administration of medication. Staff were observed to ensure that residents’ privacy and dignity were maintained when providing personal care. All the residents are spoken to said that the staff are very good, caring and look after them well. One resident said, “The staff are very kind and caring and are good at helping me”. Visitors spoken to confirmed that staff are patient and kind when interacting with the residents and involve them in discussion about how best to provide sensitive personal care. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities programme at the home generally meets the current needs of residents. Contact with visitors and the local community is satisfactory. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. EVIDENCE: As at the last inspection there is an activity program in place and a dedicated activities officer who works at the home. He was available to discuss the programme of activities and was found to be very personable and interactive with residents. Residents and relatives spoken to confirm that a variety of activities are on offer both within the home and day trips are planned outside during fine weather. Photographs were seen of outings that have already taken place and three residents spoken to say they really enjoy the trips out. Two relatives spoken to stated that staff often sit with the residents and play games with them or sit and chat to them. I observed this on the day of the inspection and also saw that there was a ball throwing exercise taking place in the lounge area involving about 10 residents. Other entertainers including musicians are invited to the home to play old-time songs, which are thoroughly enjoyed by the residents. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 16 Residents were seen by me to be occupying themselves by watching television, reading, engaged in conversation with staff. Some residents had visitors and they were seen sitting in the lounges or in the bedrooms chatting to their relatives and friends. Visitors I spoke to said that they are encouraged to come and see their relative or friend and are always made to feel welcome. One visitor said that “ my mother feels that this is her home and the staff are very good humoured and willing to help.” Residents I spoke to said that they had choice of activities but were not pressured to take part if they didn’t want to. The dining area is large and residents were having their lunches here with many choosing to sit in the lounge or in their bedrooms for lunch. Residents I spoke to confirmed that the food was good and they have a choice of food at mealtimes. Two visitors said they find the food is very good and when their relative asked for something different they were able to have it. Two residents said that the chef does come out to talk to them about the food offering choices and asking about the quality of the food. There was a requirement made at the last inspection asking that the home ensure that residents are happy with arrangements for mealtimes as there was one resident about whom concerns had been expressed regarding sitting at an armchair rather than at the dining table when eating. This requirement is now met and the home has asked all residents about their preferred seating arrangements including whether they want to eat with others or to dine privately. Their individual preferences are now recorded in their care plans and are implemented. I discussed with the cook how the menus are devised and found that there is a good system for the cook to be advised about all residents individual food preferences and that she is advised quickly about special dietary needs by care staff. The menus were seen to offer a good range of wholesome food. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints system in place, which ensures that people’ concerns would be listened to. The home has systems in place, which help to ensure that residents are protected from abuse but reporting of allegations to the regulator is not always consistent. EVIDENCE: The following comments were recorded by the inspector at the last inspection and were seen to be relevant to today’s inspection: The home has a clear complaints procedure, which is displayed around the home and is available in the Service User Guide. Both residents and relatives say that the manager is often available to them and that they are clear how to make a complaint or raise a concern. From discussion and comment, it is clear that residents in the home are comfortable with raising any concerns and are happy to speak their minds on anything that is an issue for them. The documentation was reviewed and a complaint log is kept. There is evidence that the majority of complaints are minor and that manager lists all levels of concern, which shows good reporting. Records show that concerns are dealt with promptly and dates are noted. The homes Annual Quality Audit Assessment, which was returned in June 2007 to CSCI, shows that 41 complaints had been made in a one-year period prior to June 2007 and that none of these were upheld. I queried this that the Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 18 inspection and the manager explained that the majority of these were minor concerns, which were dealt with very quickly and were not then reported as complaints upheld if they had been resolved quickly. Is very detailed complaints register or book being completed, which clearly shows to, concerns which have been raised and the date they had been resolved. The majority of these were seen to have been dealt with within 24 hours, and included issues such as: staff not having shaved and resident, urine on a bedroom carpet, residence belongings been mislaid the example pyjamas, and a resident being left wet on one occasion. While the is clearly responding quickly and efficiently to concerns raised by residents and good records are being kept of these, is also clear that some more serious concerns such as one relative complaining that her mothers watch had gone missing, or a resident being left unattended while still wet, being lost amongst more minor concerns making it difficult to monitor the regularity of the more serious concerns. It is also the case that the whole has been recording concerns as not upheld when they are resolved quickly. This is not a correct procedure, and all concerns which are shown to have merit when investigated should be recorded as upheld. It is recommended that the home consider categorising complaints, which are dealt with quickly, and are not of a serious nature as concerns, and highlighting them as such in the homes records and monitoring returns. If any of these are seen to have been merited then they should be recorded as upheld. Most serious concerns or complaints regarding such things as potential negligence, personal belongings going missing, or potential abuse should be separately categorised in the complaints book to enable better monitoring, and all of these complainants should receive a written outcome regarding the complaint. (Refer to Recommendation OP16) Following the inspection there was a complaint received from a residents relative raising concerns about smells of urine in the home, hygiene of bed linen, and an allegation that the resident had not had a drink offered to her for some time. This complaint was referred to social services was investigated by the commission quality performance team very quickly. The outcome showed that all of the complaint was unsubstantiated or was unable to be a substantiated but the exception of the concern regarding smells of urine. (See comments and requirement under Standard 26 of this report) The home of has an up to date adult protection policy and procedure in place, which was reviewed in 2006. This includes local guidance on adult protection procedures and inter agency reporting. Training records show that the home has provided up to date training for all its staff with regard to adult protection. Discussion with three care and nursing staff showed they had a good understanding of the nature of adult protection issues and the need to report quickly and efficiently. There has been one Adult Protection issue recorded since last inspection and this was made by a relative of a resident to the hospital and to social services Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 19 alleging that the home may not have been properly washing or feeding their relative. This allegation was probably reported by the home to CSCI and was investigated by social services. The manager explained at various meetings took place and the issue was fully investigated by social services. The home was not advised that any of these allegations were upheld but the manager also said that she had not received a formal outcome of this investigation. It is recommended that the home contact social services and asked for a formal outcome to be provided regarding their findings show that the home can take any necessary action to improve the quality of care if necessary. This does not suggest in any way that the home had acted other than responsibly. (Refer to Recommendation OP18) A complaint was made by a relative containing an allegation that her relative, who is a resident, had not had a drink offered to her for some time. (This allegation was investigated by social services and found to be not substantiated) This particular element of the complaint is of the nature of an adult protection issue and while it was reported to social services, it was not reported to CSCI. The home must report all issues of adult protection or concerns about the safety or wellbeing of residents promptly to CSCI. (Refer to Requirement OP18) Some comments were also received suggesting that the home may not be as effective in communicating adult protection issues when the manager is absent or on leave. The manager and provider should consider the merits if this comment and ensure that the senior staff responsible for the running of the home in the managers absence are fully able to implement adult protection procedures including recording and communication with social services and with the providers internal management. (Refer to Recommendation OP18) Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained but work is needed in some areas. The home is generally clean but attention to detail is needed. EVIDENCE: Romford Grange is a purpose built care home with nursing situated in a residential area of Romford. It is within walking distance of local shops, and on several bus routes into Romford town centre. The home is registered for 41 older people, who need 24-hour nursing and personal care. There are bedrooms on the ground and upper floor, and a passenger lift that is wheelchair accessible. One of the bedrooms on the upper floor has been converted into a sensory room. There is a large, open plan, lounge and dining area on the ground floor, plus a smaller, similar purpose room, which is also used for meetings. The bedrooms are all single, but do not have ensuite toilets, so each room has a commode. There are bathrooms and toilets on Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 21 both floors, a total of six bathrooms in all. A small patio area off the main lounge contains raised planted beds, and outdoor seating. There was a requirement made at the last inspection for the home to ensure that communal bathrooms and toilets in the home be in good decorative order in working condition. This is partially met as the home has done some work on bathrooms, and has secured funding to carry out the necessary further work to bring the bathrooms up to a good standard. Bathrooms have been decorated and de-cluttered. However some need further work need to be done in decoration and replacement of flooring. Though progress has been made this work has not yet been completed and therefore the requirement is repeated. (Refer to Repeated Requirement OP19) The home was seen to be generally in good decorative order. The main areas of the home that require work are the bathrooms and toilets which have been in place since 1991 and look very tired. These reflect poorly on the home. One bathroom has a new suite on order and will be refurbished – including the floors. Furniture throughout the home was seen to be in a satisfactory condition. The home employs a maintenance man who works 30 hours a week. Basic records are maintained but they do not give dates of problems/works identified and dates of completion. The maintenance man checks the hot water temperatures in the home and keeps records. Records also show that he checks and maintains wheelchairs. The walls and doors of the homes suffer somewhat from damage caused by wheelchairs, especially in communal hallways. The manager said that there has been a delay in doing some work due to the absence of a maintenance person, but a new maintenance man has now started work and it is envisaged that all outstanding work will be brought up to date. The manager should agree a schedule with the maintenance man for completing this work. (Refer to Recommendation OP 19) There was a requirement made at the last inspection for the home to ensure that the gardens are maintained in good order for residents to enjoy. It was not fully possible to inspect this of todays inspection due to the time of year not been conducive to garden maintenance. Overall the gardens look to be in a reasonable state of maintenance and the manager reported that adequate work had been done to address any problems previously spoken about. The home has secured funding from the dignity grant to enable them to landscape the rear garden of the home. This requirement is now removed but the garden should be inspected further at a more appropriate time of year. At the last inspection comments were made that the home has a sensory room which is obviously unused and possibly of limited value in this home. At the time of the inspection it was being utilised as a pad and equipment store. This needs to be reviewed as it is referred to in the Service Users’ Guide, as a Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 22 service available to residents. Progress on this has not been as checked this inspection and should be included in the next inspection. On the day of the inspection the home was seen to be generally clean. The home provides support for many residents who have continence support needs, and it is inevitable that they may be some incontinence odours from time to time. There was some evidence of this, which was not of serious concern at the time. There was an incontinence disposal bin with a broken lid causing some unwanted odours and the manager said that she was double bagging the contents until the arrival of a new bin, which was on order. Immediately following the inspection a complaint was made concerning odours in the home, and following investigation by social services it was concluded that this allegation was substantiated, and that the odours may be emanating from two particular bedrooms where continence management is an issue. It was suggested that the home consider alternative flooring to be used in these residents’ bedrooms. The home must act on the recommendations of this complaints report, in consultation with the residents concerned, and any change from soft flooring to hard flooring must be done in consultation with CSCI. The home must also ensure that continence pad disposal bins are in good working order, and the carpets are cleaned quickly when necessary. (Refer to Requirement OP26) There was a requirement made at the last inspection to take adequate precautions against risk of fire with regard to maintaining the fire alarm system. This requirement has now been met. Fire safety records in the home were checked and found to be satisfactory. The facilities manager for the company has completed a full fire risk assessment and the manager reports that the local fire officer is satisfied with this. Company contractors now come to the home and carry out 3 monthly fire maintenance checks. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and mix of staff at the home meet the residents’ needs. Training provide in the home is generally sound. Residents are protected by the homes recruitment policies and procedures. Staff are trained to do carry out their roles and responsibilities but induction records are not available for inspection. EVIDENCE: Staffing levels in the home were discussed and staff rotas inspected. At the current time, because resident numbers have dropped, there are 2 nurses and 5 carers on duty during the day. (Currently there are 37 residents in the home with four vacancies) One nurse and three carers are provided at night. There are six 6 carers when the home is full. Nursing staff float and are available to help when she needed. Discussion with residents, relatives and a visiting health care professional showed that it is generally felt that there are always staff available to provide the necessary care and respond to emergencies, and the above levels of staffing are within acceptable levels. There are sufficient numbers of ancillary staff employed as follows: a maintenance man doing 30 hours a week, a full time cook with additional support at weekends, an activities co-ordinator, laundry staff and an administrator. I spoke with these staff all of whom were well informed about Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 24 their roles and showed also a good level of awareness of how communicate with residents and to get the information they needed to do their jobs. The rotas show that staffing levels are maintained with minimal agency use and the home using a bank of their own staff. Staff spoken to are happy working at the home and enjoy coming into work as they feel the home has a good atmosphere. The home has a stable staff team. All staff are provided with the opportunity to go on NVQ training appropriate to their roles and staff interviewed confirmed this. The homes records showed that substantially more than 50 of care staff are now qualified to NVQ Level 2/3. Recruitment policies and procedures are in place. No new care staff had been employed since the last inspection and one new maintenance man has been employed since that time. Four employee personnel files were viewed. These were generally well kept and included all of the information required by regulation. There was a requirement made at the last inspection for the home to ensure that all of the required documentation is stored in staff files with reference to photographs. This is now being done and this requirement is met. However not all missing information is being held on staff files. Three of the four files examined were care staff who should have had a record of induction available for inspection, but all three did not have this information on file. The manager explained that some of these were still held by the staff in question and others may be held at head office. The manager was able to provide a copy of the induction system, which does meet the Skills for Care requirements, but it was not possible to check whether the staff concerned had been fully inducted under this system. The home must ensure that these records are held on staff files available for inspection. (This was also an issue at the last inspection) (Refer to Requirement OP30) There is now a good file index being used on each of the staff personnel files showing how the information is collected, and this helps to monitor that staff are being recruited safely and in a fair manner. Recruitment records have much improved and the filing system is easier to follow. All the staff are expected to attend training on a rolling basis. Staff stated that they have done specialist-training courses through external trainers as well as senior staff internally providing the training. Staff files showed that they have done training in essential areas, such as food hygiene, health and safety, and adult protection, NVQ level 2, catheter care, first aid, diabetes care and in continence management. Records show that the provider has good compliance levels with statutory training such as manual handling, fire and health and safety. Good records of training are held on individual staff files. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 25 There is a good induction in place for new staff, which is in line with the Skills for Care requirements. The home has a training schedule, which includes; equal opportunities, dementia, diversity, health and safety, fire safety, moving and handling, infection control, and medication and food hygiene. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is well qualified are very experienced and manages the home in the best interests of the residents. Resident’s financial interests are safeguarded. Staff formal supervision is not adequately implemented. The homes policies and procedures are up-to-date and protect resident’s rights and interests, and health and safety is well managed within the home. EVIDENCE: The manager is a qualified Registered General Nurse and RMA and holds an NVQ level 4 in management and care. She is also very experienced in nursing care and care of the elderly, and is very knowledgeable, and offers staff and residents the opportunity to come and speak in an open and friendly manner. The staff interviewed spoke highly of the manager stating that she is always available and works hands on with residents when needed. Residents and Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 27 visitors also spoke highly of the manager saying that she is always available to speak to about any concerns they may have, and that she is quick to act to sort things out. An administrator who now provides additional support hours supports the manager. There was a requirement made at last inspection for the home to develop the quality assurance program to take into account the views of the residents, relatives and other stakeholders in the home. This requirement is now met old quality assurance system has been further developed to meet the requirements of the Care Standards Act. A senior manager within the organisation carries out monthly visits to the home and routinely inspects the physical environment, the care provision, and staff supervision of employment. Written reports are now consistently kept with recommendations for improvement. The manager carries out a monthly audit using a rolling checklist due written report with an action plan for improvements needed. There is a further order to carried out every two months by the regional manager, and there are quarterly meetings held with residents, facilitate usually by the manager, to discuss issues they may have and plans for the development of the home. Minutes of these meetings are kept and were seen at inspection. There are twice yearly surveys carried out with relatives and residents and an action plan is produced showing the issues that had been identified and how they will be addressed by the home. As a result of the quality assurance inspections Southern Cross, the registered provider, is planning to introduce a system whereby the nutritional values of foods are identified for each food product. This will be available for catering staff to plan their menu to give nutritionally balanced meals. There 37 residents currently living at the home all of whom are Independent in managing their own finances and benefits, or have support from family or the Court of Protection to do so. Only one resident receives support from the Court of Protection and the home does not manage benefits of bank accounts for residents. Laundry, food and toiletries are included in the homes fees, and the residents pay for additional personal items only. The home looks after small amounts of money for residents, up to £50, at the request of the resident all of their relatives and receipts are kept for all transactions. A new system is being introduced by the registered provider to ensure that a maximum amount of £500 is held at the home for all residents, to better protect resident’s money. This will involve opening a bank account jointly for all residents, and the home is in the process of securing residents full agreement for this to happen before it goes ahead. There was requirement made at the last inspection for the home to develop a staff supervision programme, so that staff would receive more consistent formal supervision. This program has now been developed and all at the start of are included in a programme for supervision every two months. However examination of for staff files showed the two of these did not have adequate Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 28 records of supervision on file. One of these had a record of a supervision taking place in May 2007 and although two others were scheduled since then, there was no written records of these having taken place on file. The other staff member’s file did not contain a written record of supervision. The registered manager must ensure that all staff receive supervision at least six times a year and that a written records is kept of these supervisions available for inspection. (Refer to Requirement OP36) There was a requirement made at the last inspection for the home to ensure that the policies and procedures required to run the home are updated to include the details of the new owners. This has now been done and this requirement is met. The owners, Southern Cross, reviewed the policies in 2006, and they now include all of the information required about to registered provider. There was a requirement made at the last inspection for the home to ensure the health and safety of residents and staff and undertake safe working practice risk assessments. This has now been done and this requirement is now met. The homes health and safety policy was reviewed in June 2006 and includes the management of risk and risk assessment to ensure safe working practices. This policy covers moving in handling, fire safety, first aid, food hygiene, and the risk associated with providing care to residents. Residents files were seen to include a broad range of relevant risk assessments connected with the care provision. The home has an up-to-date fire risk assessment and they are risk assessments in place regarding health and safety in the kitchen. The registered manager is responsible person for health and safety and is supported by a deputy manager, the maintenance man and a housekeeper. All relevant documentation regarding health and safety, fire safety, electrical and gas equipment, and risk assessments are in place and are up-to-date. Fire equipment list checked weekly and the home has a list and a number of hoists for use in bathrooms, which are under contract for maintenance. One of these hoists is out of order and it is currently stored with others, and a manager agreed there was important to quickly put a sign on this equipment to show it is not to be used, and is in the process of either having it repaired or removing it from the premises. Romford Grange Nursing Home DS0000015601.V351699.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 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 17 X 18 2 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 3 Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 18.1 a Requirement Timescale for action 31/01/08 2 OP8 12.1 a&b 3 OP18 13.4 & 13.6 4 OP19 23 The registered manager must ensure that appropriately qualified staff are available to facilitate healthcare professionals monitoring visits as discussed in this report under Standard OP8 The registered provider and 29/02/08 manager must put in place a system for monitoring trends and reasons for hospital admissions with a view to better understanding and intervention if appropriate The registered provider and 31/01/08 manager must report all allegations of negligence or abuse promptly to CSCI so that they can take any necessary action to ensure residents are protected. The registered person must 30/04/08 ensure that the communal bathrooms and toilets in the home are in good decorative order and in working condition. This is a repeat of a requirement made at the last inspection, timescale 14/09/06, partially met, DS0000015601.V351699.R01.S.doc Version 5.2 Romford Grange Nursing Home Page 31 timescale revised. Failure to meet this requirement may result in enforcement action. 5 OP26 16 The registered provider and manager must act on the social services complaints report as discussed in this inspection report Standard OP26, and ensure that appropriate flooring is in place, and action is taken to eliminate sources of unwanted odours in the home The registered provider and manager must ensure that copies of staff induction are kept on staff files available for inspection The registered provider and manager must ensure that all care nursing staff receive formal supervision at least six times a year and that written records are maintained on their personal files 29/02/08 6 OP30 18.1 a & 19.5 b 29/02/08 7 OP36 18.2 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP16 Good Practice Recommendations The registered provider and manager should consider a system for separating out the more serious complaints received and provide these complainants with a written outcome of their findings and use the information to improve the quality of the service provided The registered manager should ask social services for the outcome of the complaint discussed in this report so that the home can be fully aware of the merits of the concerns raised and whether any further action is necessary The registered manager should agree a timetable with the maintenance man for the repair and redecoration of DS0000015601.V351699.R01.S.doc Version 5.2 Page 32 2 OP18 3 OP19 Romford Grange Nursing Home 4 OP18 hallway walls and doors damaged by wheelchair use. The registered provider and manager should consider areas whether senior staff responsible for the running of the home in the manager’s absence are fully able to implement adult protection procedures, including communication with social services, and with the providers internal management. Further to this action should be taken if necessary to improve performance in this area. Romford Grange Nursing Home DS0000015601.V351699.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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