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Inspection on 14/08/06 for Scarsdale Grange Nursing Home

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

This inspection was carried out on 14th August 2006.

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

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

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

Trial visits to the home, prior to admission were encouraged to enable prospective service users and their representatives to make an informed choice. Service users said that the meals provided were enjoyable and plentiful. Service users spoken to all identified staff members that they felt were caring and patient. Staffing levels were being maintained at the agreed levels and service users and staff spoken to said that the manager was friendly and approachable. Service users monies were handled safely and accurate records were maintained.

What has improved since the last inspection?

Following requirements made at the last inspection the manager had completed a staff training audit and staff were in the process of completing training in subjects that would assist them to carry out their work role to a satisfactory standard. One member of staff had been identified to be the homes `trainer` and had completed a `training the trainer` course. Staff said they had completed training in food hygiene, moving and handling, adult protection and fire. The homes complaints procedure had been revised to include details of any action taken and if the complainant was satisfied with the outcome. All service users spoken to said that ample hot and cold drinks were on offer throughout the day. All areas of the home seen were clean and hygienic, bed linens had been changed as required and clean linens were placed neatly on shelves. The providers had carried out visits to the home to check that the service being provided was adequate.

What the care home could do better:

The homes care plans, record keeping and policies and procedures had not safeguarded service users rights and best interests, as they had not been followed and could have placed service users at risk of harm. The service users health and safety had not been promoted and protected in several areas, including care planning, medication and risk assessment, which once again could have placed them at risk. The registered owners must ensure that they produce a quality assurance system to ensure that following their visits to the home a thorough check on all aspects of the service provision has been undertaken. There should be a system in place to monitor the health and safety needs of service users and report any concerns to the service users GPS immediately. The daily recording of all health and safety checks made on service users must be fully completed. Areas around the home with damaged decoration must be redecorated, to make the home more pleasing and help to achieve a more homely impression. The Service User Guide had been at the printers for four months and it is unacceptable that service users were not provided with information necessary to make an informed choice about living in the home. The home had admitted service users who were `out of category`, and could therefore not fully meet their full care needs. Although improved, staff training in mandatory subjects remained incomplete and recruitment procedures did not fully protect the service users from being placed at risk. Considering all of the above issues, service users were not overall, benefiting from the ethos, leadership and management approach of the home at this point, even though it is acknowledged that the manager is very experienced.

CARE HOMES FOR OLDER PEOPLE Scarsdale Grange Nursing Home 139 Derbyshire Lane Sheffield South Yorkshire S8 5EQ Lead Inspector Sue Turner Key Unannounced Inspection 14th August 2006 08:10 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 Scarsdale Grange Nursing Home DS0000021804.V304056.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. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scarsdale Grange Nursing Home Address 139 Derbyshire Lane Sheffield South Yorkshire S8 5EQ 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) 0114 258 0828 0114 258 0828 scarsdalegrange@onetel.com Mr John Martin Foster Mrs Elaine Pearl Adams Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three service users aged 60 years and over may be accommodated at the home. 10th April 2006 Date of last inspection Brief Description of the Service: Scarsdale Grange is a purpose built home, providing care for up to 40 older people, some of who require nursing care. The home is in a residential area of Sheffield, with good access to public services and amenities, such as public transport, shops and public houses. The home has two floors, accessed by a passenger lift. Each floor has communal lounge, dining rooms and bathing facilities. All of the bedrooms are single, each with en-suite toilet facilities. The home has gardens and a car park. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from 10th April 2006 were £410 - £475 per week. Additional charges included newspapers, hairdressing and private chiropody. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector was on site during the morning of this inspection and was joined by another inspector for the afternoon. The inspection, which was unannounced took place over 8 hours from 8.10 am to 4.20 pm. An inspection of the environment was undertaken. Records were examined, including: 3 care plans, complaints, staff recruitment and training, menu and fire records. All CSCI’s key standards were checked and interactions between staff and service users were observed. The inspector spoke with a proportion of the staff on duty (5), and 5 service users. The homes manager was interviewed and discussions took place with the administrator. Five relatives/friends visiting on the day of the inspection were also spoken to. What the service does well: What has improved since the last inspection? Following requirements made at the last inspection the manager had completed a staff training audit and staff were in the process of completing training in subjects that would assist them to carry out their work role to a satisfactory standard. One member of staff had been identified to be the homes ‘trainer’ and had completed a ‘training the trainer’ course. Staff said they had completed training in food hygiene, moving and handling, adult protection and fire. The homes complaints procedure had been revised to include details of any action taken and if the complainant was satisfied with the outcome. All service users spoken to said that ample hot and cold drinks were on offer throughout the day. All areas of the home seen were clean and hygienic, bed linens had been changed as required and clean linens were placed neatly on shelves. The providers had carried out visits to the home to check that the service being provided was adequate. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 6 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. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 7 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 Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was not providing sufficient updated information to inform service users about their rights and choices. Service users needs were not adequately assessed prior to admission. The home was not complying with their registration category. EVIDENCE: Service users spoken to said they had not received a copy of the service user guide. The manager said that the revised and updated service user guide had been sent to the printers and had not yet been returned. The guide was reported to be at the printers on 1st June when the manager replied to the requirements issued following the inspection on 10th April 2006. The manager was asked to enquire why the guide was taking so long to be returned from the printers. This requirement is therefore carried forward in this report. The care files for three service users were seen. One service user recently admitted into the home had been assessed as needing specialised care prior to Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 9 their admission to Scarsdale Grange. The manager was asked why this person had been admitted as the home was not registered to care for this specialism. She said that social services had asked her to admit him/her and she was aware of the homes registration category. The manager also said that she had not carried out the homes own assessment of the service users needs to establish if they were able to care for him/her. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Procedures were not in place to closely monitor all the health, safety and personal care of each service user. Care plans did not truly reflect the service users health, personal and social care needs. The homes medication practices did not fully protect the service users from being administrated inappropriate medications. There were issues around ensuring peoples dignity with sensitivity. EVIDENCE: Three care plans were sampled. The information contained in all three files was insufficient and inaccurate. Examples of the contradictory information within the care plans seen are: • One portfolio stated that the service user had diabetes controlled by tablets and diet. Their care plan stated ‘has no special dietary needs’. • One file stated that the service user was continent in one section and as doubly incontinent in another section. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 11 For one service user the GP had requested a urine sample to be taken and his/her feet to be elevated. There was no further information about if the urine sample had been sent and observations of the service user confirmed that his/her legs were not elevated at any time during the site visit. • On the 9th August 2006 one service user was reported as being ‘poorly’, on 12th August 2006 report stated ‘remains very frail and refusing to eat’. There was no record that the GP had been contacted or any further action had been taken. • Care plans did not include information regarding leisure preferences, weight monitoring or wishes around death and dying. The manager said that the home did not have a policy/procedure detailing staff’s responsibilities in regard to requesting medical visits, but she would expect the qualified staff to assess if a GP was needed. The manager was asked to provide to the CSCI information regarding if a urine sample had been taken from the named service user and if the GP had been contacted for the service user described as ‘poorly’. The manager said that she did monitor the care plans about every two weeks, however there was no evidence to confirm monitoring took place and the information seen in the care plans sampled was very poor. Following a complaint made to CSCI, prior to the last inspection, two requirements were issued relating to care planning and health needs (see requirement numbers 2 and 3 carried forward into this report) in agreement with the manager and in recognition of the work involved the timescale for completion of these requirements was extended. It is therefore unacceptable that, five months later, care plans and health care needs of service users continue to be a concern following this inspection. Four relatives/friends spoken to said they had not been asked to contribute to any care planning for their relative/friend. Care plan reviews had been signed by staff each month, however no changes had been made to any care plans seen and for one person this was over a twoyear period. Requirements relating to inadequate service user records were highlighted at the last inspection. The inspectors discussed with the manager the possible professional and legal consequences for some qualified nursing staff if their continued failings persist in maintaining and updating service user records. The inspectors observed staff administering medication and found that the standard of medication administration had improved since the last inspection and the staff had clearly made an effort to meet the requirements made at the last inspection. A nurse and student gave out medications. Service users were offered water and staff ensured that medication was taken before signing the Medication Administration Record (MAR) sheet. Medications were kept securely stored and fridges were available. MAR sheets were checked and a number of gaps were found in the records. The inspectors observed that staff were in the main friendly and polite when speaking with service users. One service user spoken to was very upset and said she hadn’t been dressed properly that morning. She said the staff couldn’t Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 12 • find her underwear so had dressed her without it. The inspector looked in the ladies cupboards and found many items of underwear. The service user also said that the staff member had been very ‘rough and tumble’ with her. The manager was asked to go and see the service user, record her concerns and carry out an investigation. The manager was asked to forward to CSCI the outcome of the investigation and any action taken to resolve the issue. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users were able to maintain contact with family and friends ensuring that they continue to be involved in community life. The home has an open visiting policy, which assisted in maintaining good relationships with residents’ representatives. Meals served at the home were of a good quality. Activities should be further promoted and the activities worker should be assisted in making the activity more engaging. EVIDENCE: Service users were able to spend their day as they wished and move freely around the home. Service users said that they were able to maintain contact with their family and friends. Relatives said they were always made to feel welcome when they visited and were offered hospitality. Service users said they chose when they got up and went to bed and generally how they spent their day. Some service users said they preferred to stay in their room at certain times of the day and the staff respected their decision. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 14 The home employed an activities worker who was seen playing bingo, in the dining room with a number of service users. Many of the service users playing were not able to follow their own bingo card, so the activities worker kept stopping so that she could check all the cards. At the same time the carers were sitting at a table chatting and reading and didn’t assist in the activity. At the last inspection it was noted that up to date information regarding the activities available was not circulated or on display, which would have assisted service users in deciding if they wished to participate, this had not been actioned. Service users spoken to described the meals offered as ‘good’ and ‘OK’. They said there was always enough food and they were offered alternatives. The inspector observed breakfast being served. Tables were set nicely and service users were asked their preference of cereal and cooked choices. There were four weekly rotating menus, which provided adequate options, however the main meal served was not what was featured on the menu. To ensure service users have adequate choices and receive a healthy balanced diet, meals featured on the menu should be served. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints procedures were in place to enable service users and relatives to feel confident that any concerns they voiced would be listened to. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure service users were protected from abuse. EVIDENCE: The homes complaints policy was on display in the entrance area of the home. It contained relevant information and informed the complainant who to contact external to the home, should they wish to do so. Since the last inspection the homes record of complaints had been revised and now included a record of any action taken and the outcomes of any complaint reported to the home. The manager said that since the last inspection there had been no complaints received at the home. The inspector checked the record of complaints and none were recorded. CSCI had not received any complaints about the service since the last inspection. On the day of the inspection a service user raised concerns about the care provided to him/her, the manager was asked to investigate the concerns using the homes complaints procedure and provide feedback to CSCI about the action taken and the outcome. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 16 The homes adult protection policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their senior manager. The manager said and staff confirmed that they had received training in adult protection procedures. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment within the home was not maintained to an adequate enough standard to provide a comfortable home for service users. EVIDENCE: Grounds around the home were kept tidy and accessible. There were no unpleasant odours noticeable in the home. Service users said that their rooms were kept clean. Bedrooms seen were comfortable and homely. The manager said that a rolling programme had commenced to replace bedroom furniture that was worn, and replace bed linen and curtains. The home had sufficient bathing, washing and toileting facilities. The inspectors carried out a full environment check, since the last inspection the bathroom walls had been painted, some communal areas had been tidied and all beds seen had clean linen. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 18 A number of areas within the home were in need of decoration and/or cleaning. Observations of the environment were: • A number of bedrooms had broken, scratched and marked furniture • Bathroom floors were stained and marked. The manager said that these had been thoroughly cleaned since the last inspection, however they remained soiled and therefore were in need of replacing. • No blinds or curtains were fitted to the bathroom windows. • The floor in both dining rooms was stained and marked. • Diffusers on strip lights required cleaning. • Bathrooms were being used to store hoists, chairs and seat covers. • The first floor sitting room was cluttered and untidy, the carpet was stained and the wallpaper was torn. • Some service users had complained of feeling cold over the past few days, they were unable to adjust their radiators due to the radiator. covers. The handyman had therefore readjusted the temperature for the whole of the home. • The main kitchen was in need of painting. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff were employed in sufficient numbers to meet the service users needs. Recommended levels of NVQ trained staff had not been achieved, so did not ensure staff had the competencies to meet the service users needs. Recruitment systems in place did not fully promote the safety of service users and meet the standards A staff-training programme had been organised and planned, in order that staff had the skills to meet the needs of service users. Not all staff had undertaken statutory training. EVIDENCE: The manager stated that agreed staffing levels were being maintained and the staff rota identified agreed staffing levels had been met. Staff said staffing levels were adequate. Service users said there was always a member of staff available when they needed them. Of the 26 care staff, 6 staff had achieved NVQ level 2 in care, a further 10 staff were undertaking the training, some were very near completion. Whilst this is an improvement, the numbers of NVQ trained staff did not meet the recommended 50 of the care staff trained to NVQ level 2 in care by 2005, to ensure the staff team was qualified and competent to carry out their duties. Three staff files were checked. All three checked included two written references, full employment histories, medical checks, proof of identification Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 20 and of any qualifications and a recent photograph of the employee. Two files checked contained enhanced CRB checks, the third contained a copy of a CRB check undertaken by the persons previous employer. The administrator said that they did not carry out a CRB check for anyone who had already undertaken a check previously. Guidance from the CRB is that CRB checks are not portable from one organisation to another and a new check must be carried out for each new member of staff. Since the last inspection the manager had undertaken an audit of the staffs training needs and staff had commenced training in food hygiene, moving and handling, fire and adult protection. The manager said that the training programme would be completed be by 31st December 2006 when all staff would have completed training in mandatory topics. Staff spoken to said they had found the training they had undertaken valuable and interesting. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users were not overall, benefiting from the ethos, leadership and management approach of the home at this point, even though it is acknowledged that the manager was very experienced. The homes record keeping, policies and procedures did not safeguard service users rights and best interests as they had not been followed and had placed some service users at risk of harm. The service users health and safety had not been promoted and protected in several areas. EVIDENCE: The manager is a registered nurse who had a lot of previous management experience in residential care settings. The manager was co-operative with the Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 22 inspectors and responded to all requests for information. Staff spoken to said they were able to speak to the manager about any issues of concern and she would assist them. The number of and the severity of the issues raised in this report demonstrate that current management arrangements were not organised and there was little evidence of direction. The care given to the service users met some basic needs, but did not meet the full range of health care needs. At present the home is not meeting the service users needs in an acceptable manner. Some policies and procedures were not being followed and in some cases there was no policy or procedure to follow. This then resulted in the manager and staff deciding themselves what was in the best interest of the service users which was not consistent and put service users at risk from harm. The responsible individual had made visits to the home but the reports show that any inadequacies of the service had not been picked up. Since the last inspection, records kept at the home had been securely stored, however the general levels of record keeping in many areas were wholly insufficient. Staff spoken to said they were not receiving one to one formal supervision from their line manager. Three service users monies were checked. Receipts, records and money all tallied and all were kept securely. Staff spoken to said that they had recently undertaken fire training and fire equipment seen had been tested at the required frequency. Records of mandatory training did not include all aspects of training. Some staff required training in food hygiene, COSHH and health and safety in order to maintain safe standards. During the inspection the inspectors observed a number of concerns relating to the health, safety and welfare of the service users. • One bathroom had hazardous substances insecurely stored. This was a requirement at the previous two inspections and is carried forward in this report. The manager was instructed to make sure that all substances hazardous to health were securely stored immediately. • Many of the service users beds had metal frames. At the previous inspection, one relative spoken to said that the bed had caused bruising to the service users legs, whilst being transferred from bed to chair and the manager was asked to carry out a risk assessment. This had not been actioned. The manager said that she had spoken to all relatives, staff and service users and none had raised concerns about the beds and she had therefore considered the risk low. There was no written evidence of this. • Risk assessments seen for service users not using footplates had not been reviewed within the stated timescale. • One fire door with a sign stating ‘Fire door must be kept closed at all times’ had been propped open. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 2 1 1 Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4 Requirement Timescale for action 01/09/06 2. 3. OP3 OP4 OP3 OP4 OP3 OP4 14 4. 5. OP7 OP8 6. OP7 OP8 Care Standards Act Section 24 4 The home must apply for a 5 variation to their registration, in order to continue to care for the service user with specialised needs. 15 Information within all care plans must be reviewed and updated to reflect each service users current health, personal and social needs. (Previous timescale of 01.08.06 not met). 12 All service users assessed health 13 needs must be promoted and DS0000021804.V304056.R01.S.doc The service user guide must be updated to ensure all of the information included is up to date. Copies of the guide must be provided to current and prospective residents. (Previous timescale of 30.04.06 not met). All service users must have 14/08/06 needs clearly assessed before admission. No service user must be 14/08/06 admitted to the home who is ‘out of category’. 01/09/06 01/10/06 14/08/06 Scarsdale Grange Nursing Home Version 5.2 Page 25 7. OP7 OP8 15 17 8. OP7 OP8 OP7 OP8 OP9 12 9. 12 13 13 10. 11. 12. OP10 OP10 12 24 13. OP11 15 14. OP12 12 16 16 23 15. OP19 maintained. (Previous timescale of 11.04.06 not met). Staff must keep up to date records of any nursing/care provided to the service user, including a record of his/her condition and any treatment. The manager must investigate that the service users identified have received the health care necessary. There must be in place a policy/procedure which details when medical attention should be sought for service users. There must be arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. (Previous timescale of 11.04.06 not met). Service users wishes and feelings must be taken into consideration at all times. The manager must investigate the concerns raised by a service user regarding the care provided to them and submit the findings to the CSCI. Service users wishes regarding dying and death must be sought and recorded in their care plan. (Previous timescale of 01/08/05, 30/04/06 and 01/06/06 not met) Service users must be supported to be given the opportunity for stimulation through leisure and recreational activities. All areas of the home must be well maintained therefore: Dining room floors must be thoroughly cleaned. Diffusers on the strip lights must be thoroughly cleaned. Communal areas in the home DS0000021804.V304056.R01.S.doc 14/08/06 28/08/06 28/08/06 14/08/06 14/08/06 28/08/06 01/10/06 14/08/06 01/09/06 Scarsdale Grange Nursing Home Version 5.2 Page 26 16. OP21 16 23 17. OP24 16 23 18. OP25 16 23 18 19. OP28 20. 21. OP29 OP30 19 18 must be tidy and uncluttered. The main kitchen must be repainted. (Previous timescale of 01/08/05 not met). All areas of the home must be well maintained therefore: Bathroom floors must be thoroughly cleaned or replaced. (Previous timescale of 01/08/05 not met). Curtains/blinds must be fitted to all bathroom windows. Bathrooms must not be used for storage. All areas of the home used by the service users must be well maintained therefore: The programme of replacement of bedroom furniture must continue. (Previous timescale of 01/08/05 not met). Central heating levels must be maintained at an appropriate temperature, throughout the home at all times. 50 of the care staff must be trained to NVQ level 2 in care. (Previous timescale of 01/08/05 not met). All staff employed at the home must undertake a CRB check at the correct level. A staff-training plan, which meets the National Training Organisation workforce training targets, must be developed. (This requirement has been outstanding since June 2003). All staff must receive statutory training, records must be accessible and organised so that information can be easily retrieved. All staff must undertake training in COSHH and Health and DS0000021804.V304056.R01.S.doc 01/09/06 01/12/06 14/08/06 01/12/06 01/10/06 01/12/06 Scarsdale Grange Nursing Home Version 5.2 Page 27 22. OP31 OP32 OP33 9 17 26 23. 24. OP31 OP33 9 26 25. OP36 18 26. OP38 13 Safety.(Previous timescales of 01/03/05, 01/09/05, 31/03/06 and 01/08/06 not met) Improvements must be made in how the home is run, therefore the manager/provider must: Ensure that a thorough check is made of all aspects of the service provision following his monthly monitoring visits to the home. Action all the requirements issued within the timescales identified. The manager must be trained to NVQ level 4 in management. The responsible individual must ensure that a thorough check is made of all aspects of the service provision following his monthly monitoring visits to the home. Staff must be given formal supervision. (Previous timescales of 01/08/06 not met) The health, safety and welfare of all service users must be promoted and protected at all times, therefore: All substances that may be hazardous to health must be securely stored at all times. (Previous timescale of 17/01/06 and 01/08/06 not met) Individual risk assessments must be carried out, for each service users who has a metal bed frame. Appropriate action must then be taken to reduce any risks identified. (Previous timescale of 01/08/06 not met) All risk assessments must be reviewed and updated as required. DS0000021804.V304056.R01.S.doc 01/12/06 01/12/06 01/09/06 01/10/06 14/08/06 Scarsdale Grange Nursing Home Version 5.2 Page 28 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 OP12 OP15 Good Practice Recommendations Up to date information about activities should be circulated to all service users in formats to suit their capabilities. Meals served should be as shown on the menu. Scarsdale Grange Nursing Home DS0000021804.V304056.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 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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