CARE HOMES FOR OLDER PEOPLE
The Grange Nursing Home Church Green Stanford In The Vale Faringdon Oxfordshire SN7 8HU Lead Inspector
Annette Miller Unannounced Inspection 26th January 2006 12:00 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 Nursing Home DS0000027178.V280667.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 Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Grange Nursing Home Address Church Green Stanford In The Vale Faringdon Oxfordshire SN7 8HU 01367 718836 01367 710672 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) www.grangenursing.co.uk Bonneycourt Limited Mr Kenneth Ian Mead Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (3) of places The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. Up to 3 of the total registered number may be admitted between the ages of 18 - 59. The total number of persons that may be accommodated at any one time must not exceed 49. 5th July 2005 Date of last inspection Brief Description of the Service: The Grange Nursing Home is registered as a nursing home for up to 49 male and female residents aged 60 years and over. Registered nurses are on duty 24 hours a day. Two lounges and a separate dining room are located on the ground floor, with bedrooms on both floors. Some bedrooms have en-suite facilities comprising washbasin and toilet, with two romms also having a shower. There are five double rooms. Social and recreational activities are provided and there are pleasant gardens that are accessible to residents and visitors. Community links in the village include a small shop, public house and post office. The market towns of Wantage and Faringdon can be reached by car or public transport. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector from 12.00 midday to 5.45pm. During this time a tour of the building took place and documents were examined. The inspector spoke to residents and members of staff. Mr Ian Mead (Registered Manager) was visiting a resident in hospital and returned to the home at 12.30. He was present for the remainder of the inspection. The inspector was made to feel welcome by all staff and appreciated their cooperation. In order to gain an overview of the standards inspected during 2005/6 the previous inspection report dated 5th July 2005 should also be read. What the service does well: What has improved since the last inspection?
More than half the carers have achieved at least Level 2 NVQ in Care and this reflects well on the commitment of individual staff, as well as the home’s senior staff and the company for the support and encouragement provided. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 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 Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 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 Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected during this inspection. EVIDENCE: The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 9 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): 9 and 10 Improvements to some aspects of medication procedures are needed to ensure that safe medication systems are in place. Personal support is offered in such a way as to promote and protect residents’ privacy and dignity. EVIDENCE: Records are kept of all medicines received, administered and leaving the home, ensuring there is no mishandling. A record is maintained of current medication for each resident and a selection of medication record charts were sampled and entries were found to be complete. There were no residents self-medicating, although policies and procedures are available to cover this eventuality. Controlled drugs are stored appropriately in a metal drug cabinet situated within a locked room, and administration of these drugs was found to be satisfactory.
The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 10 The controlled drug records of four residents were checked and found to be correct. It is advised that the quantity of medication for each resident does not exceed a maximum of one month’s supply and that medication no longer needed is disposed of promptly. The home has a contract with a company authorised to collect and dispose of medications. The position of the drug fridge is not ideal, as it is on the floor in a corner of a room and is some distance from the drug storage rooms. Consideration should be given to moving the drug fridge nearer to the rooms used to store drugs and, for hygienic reasons, to keep the fridge above floor level. The fridge is locked when not in use, ensuring unauthorised people do not have access to medicines. The temperature of the drug fridge is not regularly checked (last done October 2005). Therefore, the manager cannot be sure that the fridge is kept at the correct temperature of 8ºC or below (optimum 2 - 5ºC). The inspector checked the temperature with a digital temperature probe and found the temperature to be 8.5ºC. A number of residents are prescribed a laxative that is supplied in half litre bottles, with each bottled named for a specific resident. The home’s medicine trolleys are not large enough to carry all the bottles needed at one time, and to overcome this problem one bottle is carried in each trolley and is used to supply all residents taking the medicine. As this practice is not strictly legal, the manager is advised to discuss with GPs the possibility of prescribing the medication in a bottle showing the name of the home (i.e. bulk prescription), or listing all residents taking the medication on one bottle. If neither of these measures is possible, each resident’s own supply must be used. The manager is advised to keep a list of signatures and initials of all registered nurses involved in administering medicines in order that initials can be easily identified if a query about a specific dose of medication is raised. Issues regarding privacy and dignity are covered with new staff during induction. Residents can choose to stay within their rooms throughout the day, where they can have meals served if this is their preference. The inspector observed that most residents were called by their first name and was told by a member of staff that residents are asked about their preferred term of address on admission. Members of staff were seen to knock on bedroom doors and wait before entering. Screens are provided in the shared rooms for privacy. The inspector concluded that staff treated residents in a dignified and respectful way. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 11 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): These standards were not inspected during this inspection. EVIDENCE: The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 12 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 The home has procedures in place to protect residents from abuse. EVIDENCE: There are policies and procedures in place to protect vulnerable adults from abuse. The manager confirmed that the home had a copy of the Oxfordshire interagency guidelines for the protection of vulnerable adults in which there is guidance in relation to how any concerns or allegations are investigated in Oxfordshire. Adult protection training for the home’s staff was arranged on three occasions during 2005 and training records were available for inspection. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 13 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): These standards were not inspected during this inspection. EVIDENCE: The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 14 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): 28 and 29 Training opportunities are good, enabling staff to achieve the level of training that is needed to ensure that they have the necessary knowledge and skills to provide good care. Whilst most of the recruitment information and checks had been obtained, some important information was missing, potentially placing residents at risk. EVIDENCE: Eleven out of 30 carers have achieved at least Level 2 NVQ in Care (four have NVQ Level 3) and six carers have equivalent qualifications. This gives a ratio of 57 trained members of care staff, and another seven carers have started NVQ training. A range of other training opportunities is provided and training records showed good attendance by all grades of staff. Three recruitment files were randomly selected for inspection. The manager confirmed that two written references are routinely obtained for all staff and evidence of this was seen in two files, but in the third there was only one written reference. The manager assured the inspector that a second reference had been obtained and that it would be located and placed on file. The inspector selected at random a fourth file to check specifically for references and found that two had been obtained. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 15 One application form gave only the year when periods of employment started and finished. Applicants must provide a full employment history with precise details in order that gaps in employment can be checked. Applicants must also provide a health declaration as to their fitness to perform the work to be undertaken. This information was not provided in two files. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 16 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): 38 Improvements to some aspects of safety are needed to ensure that residents are not exposed to risk. Nevertheless, the home has a good health and safety record and appropriate and prompt action is taken when shortfalls are identified. EVIDENCE: Maintenance records of routine safety checks were seen and found to be in good order. The maintenance man confirmed that temperature control valves are fitted to baths and showers to limit water to a safe temperature. Washbasins in residents’ rooms, with the exception of two, have also been fitted with these valves. Residents currently occupying the rooms without temperature limiting valves to hot taps are not exposed to risk as they have poor mobility and cannot use the sinks.
The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 17 Fire safety checks are carried out at appropriate intervals and records kept. Fire training is well managed and is provided by trained fire marshals, as well as by fire safety experts who visits the home to check fire extinguishers and to provide further training. Fire marshals are employees of the home and attended appropriate training in 2003 – training updates are due in 2006. Records of staff attendance on fire training were up to date and complete. The home has good checks in place to ensure that all staff attend bi-annual fire training. New workers are accompanied by a fire marshal on a tour of the building when fire safety procedures are explained. This is part of the home’s induction training. Two bedroom doors on the first floor were propped open with waste paper bins and one was wedged open with cardboard. In the event of fire this potentially places residents at risk. The manager must seek advice from Oxfordshire Fire Service about how to keep fire doors open safely when residents do not want them closed. Devices that restrict the amount windows can be opened are fitted to most windows above ground floor level to prevent residents falling out. However, the lower section of a sash window in a bedroom on the first floor opened fully, exposing a large opening onto concrete below. The maintenance person arranged for a restrictor to be fitted and also planned to carry out checks on all other windows to check that these devices were in place. The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 19 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 OP9 Regulation 13(2) Requirement Medication prescribed for a specific resident must not be administered to another resident from the same supply, even when residents are prescribed the same medication. The drug fridge must be maintained at 8ºC or below. A full employment history, together with a satisfactory explanation of any gaps in employment, must be obtained. Timescale for action 31/03/06 2 3 OP9 OP29 13(2) 19(1) 26/01/06 26/01/06 4 OP29 19(1) A signed declaration from a new 26/01/06 worker that he/she is physically and mentally fit for the work to be undertaken must be obtained. Advice from Oxfordshire Fire 31/01/06 Service must be sought regarding fire doors that need to be kept open for the convenience of residents. 5 OP38 23(4) The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 20 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 Refer to Standard OP9 Good Practice Recommendations âThe amount of medication held for residents should not exceed one month’s supply âUnused medication should be disposed of promptly using approved procedures âMove the drug fridge nearer to the rooms used to store drugs âSituate the drug fridge above floor level âMonitor and record daily the temperature of the drug fridge to ensure it is 8ºC or below âA list of nurses’ signatures and initials should be kept at the front of each file containing medication administration sheets and should be kept up to date to take account of staff changes 2 OP38 Any window above ground floor level that is accessible to vulnerable residents should be fitted with a restrictor to limit the amount the window can be opened to 100mm The Grange Nursing Home DS0000027178.V280667.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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