Key inspection report CARE HOMES FOR OLDER PEOPLE
Solent Grange Staplers Road Wootton Isle of Wight PO33 4RW Lead Inspector
Janet Ktomi Key Unannounced Inspection 23rd November 2009 09:00
DS0000068218.V378241.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Solent Grange DS0000068218.V378241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Solent Grange Address Staplers Road Wootton Isle of Wight PO33 4RW 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) 01983 882382 solent@lrh-homes.com www.lrh-homes.com London Residential Healthcare Ltd Post vacant Care Home with Nursing 91 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Solent Grange DS0000068218.V378241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 91. Date of last inspection 23rd June 2008 Brief Description of the Service: Solent Grange is a registered residential home providing nursing or residential care and accommodation for up to ninety-one older people who may or may not have dementia. Solent Grange is located in an extended older property in a rural location yet within a short bus ride or car journey from the town of Newport. The majority of bedrooms are for single occupation. All bedrooms in the new extension completed in 2008 have en suite facilities as do some in the original building. The home is owned by London Residential Healthcare Ltd and at the time of this unannounced inspection did not have a registered manager. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use the service experience poor quality outcomes. The home was previously inspected in June 2008 and had an Annual service review (ASR) in June 2009. This report contains information gained since the previously inspection and during an unannounced visit to the home undertaken on the 23 November 2009. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by two inspectors and lasted approximately nine hours commencing at 9.00 am and being completed at 6.15 pm. The inspectors were able to spend time with the manager and staff on duty. The inspectors were provided with free access to all areas of the home, documentation requested and people who live at the home. The previous registered manager completed the homes Annual Quality Assurance Assessment (AQAA) prior to the ASR in June 2009 and information from this is included in this report. Information was also gained from the homes service file containing notifications of incidents in the home. Since the previous inspection in June 2008 thee have been several safeguarding investigations into the home carried out by the Isle of Wight Social services safeguarding team. At the time of this key inspection a further safeguarding investigation was being carried out. Information from safeguarding reports is also considered as part of this inspection. What the service does well:
We observed interactions between staff and service users to be warm, friendly and positive. What has improved since the last inspection?
There were no requirements made following the previous inspection in June 2008. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.2 Page 6 What they could do better:
Requirements are made following this inspection visit. Care plans and risk assessments were inadequate to inform care and ensure that people’s needs would be met and they would be safe. The responsible person is required to ensure that care plans and risk assessments contain accurate detailed information as to how an individuals needs are to be met and demonstrate that the persons views, or those of their relatives have been taken into account when formulating and reviewing care plans. There was evidence that people’s needs were not being met. The responsible person must ensure that people receive the care they require to ensure that they are safe. We observed institutional and task orientated practises and occasions where people’s privacy and dignity was not maintained. The responsible person must ensure that all institutional and task orientated practices are discontinued and that the home ensures that people’s privacy and dignity is maintained at all times. This is required to ensure that people are treated as individuals and that their privacy and dignity is respected and maintained. We found that medication was not being correctly administered as per the doctor’s prescriptions. A requirement is made that the home must ensure that medication is administered as prescribed by the person’s GP. That full and accurate records are maintained and that guidelines are in place for as required medication. The home must also ensure that its medication procedures ensure that people are not placed at risk of infection. This is required to ensure that people are safe and not harmed. We found that there were limited activities and no safe outdoor area or garden. A requirement is made that the responsible person must ensure that activities suitable for all people in the home are provided on a daily basis. The home must ensure that people are able to access safe outdoor spaces and fresh air as they wish. This is required to ensure that people receive physical and mental stimulation and do not become bored or depressed. One section of the home had no equipment to keep meals hot therefore people who had to wait for staff assistance would receive cold food. There are also food hygiene risks associated with people receiving meals that have not been kept hot. A requirement is made that the responsible person must ensure that people receive their meals hot. A requirement is made that the home must have a clear policy and procedure for the receiving, recording and responding to complaints that ensures the confidentiality of service users and complainants and ensures that complaints are responded to in a timely and satisfactory manner.
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DS0000068218.V378241.R01.S.doc Version 5.2 Page 7 Staff were not all aware of safeguarding and reporting procedures. A requirement is made that all staff must receive additional safeguarding training to ensure that they are able to recognise abuse and know what action they should take in the event of their having safeguarding concerns. This is required to ensure that people are protected from abuse. We identified parts of the home and practises within the home that were unsafe for people. A requirement is made that the responsible person must be safe for the people who live there. Infection control procedures must be robust and used. Items hazardous to health and dangerous areas must be secured. This is required so that people are safe. We identified that staff have commenced working in the home before two written references had been received confirming that they were suitable people to work with vulnerable adults. A requirement is made that the responsible person must ensure that staff must not commence employment at the home until all pre-employment checks have been completed and that the responsible person is satisfied that people are safe to work in the home. Staff had not all received an induction and did not all have the necessary training to ensure that they had the skills to meet people’s needs. The responsible person must ensure that staff have an induction and receive all the necessary training to provide them with the skills they need to meet people’s needs before they commence working with people. This is required to ensure that people’s needs are met and they are safe. The provider and responsible individual for the service were unaware of the concerns at the home and the systems in place to monitor the quality of the service had failed to address issues identified by the area manager and ensure that people receive a good service. A requirement is made that the responsible person must ensure that there are systems in place to monitor the quality of service provided and to ensure that action is taken to ensure that people receive a good service and are not at risk. We identified that staff do not receive supervision. A requirement is made that staff must receive formal supervision that is recorded at least every two months. This is required to ensure that people are safe. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 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 Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate pre-admission assessment procedures however whilst the staff who complete assessments for the residential side have received training for this the person who will be completing assessments for nursing people has not undertaken training to complete pre-admission assessments so was not equipped with the skills to ensure that the service could meet people’s needs. Whilst people living in the residential part of the home would appear to have most of their needs met there is no evidence that people living within the nursing section of the home are having all their needs met and are therefore at risk. Standard 6 is not applicable as the home does not provide intermediate care.
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 11 EVIDENCE: As a result of the ongoing safeguarding investigation the Isle of Wight social services and health trust had suspended admissions to the home initially into the nursing section and subsequently to the whole home. Following further concerns being brought to the attention of the commission the week before the inspection visit the Responsible Individual for the home was asked by the commission to voluntarily agree to a hold on all admissions to the home. The Responsible individual agreed to this and a letter was received during the inspection confirming this. The manager explained the admission procedure that would be used and the preadmission assessments for two people admitted most recently to the homes residential side were viewed. The inspectors discussed admissions with nursing and care staff. Due to age related memory loss it was not possible to discuss the admission process with the people who live at the home but one visitor was asked about the admission procedure used when her relative was admitted about five months before the inspection. The manager stated that for the residential service users the deputy manager would undertake pre-admission assessments and that for nursing admissions that the chief nurse would undertake pre-admission assessments. We spoke with the deputy manager who confirmed the process that would be used for residential service users and showed us the two most recently admitted peoples pre-admission assessments. The assessment forms cover all the relevant areas necessary to determine the person’s needs and enable the home to decide if it can meet those needs. The completed assessments were viewed. One contained very detailed information and relatives had also been involved in the assessment. The second contained less information but sufficient to determine that the home would be able to meet the persons needs. The deputy manager stated that people or their relatives were invited to visit the home to view the facilities and select a room from those available. A visitor to the residential section confirmed that the deputy manager had visited their relative prior to admission to undertake an assessment and also that they had been able to visit the home and chosen the room from those available. We also spoke with the person who would be completing the pre-admission assessments for people admitted to the nursing wing of the home. The person had not completed any assessments and was not clear about the procedures that would be used. The person stated that they had not received any training in respect of pre-admission assessments and had not had any opportunities to shadow with admissions to the residential part of the home.
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 12 The safeguarding team identified that one person must remain in bed as the home did not have the necessary chair for them. This should have been identified prior to admission and the home should not have admitted anyone whose needs it could not meet or for whom it did not have all the necessary equipment. Information viewed during the inspection including care plans and medication management procedures as well as observations during the inspection could not demonstrate that once admitted people have all their needs met. Information in respect of this is detailed in the next section of this report. In addition the manager could not demonstrate that staff have received all the mandatory and service specific training and are not receiving supervision. The safeguarding investigation centre’s around a concern that people are at risk of not having their needs met in a safe way. The home does not provide dedicated accommodation for intermediate care or specialised facilities for rehabilitation therefore standard 6 is not applicable. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although everyone has a care plan and risk assessments there were inconsistencies in these and a lack of recording meant that it was not possible to determine if people’s health and personal care needs are being met placing people at risk. Equipment in the nursing section of the home was not being used correctly placing people at risk of harm. Medication was not being administered as prescribed by the person’s GP and records in respect of medication had not been fully maintained placing people at risk of harm. Some task orientated and institutional practices were observed in the nursing section of the home and people’s dignity was not always maintained. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 14 EVIDENCE: Four care plans were viewed, two for people admitted to the nursing section of the home and two for people in the residential section of the home. The inspector discussed with staff, visitors and people who live at the home how care needs are met. The inspectors spent time around the home and observed support provided to people in communal areas. The home’s medication administration systems were viewed in the nursing section and records relating to medication in the residential section and part of a medication round in the residential section were also viewed. The home uses different care plan and care recording systems in the nursing and residential sections of the home. The two care plans viewed in the nursing section of the home contained sections covering different aspects of health and personal care however there were inconsistencies between the sections and with the daily recordings. One care plan stated that a person should have a continence management system in use at night and pads during the day. A record completed by a night staff member noted that the home did not have any of the continence management system that should be used at night and that more was required. We asked the chief nurse about this and were informed that the home had run out and more would be arriving two days after the inspection. We were informed that due to an additional medical problem that pads were now more appropriate. There was no information in the care plan to confirm this or that the person’s care needs had changed. Medication prescribed on the medication administration sheet would confirm the statement about the person’s new medical condition. The same care plan stated in one section that the person was to have thickened fluids and the night care plan stated that the person should be given an evening drink but did not state that this should be thickened. One person’s care plan stated that their blood sugar levels should be checked on a Monday and Thursday. There was no further information as to what time or how many times each day this should be done. The recording form showed that on some occasions this was done once a day and on other days three times. When we asked the person in charge of the nursing section they agreed that it was not clear but were themselves unsure how often this should be done. Care plans contained assessments of the person’s risk of developing a pressure injury and stated that pressure mattresses should be used as part of the risk management plan. We visited people’s bedrooms and observed that pressure mattresses were in place however they were all set on high and cornered sheets were in use. We asked the person in charge of the nursing section about the pressure mattresses and cornered sheets. The person in charge appeared aware that the mattresses should be set according to the person’s
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 15 weight and turned one down to about half setting. When asked if that was correct for the person’s weight they stated they thought so. They also stated that they were aware that cornered sheets should not be use as they interfered with the working of the pressure mattresses. We asked if the operating instructions for the pressure mattresses were available so we could check the setting. The person stated they were not sure where the instruction manuals with the setting guidelines were. We returned to the nursing area several hours later in the inspection and no action had been taken to change the cornered sheets for loose sheets. The care plans also contained statements such as the person should see the chiropodist ‘periodically’ and another that the person should see the chiropodist ‘six monthly’. Care records indicated that they were seeing the chiropodist six weekly. Another care plan stated ‘use appropriate pads’ without specifying which ones were appropriate for the person. Daily recordings were completed onto pre-printed sheets and provided limited space for staff to record care provided. Daily records were also missing for some days and others contained limited information. Similar concerns in respect of care plans and daily recordings were noted by the Isle of Wight safeguarding team when they visited the home prior to the key inspection. Inconsistent and inaccurate or vague information on care plans places people at risk that their needs will not be met and people will be at risk. Care plans contained some negative terminology such as ‘cot sides’ when the term ‘bed rails’ is more appropriate for adults. We also viewed two care plans in the residential section of the home. These were formatted differently and were overall of a better quality providing more individual information about the person. One care plan contained information as to how a person should be supported who may present inappropriate behavior. The plan noted that the person disliked mornings and provided staff with some strategies to relax the person and gain their cooperation with personal care such as singing to them or to leave and return later. However one daily log stated that it had taken four staff to get the person washed and dressed due to their behavior. It was not clear how the behavior management plans had been followed on this occasion or why four staff had been required. Within all care plans viewed it was not clear how people whose plan it was or their relatives had been involved in the formation or reviews of care plans. A requirement is made that the home must ensure that care plans and risk assessments contain accurate information as to how a person’s individual needs are to be met and demonstrate that the person’s views have been taken into account when formulating and reviewing care plans. The home must also
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 16 be able to evidence that care needs have been met and that equipment in use has been used correctly and staff are aware of how equipment should be used. Within the residential section of the home we noted daily record charts for people who require monitoring of their food and fluid intake. On the afternoon of the inspection visit these had not been recorded in the morning and only the lunchtime meal was recorded. Previous days recordings were also incomplete. Within the nursing section of the home we observed recording sheets for fluids and changes of position. These appeared to be more fully completed and stated if the person had refused fluids. We were concerned that one person had been left with milk shake in a hot room with no indication as to what time this had been made and placed there. Around the home, both the nursing and residential, we observed many tubs of fluid thickener some with names and some without. None had a date when they were opened and there was no additional information as to how thick individual people’s fluids should be other than in one care plan viewed. During the inspection visit we observed several instances of institution and task orientated care practises. This included that in all lounges televisions were on set to morning tv and in one instance to a tv programme aimed primarily at teenage girls. We asked some people if they were watching the television and they stated no. Another task oriented practise was observed in the nursing lounge when everyone was given their lunch time meal sat in their lounge chair, although the lounge did have dining tables. Bibs were placed around everyone’s necks even those who were not to receive their meal until staff had finished feeding other people. We asked the person in charge of the nursing section about this and they stated that was what they did. Bedroom doors in the new section of the home are fitted with automatic door closures however this meant that doors can only be wide open or shut and not half way. The positioning of the beds in the rooms and the leaving of doors wide open means that anyone walking past can see fully into some rooms and observe people in bed. Whilst viewing the home we directed the manager’s attention to a service user who was in bed with the door wide open and had pushed down the bedcovering exposing their lower body. The manager adjusted the bedcovering to protect the person’s modesty however when we later returned to this section of the home the same situation was observed. In both parts of the home we noted that continence products were stored in people’s bedrooms on tops of wardrobes and not placed out of sight. This compromises the person’s dignity. A requirement is made that the home must ensure that people’s right to privacy and dignity is maintained and all institutional and task orientated care practices must cease. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 17 We looked at how the home manages medication. We noted that at 11.15 am a medication round was being carried out in the ground floor of the new residential part of the home. We asked the manager about this and they were not sure what medications were being administered. We asked the staff doing the medications and they stated that this was the 8am morning’s medications and that they had started at 8.30am. When asked why it took so long they stated that they had two floors to do. Some people would therefore only be receiving their morning medication late in the morning and there is a risk that any who were receiving regular pain medication would have spent the morning in pain. Many medications are prescribed to be given several times per day and if people receive their morning medication late then there may be an insufficient gap before they are given their next dose placing people at risk of overdose. We looked at some medication administration sheets for people in the residential part of the home and these had been well completed with only one gap. Action as requested by a consultant to change a person’s medication had been followed. In many bedrooms around the residential and nursing section of the home we found tubes and tubs of creams that were in use. Most had a person’s name on them but none had a date when the tube or a tub had been opened. This places people at risk as once opened creams especially those in tub can become infection risks and should not be used for more than one month after opening. We looked in detail at the medication arrangements in the nursing section of the home. Several weeks prior to the inspection there was a medication error when one person was administered another person’s medication. The local safeguarding team and the commission were not notified about this and the safeguarding team identified this during a visit to the home. The nursing section of the home has a treatment room containing appropriate storage facilities for medications. This is air conditioned however this was not operating when we visited and the room was hot. The nursing section does not have a medications trolley and we were informed that one was on order. The medication administration records were viewed and these contained many gaps where it was not recorded if medication had been administered or not. One person was prescribed a cream to be applied two to three times per day to treat an infection. This had not been applied as prescribed with most days not being applied in the morning. We asked about this and were informed that the night staff get the person washed and dressed and that therefore it was not possible to apply the cream in the morning. It was also not clear from the care plan if it was the person’s wish that they are washed and dressed early by night staff every morning. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 18 We also noted that one medication was prescribed to be given as required and that half or one tablet could be given. There was no record as to whether a half or one had been given or any guidelines to staff as to when to give the medication and how to decide if half or one tablet should be given. We looked at the arrangements for the storage of controlled medications. Theses were appropriate however we noted that used analgesic patches that had been removed from a person had been returned to the storage cupboard and left unsealed adjacent to other people’s oral medication. This is an infection risk. Controlled medication must be disposed of according to good practice guidelines. The home has a fridge to keep medication that must be kept at cooler temperatures. This has a thermometer and the nurses had been recording the fridge temperatures. They had however been recording 0.2, 0.4 etc when the fridge was showing 02. If the fridge was in fact 0.2 then this would mean that medication inside had been frozen and would have been damaged and require replacing. Nurses would appear to have been recording the temperatures without being aware of what they were recording and those in charge of the home and nursing section had not addressed this either. Also noted in the nursing section were stocks of food supplements that had been prescribed for a named person. This was no longer on the medication administration record for this person and we were informed that the person was no longer prescribed this. The supplements should therefore have been discarded as no longer in use. A requirement is made that the home must ensure that medication is administered as prescribed by the person’s GP. Full and accurate records must be maintained and that guidelines are in place for as required medication. The home must also ensure that its medication procedures ensure that people are not placed at risk of infection. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Examples of institutional and task orientated practises were observed in parts of the home. Although the home has an activities coordinator there was little evidence of activities at the home placing people at risk of mental and physical deterioration. People have limited opportunities to go outside as there is no safe garden or outside areas. People were positive about their meals however those in the nursing section may receive cold unappetising meals and be reluctant to eat adequately as there is no system or equipment in place to keep food hot until staff are available to help people. Visitors are able to visit at any reasonable time however private space for visiting is limited and people may be deterred from visiting due to limited parking availability. EVIDENCE: Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 20 Information from care plans, discussions with staff, the manager and visitors is considered. We observed how people living at the home spent their day and observed people having lunch and evening meals in both the residential and nursing sections of the home. We spoke with several people visiting relatives on the day of the inspection. Information from social services safeguarding is also considered. Care plans in the nursing section of the home contained limited information about peoples social and leisure interests. What was available was general and it was not clear how interests were supported by the home. An example being one care plan stated that the person liked music. The person’s bedroom contained numerous CD’s and music playing equipment however the person was noted to spend the whole day of the inspection in the homes lounge with the television on. It was not clear from the care plan how the person would request to go to their room to listen to music or if at specific time of day staff should suggest this and support the person to listen to music. Some people in the nursing part of the home remained in their beds due to their health needs. There was little information in care plans as to how they should be supported with activities. People were noted to be alone in their rooms without televisions or music to stimulate or entertain them. In all the homes lounges televisions were noted to be on throughout the inspection. At the start of the inspection most were showing the same morning TV with one showing a programme usually aimed at teenagers. Throughout the day televisions seemed to show whatever was on the channel that had been selected in the morning. Nobody appeared to be watching the televisions. One television had very poor reception making the screen flicker and this could have triggered a seizure should anyone suffering from photophobic epilepsy be in the room and for other people would be most unpleasant to watch. We asked people in some of the lounges if they were watching tv and they stated no. We were informed that the home has an activities coordinator and that activities are arranged. On the day of the inspection visit the activities person was not working. The home is registered to accommodate up to ninety-one people and it is not clear how one activities person could provide group and individual activities for that number of people on a daily basis. Daily records in care plans viewed in both residential and the nursing section of the home contained very little, if any, information about activities people had engaged in and how they had spent their day. We were informed by the manager that the activities person maintained their own records and kept these in their office. We were unable to view these however all records relating to people should be kept together. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 21 The home does not have a garden or access to a safe outside place where people could enjoy fresh air or a walk. A requirement is made that the responsible person must ensure that activities suitable for all people in the home are provided on a daily basis. The home must ensure that people are able to access safe outdoor spaces and fresh air as they wish. As stated in the previous section of this report some examples on institutional and task orientated care practises were noted. There was information that one person was washed and dressed by night staff every day but no information as to whether this was their choice or request to get up early every morning or if they were given a choice on a daily basis. It was not possible to discuss this with the person. The safeguarding team identified that one person was confined to bed as the home did not have the correct seating available for the person. This should have been identified before the person moved into the home and the home should not have admitted a person for whom they did not have all the necessary equipment to meet their needs. The safeguarding team also identified that the week prior to the inspection visit that all people in the nursing section had been put to bed before 5.45 pm so that flowers could be painted on the lounge walls. We were able to speak with several people who were visiting relatives on the day of the inspection. Their main concern was in connection with parking at the home and that when elderly people visit the home they are unable to park near the home and this can cause problems. People stated that when they visit they sit either in the main lounges with their relative or in their relatives bedroom. We observed the lunch time meal in both the nursing and residential parts of the home and the evening meal in the residential parts of the home. Whilst viewing the home at the start of the inspection we observed that some people had had breakfast in their bedrooms and still had dishes and drinks in front of them at 10am. Not all food and drink had been eaten/drunk. We noted food and fluid charts in the residential part of the home were not being fully completed. In the afternoon of the inspection visit these indicated that people had not received breakfast or any drinks until their lunch time meal. Records of fluids in the nursing section had been completed however this had not been the case when safeguarding had visited the nursing section the week prior to the inspection visit. We observed people having lunch in the nursing section. This part of the home has seven people and three staff. Two people are able to manage their own meals with supervision and the others require total assistance. Therefore some people must wait for their meals till others have finished. We observed that even though people would not get their meals until others had been assisted a bib had been placed round their necks and they sat and waited whilst others
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 22 had their meals. Two staff had taken meals to people in their rooms and one was in the lounge assisting one person and observing two people who were managing on their own. The nursing part of the home does not have any system or equipment to keep meals hot whilst people are waiting for staff to be available to assist them. Those who did not receive their meals first are therefore going to get cold food. The residential parts of the home have heated trolleys to keep food hot. We observed that people in the older part of the home receiving residential care had generally received their meals in the homes dining room with some having their meals elsewhere in lounges. Staff serve food from the heated trolley and therefore people are able to make choices about vegetables at the time of the meal. People stated that the food was good and all seemed to be eating and enjoying their meal. High sided plates were available to maximise independence for some people. Those requiring assistance appeared to be receiving it. We also observed people in the residential part of the home having their evening meal at approximately 5 pm. This was a lighter meal of sandwiches and crisps with cake for pudding. Again staff were able to serve the meal themselves from a trolley providing choice at the time the meal was served. There are food hygiene risks when people receive food that has not been kept at the correct temperature and people with poor appetites may be reluctant to eat cold meals. A requirement is made that people must receive meals at the correct temperature so that they are safe and that meals are an enjoyable occasion. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 an 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have the necessary systems in place for recording complaints or ensuring that action is taken to address issues raised by service users or their representatives. The home has failed to ensure that people are safe and have their needs met. EVIDENCE: We discussed complaints and safeguarding with the manager and viewed related records. We also talked to staff about safeguarding and visitors about complaints. Information included in other sections of this report including health and personal care, staffing and management are also considered in respect of safeguarding. The manager stated that if any complaints were received that they would investigate these and that the area manager would be involved in investigations depending on the nature of the complaint. We asked the manager if any complaints had been received since the previous inspection. The manager stated that since they had been managing the home (nine weeks) none had been received. We asked if there was a complaints log that may provide information about complaints prior to the new manager commencing at the home. We were shown the book that is kept on the front
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 24 desk and available for people and visitors to add compliments and complaints. We viewed this book. This contained a detailed complaint naming a specific service user that a relative had written. The information was available to anyone visiting the home and therefore the person’s confidentiality had not been maintained. We asked the manager what action had been taken to address the issues raised and they were unaware of the issues and no action would appear to have been taken to resolve the complaint. The recording of complaints in a book that can be viewed by all staff and any visitors does not ensure confidentiality and will deter people from complaining. Visitors did not identify any concerns other that the problems with car parking which one stated they had raised with staff but were not sure what if any action was being taken to rectify the problems. A requirement is made that the home must have a clear policy and procedure for the receiving, recording and responding to complaints that ensures the confidentiality of service users and complainants and ensures that complaints are responded to in a timely and satisfactory manner. The home has been the subject of several safeguarding investigations since the previous inspection. At the start of the inspection the manager stated that they felt that they had addressed all the safeguarding concerns. There were however further safeguarding issues identified during the inspection and the commission would have made a safeguarding referral following the inspection if the home was not already being investigated. The commission has discussed the concerns from this inspection with the safeguarding investigation team. We spoke with staff about safeguarding. Staff undertake safeguarding as part of their formal induction and should have been aware of safeguarding procedures. One staff member we spoke with had been working at the home three weeks and had not had any formal induction. They were unaware of safeguarding procedures and were unaware of how to report safeguarding outside the home. This staff member had also not undertaken any mandatory training since commencing working in the home and was daily in charge of a section of the home. We spoke with other staff who had been working at the home for longer periods of time. Not all were aware of safeguarding or reporting procedures. A requirement is made that all staff must receive additional safeguarding training to ensure that they are able to recognise abuse and know what action they should take in the event of their having safeguarding concerns. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has completed a large extension however despite this having been complete in excess of one year the home has not addressed issues such as parking and access to outdoor space. Staff at the home are unaware of how to use some equipment which has placed people at risk. Parts of the older building are in need of redecoration and carpets throughout the home appear dirty. EVIDENCE: We viewed the home with the manager towards the start of the inspection. All communal rooms and randomly selected bedrooms were viewed in all parts of the home. We also viewed bathrooms, WC’s, laundry and clinical areas.
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 26 Certificates relating to the safety and testing of services, equipment and fire detection systems were viewed. The home is situated in a rural location between the towns of Newport and Ryde. A main bus route runs past the home. One year prior to this inspection a large extension to the home was completed. This has increased the home from a forty bedded home to ninety-one beds. All bedrooms in the new section are spacious with en suite facilities of shower, WC and washbasin. The new section of the home has assisted bathrooms and communal rooms appropriate for the number of people in each area. The new extension covers three floors, ground, first and second with a shaft lift providing access to all floors. The extension is linked to the original home on the ground and first floors via a secure entry system. The original home has a dining room and two lounges and provides predominately single rooms although some could be used as twin if required. There are two shaft lifts in the older part of the home. The manager showed us round the home. Parts of the older building are in need of redecoration and some areas and rooms felt cold. The manager stated that there had been problems with the boilers serving some of the older section of the home and that action was being taken to address this. The manager also stated that there were plans to redecorate parts of the older section of the home. Carpets in corridors had been replaced following the completion of building work however despite this being only one year they were looking stained and dirty. The manager stated that the home had two carpet cleaners however they were not sufficiently robust to meet the needs of the home and failed to leave carpets looking clean. Despite being in need of redecoration the older section of the home felt friendly and homely and people had choice about which lounge they sat in with others choosing to sit in the large hall below the main stairs. The new section of the home was also viewed and although generally this was decorated to a higher standard parts were already showing signs of wear and tear through daily use. Again carpets in the new section were stained and dirty. The laundry room is situated on the ground floor in the older part of the home. We were informed by staff that this operates all day and night. The machines are commercial standard and appropriate for the needs of the home. The home employs laundry staff and we observed a laundry worker placing clothing into the washing machine not wearing protective gloves. We asked if these were supplied and were informed that yes they are supplied with gloves but that they did not use them. This represents an infection risk as the person may touch clean items with hands contaminated by soiled and used clothing. As stated the laundry operates all day and night and throughout the inspection the door to the laundry was seen to be open with noise from the machines audible in the corridor outside. We were informed that the door is kept open as
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 27 the laundry gets hot. Opposite the laundry is an occupied bedroom. The person using this room would not be able to avoid the sound of the laundry equipment and is at risk of having disturbed sleep or daytime rest periods. Once clean clothing is returned to the owner’s room and towels and bed linen to laundry cupboards around the home. We viewed some laundry cupboards and noted that there were insufficient shelves so that clean laundry is stored on the floors of these cupboards. Around the home in bathrooms and WC’s we saw a number of bins for contaminated waste that did not have lids or where the lids were broken. People with dementia may try to retrieve items from these bins placing them selves at risk of infection. Bedrooms in the new section all have en suite facilities. We noted that the washbasins had been fitted in such a way that they are too high if someone were to need to sit at the wash basin to use it and that the filled in section under the wash basin would also prevent them getting close enough to the wash basin in a wheelchair or if not standing. This would prevent people maximising their independence and maintaining skills. Previous sections of the report have identified that staff were unaware of how to operate some equipment such as the pressure relieving mattresses and that a person had been admitted to the home when the home did not have the correct chair to meet their needs. We also noted one bathroom/WC near to the two lounges in the older person section of the home that had numerous continence pads left in the bath and around the room. This bathroom also had no paper hand towels, no toilet roll and had a fabric towel which is an infection risk. The hoist in this bathroom was dirty. We observed staff using a standaid the base of which was dirty in the new part of the home. Safety concerns were identified in the newer section of the home with sluices not locked, unlocked access to areas dangerous to service users such as one stating danger electric supply. Steradent tablets were stored in the same cupboard and urine testing equipment and a box of assorted false teeth and another of perhaps twenty pairs of glasses were found in another unlocked cupboard. All around the home we found substances hazardous to health including cleaning products and toiletries and sprays that were accessible to service users. These were removed during the inspection by the manager and therefore an immediate requirement was not issued. The home does not have adequate parking provision considering the size of the home, number of staff and visitors. Visitors described how sometimes there are cars parked all along the drive and this may impede emergency vehicles were they required at the home. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 28 The home does not have any outdoor space/garden that is safe and accessible for service users. Certificates were viewed for some of the homes equipment and services. These indicted that equipment should be safe. We also viewed records of weekly check of the homes fire detection and emergency equipment. This showed that the systems are checked weekly. A requirement is made that the home must be safe for the people who live there. Infection control procedures must be robust and used. Items hazardous to health and dangerous areas must be secured. The week prior to the inspection visit the commission became aware that the home was providing accommodation to staff within the empty rooms at the home. The responsible individual was contacted and informed that this was unacceptable and that staff would have to be found alternative accommodation. The responsible individual informed the commission by letter during the inspection to confirm that this would happen. Staff were informed on the day of the inspection visit that they would no longer be able to live in vacant rooms registered for residential care and moved that day to alternative accommodation. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now employs appropriate numbers of care staff although some are working excessive hours which may place them or service users at risk. Not all staff have received an induction or the necessary training to ensure they have the necessary skills to meet the needs of the people who live at the home and ensure that they are safe. The home could not evidence that all preemployment checks had been undertaken before staff commenced working in the home therefore people have been placed at risk. EVIDENCE: We viewed duty rotas, observed how staff are deployed in the home and what they were doing at various times of the inspection. Also considered are discussions with staff and visitors and records viewed relating to staff training and recruitment. In August 2009 concerns were raised and confirmed via a safeguarding investigation that the home had insufficient staff to met the needs of the people who live at the home. The manager stated that initially lots of agency staff had been used to cover staffing shortages but that new staff had been recruited and the home now had adequate staff. We viewed duty rotas and
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 30 these showed that some staff are working very long hours, some working up to sixty hours per week. It was not possible to fully determine the number of hours staff are working as duty rotas are separate for different parts of the home and staff may be rostered to work in different parts of the home ie an early shift in the older section and a late shift in the new section. There is a danger that if staff work very long hours they will make mistakes or have less energy to meet the needs of service users. Although staff files showed that they had signed to agree to work excessive hours it was not clear if this was a free choice or whether this was an expectation of the job. There is also a danger with staff working long hours that should they have leave for holiday or sickness that it is hard to cover the hours and the home will not have sufficient staff to ensure people are safe. We looked at the home’s recruitment procedures. We viewed five staff files for staff recently recruited to the home. Three of these did not have any references, although each did have evidence that a check had been made that the person was not listed as unsuitable to work with vulnerable adults (ISA vetting and baring list) and a criminal record check had been sought. The remaining two staff files evidenced that staff had commenced working in the home when only one reference had been received. They also had been checked against the list of unsuitable people and had a criminal records check applied for. Employing people to work in the home prior to the completion of all preemployment checks including two written references having been received places people at risk that unsuitable people may be working at the home. A requirement is made that the people must not commence employment at the home until all pre-employment checks have been completed and that the responsible person is satisfied that people are safe to work in the home. We asked the manager about induction and training of staff. The manager informed us that staff undertake a five day induction and then undertake shadow shifts until they are competent to work in the home. We were informed that the records for induction were held in the deputy manager’s office. We tried to find evidence of the inductions for the staff for whom the recruitment records had been viewed but were unable to locate these. We did note some induction records in other staff files. We were informed that the home’s training manager had left the homes employment in September 2009. That a senior staff member was due to take over the role of training manager however the home did not have sufficient senior staff to release the person from their night duties. We were informed that a training manager from one of the provider’s other homes had undertaken some induction training in October 2009. When speaking to a new employed nurse we were informed that they had not undertaken any induction and had two shadow shifts before working on their own. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 31 We were therefore unable to confirm that all staff receive an induction and a requirement is made that all staff must receive an induction covering all the skills and knowledge that they will require in order to safely meet the needs of the people who live at the home. We asked the manager about staff training and the manager pointed to a folder on his desk stating that he was reviewing the training that staff had completed and would then be able to produce a matrix and identify staff training needs. The manager was not able to provide evidence that all staff had undertaken all mandatory and service specific training. We looked in staff training files and there was evidence of some staff training in the form of certificates. We spoke with staff and they stated that training had been good until the training manager had left and that they had not received training since that time. A requirement is made that the home must have a training plan that shows what training each staff member has undertaken, when updates are due. All staff must undertake all mandatory training and any specific training relevant to the role they are to perform. This is required to ensure that staff have the necessary skills to meet peoples needs and ensure that they are safe. We asked for and were provided with information about the number of care staff who have a recognised qualification in care to at least NVQ level 2. We were informed that the home has fifty-six care staff of whom 15 are overseas nurses whose qualification is not recognised in the uk, and that 17 care staff have an NVQ to at least level 2 with three staff doing an NVQ level 2. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 32 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been adequately managed to protect the people who live there and ensure that they are not at risk. The home’s quality assurance procedures have failed to identify or take action to improve the service provided and ensure the safety of people who live at the home. EVIDENCE: Information from other sections of this report along with information from discussions with the manager and responsible person before and during the inspection are considered. Records relevant to the organisation and running to the home are also considered.
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 33 The home’s registered manager resigned in August 2009 and a new manager commenced in mid September 2009. The new manager has not yet commenced the registration process. The responsible individual for the company was contacted by the commission the week prior to the inspection visit following concerns being identified by the safeguarding team. The responsible individual stated that they had last visited the home in July 2009 and had been unaware of the safeguarding investigation in the summer or the ongoing safeguarding investigation. The responsible individual was also unaware that staff were living in registered rooms at the home. The manager was asked about the home’s quality assurance systems and how the provider monitors the quality of the service. The manager stated that there is an area manager who undertakes Regulation 26 visits on behalf of the provider. We asked for copies of these and were provided with one completed in September 2009. This was completed by the area manager and concluded that outcomes for people at the home were poor. We asked if there were other regulation 26 reports and what action the area manager had taken as a result of identifying poor outcomes for people. The manager was unable to provide any further regulation 26 reports or provide evidence of what action the area manager had completed on behalf of the provider to address issues identified in the September regulation 26 report. A requirement is made that the responsible person must ensure that there are systems in place to monitor the quality of service provided and to ensure that action is taken to ensure that people receive a good service and are not at risk. The responsible person will be asked to provide an improvement plan following this report to identify how the requirements made will be complied with and how they will ensure the safety of the people who live at the home. The home failed to inform the commission of a medication error that was identified by the safeguarding team. There may be other incidents that have not been reported. The commission asked the responsible person to agree to a voluntary hold on admissions and we have received written agreement to this. We looked at the arrangements in respect of peoples personal finances. The manager stated that the home does not charge extras for toiletries or refreshments for outings. Hairdressing and chiropody are charged additionally and we were shown how these are added to invoices such that they are itemised and it is clear to the person paying the bill how much and for what they are being charged. The manager stated that nobody connected to the home is appointee for any service users. The manager also stated that there are some small sums of money held in the homes safe that have been given to
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DS0000068218.V378241.R01.S.doc Version 5.3 Page 34 the staff by relatives for service users. The manager was not sure what the money was for as extras would be added to invoices as described above. It is recommended that the manager write to the people responsible for the person’s money and inform them that extras will be added to invoices and that it is not necessary for the home to hold money for these items. We asked the manager about staff supervision. The manager stated that this was not yet occurring however he had planned to provide training for senior staff the week of the inspection visit so that they would be able to provide supervision via a cascade system. We spoke to staff about supervision. They confirmed that they were not receiving supervision. A requirement is made that the home must ensure that staff receive formal supervision that is recorded and occurs at least six times per year (every 2 months). During the inspection we viewed a range of records relating to care, staff and the organisation of the home. These have been described in more detail in the relevant section of this report. Records were not all stored securely to ensure the confidentiality of information. Records had not been fully completed others were not available. Various concerns in respect of health and safety have been identified in previous sections of this report. The more significant of these include the failure to ensure that substances hazardous to health are stored securely, infection control issues and that staff have not all had mandatory training and are aware of how to use equipment required by service users. The home cannot ensure the safety of people living there. Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 35 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 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 2 X 2 X X X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 1 2 1 Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 36 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that, after consultation with the service user or their representative, that a written plan as to how the service users needs in respect of health and welfare are to be met is prepared. This must be kept under review to ensure it clearly states how the person’s health and personal care needs will be met. This is required to ensure that people’s needs are met and they are safe. The registered person must ensure that people’s health and personal care needs are being met. This is required to ensure that people’s needs are being met and they are safe The responsible person must ensure that medication is administered as prescribed by the persons GP. That full and accurate records are maintained and that guidelines are in place
DS0000068218.V378241.R01.S.doc Timescale for action 01/02/10 2 OP8 12 01/01/10 3. OP9 13 01/01/10 Solent Grange Version 5.3 Page 37 for as required medication. This is required to ensure that people receive their medication safely. The responsible person must 01/01/10 ensure that all institutional and task orientated practices are discontinued and that the home ensures that peoples privacy and dignity is maintained at all times. This is required to ensure that people are treated as individuals and that their privacy and dignity is respected and maintained. The responsible person must ensure that activities suitable for all people in the home are provided on a daily basis. The home must ensure that people are able to access safe outdoor spaces and fresh air as they wish. This is required to ensure that people receive mental and physical stimulation and do not become bored or depressed. 6. OP15 16 The responsible person must ensure that people receive their meals at a suitable temperature. This is required to ensure that people enjoy and eat their meals and that they are safe to eat. The responsible person must ensure that the home has a clear policy and procedure for the receiving, recording and responding to complaints that ensures the confidentiality of service users and complainants and ensures that complaints are responded to in a timely and satisfactory manner.
DS0000068218.V378241.R01.S.doc 4. OP10 12 5. OP12 16 01/02/10 25/12/09 7. OP16 22 01/02/10 Solent Grange Version 5.3 Page 38 This will ensure that people feel able to raise concerns and that action is taken to respond to complaints. 8. OP18 13 The responsible person must ensure that all staff receive additional safeguarding training to ensure that they are able to recognise abuse and know what action they should take in the event of their having safeguarding concerns. This is required to ensure that people are safe from abuse. 9. OP19 13 The responsible person must ensure that the home must be safe for the people who live there. Infection control procedures must be robust and used. Items hazardous to health and dangerous areas must be secured. This is required so that people are safe. 10 OP29 19 The responsible person must ensure that staff do not commence employment at the home until all pre-employment checks have been completed and that the responsible person is satisfied that people are safe to work in the home. This is required to ensure that people are cared for by people who have been through a recruitment process that ensures that they are suitable to do so. 11. OP30 18 The responsible person must ensure that staff have an induction and receive all the
DS0000068218.V378241.R01.S.doc 01/02/10 01/01/10 01/01/10 01/02/10 Solent Grange Version 5.3 Page 39 necessary training to provide them with the skills they need to meet people’s needs before they commence working with people. This is required to ensure that people’s needs are met and they are cared for by suitably qualified staff. 12. OP33 26 The responsible person must ensure that there are systems in place to monitor the quality of service provided and to ensure that action is taken to ensure that people receive a good service and are not at risk. This is required to ensure that people are not at risk. 13. OP36 18 The responsible person must ensure that staff receive formal supervision that is recorded at least every two months. This is required to ensure that people are safe. 01/02/10 01/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Solent Grange DS0000068218.V378241.R01.S.doc Version 5.3 Page 40 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
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