Inspection on 01/06/07 for The Grange Care Centre

This inspection was carried out on 1st June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Grange Care Centre 04/06/08

The Grange Care Centre 22/03/06

The Grange Care Centre 25/11/05

The Grange Care Centre 18/11/04

The Grange Care Centre 20/04/04

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

CARE HOMES FOR OLDER PEOPLE The Grange Care Centre Eastington Stonehouse Glos GL10 3RT Lead Inspector Mr Adam Parker Unannounced Inspection 09:30 1 ,4 & 7th June 2007 st th 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 Care Centre DS0000016609.V330794.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 Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Care Centre Address Eastington Stonehouse Glos GL10 3RT 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) 01453 791513 thegrange@eastington.freeserve.co.uk Saddlers Hotels Limited Mrs Linda Rose Barnes Care Home 75 Category(ies) of Dementia - over 65 years of age (75) registration, with number of places The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2006 Brief Description of the Service: The home is registered to accommodate 75 older people whose nursing/care needs arise from frailty due to a dementia illness. The Grange is a Grade II listed Georgian Country House with Victorian and modern extensions situated on the fringe of the Cotswolds and the outskirts of the village of Eastington, near Stonehouse. It is set in five acres of parkland with enclosed gardens to the rear of the home and a large enclosed courtyard to the side. There are plenty of lounge and dining areas on the ground floor. A recently refurbished and extended conservatory provides additional lounge and dining space. The conservatory also provides easy access to a landscaped secure garden area. The accommodation consists of both single and double en-suite bedrooms. They are well furnished and maintained to a good standard. There are en-suite facilities in all but one room; there are assisted bathrooms/shower room and a number of toilets in the home for service users to access. Specialised equipment is provided to meet with individual needs. Current fees are £570 per week.Hairdressing, chiropody, toiletries, entertainment, pension and benefits allowance administration and acting as a trustee are charged extra. The home makes information about the service, including CSCI reports available to residents and their representatives through a service user guide and statement of purpose available in the home. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector over three days in June 2007. The registered manager of the home was present for all three days of the inspection visit which consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Observation was made of the care and supervision of the residents in communal areas. Comment cards were received from residents relatives, staff working in the home and General Practitioners (GP). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The home has increased its registered numbers and in the newly built areas has provided some excellent individual rooms for residents as well communal areas and enclosed gardens to the side and rear of the home. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The assessment documentation for a number of residents recently admitted to the home was looked at. These had been completed following an assessment of the service user’s needs recorded on an assessment summary prior to admission to the home. In addition copies of assessments and care plans produced by funding authorities had been obtained as well as a hospital discharge summary for one resident. Generally prior to admission the home meets with members of the prospective resident’s family and advises them to view other homes before coming to a decision. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care and so Standard 6 does not apply. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there is a good individualised care planning system in place and the privacy and dignity of residents is upheld, shortfalls in medication administration records have in some cases compromised the home’s ability to fully meet the medication needs of some residents. In addition there are some care practices which need assessment to ensure residents’ safety. EVIDENCE: Examination of selected care plan files for residents showed that they had care plans for certain identified needs used in conjunction with a ‘personal holistic profile’. These documents gave staff the information to meet residents’ needs. As well as this residents also had a night profile and a day profile giving basic information about their needs. A care plan for one resident for sleep and rest was noted to be worded using a ‘person-centred’ approach. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 11 Risk assessments had been completed for pressure areas and moving and handling and had been subject to review. One risk assessment for moving and handling had been evaluated with good detailed and personalised information. With another the actions carried out by the staff to move a resident from a wheelchair into an armchair were completely in line with the actions described in the risk assessment. During an observation of residents in one communal area of the home it was noted that some residents were being moved in wheelchairs without foot rests. When asked about this staff stated that this was to prevent injuries to the residents lower legs caused by foot rests. It is acknowledged that this practice was being carried out in the interests of the residents although staff must ensure that moving and handling procedures are safe. The practice of moving a resident in a wheelchair with only the back wheels in contact with the ground is not safe for either the resident or the staff member. There was recorded evidence of residents having input from health care professionals such as GPs, community psychiatric nurses, dentists and chiropodists. Examination of documentation showed how the home had acted in the interests of one resident in respect of their medical and dental needs. One resident whose care was looked at was using bed rails, however no risk assessment had been completed in respect of this. It became evident that it had not been the usual practice in the home to risk assess the use of bed rails. The management of the home were made aware of some recent developments in the field of bed rails involving a prosecution by the Health and Safety Executive of another care home provider. Since the inspection, the home has carried out an audit of the use of bed rails in conjunction with a literature search and has supplied information relating to this to the Commission. This has resulted in risk assessments being completed for a number of residents. Medication storage and administration arrangements were looked at in all four units of the home. Shortfalls in all these areas were of sufficient concern to warrant a letter to the home requiring urgent action in respect of medication practices. These areas of concern were: • The medication administration records in all units contained many examples of handwritten entries including directions for giving medication that had not been signed or dated by the person making the entry. In addition the use of hand written lines and crosses on the medication records and directions to stop medication had not in all cases been clarified in writing. This was particularly evident with the directions for sleeping medication for one resident which had a large hand written cross through it. Also (and of particular concern) medication prescribed for angina for another resident had only been given once a day for three weeks most probably due to a line written on the medication administration record when the directions and the medication container stated twice a day. In addition the directions for other medication for a number of residents were unclear following hand written amendments to DS0000016609.V330794.R01.S.doc Version 5.2 Page 12 The Grange Care Centre • • • the directions. With one resident there was no evidence for the reason for this change in the notes or in a discussion with a member of the nursing staff. The administration of some doses of medication had not been recorded or an appropriate omission code used. This was evident with an antibiotic prescribed for a resident which had been prescribed four times a day but on some days had only been recorded as being given three times a day. The record in the controlled drug register for the administration of analgesic patches to one resident was looked at. Problems with supply had apparently resulted in one patch being administered over the 72 hour interval. In addition it was unclear from the records whether patches were being administered at the appropriate intervals because of a possible combination of the use of 12 hour and 24 hour clock times. In Hardwicke and Victoria Units there was no evidence of the monitoring of storage temperatures in medication storage areas rooms apart from the refrigerator in Victoria Unit. In the Adelaide unit special film had been placed on the windows to reduce the warming effect of the sun although there were no recent temperatures recorded to demonstrate if this was working. In the summer of 2006 a temperature as high as 37°C had been recorded in the medication storage room. It was also noted that there were no care plans or individual protocols in place to guide staff in the administration of medication prescribed for example for anxiety symptoms. In some cases the dose of medication given where there were variable dose directions had not been recorded. On St George’s unit bottles of liquid medication stored on the night trolley had not been dated on opening. This is common practice in other areas of the home and is a useful method to prevent medication being given after the expiry date. Also on St George’s unit it was noted that the medication administration record folder was not in a good state with several records having become detached from the binder. The majority of residents had their photographs included in the medication administration records as an aid to identification, a recent audit had picked up where there were a number missing. One incident regarding medication showed that staff had been vigilant and acted in the interests of a resident when the wrong medication had been prescribed and the prescriber was quickly alerted to remedy the situation. Residents receiving nursing care have their medication administered by registered nurses. Residents receiving personal care have their medication administered by care staff who have received training in Drug Administration Competence. It is acknowledged that the provider has responded swiftly and appropriately to the concerns raised about medication practices in the home. A full medication audit has been carried out and the findings supplied to the Commission with the provider being open about any further shortfalls found. Medication audits had been carried out in the home in the past and the most recent had picked The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 13 up some shortfalls. The provider has made contact with the supplying pharmacist and a meeting arranged with a view to improving the service provided. The provider is also arranging a further audit by an independent pharmacist. Improvement in medication administration and storage systems must be sustained and this will be checked at a future specialist inspection by a CSCI pharmacy inspector. The Statement of Purpose for the home states that the home will “ Administer medication as prescribed and keep accurate records as required by the National Care Standards Act.” Staff were observed treating residents with respect and up-holding their privacy. In the one shared room looked at, a dividing curtain was in place for privacy. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. 12,13,14 & 15 This judgement has been made using available evidence including a visit to this service. The home takes an active role in encouraging residents’ contact with family, friends and parts of the local community. This in conjunction with varied and stimulating activities provides a good degree of social contact. In addition resident’s are well supported by staff at mealtimes. EVIDENCE: The home offers a wide range of activities for residents both inside and outside of the home, these include art and craft activities and gardening. At the time of the inspection visit some residents were decorating small boxes that they had made, these were to be used in residents’ bedrooms. Trips out of the home include coffee mornings, tea dances and visits to a local church. Trips to seaside resorts and other attractions also take place with Burnham-on-Sea and Bourton-on-the-Water being past destinations. A number of musical entertainers also visit the home including music therapists who play the lyre instrument on a one-to-one basis with selected residents. The activities coordinator reported that in planning activities she takes into account The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 15 information from conversations from residents about activities they have enjoyed in the past as well as information recorded in care plan files. Residents receive visits from religious representatives on a regular basis with Holy Communion being held in one of the lounges on a monthly basis. The home has plans to develop a multi-sensory room suitable for the needs of people with dementia and a grant from the Department of Health has been applied for and approved. One survey form completed on behalf of a resident stated “This home provides brilliant entertainment for residents.” The home enables residents to maintain contact with family, friends and representatives. Visitors were welcomed into the home and are able to visit service users in communal areas or their individual rooms with no visiting restrictions. Some activities provide a degree of contact with the local community. A Summer fete was planned for June. There were no residents in the home currently controlling their own finances. Relatives and representatives were helping residents with this or acting on their behalf. The home has information available on how to contact advocacy services who may act in the interests of residents. Evidence was seen of residents bringing their own personal possessions into the home including items of furniture. Lunch was observed being served in all areas of the home on one day of the inspection visit. Assistance was given by staff to residents who needed this on an individual basis and there was a relaxed and calm atmosphere. In one unit a number of residents were having assistance from relatives with their meals. Where meals were pureed they were presented in such a way that all the portions of the meal were identifiable. One resident whose care was looked at was a vegetarian and this had been well documented in the care plan file. A record of the vegetarian option provided was being kept although this record did not show which residents had received this. However on the final day of the inspection visit a system for recording this was in place. The home offers a three week menu that changes with the seasons. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. 16 & 18 This judgement has been made using available evidence including a visit to this service. Although complaints are acted upon in the interests of the residents, a incident in the home has shown that policy was not put into practice in regards to sharing information about an incident of abuse. EVIDENCE: Details of one recent complaint were looked at. As well as a response in writing the nurse manager had met with the complainant on two occasions with plans to meet again. The complaints procedure is clearly displayed on a notice board in the home and is available to relatives and representatives of relatives in the statement of purpose document. This acknowledges the role of other agencies and gives guidelines to any prospective complainant on who to approach. The home generally intends to resolve any concerns or issues before they become a complaint and has on-going contact with relatives and representatives of residents including six-monthly meetings. Staff receive induction training in recognising and responding to abuse and neglect and this also forms part of the NVQ training. The home has a clear policy statement on gifts to staff from service users or their relatives and a guidance to staff precluding them from involvement in resident’s wills. All of the staff surveys received indicated that they were aware of adult protection procedures. Staff training in protecting vulnerable adults is provided on an on going basis. Sixteen staff have attended a Conflict Resolution training day aimed at staff dealing with incidents of potential violence and aggression. An incident of abuse occurred in the home in January The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 17 2007. The home dealt with the staff involved and took disciplinary action and in one case further training. There was a delay in reporting the incident to the Commission (in fact the Commission learned about the incident from another source) and in sharing the details with other parties. The home had not followed its’ own written procedures regarding reporting the incident to other agencies. Issues around the sharing of information about the incident were addressed with the home via a letter. However the home responded appropriately to this, contacting all relevant parties and has reviewed its reporting procedure in light of the events. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. 19,24 & 26 This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a well maintained and clean, environment with personalised individual rooms. EVIDENCE: A tour of the premises was conducted. All areas of the home inspected were found to be clean, well maintained with appropriate and attractive decoration. Cleaning and maintenance staff must be commended for this. There are a variety of communal spaces available for service users throughout the home. Outside there are well maintained gardens including a large enclosed courtyard to the side of the home. During the inspection visit the home was awaiting the delivery of furniture for this area as well as the completion of a number of features. Individual rooms were very clean and well decorated with plenty of personal items evident. In the recently registered The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 19 parts of the home, residents individual rooms are equipped to a high standard all with en-suite wet rooms providing toilet, washing and shower facilities. A new laundry is currently being fitted and it is hoped that this new enlarged facility when completed will go some way to improving the laundry service which has been the subject of comment from several relatives of residents. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 27,28,29 & 30 This judgement has been made using available evidence including a visit to this service. Residents needs are met by the numbers and skills of staff although recruitment practices have not been robust and have potentially put residents at risk. EVIDENCE: At the time of the inspection visit the home had started to introduce an arrangement where each unit of the home had a separate staff team of care staff during the day. A ‘twilight’ shift is also worked by a member care staff late in the evening to provide support where needed over the whole home. Nursing staff are allocated to cover the whole home with two registered nurses on duty during the day and one at night. Nursing and care staff are supported by cleaning staff, catering staff, administration and maintenance staff. The home has around 50 of care staff trained to NVQ level 2 or higher level with one having achieved a level 4 and a number undertaking level 3. The majority of care staff have completed NVQ foundation training and are currently undertaking NVQ 2. Nursing staff have completed additional qualifications at degree level supported and paid for by the home. An examination of staff files showed that a number of staff had not been recruited with the required two written references. This was shared with the The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 21 management of the home during the inspection visit and an audit of staff recruitment files was quickly undertaken. In addition a recruitment checklist has been introduced to monitor information received as part of the recruitment process. All care staff receive induction training using the common induction standards. This then leads on to NVQ training. Staff receive more than 3 paid days training per year. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 31,33,35 & 38 This judgement has been made using available evidence including a visit to this service. Despite a strong management team and quality assurance systems being in place areas where the residents have been put at risk have not always been identified. Nevertheless the home has worked towards maintaining a safe environment. EVIDENCE: The registered manager has a number of years experience in management, has achieved the registered managers award and has a relevant qualification in mental health. She has recently undertaken training in conflict resolution. The manager is not a nurse but is supported by a support manager who is a registered nurse. There is a senior carer with an NVQ qualification in charge of the residential unit. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 23 Quality assurance and quality monitoring systems are in place in the home. There is no doubt that the home aspires to provide a very high standard of service to the residents. However shortfalls in a number of key areas as evidenced in this report show that quality monitoring systems have not been robust enough to identify where failures have potentially put residents at risk. When raised with the home, shortfalls were discussed at a senior management team meeting with various actions allocated to senior staff in respect of these shortfalls. The home has achieved a number of awards such as the Investors in People Award and the Investors in People Management and Leadership Award. In addition the home has been awarded ‘winner’ status in the Gloucestershire Workforce Development Award in 2006 and was the winner of the south west Age Positive Award in 2006. Also the home was the first UK organisation to be awarded the Work Life Balance and Recruitment and Selection Investors in People models and an additional profile award in this area. The home does has secure facilities for storage of cash and valuables although these are rarely used except for items that are found in the home. The general arrangement is for service users’ representatives to take responsibility for these. The home is not involved in paying any money into bank accounts on behalf of residents. Staff are provided with training in safe working practices such areas as food hygiene, fire safety, first aid and infection control. Fire drills are carried out every two weeks with a record kept. Moving and handling training is provided to the staff by registered nurses in the home who are recognised trainers in this area. The home has had specialist work undertaken to reduce any risks to service users and staff from Legionella and this has been ongoing as the home has expanded in size. It was reported that there was one further piece of work to do regarding the chlorinisation treatment of the water system when the new laundry is completed. Checks have been undertaken on electrical and heating systems as well as lifts and moving and handling equipment in the home. The checking of the functioning of window restrictors had been carried out in the home although this practice had recently lapsed. The home has devised a Window Inspection Schedule document and plans to reintroduce these checks. Monthly checks are carried out on the temperatures of hot water outlets in the home. The storage of cleaning materials was looked at. Several examples were found where cleaning substances had been decanted into bottles that were either inadequately labelled or had no labels at all. In order to provide information for staff in the event of any accidental contact with these substances by residents, containers must be adequately labelled. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 24 The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 4 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 2 The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 13 (4) (c) Requirement Where bed rails are used for residents, a risk assessment must be completed in order that any potential risks to the resident’s safety are identified. Where residents are moved in wheelchairs the method of moving them must ensure their safety. When handwritten directions or marks are made on medication administration records then these must be signed and dated and checked for accuracy by another member of staff to avoid the risk of possible medication errors and to ensure that residents receive their medication as prescribed. When medication is administered to residents or omitted for a reason then this must be clearly recorded. The dose given must also be recorded with variable dose directions. This will ensure that people receive the correct levels of medication. Where medication is prescribed for residents on an ‘as required’ DS0000016609.V330794.R01.S.doc Timescale for action 31/07/07 2. OP8 13 (5) 31/07/07 3. OP9 13 (2) 31/07/07 4. OP9 13 (2) 31/07/07 5. OP9 13 (2) 31/07/07 The Grange Care Centre Version 5.2 Page 27 6. OP9 13 (2) 7. OP9 13 (2) 8. OP9 9. OP18 17 (1) (a) Schedule 3 Paragraph 3 (l) 37 (1) (g) 10. OP29 19 (1) (b) Schedule 2 10. OP38 13 (4) (c) or ‘PRN’ basis then there must be a care plan or individual protocol in place to guide staff in administration. This will ensure that residents receive medication when necessary and in line with planned actions. Controlled drugs for analgesia must be administered as close as possible to the directed time and administration times must be recorded clearly. Medication storage temperatures must be monitored in all areas where medication is stored. This is to ensure that the home is keeping resident’s medication in line with the manufacturers directions. Where a plan for medication administration is formulated through consultation with health care professionals then this must be recorded. Where there is any allegation of misconduct by any person working at the home the Commission must be notified of this without delay. Before a person starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations must be obtained to ensure that residents are protected through robust recruitment procedures. All cleaning materials must be kept in correctly labelled containers so that there is information readily available to deal with any unwarranted contact with these materials by residents. 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP9 OP38 Good Practice Recommendations Containers of liquid medication on St Georges’ unit night trolley should be dated when opened so that staff can check that medication is not given after the expiry date. The medication administration record folder in St George’s unit should be kept in a good state of order. Checks should be carried out on the functioning of window restrictors. The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange Care Centre DS0000016609.V330794.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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