Inspection on 04/06/08 for The Grange Care Centre

This inspection was carried out on 4th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Grange Care Centre 01/06/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Grange Care Centre Eastington Stonehouse Glos GL10 3RT Lead Inspector Mr Adam Parker Key Unannounced Inspection 09:25 4 , 5th & 6th June 2008 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.V361130.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.V361130.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.V361130.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2007 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 two 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 residents to access. Specialised equipment is provided to meet with individual needs. Current fees are £467.30 for local authority funding to £650.00 for privately funded residents 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.V361130.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection visit was carried out by one inspector over three days in June 2008. 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 some communal areas. Survey forms were received from residents’ relatives, staff working in the home and General Practitioners (GP). Three residents were spoken to during the inspection visit. We requested an Annual Quality Assurance Assessment (AQAA) from the home, which was provided. 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: The home has a good system in place for assessing the needs of potential residents and uses a person centred approach to planning care. The privacy and dignity of residents is upheld by the way staff work with them. A varied range of suitable activities are offered to residents, with some contact maintained with the local community. Residents’ relatives are encouraged to maintain on-going contact with staff in the home in the interests of the residents. The home was well-maintained and very clean providing residents with a comfortable environment. A high priority is given to ensuring that residents are cared for by suitably trained staff and the home is staffed to meet residents’ needs. The home has won a number of national quality awards. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Grange Care Centre DS0000016609.V361130.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.V361130.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 residents are admitted 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 their 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. Assessments are also made pre-admission for the use and risk of using bed rails, issues around the administration of medication, falls, evacuation in the event of fire and meal likes and dislikes. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 9 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 home does not provide intermediate care and so Standard 6 does not apply. The Grange Care Centre DS0000016609.V361130.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 good. This judgement has been made using available evidence including a visit to this service. There has been a great improvement in medication practices and this combined with a generally good care planning system ensures that residents’ personal and healthcare needs are met. EVIDENCE: Examination of selected care plan files for residents showed that generally they had care plans for certain identified needs used in conjunction with a ‘personal holistic profile’. Some residents however did not have ‘personal holistic profiles’ completed and it was explained that the completion of these was largely reliant on information from relatives. One resident recently admitted to Victoria unit had a profile but no care plans and this was apparently due to the assessment document not being completed which is used to generate care plans. In addition a manual handling assessment had not been completed although another assessment indicated that the resident may have needed assistance with moving and handling. As The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 11 well as this residents also had a night profile and a day profile giving basic information about their needs. Where identified care plans and a moving and handling risk assessment were completed for residents before the end of the inspection visit although the home should check that other residents have care plans in place for their assessed needs. Risk assessments had been completed for pressure areas and nutritional risk assessments had been completed using the recently introduced Malnutrition Universal Screening Tool (MUST) tool. There was recorded evidence of residents having input from health care professionals such as GPs, community psychiatric nurses and consultants, dentists and chiropodists. One resident had a recent physiotherapy referral following a hospital admission. Where appropriate relevant information had been obtained from community mental health teams. The arrangements for medication storage, administration and recording were checked. Medication was stored securely in several generally being kept at correct levels. Where problems had been identified there was evidence of action being taken to achieve correct temperature levels. Medication containers had been dated on opening and medicines for external and internal use had been separated in storage. Examination of the medication administration records (MAR) showed that these had been kept in good order and where omissions had been made, appropriate codes had been used. In addition detailed information about the administration of medication to be given on an ‘as required’ basis had been recorded. Any changes to medication directions had been made with two staff signatures and reference to contact with health care professionals about the issue. Where staff had hand written directions these showed that they had been checked and signed by a second member of staff. Work had also been carried out to ensure that information on any allergies was made known to the supplying pharmacist for printing on the MAR. Assessments have been undertaken as part of the admission procedure to identify any issues with medication prior to the resident entering the home and this is good practice. The most positive factor in the management of medication in this home is the monthly audit conducted by a member of the nursing staff which is a commendable piece of work. In addition staff work towards an NVQ level 3 in administering medication to individuals. 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. One relative of a resident stated on a survey form in response to a question about what the home does well “Create an environment in which personal dignity is maintained.” The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. 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 appropriate activities provides a good degree of social contact. In addition residents are offered a varied diet and are well supported by staff at mealtimes. EVIDENCE: The activities organiser was spoken to and she described the range of activities provided for residents both inside and outside of the home, these had changed since the previous inspection in line with the needs and abilities of the residents. Trips out of the home were still taking place to local coffee mornings although more activities were being provided in the home such as a range of musical entertainers and the use of the new sensory room. Holy Communion is now being held on a one to one basis as it was felt that residents benefited from this approach. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 13 One survey form completed by a relative of a resident stated “Good varied entertainment and outings.” During the inspection visit a small group of residents were engaging in a craft group with the activities organiser. Observation was carried out of communal areas in Victoria unit and Adelaide unit during the inspection visit. In Victoria during the morning residents were sitting in the communal lounge with some still taking their breakfast. Although the television was on it was noted that residents were taking no notice of it. A similar picture was evident in Adelaide unit with two residents sitting in front of the television asleep. However in another part of Adelaide music was playing. A discussion was held with the management of the home relating to the use of the television in communal areas and the suitability of certain types of programme. It was noted however that during lunchtime in Victoria unit music was playing and the television was switched off. In Adelaide staff were seen giving one to one attention to residents whilst performing hand care. There are plans to recruit two more part time activities organisers. During the inspection visit a number of visitors were seen and there were no visiting restrictions as outlined in the home’s Statement of Purpose. There were positive comments on survey forms about how well the home communicated with relatives about residents. As mentioned above some activities provide a degree of contact with the local community with shopping trips also taking place. A summer fete was being planned for July. 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 a number of areas of the home during the inspection visit. Staff gave assistance to residents who needed this on an individual basis and there was a relaxed atmosphere. In St George’s unit a resident was receiving assistance from a visiting relative with their meal. Where meals were pureed they were presented in such a way that all the portions of the meal were identifiable. A record of alternative meals provided such as vegetarian was being kept that showed which residents had received this. The home offers a three-week menu that changes with the seasons. The cook has an award with credit in food safety and has also undertaken training in healthy eating in care homes. Three residents spoken to praised the meals offered in the home. One person on a short stay described the meals as “lovely” and had eaten every meal served to them. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place that enable complaints and concerns to be raised by residents and their representatives. Improved reporting procedures and the training given to staff should safeguard people from possible harm or abuse. EVIDENCE: The details of one recent complaint were looked at. A response in writing had been provided to the complainant and this addressed the issues raised. 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. A time line has also recently been added clearly setting out the process of how a complaint would be dealt with. 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. Dealing with complaints forms part of the training provided to staff following their induction. The home has produced a policy on the Mental Capacity Act 2005 that outlines how it would act if this legislation were enacted for any resident in the home. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 15 One member of staff spoken to confirmed their awareness of the Mental Capacity Act through recent training that they had attended. 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 whistle blowing policy and a group of staff spoken to confirmed that they were confident that staff would use this in the home to report any untoward practice. 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. From July 2008 the home is planning to introduce safeguarding adults training as part of the foundation training provided to staff. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are accommodated in a well-maintained and clean property with on going upgrading that is designed and furnished to suit their needs. 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. Recent additions include a wet room and a sensory room and a room for hairdressing. There are a variety of communal spaces available for residents throughout the home. Outside there are well maintained gardens including a large enclosed courtyard to the side of the home providing a safe area for residents to access. Since the previous inspection outside areas have been further developed with garden furniture and plants to provide a sensory garden. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 17 Individual rooms were very clean and well decorated with plenty of personal items evident in most of them. As well as the more recently registered parts of the home some rooms have been upgraded in the older part of the building with one room being provided with its own enclosed courtyard. One resident on a short stay described their room as “ beautiful.” On a survey form one GP stated “ Excellent facilities and Environment.” A new laundry has been completed and was equipped with hand washing facilities and suitable wall and floor coverings. On a survey form one relative of a resident described the new laundry as a “major improvement” The home places great emphasis on infection control and in particular the hand hygiene of staff. Hand cleaning gel is available at points throughout the home along with reminders as to the importance of hand hygiene in controlling infection. The home has embarked upon an infection control action plan lasting twelve months from May 2008. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the numbers and skills of staff with a strong emphasis on training although recruitment practices have again not been robust and have potentially put residents at risk. EVIDENCE: The home has introduced an arrangement where each unit had a separate staff team of care staff during the day. A shift is also worked by a member care staff 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 with one and sometimes two at night. Nursing and care staff are supported by cleaning staff, catering staff, administration and maintenance staff. The home has well over 50 of care staff trained to NVQ level 2 or higher level with one having achieved a level 4. The home has started City and Guilds Vocational Related Qualifications (VRQ) and a number of staff had completed units of this in Promoting the Mental Health and Wellbeing of Older People at levels two and three. This is a very new qualification and due to this awards have not yet been made. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 19 Nursing staff have completed additional qualifications at degree level supported and paid for by the home. As part of the homes recruitment process (and before recruitment checks have been finalised) applicants who have not previously worked with the people using the service are invited to work a trial shift alongside a team leader. This does not involve carrying out any personal care and this was confirmed by one staff member spoken to on the subject. Following discussions both during and after the inspection it is recommended that the home should clearly state the expectations of a trial shift in terms of contact with people using the services, their money and medication. Examination of the recruitment files for staff showed that out of five staff members selected, three had commenced work at the home without initial checks against the Protection of Vulnerable Adults register (PoVA). This is despite a requirement issued following the previous key inspection about the information that must be collected before staff start work in the home. With another two staff although it was reported that PoVA first checks had been carried out, no supporting evidence could be found during the inspection visit. One member of staff recruited gave no reasons on their application form for leaving two posts involving caring for vulnerable people. It was confirmed through discussion with a member of staff on the interview panel that this was not explored during the interview. In addition one reference had been received relating to employment in a care setting that did not come from the previous employers but from the previous manager. The home should review its position on accepting such references. The provider had included a printout from the website of the Nursing and Midwifery Council (NMC) on the file that indicated the nurse registration of the staff members. However it is recommended that the nurses’ registration should be checked using the NMC’s on line employer confirmation service through their website. The home’s AQAA document indicated that satisfactory pre-employment checks had been carried out on all staff. In addition under the staffing outcome area on the AQAA document there was a great emphasis on staff training but no mention of recruitment practices. Since the previous inspection some other aspects of the recruitment process have improved for example with prompts included on the interview question sheet about gaps in employment history and written evidence that this was being put into practice with some if not all of the staff files examined. All care staff receive induction training using the Common Induction Standards. This then leads on to NVQ training and a City and Guilds certificate in Health and Social care. Staff are also required to sign certain policies to indicate that they have read and understand them during the induction period. Staff receive more than 3 paid days training per year. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite a strong management team and good work in a number of areas, there is still improvement needed and management input in some safe working practices including recruitment to ensure the safety and well being of the residents. 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 adult protection. The manager is not a nurse but is supported by a support manager who is a The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 21 registered nurse. There is a senior carer with an NVQ qualification in charge of the residential unit. Quality assurance systems are in place in the home in the form of resident quality assurance questionnaires. These were carried out with a number of selected residents which despite having dementia were able to complete the questionnaires with support from a carer. The results have been compiled and recorded. Other forms of quality assurance are the senior management meeting, team leaders‘ meetings and the previously mentioned medication audits. There is a business plan for the home which sets out planned developments and objectives over a twelve month period. Despite this there are still a number of areas, these being recruitment, the storage of cleaning materials and moving and handling which require some quality monitoring and management input to ensure the safety of residents. 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 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 as food hygiene, fire safety, first aid and infection control. One registered nurse has completed a course in training first aid to other staff in the home. Infection control and in particular hand hygiene has been a recent priority in the home. The home has recently started a health and safety group, which will meet on a fortnightly basis. Fire drills are carried out every two weeks with a record kept. The home has extended its fire safety work to include emergency evacuation plans for residents looking at individual needs in the event of a fire emergency. In addition 26 staff have completed training in fire safety to become fire marshals in the home. The home has a fire risk assessment and has received a visit from the fire safety officer in 2007 where no issues were raised. Moving and handling training is provided to the staff by registered nurses in the home who are recognised trainers in this area. Staff are not able to undertake moving and handling until they have completed training and are required to sign to indicate that they will abide by the training before they receive their certificate. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 22 However observation of staff moving and handling residents in Victoria unit showed that three residents were being moved from wheel chairs into arm chairs using an underarm moving technique. When discussed with the moving and handling trainer it was confirmed that staff were not expected to use this technique and it had not formed part of the training provided to them. However it was noted that staff were communicating and explaining to the resident the task that they were performing. A check of the moving and handling assessments for the three residents showed that one of the residents should have been moved using a hoist. As previously mentioned one resident did not have a moving and handling assessment completed. The home must ensure that these are completed for all residents that need assistance in this area as a guide for staff in safe practice. 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. The home has a water system that is designed to be ‘Legionella limiting’. Checks had been undertaken on boilers 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 with records kept. These form part of the monthly maintenance checks along with bed rails and water temperatures. The testing of portable electrical appliances is carried out every December and although no separate records are kept, each electrical appliance tested has a sticker attached to it. Through discussion with the maintenance manager, it may be possible that some appliances have been introduced to the home and may not have yet been picked up in the annual check. The home had commissioned a report from a health and safety consultant in which the practice of portable electrical appliance testing was addressed with the recommendation “need to make sure that all PAT testing is carried out.” In the light of this the home should check if there is any untested electrical equipment in resident’s rooms. Following a requirement in the previous inspection report, the storage of cleaning materials was looked at. As at the previous inspection examples were found where cleaning substances had been decanted into bottles that were either inadequately labelled or in one case had no label 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. This was discussed with the management of the home and a new system of weekly checks is to be introduced. The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 4 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 3 18 3 4 X X X X 4 X 4 STAFFING Standard No Score 27 3 28 4 29 1 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 (1) (b) Schedule 2 Requirement 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. This requirement has been repeated from the previous inspection. 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. This requirement has been repeated from the previous inspection. To ensure the safety of residents moving and handling techniques must be carried out in line with the training provided in the home. To ensure safe practice all residents that need assistance with moving and handling must have appropriate assessments completed. DS0000016609.V361130.R01.S.doc Timescale for action 30/09/08 2. OP38 13 (4) (c) 30/09/08 3. OP38 13 (5) 30/09/08 4. OP38 13 (5) 30/09/08 The Grange Care Centre Version 5.2 Page 25 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 OP7 OP29 Good Practice Recommendations A review should take place to check if residents have care plans for their assessed needs. The expectations of contact with people using the service, their money and medication should be clearly stated in writing to applicants undertaking a trial shift as part of the recruitment and selection process. The registration of nurses should be checked using the employer confirmation service provided by the Nursing and Midwifery Council. The home should review its position on accepting references that do not originate from employers but relate to employment in a care setting. A check should be made in resident’s rooms for the presence of any untested electrical appliances. 3. 4. 5. OP29 OP29 OP38 The Grange Care Centre DS0000016609.V361130.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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