Inspection on 24/10/07 for Scarsdale Grange Nursing Home

This inspection was carried out on 24th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Scarsdale Grange Nursing Home 11/02/08

Scarsdale Grange Nursing Home 14/05/07

Scarsdale Grange Nursing Home 14/08/06

Scarsdale Grange Nursing Home 10/04/06

Scarsdale Grange Nursing Home 17/01/06

Scarsdale Grange Nursing Home 17/05/05

Scarsdale Grange Nursing Home 08/12/04

Scarsdale Grange Nursing Home 06/04/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Scarsdale Grange Nursing Home 139 Derbyshire Lane Sheffield South Yorkshire S8 9EQ Lead Inspector Ms Shelagh Murphy Key Unannounced Inspection 24th October 2007 09:40 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.V349833.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.V349833.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 9EQ 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 None. Mr John Martin Foster Vacant 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.V349833.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. 14th May 2007 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. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The range of monthly fees from April 2007 were £410.00 - £475.00 per week. Additional charges included newspapers, hairdressing and private chiropody. Further detailed information about fees is available form the home. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced; it took place between 9:40 am and 17:50pm. Shelagh Murphy was the lead inspector and Mike O’Neil carried out some aspects of the inspection for an hour later in the day. This was a key inspection and the inspectors checked all the key standards for which, records/ information was available. An expert by experience also accompanied us on the visit. An expert by experience, is someone who has experience of/or has previously used social care services. For this visit Margaret Ferry, supported us to carry out the inspection by seeking the views of people who live at the home. She also had lunch with people and made observations about how people were treated by staff and made observations about the general environment and atmosphere within the home. The inspectors sent surveys to all of the people who live at the home. All relatives were also sent surveys. Five health professionals were also surveyed. Two qualified nurses, two care workers and the manager were interviewed. Hassan Jeeto had been appointed as the manager in July 2007 and has completed the process to become registered manager with the Commission for Social Care Inspection (CSCI). The manager and the qualified nurses in charge of each floor assisted with the visit. Mrs Foster, the owner, was present for a short time during the visit. During the visit the inspectors and the expert by experience spoke to and interviewed people. We looked at the environment, and made observations on the staff interactions with and attitudes towards people. We checked samples of documents that related to peoples’ care and safety. These included needs assessments, care plans and medication records. Some records were not available for inspection as they could not be found. The inspectors checked other information before visiting the home. This included the Annual Quality Assurance Assessment (AQAA), which the Commission for Social Care Inspection (CSCI) had requested. We also used evidence from a report compiled by Sheffield City Council’s, Older Peoples Reviewing Team (ORPT). The inspector would like to thank the people who live at the home, relatives and staff for their contributions to this report. What the service does well: Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 6 People who live at the home had their needs assessed. Some people said they received the care and support they needed. Most people said they were satisfied with the care they received. One person said; “The staff care for me and cheer me up”. People were supported to maintain relationships with family and friends as appropriate. Visitors said they were made welcome at the home. Some people enjoyed the meals provided by the home. What has improved since the last inspection? What they could do better: Some people need their needs re-assessing to ensure the staff understand how to meet their needs. The needs assessment tool needs to be reviewed, to ensure all of the relevant information staff need to support people is available to them. People need to have better care plans that reflect their present needs better. Therefore care plans need to reviewed to ensure that people’s individual health, personal and social needs are recorded in the plan. This will better inform staff how to support people appropriately. One person said that they received the care and support they needed ‘sometimes’. Another person said, “Certain members of staff have difficulty in realising that all residents are there for nursing care. I have difficulty in getting peoples attention when I need the toilet”. This did not protect people’s dignity. At present risk assessments do not adequately record the reasons why people may be at risk or the steps in place to support people’s independence. This does not protect peoples rights. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 7 Medication practices were wholly inadequate to meet people’s needs. New systems and procedures need to be devised to protect people’s health and welfare. The mealtimes needed to be better organised to meet people’s needs and maintain their dignity. The first floor needs to be better staffed at mealtimes to meet people’s higher dependency levels. This will improve people’s welfare. A record of all complaints needs to be maintained in order to monitor any issues within the home. This will protect people’s rights. Adult protection investigations must be carried out as required by the safeguarding proceduressx and the timescales for reporting back must be adhered to, in order to protect people. Some décor, furnishings and flooring do not promote good standards of cleanliness and some areas of the home need redecoration or repair, to ensure people are living in a clean and homely environment. People said the staff did not always meet their needs in the way they preferred. For example some people said they had to wait a long time to be supported to use the toilet. Some health professionals and relatives had concerns about some of the staff attitudes towards people. Some of the homes working practices, policies and quality assurance practices do not protect and promote people’s safety and welfare. For examples not all staff had Criminal record Bureau checks on their recruitment files, and this was due to poor management systems and a lack of leadership at the home. The management should improve how it monitors the quality of care to people by having a development plan and making a monthly report on the homes progress to meet this plan. Staff need up to date training including health and safety and moving & handling to make sure people are offered safe support and consistent care practices. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 8 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. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 was not applicable as the home had no referrals for intermediate care. People who use the service experience adequate quality outcomes in this area. People who live at the home had their needs assessed. Some people’s needs assessments showed that they now need to be reassessed. They had complex needs, which, the staff were not trained or experienced in managing. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Needs assessments were checked. People had local authority needs assessments on their care files. The home had its own assessment record which the manager or nurses had completed. This was a very basic assessment. At the last inspection the owners were advised that this assessment tool needed to be improved to help them get better information about peoples lives, their aspirations and their care needs. The assessment tool had not been altered when checked at this inspection. Three peoples needs assessments were checked. One person was observed to have complex needs and the staff were observed to find it difficult to manage Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 11 the persons needs and respond appropriately. The manager said this person had recently been referred for an assessment to the Community Mental Health Services. (see standard 7) Two other needs assessments were checked and had appropriately identified how people’s needs should be met. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. People’s individual plans did not fully reflect their health, personal or social care needs. Staff had not reviewed peoples care appropriately, some people and their relatives voiced concerns about not being treated with respect by staff. The medication practices were not safe and did not protect people’s health and welfare. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We surveyed people who lived at the home and these are some of their comments: Most people said they were satisfied with the care they received. One person said, “the staff care for me and cheer me up”. There were some concerns raised. One person said that they received the care and support they needed ‘sometimes’. Another person said, “Certain members of staff have difficulty in realising that all residents are there for nursing care. I have difficulty in getting peoples attention when I need the toilet”. This did not protect people’s dignity. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 13 One relative raised similar concerns. They went on to say, “My Mother does not complain about this as she fears she would be victimised”. Another relative said, “I would like to see more emphasis on the personal care part of my mothers care at the home, It is after all her home and some more respect for her as an individual would make her smile more.” Three peoples individual plans of care were checked, the information contained in them all was very similar. The information gave little insight in to the person’s individual needs, wants and personal likes. The plans had been all reviewed every month. However, the quality of these reviews was poor. Three of the plans checked had been reviewed on the same dates, the majority all said that there were, ‘ no changes’, to peoples needs in the same areas. For example in relation to nutritional assessments, personal care and mobility. This had been the case each month, for a period of six-eight months and in one case for over a year. It was clear from reading these individual plans that the review system was not identifying peoples changing needs. People’s leisure and social needs were not addressed at all in the plans checked. There was no evidence that people or their relatives had been involved in reviewing these plans. It appeared that the reviews had become a paper exercise. This issue was highlighted at the last key inspection and had not been addressed. The Older Peoples Reviewing Team from Sheffield City Council, had raised similar concerns to ours, during reviews they had carried out weeks earlier. All of these issues placed people at risk of harm. All of the care plans checked showed that each person had bed-sides put on their beds to prevent them from falling. People had some risk assessments forms on file, however, they did not identify why the person was at, ‘medium risk’ from ‘falling out of bed’. This risk assessment had then been used to justify why all of these people had ‘bed-sides’ fitted to their beds. The same was the case for people needing wheelchairs. Only 2 people out of 16 were not using wheelchairs. The care plans had not clearly identified in each case why people needed them. The manager agreed these are not good practices and that they limited peoples independence. People said they see the local G.P. on a regular basis. The manager said they visit on a weekly basis and are called out to see people if they need this. Two health professionals were surveyed. One said, “Senior nursing staff are competent and able to manage patients effectively and refer to primary care team appropriately”, they went on “ the recent changes in management have put extra burdens on the nurses who have coped admirably”. Another said, the service only ‘sometimes’ acted upon and managed peoples health care needs. ‘Sometimes’ met peoples care needs, respected peoples privacy and dignity. They went on to say, “the home needs to provide a better skilled workforce in order to meet people’s needs”. We checked the medication practices including, ordering, storage, administration, recording and disposal of medication and found unsafe Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 14 practices at each stage. This was not safe and put peoples health and welfare at risk. Examples of the poor practices included: • a months supply of extra medication had been ordered for one person, without any record as to why this was. This extra medication was found in a plastic box on the worktop in the clinical room. It had not been locked in an appropriate drug cabinet. This is not a safe way to store medication. we checked the present medication system. There was medication left in the cartridges, we found discrepancies between medication dispensed from the cartridges and medication that had been signed for. It appeared that staff had administered some medication but not signed for these. on the worktop in the clinical room were two yellow buckets. They both contained medication for disposal. Neither were sealed appropriately and the nurse on duty was not clear about the procedures for the safe disposal of medication. the controlled drug book was checked. The medication in use at this time had been signed and accounted for. However, we found entries in the book from last year that showed discrepancies between the medication which had been signed out and that which should have been left. • • • The issues with the medication were brought to the manager and the owners attention immediately and an immediate requirement to address these issues was made on the day of the visit. Scarsdale Grange Nursing Home DS0000021804.V349833.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): Standards 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. Some people said the lifestyles in the home had matched their expectations. The mealtimes needed to be better organised, people need to be given more choices over what they eat and when they eat, in order to meet people’s needs and maintain their dignity. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Peoples leisure and social needs were not recorded on the three care plans we checked. People said there were activities. On the day of the visit some people were playing bingo with the activities co-ordinator. There was recorded evidence to show us that some activities had been taking place. People said the activities co-ordinator comes in 2 days a week to provide activities. A hairdresser comes in on two mornings and people can have a manicure if they so wish. People told us they did not go out unless a relative or friend facilitated this. However, there was some evidence some people had been out on a day trip since the last inspection. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 16 One relative said, said the staff should “spend more time with residents”. People said they could have visitors and could see them in a private area. Relatives told us they were made to feel welcome by the staff team. Some people liked their meals, others said they could be better and that they should be offered more choices. The expert by experience who accompanied us on the visit spent over three hours at the home, speaking to people, having lunch with people and observing interactions between staff and people who lived at the home. She made the following observations about meal times: • the paper on which the weeks menus were written was hardly legible, and the paper was stained and dog-eared. The menu for the day is written on a board downstairs, but there nothing upstairs. The weeks menu was plain, and unimaginative, particularly in relation to deserts; usually a hot desert, yoghurt or a piece of fruit. there was a cooked breakfast available three times per week. The rest of the week cereal and toast was provided. Tea was also offered. The times breakfast is served was unclear, ‘early’ was the closest answer I could get from people who live at the home. However on the day of our visit people were still eating breakfast at 11am. This led us to believe that breakfast time was a flexible arrangement. lunch is served between 12 and 12.30 daily. This meant that some people were being offered lunch about an hour after they had finished breakfast. This may have been one of the reasons that some people did not appear hungry at lunchtime. many people had poor appetites, and there were some jocular attempts to persuade them to eat, but only to one or two people. Other people were not prompted at all. the meal of the day should have been lamb stew, (which turned up as beef stew,) mashed potato, cauliflower and broccoli, followed by ice-cream, yogurt or fruit. The food was hot and reasonably well cooked, though rather bland. The beef contained gristle, and many people had only mashed potato, gravy and mushy peas. No mention of mushy peas had been made on the menu. People said that they were a standard on the menu. The alternative meal was egg and chips. a carer was feeding one person. There was good interaction between the two. everyone wore a bib and because the dining tables were not appropriate for the wheelchairs to fit under, most people had to lean over which resulted in • • • • • • Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 17 them spilling their food. One person deliberately took off the bib, (which had been placed on them), and said, ‘I am not a child’. These issues showed that people were not offered appropriate opportunities to choose meals, to eat at times convenient to their needs or to be served what they had chosen from the menu. This does not protect people’s rights. Other people were observed to need more support and encouragement to eat their meals and need to be treated with more dignity and respect. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18. People who use the service experience poor quality outcomes in this area. People knew who to make complaints to, however, complaints records were not available for inspection. This did not promote peoples rights. Adult protection procedures were in place, but were not being followed as some equipment to keep people safe was being used inappropriately and this could be seen as restraint. This did not protect people’s rights. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Most people said they could raise concerns and complaints and that staff would listen, one person said, “ I would speak to the manager if I had any complaints. The manager said no complaints had been made since the last inspection in May2007. The complaints records were asked for but could not be found on the day of the inspection. This did not promote peoples rights. Social workers had reported that they had observed two people with lap belts on without clear information as to the need for this. These can be seen as a form of restraint and therefore should only be used to protect people from harm if they are clearly risk assessed as needing this. Assessments had not been completed in either case and immediate requirements to address these issues were therefore made. We asked how many people needed bed side rails to protect them from falling out of bed and were told all of the people on one floor and the majority of the Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 19 people on the other floor required these aids. However, when we asked to see risk assessment documentation to support the need for these aids this was not adequate. The risk assessments only identified the level of risk, they had not identified the need for the aids or any history of why an individual may need this support. For this reason the manager was asked to reassess people and only use the bedside rails for those people at risk. As again this could be identified as an inappropriate form of restraint. These practices did not promote peoples rights. The OPRT had informed the CSCI inspector that they had seen a wardrobe laid on its side in one person’s bedroom, they said this was being used to ensure someone did not fall out of bed. This is a totally inappropriate practice and an immediate requirement to remove this and inform staff of the need to cease such practices was issued. This did not promote peoples safety or protect their welfare or dignity. Most people were observed to be sat in wheelchairs and to stay in these throughout the day. We also saw one person who was in a wheelchair at lunchtime, yet had earlier in the day been walking around, (albeit slowly). It was not clear whether people were in wheelchairs because they had been assessed as needing this aid or because it was more convenient for staff to have people in wheelchairs. Some staff spoken to and surveyed said they had completed adult protection training over the last few months. Staff training records, confirmed this. The adult protection procedure was available for staff. The manager said they had not had any adult protection referrals at the home, since the last inspection. Allegations of poor staff practices had been made to the local CSCI office, just before the visit. These were then referred to the local team responsible for adult safeguarding and a strategy meeting was called to look into whether the allegations needed further investigation. Due to the fact that this is an ongoing adult safeguarding referral the outcome will be referred to in the next inspection report. Scarsdale Grange Nursing Home DS0000021804.V349833.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): Standards 19 and 26. People who use the service experience poor quality outcomes in this area. People who live at the home are generally satisfied with their environment. Most areas of the home require some redecoration, some décor, furnishings and flooring did not promote good standards of cleanliness or homeliness. Fire safety practices were observed, which could place people at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Overall, most people said they were satisfied with the environment and cleanliness of the home. The people we spoke to said they were happy with their bedrooms. We checked a sample of rooms. Most rooms were clean and homely, people had personalised bedrooms and most bathrooms were clean. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 21 The expert by experience made the following observations: The home is clean, but very basic. There are no flowers or interesting displays to stimulate people. The upstairs lounge is only a circle of chairs around a television, and the most colourful item downstairs is a fish tank. There are two dining rooms, one attached to the downstairs lounge, and a separate room upstairs. Downstairs, the tables with 4 settings to a table had clean red cloths with matching linen napkins, heavy cutlery and 4 glasses per table. Upstairs the dining room is bleak, again tables had clean red cloths, but no napkins, ordinary stainless steel cutlery, and 4 glasses. No condiments were set on the tables, in either dining area. We made a check of the environment in the lounges on both floors there were numerous lounge chairs with dirty or stained seat cushions, arms and legs. Most of the chairs are not used, as most people sit in wheelchairs throughout the day. Many areas are in need of re-decoration, including some bedrooms as the walls are dirty and scuffed. The walls in the toilets and bathrooms needed redecorating as they were also dirty, stained and scuffed. In bedrooms and bathrooms we saw dirty skirting boards, paint was chipped, aged or stained. The flooring in several toilets and bathrooms were badly stained and needed cleaning or replacing. This did not promote good standards of hygiene. In the bathrooms there are walk in showers without any curtains around them, there were obscured windows but these did not have any blinds or curtains on them. This did not protect people’s dignity. In the upstairs lounge the walls were bare, there were no pictures or ornaments to make the area look homely. The room needed cleaning, as there was food debris on the coffee tables/floor. Many of the chairs were damaged and stained. This did not provide a homely environment for people. A fire door on the ground floor was obstructed by a mobile hoist machine. This practice can place people at risk. The staff were asked to remove this immediately. All of these issues in the environment were brought up at the last key inspection and none had been addressed. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 22 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): Standard 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. Some people, who live at the home and their relatives, are satisfied with the home’s staff. However, others told us that people were not always supported appropriately. The homes staff deployment, recruitment and supervision practices do not protect and promote peoples welfare. Some staff training has been completed since the new manager took over. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The surveys completed by relatives and people who lived in the home showed that most people said they received the care and support they needed either ‘always’ or ‘usually’. One person said, “I’m quite comfortable”, at the home. Another said “the staff are good to me”. A significant number of other people and their relatives said they only, ‘sometimes’ received adequate care and support from staff. One relatives said of the staff, “Certain members of staff have difficulty in realising that all the residents are there for care and nursing. My Mother has problems at times getting attention immediately when she needs toilet attention” Staff attitudes was an area of concern raised by the OPRT and the expert by experience on behalf of people who lived at the home. The OPRT said that they had concerns that staff had shown “disrespect for residents”, in that “concerns had been raised by residents and their families that they had to wait an unreasonable amount of time to be taken to the toilet. And in some cases Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 23 people were told they would have to wait until staff had finished their breaks or until lunch was over before they were free to attend to them”. This is not acceptable or respectful of people’s dignity. The expert by experience observed a member of staff ‘tut’, when a person asked to be taken to use the toilet. She went on to say she observed ‘favouritism’, where staff would support some people with drinks and meals even though they were capable of completing the task independently, whilst other people appeared to be ‘left to get on with it’ even though it was apparent they needed support. One person said she was, ‘fuming’ that a carer the day before had spent 3 hours watching tea time ‘rubbish’ on the television. This lady was very articulate and stressed that they should have been helping with teas, baths, showers and ‘hands on’ personal care of people. This information was passed on to the manager to address as a priority. One relative said via a survey, “some staff are excellent. But some would appear to have forgotten why people like my Mother are in a nursing home”. It was observed that none of the staff wore name badges, this is poor practice and should be addressed to ensure people know who they are speaking to. There were adequate numbers of staff on duty to meet people’s needs. There were two qualified nurses and six carers to meet the needs of 27 people at the home. This met the minimum staffing requirement at the home. An issue, which was brought to our attention by the manager, was that none of the qualified nurses worked more than two days at the home. This was given as a cause for concern and identified by them, as one reason the home was not functioning adequately. He said that the qualified nurses did not have appropriate accountability or ownership over the way the home ran and for this reason standards had slipped. Because of this a requirement to review the present system has been made in this report. A requirement made at the last inspection to review the deployment of staff at the home. This had not been carried out. Therefore people who lived on the first floor of the home, who had higher dependency needs in general, were still not being offered adequate levels of support at all times. For example at lunchtimes. This did not meet people’s needs. The manager said that the percentage of care staff who have NVQ2 care award was 20 , he said that eleven care staff had recently been enrolled on to the award scheme. This is good practice and shows a commitment to improving the skill levels of the staff team. There was also evidence to show that most staff had recently completed fire safety and health and safety training. However, the staff training records given to us showed that mandatory annual Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 24 training for staff was out of date in the some areas including food hygiene and moving and handling. The inspector checked three staff recruitment files, there was one file which contained all of the information required, however of the other two the following information was missing; no evidence that a CRB check had been completed on one file, no written verification as to why in previous employment the person had ceased working with vulnerable adults, another had a reference which stated the referee would not reemploy due to CRB check and this had not been followed up. There was no health statements and full employment histories had not been sought. These practices place people at risk. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 37 and 38. People who use the service experience poor quality outcomes in this area. This service has a new manager who has tried to make some improvements over the last three months, however, at present people are living in a home where the staff do not offer them all adequate standards of care and support. Overall, the record keeping procedures were extremely poor; some records were not available for inspection. Some of the homes working practices/policies and quality assurance practices do not protect and promote people’s safety and welfare. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A new manager was appointed to run the service in August 2007. Hassan Jeeto is a qualified and experienced manager. There was evidence that he has started to address some of the issues at the service but far more needs to be done. The manager has applied to become the registered manager and his application is presently being processed. Stable management at the home Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 26 should help to promote peoples welfare. One relative said “ since the new manager started work, I have noticed that residents appear to look more comfortable and staff look happier”. At present people are not fully benefiting from the ethos, leadership and management of the home. The home’s owners are presently in negotiations to sell the home. This has left the new manger and the staff in a kind of ‘limbo’ as they are uncertain of their future and the present owners are reluctant to make significant changes within the home. This does not promote a good atmosphere in the home and leads to poor staff morale. The manager is struggling to communicate a clear sense of direction and leadership to staff because, all of the nursing staff are part time and therefore there is no consistency or ownership over line managing the care staff team. This places peoples welfare at risk. The quality assurance system, (via Regulation 26 or owners monthly reports) is not effective at monitoring standards as it does not identify problems within the service. It needs to be reviewed. The people who live at the home are not supported to offer their views of the service and the areas they would like to see changed or improved. This does not respect peoples rights. Some staff told us they have recently had one supervision session with a nurse, there was no written evidence available for inspection that records of the supervisions had been kept. This practice does not support staff appropriately or enable management to have clear lines of accountability. Record keeping in the home was overall very poor. We found numerous documents in the office, which were out of date and the manager struggled to find other information. This issue has been highlighted in previous reports and has still not been addressed. This situation hinders the effective and efficient running of the service. Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 X X x 1 1 Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (2) (b) Requirement Information within all care plans must be reviewed and updated. The plans must reflect each person’s current personal care, health and social care needs. (Previous timescale of 01.08.06, 01/10/06 and 31/03/07, 14/6/07 not met). Medication policy, procedures and practices must be reviewed. As appropriate nursing staff must be informed of the new policy, procedures and practices they must adhere to ensure peoples health and welfare. Staff must be instructed that people must be treated with respect and their dignity must be protected at all times. Therefore they must meet people’s continence and other needs as appropriate. Staff must be better deployed at meal times to meet individual’s needs to eat their meal in a congenial setting at a flexible time of their choosing. A record of all complaints made to the home must be made DS0000021804.V349833.R01.S.doc Timescale for action 31/12/07 2 OP9 13 (2 ) 28/10/07 3 OP10 12 (4) (a) 31/10/07 4 OP15 18 (1) (a) 30/11/07 5 OP16 22 (8) 30/11/07 Scarsdale Grange Nursing Home Version 5.2 Page 29 6 OP18 12 (1) (a) 13 (8) available for inspection to protect people’s welfare. The use of aids such as bed sides 30/11/07 and lap belts must only be used to protect people from harm and after a thorough assessment of their needs has been carried out and agreed by appropriate parties. Therefore all people for whom these aids are used must have their needs reassessed to protect their health and welfare. People who presently use wheelchairs must have their needs reassessed at their next care plan review, to ensure peoples needs are being met. The allegations of poor care practices at the home must be investigated via the local adult protection procedures. Any action the home is told to take must be adhered to within the timescales laid down. All areas of the home must be kept clean and well maintained therefore: Communal areas must be checked and action taken to ensure the home is well decorated and homely. Staffing levels must be reviewed to ensure that those people with high dependency levels can be met at all times. All staff employed at the home must undertake a CRB check at the correct level. (Previous timescale of 01/10/06, 31.3.07 and 14/06/07 not met). All staff must undertake training in Health and Safety. (Previous timescales of, 01/03/05, 01/09/05, 31/03/06 and 01/08/06, 31/03/07 and 14/06/07 not met). An effective quality assurance and monitoring system must be DS0000021804.V349833.R01.S.doc 6 OP18 12 (6) 31/10/07 7 OP19 OP26 16 (2) (c)23 (2) (b) 31/12/07 8 OP27 OP28 18 (1) (a) 31/12/07 9 OP29 19 (1) (b) (i) 14/11/07 10 OP30 18 (1) (c) (i) 31/12/07 11 OP33 26 (1-4) 31/12/07 Page 30 Scarsdale Grange Nursing Home Version 5.2 12 OP37 17 (2) (3) 13 OP38 13 (6) put in place to ensure the home is meeting its aims and objectives to ensure peoples welfare. To protect peoples welfare and their rights, records must be kept up to date, secure, and at all times be available for inspection in the care home. To ensure peoples health, safety and welfare, all staff must be trained in fire safety, food hygiene and infection control. 31/12/07 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 Good Practice Recommendations The homes assessment tool should be reviewed to ensure it contains relevant information in order to meet peoples individual needs. The person identified must have their mental health needs assessed to ensure that the home can still meet their needs. Up to date information about activities should be circulated to all service users in formats to suit their capabilities. OP8 OP12 Scarsdale Grange Nursing Home DS0000021804.V349833.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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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