Inspection on 01/08/06 for The Grange Nursing And Residential Home

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 Nursing And... 25/09/07

The Grange Nursing And... 11/01/06

The Grange Nursing And... 02/09/05

The Grange Nursing And... 27/09/04

The Grange Nursing And... 26/02/04

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Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Grange, The Nursing And Residential Home Field Drive Shirebrook Nottinghamshire NG20 8RL Lead Inspector Rose Veale Unannounced Inspection 1st August 2006 10:30 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 Grange, The Nursing And Residential Home DS0000002082.V305881.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. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange, The Nursing And Residential Home Address Field Drive Shirebrook Nottinghamshire NG20 8RL 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) 01623 747070 01623 746513 Southern Cross Care Management Limited Angela Susan Flavell Care Home 50 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (50) of places Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1 place for (YA) for named person, (identified in the proposal notice), for as long as they are accommodated at the home. 16 places for (DE) when all the requirements made in the site visit report of 08/08/05 have been satisfactorily met. 11th January 2006 Date of last inspection Brief Description of the Service: The Grange Care Centre is situated in village of Shirebrook, near to local shops, pubs and public transport. The home provides personal and nursing care and accommodation for up to 49 older people, including 16 people with dementia, plus 1 place for a named person under the age of 65. All residents are accommodated in single rooms with en-suite toilets. The home has lounge and dining areas suitable for use by small or larger groups of residents. There is a large garden area with patios accessible to residents. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 6½ hours. There were 44 residents accommodated in the home on the day of the inspection, including 11 residents assessed as needing nursing care and 12 residents assessed as needing dementia care. Residents, visitors and staff were spoken with during the inspection. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire had been completed and returned prior to the inspection and information from this has been included in the body of this report. What the service does well: What has improved since the last inspection? What they could do better: Some of the care plans seen did not include enough detail to ensure residents’ needs were fully met. Not all the staff had not received training to ensure they were fully competent, specifically dementia care training and training in the protection of vulnerable adults. Staff had not received regular supervision or appraisal to support them in their work roles and encourage personal development. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 6 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. Grange, The Nursing And Residential Home DS0000002082.V305881.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 Grange, The Nursing And Residential Home DS0000002082.V305881.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The assessment process ensured that residents were confident that the home could meet their needs. EVIDENCE: The care records of 6 residents were examined, including records of residents assessed as needing nursing care and those needing dementia care. All the records included a good range of assessment information. For residents recently admitted, there was assessment information from the care manager and / or hospital. There was a pre-admission assessment by the home’s manager. Following admission there was a range of information including assessments of nutritional needs, risk of developing pressure sores, and assessment of dependency. These assessments had all been reviewed and updated monthly. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 9 Residents recently admitted had received confirmation in writing from the home that their needs could be met. This met a requirement made at the last inspection. Residents and their relatives spoken with were satisfied that the home was able to meet their needs. Standard 6 does not apply to this service. Grange, The Nursing And Residential Home DS0000002082.V305881.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ care needs appeared to be met. Some care plans did not include sufficient detail about the assessment of residents’ needs and of how staff should meet those needs. Improvements had been made to ensure the medication system and procedures were generally safe. EVIDENCE: The care plans seen for the residents accommodated in the main part of the home generally covered all the assessed needs of residents and had been updated at least monthly. The care plans included details of the action staff should take to ensure residents’ needs were met. The care plans seen for residents in the dementia unit did not cover all the needs of residents and did not include enough detail. For example, there was no care plan for oral health in one record; one care plan for communication did not give details of how staff could communicate effectively with the resident; a care plan for continence did not include the information that the resident was regularly Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 11 incontinent of urine and did not give details how this should be managed by staff. Two records seen were of residents admitted for short-term care on the dementia unit and the assessments had not been fully completed. For example, one of the records had no continence or falls risk assessment. Care plans had not been completed for the short-term care residents. Records were seen of the visits and input of GPs, District Nurse, chiropodist, dentist and optician. Residents and their relatives spoken with said that the GP was called promptly when needed and that residents were regularly seen by the chiropodist, dentist etc. as required. There was evidence from the daily records that health problems were identified and followed up appropriately. For example, a resident with a chesty cough was seen by the GP and treated with antibiotics; a resident had problems with dentures causing a sore mouth and was referred to the dentist. Residents and their relatives spoken with said that staff were respectful in their approach to residents. Residents commented “I’m very happy here” and “I’m looked after very well”. It was observed that staff approaches and communication with residents was generally respectful and appropriate. The preferred name of the resident was noted in their care records. One relative spoken with was pleased that staff maintained the style of dress the resident preferred to wear. Residents commented that the staff were “very good”, “kind” and “they work hard”. At the last inspection it was found that the temperature in the ground floor medication room was consistently above the correct temperature for the storage of medication. At this inspection evidence was seen that an airconditioning system had been approved for installation to address this problem. New medication fridges had been provided and daily maximum and minimum temperatures were being recorded. The medication administration records were seen and were mostly correctly completed. Where handwritten entries had been made, rather than details printed by the pharmacy, the entries had not been signed by the person making them or countersigned by another person checking the entry as correct. This should be carried out as good practice to ensure the details on the medication administration record are correct. A code letter had been used on one administration record but had not been explained in the key. Grange, The Nursing And Residential Home DS0000002082.V305881.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ expectations and preferences appeared to be met by the lifestyle experienced in the home. EVIDENCE: There was a range of activities available to residents organised by an activities coordinator. Residents, relatives and staff had enjoyed a recent day trip to Skegness. Two residents spoken with had enjoyed a game of bingo on the morning of the inspection visit. Residents in the lounge on the dementia unit were involved in singing along to music and chatting with each other and with staff. Staff spoken with said it would be beneficial to residents to have more hours allowed for the activities coordinator. Visitors spoken with said they were always made welcome at the home. Relatives said they were kept informed about events in the home and had joined in with activities such as the trip to Skegness and outside entertainers coming into the home. Children from a local primary school had come to the home to perform a play for the residents and had also taken part in an Easter egg competition devised by the home. Students from the local secondary school had taken part in work experience placements at the home. Several Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 13 residents spoken with were pleased they were able to stay in the area where they had lived. Residents spoken with said the meals provided were good and that there was always a choice. The meals served on the day of the inspection appeared appetising. The dining areas were pleasant and staff were observed to assist residents with eating in an appropriate way. The menus seen appeared varied and well balanced. Grange, The Nursing And Residential Home DS0000002082.V305881.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents and relatives were confident that their complaints were taken seriously. Residents’ safety and protection was compromised by a lack of appropriate staff training. EVIDENCE: The home had policies and procedures in place regarding complaints and the protection of vulnerable adults. Residents and relatives spoken with were aware of their right to complain but had not made any formal complaints. They said they were happy to approach staff or the manager with any problems. Examples were given of concerns raised and appropriate action taken. Staff training records showed that most staff had not received recent training in the protection of vulnerable adults from abuse. Staff spoken with were generally aware of adult abuse issues and procedures. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents lived in a clean, pleasant, comfortable and safe environment. EVIDENCE: The home was clean and generally well maintained. The storage cupboards in the first floor medication storage room were in need of repair or replacement. The manager said that this work was planned. Residents and relatives spoken with were satisfied with the standards of cleanliness in the home. Staff training records showed that a few staff had received training in the control of infection. The manager said that this training was planned. The manager said that expert advice had been sought to ensure the dementia unit provided an environment appropriate to the needs of the residents. The bedroom doors were painted in strong colours and were personalised with the resident’s name or photograph. Toilet and bathroom signs had the appropriate picture. There were ‘tactile boards’ on the corridor walls with everyday objects Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 16 firmly attached to allow safe touching by residents. There were pictures and photographs of the history of the local area. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staffing levels were generally sufficient to meet residents’ needs. Residents were protected by the recruitment procedures in place. Staff training was not comprehensive enough to ensure staff were fully competent to meet the needs of all residents. EVIDENCE: The staff rotas were examined and showed that staffing levels from 8am to 8pm were 1 nurse and 2 care assistants for the residents needing nursing care, 3 care assistants for the residents needing personal care, and 2 care assistants for the dementia unit. During the night the staffing levels were 1 nurse and 4 care assistants covering the entire home. The staffing levels appeared to be in line with the Residential Forum guidance for the specified dependencies of the residents. Residents and relatives spoken with said that staffing levels appeared to meet the needs of the residents. Staff spoken with said that improvements had been made in covering staff sickness or other absence. Some staff commented that staffing levels did not always reflect the dependencies of residents, particularly if residents were ill and needing more care for a short time. The records of 4 members of staff were seen. The records included all the required information, such as a photograph and form of identification of the Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 18 person, 2 written references and a Criminal Records Bureau disclosure. The records were well organised and were stored securely. Staff training records and information supplied with the pre-inspection questionnaire showed that 10 out of 28 care assistants had achieved NVQ Levels 2 or 3. The staff training records showed that the majority of staff had received training in manual handling, fire safety and food hygiene. According to the records seen, the majority of staff had not had training in adult protection. 2 staff had undergone recent training in adult protection; some of the staff had received training in 2004. The records showed that 2 staff had received training in dementia awareness. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was well organised and run with the best interests of residents in mind. EVIDENCE: The manager had been in post for about 18 months. Staff spoken with said the home felt “more settled” now. Staff said that they found the manager approachable and said she was willing to help out if necessary. One senior member of staff was pleased that weekly meetings were held with the manager and senior staff to sort out any problems and to ensure good communication. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 20 The home’s annual quality audit was seen at the last inspection and had not been carried out again since then. The quality assurance system was satisfactory at the last inspection in January 2006. There was a system in place for staff supervision and appraisal. The manager said some staff had received supervision but the system was not fully ‘up and running’. The most recent records of staff annual appraisals were from 2004. Staff spoken with said they had not received recent or regular supervision. Health and safety records were seen including maintenance records and the fire logbook. The records seen were up to date. There was a comprehensive health and safety policy in place. Some staff had received training in health and safety. The majority of staff were up to date with fire safety training. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 21 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 30/09/06 2. OP9 13(2) 3 OP30 18(1)(c) All residents must have a care plan detailing how all their assessed needs will be met. Original timescale 31/10/05 The registered person must 31/10/06 ensure that medication is stored according to the directions stated on packaging, i.e. at the correct temperature. Original timescale 31/10/05 Staff must receive training 31/10/06 appropriate to the work they are to perform, i.e. dementia care, control of infection and protection of vulnerable adults training. 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 Code letters used on Medication Administration Records, (MARs), should be explained in the key on the record DS0000002082.V305881.R01.S.doc Version 5.2 Page 23 Grange, The Nursing And Residential Home 2. 3. 4. OP9 OP19 OP36 Handwritten entries on MARs should be signed by the person writing them and countersigned by another member of staff who has checked the entry as correct The cupboard doors and drawers in the first floor medication storage room should be repaired or replaced Staff should receive formal supervision a minimum of 6 times per year. Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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 Grange, The Nursing And Residential Home DS0000002082.V305881.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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