CARE HOMES FOR OLDER PEOPLE
The Grange Grange Road Northway Tewkesbury Glos GL20 8HQ Lead Inspector
Mrs Ruth Wilcox Announced Inspection 23rd January 2006 09:15 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 DS0000016608.V276104.R01.S.doc Version 5.1 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 DS0000016608.V276104.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Grange Address Grange Road Northway Tewkesbury Glos GL20 8HQ 01684 850111 01684 290221 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) CTCH Ltd Mrs Chris Martin Care Home 69 Category(ies) of Old age, not falling within any other category registration, with number (69) of places The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: The Grange is a purpose built care home that has been extended over the years to provide residential and nursing care for sixty-nine older people over the age of 65 years. It is owned and managed by the C.T.C.H Ltd group of homes. It is situated in the residential area of Northway, in Tewkesbury. There is a small shopping precinct nearby and a Public House. The home has car parking spaces to the front and rear of the building, with a small-enclosed garden running alongside the home and a courtyard garden. The accommodation is set out on three floors, which are accessed by stairs or a shaft lift. Bedrooms are single with en-suite facilities, but there are a few rooms that can be used as double bedrooms if couples wish to be accommodated. Assisted bathing and showering facilities are provided, and there are several lounges, dining areas and other quiet sitting areas. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out this announced inspection over seven hours on one day in January 2006. The home manager, the deputy nurse manager and the deputy general manager were present throughout the inspection providing help and information as required, remaining open and cooperative with the inspection process. The availability of information about the home to assist prospective residents and their families in making their choice about it was looked at. Care records and the systems for the management of medications were inspected. The care of six residents was closely looked at in particular, and there was direct contact with nineteen residents, three visitors and ten other staff. Their views regarding the standards of services and care at the home were sought wherever practicable. The opportunities for residents to make and pursue personal choices in respect of their daily lives were looked at, which also included the arrangements for them to receive their visitors. The standard and choice of the meals was inspected. The policies and procedures for protecting the rights of vulnerable residents were inspected, including the arrangements for the safekeeping of residents’ valuables where applicable. The provision of staff and specific checks as part of their recruitment was inspected, as were the arrangements for their training and development. The management arrangements for the home were looked at, and a tour of the premises took place, with particular attention to the standard of maintenance, health and safety and cleanliness. What the service does well:
The Grange generally provides a pleasant, clean, satisfactorily maintained and decorated home for the residents, although there are isolated areas that the Proprietor should prioritise for earlier attention. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 6 Prospective residents and their families have access to a good amount of information about the home ahead of their admission, in order that they can make an informed choice about moving there, although following this inspection two omissions in the home’s brochure were identified, which must now be rectified. Residents themselves were very happy with the care they receive from the staff, with those spoken to saying that staff were very kind, helpful, and with some saying they were ‘marvellous’, including ancillary staff such as the cooks. In addition to positive comments from the residents during conversation, observation of staff and resident interactions indicated that there are very positive relationships shared between the two. Visitors also indicated how welcome they feel in the home, and that the staff are friendly and caring. Those spoken to were also very happy with the standard of care and attention their relative was receiving. Medications are well managed on residents’ behalf, though they can manage their own medications if they are able and wish to. An excellent standard of food is provided at The Grange, with a varied and balanced diet. Meals are beautifully presented and allow for a good degree of choice for residents. Residents themselves were more than satisfied with the quality, quantity and choices of food on offer for them. There are good training opportunities at The Grange, and there is a well trained workforce in the main, with staff encouraged to achieve an NVQ qualification. Criminal Records Bureau disclosures are obtained on all new staff. The home has established a safe and transparent system to allow residents to place money or valuables in the main safe, keeping good clear records. What has improved since the last inspection?
Staff have made a number of improvements to the standard of their record keeping, and in the main record good detailed care plans based on each resident’s individual needs; however staff will need to continue to apply focus in this area to ensure greater consistency with the quality of information recorded. There has been major investment in the home to improve the environmental safety standards for the residents, and low surface temperature radiator covers have been provided throughout to reduce any risk of hot surface injury. Blending devices have been fitted to the hot water outlets in areas accessible to residents in order to ensure safe temperatures for them. The use of these is still new, and there are a few initial problems that need to be remedied, as some hot water remains still too hot to ensure safety.
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 7 Some work has been carried out to tumble drier ventilation ducting in the laundry room in order to improve safety, further to a previously identified fire risk. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 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 The Grange DS0000016608.V276104.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The pre-admission information ensures that residents have access to a good deal of information when making their choice about the home, though potentially not all that is required in every case. EVIDENCE: The home has produced a full Statement of Purpose, a copy of which has been supplied to the CSCI, and is easily available in the home to anyone choosing to read it. Prospective residents are supplied with a copy of the home’s Service User Guide, which contains much of the required information, plus a good amount of very useful supplementary information about The Grange. Although a copy of the inspection report is available in the home for anyone to read, the guide does not make mention of this, and a copy of the most recent report is not included either. The guide seen at inspection did not contain the most up to date details about the CSCI, referring to it by its previous and outdated name of the NCSC. The Grange does not provide intermediate care.
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 11 The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 There is a care planning system in place, which can adequately provide staff with the information they need to satisfactorily meet residents’ health and personal needs; very isolated omissions in recording have not compromised this at this time, and improved recording in these cases would be more representative of how health needs are being met in practice. The systems for the administration of medications are generally good, with arrangements in place to ensure residents’ medication needs are met; some additional recording would ensure greater consistency in isolated cases. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of their needs; six were selected as part of the case tracking exercise. Since the last inspection, staff have made a number of improvements to the standard of documentation, with plans being well written in the main, and regularly reviewed. Many aspects of care plans contained clear instructions as to how each individual’s health needs are to be met, with visual evidence confirming that
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 13 this is carried out during the case tracking exercise. Plans were linked to assessments, including a range of risk assessments where applicable. Recording was also very personal and individualised, containing a lot of very good detail. Plans demonstrate multidisciplinary working with other health care professionals. In one case where the Community Psychiatric Services had been involved in the care of the individual, the associated care plan made no mention of this; furthermore, the action plan to manage this particular need contained insufficient information for staff to act upon. Care plans for continence needs were appropriately detailed, though one plan for a catheter advised to address it ‘as per procedure’, and was not detailed for this particular individual. Care plans based on pressure sore risk assessments were generally good, though two who had been assessed as being at risk of developing sores had no written plans to address this; reviews of the assessments however, did indicate that pressure areas were healthy and intact with no sores developing. Staff expressed concern about the lack of ‘flat’ style bed sheets for use with pressure relieving mattresses, so that the efficiency of the pressure relief is not compromised; these were subsequently reported to be on order and will be available for use in the very near future. One resident was under the care of the leg ulcer specialist nurse, who had issued specific instructions for the person’s care; the resident’s care plan had not been updated to reflect the directives for care. Residents themselves, without exception among those spoken to, were very satisfied about the care they received in the home, speaking most positively about the staff and the way they looked after for them. Visitors too were very satisfied with the care their relative was receiving in the home. Medications are well organised, and are stored in two separate safe, clean and secured locations. The storage room in the ‘residential section’ was very warm, and the residential coordinator resolved to monitor it in case it rose above the maximum of 25°C permissible for storing the room temperature medications. Many medications are supplied in a monitored dosage system, and there is a large amount of boxed and bottled medications also; there was no evidence to suggest that this form of supply is used beyond any expiry date, though in the absence of staff routinely dating bottles on opening it is difficult to be absolutely certain of when items were opened to ensure timely usage. There are clearly printed Medication Administration Records from the supplying pharmacist, which in the main are meticulously recorded and kept by the staff. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 14 There are isolated instances of analgesia prescribed to be given regularly, not being given in accordance with instructions, with no code letters recorded on the medication chart to support why; it is understood that this is due to the medication not being required by the resident. In cases such as this, the medication had not been reviewed to take this into account, with the necessary amendment to ‘When Needed’ (PRN) not being made. Some of the medication administration charts do not include the precise administration instructions regarding the use of PRN medications; neither are there care plans to demonstrate their appropriate usage. Residents are supported to self-medicate if they wish and are able to, and this is done on the basis of a documented risk assessment. In addition to the qualified nurses, care staff who have received accredited medication training from a local college, have responsibility for administering medication to those residents not in receipt of nursing care. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 & 15 Respect is shown to residents’ personal choices, in order that they maintain some control over their lives where possible, and contact with their families and friends. Dietary needs of residents are very well catered for, with a good selection of food available that meets their tastes and choices. EVIDENCE: The home provides a relaxed environment for visitors, and does not place any restrictions on them. Residents confirmed their close contact with their relatives and friends, and visitors were seen coming in and out of the home. Three visitors confirmed that they were always made to feel very welcome when visiting their relative, saying that the staff were very friendly; one visitor said that this reassuring attitude from the staff had helped to inform their choice about the home a great deal. Another visitor said that they often stayed with their relative for a meal, and that they had no concerns about the care or anything else in the home. One resident said that staff always offer her visitor some refreshment when they are there. Residents’ individual care plans demonstrate that staff are mindful of their individual preferences and choices. Recorded minutes of resident meetings
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 16 clearly demonstrate that residents have the opportunity to raise and discuss issues that are important to them in their daily lives in the home, and to make suggestions and requests for their preferences and ideas in a variety of areas. Residents themselves said that staff are respectful to them, and that they can choose how they spend their time. Bedrooms appear individual in many regards, with residents able to personalise their room in accordance with their wishes. Advocacy information is readily accessible to residents should they need it. Menus are varied, and offer a good degree of choice for the residents. Each meal choice at lunchtime was beautifully presented, was well cooked, and looked wholesome and extremely appetising. The meal was served in the numerous dining rooms, in a calm and pleasant atmosphere. Staff were providing assistance where needed, with some less able residents being fed, with their clothes adequately protected. Eating aids and special diets were provided where applicable. All residents spoken to, without exception, were very positive and extremely happy about the quality and quantity of food provided for them, with some saying it was ‘excellent’. Residents also spoke very positively about the ‘very good cooks’ that they have in the home. One resident said that the cooks try very hard on their behalf, and produced a really excellent range of food over the Christmas period in particular. The Environmental Health Officer inspected the kitchen one month prior to this inspection; the cleaning issues highlighted during that visit for attention have been attended to. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Arrangements for protecting residents from forms of abuse are generally good, though any gaps in staff training have the potential to compromise certain individuals’ understanding. EVIDENCE: The home has written policies and procedures for the prevention of abuse and the protection of vulnerable residents. However, from discussion with a number of staff, although aware of the issues and conversant in the Whistle Blowing procedure, it was evident that they have not read these policies, or any other policies either. Newer staff receive training on abuse issues during their induction, and there are mandatory training units in the NVQ training programme. Apart from this, there has been no other training in this area. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 The Grange provides a reasonably satisfactorily maintained home for the residents, and provides clean and comfortable accommodation. Major investment and increased health and safety measures have improved safety for residents, though certain initial stage failings in this still pose a risk to some. The current provision of disability equipment is insufficient to meet the needs of those residents needing it in a consistent and timely way. EVIDENCE: A maintenance person is employed, and there is an ongoing programme of repair and refurbishment at the home, with associated records kept. The home is generally satisfactorily decorated and maintained, though there are a number of areas that are showing signs of extreme wear and tear. These include areas of worn and scraped woodwork such as skirting boards and door frames, odd small patches of torn wall paper, worn and heavily marked stair carpeting, and damaged flooring, wood panels and bath enamel in bathroom 5.
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 19 At the time of this inspection one of the washing machines was out of order, with a repair sought and awaited from a qualified engineer. Since the last inspection repair work has been carried out in the laundry to improve the ventilation ducting from one of the tumble driers, which had been identified as a fire risk. Work has been completed to fit low surface temperature radiator covers in all areas in order to reduce health and safety risks to residents. Also, blending valves have been fitted to hot water outlets that are accessible to residents, so that safe temperatures are maintained, reducing the risks of scalding injuries. However, despite maintenance records showing that random checks on hot water outlets were all safe, hand checks during this visit in at least 3 bedrooms demonstrated that hot water was scalding hot, and most certainly in excess of the recommended safe temperature of 43°C. The home is cleaned to a satisfactory standard, and despite some transient unpleasant odours at certain times, was generally fresh and odour free. Since the last inspection the sluice disinfector has been commissioned, though staff reported that this had been out of order for some time prior to this inspection. Staff expressed concern about only one sluice machine for the whole home, and also about the number of commodes available for residents preferring to use them, saying there were insufficient numbers. Staff also find it difficult to meet residents’ needs in a timely way on occasions, due to the current provision of manual handling hoists; staff are sharing the use of hoists over well spread out locations in the home, resulting in some less able residents having to wait for staff to have access to a hoist to assist them to move. The laundry room, though busy and filled with laundry at various stages of the process, was reasonably orderly. The washing machines have cycles capable of dealing with foul laundry, and the laundry worker was conversant in infection control procedures. Gloves and aprons are provided throughout the home for all staff. Liquid soap and paper towels are also provided, and following this inspection bars of hand soap in communal bathrooms and toilets were removed for hygiene reasons. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The hard working staff group is just adequate to meet the needs of the residents currently living in the home, though working practices are having a divisive effect on the team as a whole. Staff have good training opportunities, with care staff encouraged to undertake a care qualification, in order that they can fully understand their roles. EVIDENCE: Staff were attentive and sensitive during their work and interactions with residents. They appear to be a hard working and committed team of people. Recorded staff rotas demonstrate the numbers of them working, and the strong team of ancillary staff who provide support to the care and nursing team. It is the established practice of the home that the nursing and personal care residents are separated in terms of the team caring for them ie: a designated team is allocated to each specific area on each shift. This appears to have had a divisive effect on what is otherwise a very strong staff team, with working practices becoming compromised. Staff themselves spoke of the two teams not being cohesive and not providing adequate support to each other; this was reported to be particularly the case during times when a member of the care team is coordinating social activities in the afternoon. This depletes the number of care staff left to provide other elements of care to the residents.
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 21 The staff clearly work extremely hard for the benefit of the residents and care greatly about the work they do, but they feel they are overstretched and finding it difficult to cope adequately with their work load. An agency carer, who regularly works in the home, spoke very positively about it, saying it was the best one she was ever allocated to work in, with the best staff. There is a significant reliance on agency staff at The Grange, though it is recognised that a good degree of continuity and consistency amongst agency staff has been achieved in this regard. Residents themselves spoke extremely positively about the staff, with some saying they are ‘marvellous’, and that they were are very helpful and kind. Three visitors also spoke positively regarding the staff and the way their relative was cared for. There are currently fourteen care staff who are qualified to at least NVQ level 2 standard, with three of these being actually at level 3. There are nine others making progress on the level 2 programme at present, with three others doing the level 3 award. The deputy general manager has successfully achieved the NVQ level 4 in care award, though is not actually involved in the care of residents directly. The number of qualified carers does not meet the 50 target that should have been achieved by the end of 2005, though the home is making all efforts to work towards achieving it as soon as possible. Although staff recruitment was not inspected in detail on this occasion, copies of CRB disclosures were seen, which had been carried out as required on recruited staff. Staff spoke positively about the training opportunities afforded them, welcoming the opportunities that they regularly have. The training coordinator has ensured very meticulous training records for staff, with a clear indication of the range of mandatory, including induction, and supplementary training that staff have undertaken that is specific to their role. One specific training need was identified and is reported under standard 18. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 & 38 Whilst there are certain elements of robust management in this home, which will promote residents’ welfare, there are other elements, which pose risks to their health and safety. There are evidently communication problems in the home, which have the potential to impact on the lives of residents, with staff feeling discontented and undervalued. EVIDENCE: The home’s manager is a first level nurse, who has long experience of caring for people in this setting, and who is a very long serving manager at the home. She has achieved the NVQ level 4 Registered Manager’s Award, and is registered with the CSCI for her role. She has undertaken a range of training to ensure her professional development as a manager and a practicing nurse. Some staff expressed quite significant concerns about the inefficient way in which information regarding the residents and their care is shared at shift
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 23 change over, citing the removal of the designated hand over period as the cause of the problem. One staff member said that information hand over sheets are issued at the start of the shift, though access to information could prove difficult sometimes. Staff were also concerned that they felt unable to attend staff meetings if they are on duty. However, it was then reported to be the manager’s practice to conduct more than one of the same meeting so that staff have a choice of times to attend to suit their rota. It is the manager’s view that communication problems have arisen since the designated hand over period has been withdrawn. Robust financial and business management systems are in place, with the centre for business activity being focused in the head office at Cedar Lodge. The Proprietor and General Manager do the financial planning for The Grange, with only limited budgetary responsibility devolved to the home Manager. The home has current valid insurance arrangements. Some residents have placed personal money and valuables with the home for safekeeping. Clear and transparent records for each person, which include transaction details, running totals, and receipts, are kept. Residents or their representative can sign to acknowledge transactions, but where this is not possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. The home has written health and safety policies, procedures and risk assessments, and provides manual handling equipment (reference to this equipment is reported under standard 22), and associated health and safety training for staff, including regular fire safety training. Servicing and maintenance checks of certain equipment and installations are carried out by appropriately qualified engineers, with the exception of the home’s own hoisting equipment; manual handling hoists have not been serviced or safety checked under the Lifting Operation and Lifting Equipment Regulations 1998 (LOLER) since September 2004. It was reported that the home is currently sourcing a new qualified engineer to carry this urgent work out. Staff said that wheelchairs have been allowed to fall into disrepair, with poor brakes and tyre pressures, with any necessary repairs only being carried out in time for this inspection; wheelchairs seen on this day were in a satisfactory condition. A bottle of a detergent chemical had been left in a bathroom, and was promptly removed; this was an isolated case, with all chemicals generally stored safely and securely when not in use. Over half of the staff are qualified to provide emergency first aid.
The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 24 The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X 2 X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X 3 3 X X 2 The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5(1) (d, f) Requirement Timescale for action 31/03/06 2. OP7 17(1.a) Schd 3. The Registered Manager must include a copy of the most recent inspection report and the current contact details for the CSCI in the Service User Guide. The Registered Manager must 28/02/06 ensure that plans are recorded, which relate to specialist health care. (This is with reference to a clinicians directives and the community psychiatric services) (Previous timescale of 30/09/05 not met in full). Staff must give medications in 28/02/06 accordance with general practitioner instructions, ensuring that directions for usage are reviewed and amended as appropriate. The Registered Persons must 30/04/06 ensure that training in abuse and adult protection issues is provided to all staff. The Registered Persons must 31/05/06 ensure adequate provision of the necessary hoisting equipment and commodes to meet the
DS0000016608.V276104.R01.S.doc Version 5.1 3 OP9 13(2) 4 OP18 13(6) 5 OP22 23(2.n) The Grange Page 27 6 OP25 13(4.a) 7 OP27 18(1.a) 8 OP32 12(5.a) 9 OP38 23(2.c) needs of the residents. The blending valves to the hot water supply must be checked to ensure that safe temperatures are achieved in all areas accessible to residents. The Registered Persons must conduct a review of staffing provision and deployment, and take the necessary action to ensure staffing is adequate to meet residents’ needs efficiently at all times. The Registered Persons must improve the systems and opportunities for communication between them and the staff, so as to ensure the appropriate sharing of information, and promote good personal and professional relationships with each other. The Registered Persons must ensure that an appropriately qualified engineer carries out the necessary maintenance and safety checks on all load bearing equipment, and provide certificated evidence to the CSCI that this has been done and that all hoists in use are safe. 28/02/06 31/03/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations Staff should routinely date all boxed and bottled medications on opening to reduce the risks of them being used beyond their expiry date. The directions for the use of PRN medications should be recorded and linked in to a relevant plan of care.
DS0000016608.V276104.R01.S.doc Version 5.1 Page 28 The Grange 3 4 4 OP19 OP28 OP38 The Registered Proprietor should consider attending to the maintenance issues identified in the report under this standard. A minimum ratio of 50 of care staff qualified to NVQ level 2 should be achieved in the home. It is strongly recommended that the Registered Persons ensure six monthly inspection examinations be carried out on all equipment used to lift residents, by an appropriately competent person. The Grange DS0000016608.V276104.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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