Inspection on 13/03/08 for The Grange

This inspection was carried out on 13th March 2008.

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

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

The Grange 29/08/08

The Grange 21/12/06

The Grange 06/02/06

The Grange 23/08/05

The Grange 10/11/04

The Grange 18/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Grange Grange Close, Manor Road Goring On Thames Oxfordshire RG8 9DY Lead Inspector Kate Harrison Key Unannounced Inspection 11:20 13th March 2008 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 The Grange DS0000013090.V359700.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. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address Grange Close, Manor Road Goring On Thames Oxfordshire RG8 9DY 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) 01491 872853 01491 873397 The Grange Limited Mrs Susan Lewis Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition 1 The four rooms for double occupancy must be identified to CSCI by number and used for the purpose of accommodating married couples as stated in the application dated 20 September 2004. 21st December 2006 Date of last inspection Brief Description of the Service: The Grange is a residential home registered for 42 older persons who require personal care and accommodation. The home is privately owned and is situated in a quiet residential area in the village of Goring. The accommodation is a large Victorian house that has been altered and adapted for its purpose but also retains many of the features of a family home built over 100 years ago. The home provides people who live there with the opportunity of using the large extensive grounds that lead down to the river and also the convenience of the village close by. The village offers shops, pubs and cafes with transport links to Reading and Oxford. Individual accommodation is provided over 3 floors with 2 lifts available should people wish to use them. The current fees range from £650.00 to £750.00 with additional charges made for Hairdresser, Chiropodist, and incontinence pads. A special rate is available for couples who wish to share a room. More information about charges can be obtained by telephoning the home. The Grange DS0000013090.V359700.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 this service experience poor quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the home at 11.20 hours and was in the service for 5 hours. This inspection was a thorough look at how well the service is doing. It took into account information provided by the home’s manager, through the Annual Quality Assurance Assessment, (AQAA) and any information that we received about the home since the last inspection. We saw those areas of the home used by people living there and looked at records and documents relating to their care. We also looked at staff recruitment files and at training records. We asked the views of the people who live in the home, and of people we saw during the inspection or who responded to questionnaires that we had sent out, and their views are reflected in this report. It was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgements about the outcomes for the people living in the home. From the evidence we saw and from comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals of various religious, racial, gender or cultural needs, but does not always have the appropriate aids available in good condition to help people with physical disabilities. What the service does well: The Grange provides a homely atmosphere for people living there, and people living in the home said that they appreciated the grounds, as they were able to walk in the gardens and admire the views from the home. They said that the food provided was usually good and was ‘sometimes very good’. People living in the home appreciated the fact that the home is able to retain care staff for long periods, as they were able to develop relationships over time. People who responded to our survey said that they ‘always or usually’ receive the help and support they need. People said that having a dedicated hairdressing room was good, as it was easy for them to have their hair washed even when the hairdresser was not available. People living at the home say that members of staff treat them with respect, and they ‘always’ listened to them and acted on what they said. Comments about the staff team included: ‘They seem to genuinely care for people’, ‘always helpful’, ‘are excellent, very caring, charming and so cheerful’. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs of people wishing to move into the home are assessed prior to admission, so that all the care needs are known. EVIDENCE: We looked at the assessment of care needs made by the home before admitting individuals. The home’s manager is usually responsible for carrying out the pre-admission assessment and visits the individual to make sure that all the care needs are identified. The home’s brochure, including the guide about life in the home, is given to the individual so that enough information is available to help with making the decision. People who responded to our survey said that they have enough information about the home before they made the decision to move in. When the individual is referred through the local authority the manager makes sure that the information already available is sent to the home, so that all the care needs are known before admission. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 10 The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people living in the home say that the home meets their needs, the home has not met requirements about care planning information and keeping equipment well maintained, so that people are put at risk of injury and infection. EVIDENCE: People who responded to our survey said that they ‘always’ or ‘usually’ receive the help and support they need, and relatives responded that the home ‘always’ or ‘usually’ meets the needs of their relatives. We looked at the records about meeting people’s health and welfare needs. Information is sought from the individual’s general practitioner about medication and medical history following admission to the home, so that as much information as possible is available about the individual to help staff members manage care. Following our inspection visit in December 2006 a requirement was made that the care plans give staff information and instruction about how the care is to be provided. Although some care plans are detailed, and the manager said that a review had taken place to meet the requirement, we saw that the care The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 12 plan for an individual admitted two months previously had not been completed, and no information was documented to help staff members. A risk assessment about what staff needed to do to minimise the risks when helping the individual to bathe had been carried out, but there was no information detailed in the care plan. It was therefore not clear that staff members had the necessary information about minimising risks while helping the individual to bathe. Although a review of the care documentation had taken place one month after the individual’s admission, the lack of information was not corrected. The requirement made at the previous inspection about care planning information still remains, with a revised timescale. Some of the aids used in the home to assist people with personal care are not thoroughly cleaned regularly and are not maintained to a suitable standard. A risk assessment about how to help an individual bathe safely referred to a bath aid, and we saw that this aid was in a state of disrepair. A requirement is made to address these issues. The home carries out nutrition assessments for the people admitted, but uses an outdated nutrition risk assessment tool. It is recommended that the home use the nationally evidenced based tool available, and this was discussed with the manager. The home keeps medication securely, and has arrangements in place with a large pharmacy to supply medication, auditing, training and advice about medication used in the home. Staff members successfully complete a 16-week training course about medication before they are allowed to manage the medication in the home. The records we saw show that there are good systems in place to make sure that individuals receive their medication safely. The home should check that the medication policies and procedures adhere to the Royal Pharmaceutical Society of Great Britain publication ‘The Handling of Medicines in Social Care’. We saw that people living at the home were well groomed and staff members treated them with respect. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12. 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people living in the home have some say in aspects of daily life in the home, the lack of organised recreational activities is having a detrimental effect on the people living there. EVIDENCE: Although the information supplied in the annual quality assurance assessment shows that there is an activities organiser employed for 2 days a week, people told us that they were not aware of any activity programme, and we saw no evidence of an activities rota. A recommendation was made at our inspection report of December 2006 that the personal history and interests of people living in the home are recorded in greater detail, to support staff to be able to provide activities and for people living in the home to continue with their interests. We saw that these details were not recorded for a recently admitted individual. Some people who responded to our survey said they did not want activities organised for them, but during our visit several people said they were very bored, especially in the afternoons. They suggested suitable activities, such as illustrated talks and organised trips out, and several said they would enjoy different card games. Some said that there had been no organised trips out, The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 14 and that the worst thing about the home was the boredom. One individual said he/she felt that his/her brain was turning to jelly due to the lack of activities. The minutes of the last Residents’ Meeting on 12.12.07 shows that people living in the home requested activities such as a speaker on varied topics, but people said during our visit that no action had been taken about it, and that they felt that they were not listened to. A relative who responded to our survey also said that outings and activities were needed for people living in the home. The home must consult with people living in the home about their social interests, and make arrangements to enable them to engage in recreational activities, so that life in the home can become less boring. To help people living in the home to keep control over their affairs for as long as possible, the home has developed policies about keeping petty cash in safety, following our recommendation in the last inspection report of December 2006. People can bring some of their furniture with them and one recently admitted individual said that her furniture was due to arrive on a specific day. People said that the food provided in the home was good, ‘sometimes very good’, and the cook sees people regularly so that they can let her know if there are changes they would like to the menu. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Relatives of people living at the home do not know how to make complaints to the home, and the home has no formal way of recording complaints or any action taken in response to a complaint. EVIDENCE: People who responded to our survey said that they would talk to staff members if they had a complaint to make, but several relatives said that they did not know what to do in the event of wanting to make a complaint. The complaints procedure is not displayed in the home, and the manager said that there had been no concerns or complaints to record since the inspection visit in December 2006. Missing laundry items were a matter of concern recorded at the minutes of the Residents’ Meeting on 12/12/07, and people expressed concern at the meeting that queries should be dealt with promptly. A comment in the minutes says ‘it is so confusing for them to know who is responsible for what’. A recommendation was made at the inspection visit of December 2006 about a recorded system of monitoring concerns and complaints, and as it is not clear that complaints are recorded, a requirement is made in this report to establish a Complaints Record. The home should take action to make the complaints procedure available in the home, so that people know how to make their concerns known. We have not received information about any complaints made to the home since the last inspection in December 2006. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 16 The home has procedures in place about keeping people living in the home safe, and we saw that the procedures include the locally agreed procedures. Staff members receive training about safeguarding people living in the home during induction, and have update training regularly. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The requirements from our last inspection report have not been met, and people living at the home are at risk of infection or injury as a result. EVIDENCE: The home provides good outdoor areas with patio and seating areas. New flooring has been provided in the communal bathrooms following a requirement to do so in our last inspection report of 21st December 2006. A number of the bathroom fixtures continue to remain in a poor state, although a requirement was made at the last inspection visit with a timescale of 28th February 2007. One bathroom hoist needs attention where paint is peeling and rust setting in, and the oil used for maintenance is attracting dust and debris. The laminate on a chest of drawers kept in one bathroom is peeling, and the chest prevents easy access to the sink. The bath aid used in one bathroom is in disrepair, with the covering peeling off, exposing areas that The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 18 were dirty and wet, allowing a source of infection. The manager said that the aid was being decommissioned, but it is not clear that it is out of use, as it is referred to in individual care plans. Some of the baths, taps, sinks and toilets have large lime scale stains, and these need to be removed. All of the bathrooms need a thorough cleaning, including the woodwork and windowsills. The bathroom on the top floor has not been renovated but it is planned to start the work to include it in upgrading to create an en-suite room very soon. The home employs maintenance and housekeeping staff members, but there is no auditing system to make sure that work is carried out properly. At our last inspection report of 21st December 2006 a requirement was made to supply provisions such as liquid soap and paper towels in bathrooms and toilets to reduce the risks of cross infection. These have not yet been supplied, and the home continues to use communal soap bars and communal towels. There are several unguarded radiators in areas used by people living at the home. The manager has carried out risk assessment for some of the radiators, but other radiators present a risk to people living in the home, such as those in the dining room, in upstairs areas and in a bathroom. Risk assessments must be carried out and risks minimised for those uncovered radiators present in places used by people living in the home. There are no hand washing facilities in the laundry, or in the ground floor staff members’ toilet, and action needs to be taken to make sure that staff members have access to facilities so that the risk of infection is reduced. Bed coverings are stored on a shelf in the laundry room, and an assessment should be carried out to minimise the risks to people living in the home from infection and from fire. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people living in the home appreciate the good qualities of the staff team the recruitment practices and staff training need to be improved to make sure that people living in the home are in safe hands at all times. EVIDENCE: The home has a rota showing the mixture of staff available over the 24 hours to meet the needs of the people living there. People living in the home who replied to our questionnaire said that there are ‘always’ or ‘usually’ enough staff members available to meet their needs. Relatives who replied said that staff members ‘always’ or ‘usually’ have the right skills and experience to look after people properly. Several people living in the home commented on the positive qualities of the staff members, and people appreciated the fact that the home is able to retain care staff for long periods. People living in the home said that staff members ‘always’ listened to them and acted on what they said. The home has improved the way the induction procedure is recorded, and now new staff members complete the induction workbooks to make sure that the process is recorded. The home has a training programme for staff members to make sure that important health and safety training is updated, but there is no clear system in place to make sure that staff members have all the mandatory and other training they need to care properly for the people in the home. It is The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 20 recommended that the home develop a system to show what training the staff members need, so that the training needs of the staff team are identified. It is not clear how many members of staff hold National Vocational Qualifications in Care, as this section of the home’s self-assessment document was not completed. We looked at staff records to check the recruitment procedures. The home has a sister home nearby, and an individual who had worked at the sister home recently transferred to The Grange. Although the recruitment procedure had been followed regarding the individual’s employment at the sister home, it had not been followed when the individual transferred to The Grange. No application form or reference requests had been completed, although there was an appropriate Criminal Record Bureau clearance available. An immediate requirement was made that the home request the necessary information for the member of staff identified. When the home uses an agency to recruit staff members from abroad it does not acquire all the necessary information from the agency about the individuals, and a requirement is made that all the necessary information, including authenticated references, are acquired for people working in the home. The communal and private bathrooms we saw are not cleaned regularly, and pose a risk of infection to people who use them. The manager must take action to make sure all staff members have regular infection control training, and should develop systems to monitor the state of cleanliness in the bathrooms. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s management does not properly address health and safety issues, so the best interests of people living in the home are not protected. EVIDENCE: The manager has been at the home for several years and the responsible individual and proprietor is at the home on a regular basis. Three requirements made at the inspection report of December 2006 were not fully met, and several extra requirements are made in this report, including a requirement about recruitment that was issued during the inspection visit. The proprietor discussed the current issues proving to be a barrier to the home’s development, but the limited response in meeting requirements to our previous report reflects poorly on the management of the home, as they relate to issues of safety for the people living in the home. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 22 The Annual Quality Assurance Assessment (AQAA) document completed by the manager gave limited accurate information about the home. The manager said that a quality assurance survey was carried out during the recent past about the quality of care in the home, and the results are coming back to the home slowly from those consulted. There was no evidence that quality monitoring systems are in place to make sure that the home is cleaned and maintained properly, or that auditing systems are in place abut staff training, staff recruitment or other care issues managed by the home. The home has procedures in place to help people living in the home to manage their petty cash, but staff members should update the records as soon as possible after transactions take place. The home has a fire safety policy and a fire risk assessment has been carried out for the home. There is also a health and safety policy statement but equipment used by staff members and people living in the home is not properly maintained and poses a risk to staff members and to people living in the home. The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 The Grange DS0000013090.V359700.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement That the care plans give staff information and instruction about how the care is to be provided to individuals. This requirement from our inspection of December 2006 was not met and remains with a revised timescale. That the home consults with people living in the home about their social interests, and makes arrangements to enable them to engage in recreational activities, so that their boredom is relieved. That a record of all the complaints made to the home be kept, and the action taken in respect of any such complaint, so that people know that the home takes complaints seriously. That all the bathrooms are cleaned and kept clean, to prevent the spread of infection. That the aids and equipment for bathrooms and toilets are replaced where necessary to ensure service users safety and prevent cross infection. DS0000013090.V359700.R01.S.doc Timescale for action 31/03/08 2 OP12 16(2)(n) 30/04/08 3 OP16 Schedule 4 (11) 30/04/08 4 5 OP26 OP22 23 (2) d 23 (2) c 31/03/08 30/04/08 The Grange Version 5.2 Page 25 6 OP26 13 (3) 7 OP26 23 8 OP29 19 (1) c 9 OP29 19 (1) 10 OP30 13 (3) This requirement from our inspection of December 2006 was not met and remains with a revised timescale. That staff members have access to hand cleaning facilities in staff toilets and in the laundry so that the risk of infection is reduced. That the home provide people who live in the home and staff with suitable provisions such as liquid soap and paper towels in bathrooms and toilets to reduce the risks of cross infection. This requirement from our inspection of December 2006 was not met and remains with a revised timescale. That all the necessary information, including authenticated references, be acquired for people working in the home, including those recruited from abroad, to help protect vulnerable people living in the home. That the home requests the necessary recruitment information about the individual already working in the home, so that all the information is available. That action be taken to make sure all staff members have regular infection control training, to better protect people living in the home. 31/03/08 30/04/08 30/04/08 13/03/08 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Grange Refer to Good Practice Recommendations DS0000013090.V359700.R01.S.doc Version 5.2 Page 26 1 Standard OP8 2 OP9 3 OP12 4 5 6 7 8 OP16 OP26 OP30 OP35 OP38 That the home should consider using a nationally evidenced based nutrition assessment, including body mass index, to make sure people’s nutritional needs are properly assessed. That the home should check that the home’s medication policies and procedures adhere to the Royal Pharmaceutical Society of Great Britain’s publication ‘The Handling of Medicines in Social Care’, to make sure that all documents are up to date. That the service user’s personal history and interests are recorded in greater detail, to support staff to be able to provide activities and service users to continue with their interests. This recommendation remains from our inspection of December 2006. That the home takes action to make the complaints procedure available in the home, so that people know how to make concerns known. That the home should develop systems to monitor the state of cleanliness in the bathrooms, to make sure that high standards are developed. That the home should develop a system to show what training is needed by all the staff members, so that the training needs of the staff team are identified. That the records about petty cash transactions be updated as soon as possible, to make sure that the records are accurate. That an assessment be carried out to minimise the risks to people living in the home from infection and from fire posed by storing bed coverings in the laundry room. 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