Inspection on 11/01/06 for The Grange Nursing And Residential Home

This inspection was carried out on 11th January 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... 01/08/06

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

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

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

Similar services:

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 10:30 11 January 2006 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 Grange, The Nursing And Residential Home DS0000002082.V276952.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. Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 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.V276952.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. It is recommended as a condition of registration that Angela Flavell must attend the Derbyshire County Council Adult Protection training, (3 day course), within the next six months. 2nd September 2005 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.V276952.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced. There were 34 residents accommodated at the home on the day of the inspection, including 11 residents assessed as requiring nursing care. Residents, a visitor and staff were spoken with during the inspection. Care records were examined, plus staff records, staff training records, and health and safety records. Since the last inspection, the home had successfully applied to vary the registration to include 16 places for people aged 65 years or over with dementia. A separate unit had been developed on the ground floor of the home with 16 bedrooms, a large lounge with access to a patio and small garden area, a small ‘quiet’ lounge, a dining room, an office and two bathrooms. The unit shared the kitchen and laundry facilities with the main home. It was planned that the unit would officially open the week following this inspection. What the service does well: What has improved since the last inspection? What they could do better: Some of the requirements made at the previous inspection had not been met. These requirements have been carried forward in this report. These requirements included improvements in the information provided to residents and improvements in care plans, and also requirements to ensure the safe and correct storage of medication. Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 6 The staff training records were not up to date so it was unclear what recent training had been carried out. A requirement has been made in this report about staff training records. 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.V276952.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 Grange, The Nursing And Residential Home DS0000002082.V276952.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): 3 Satisfactory assessment information was seen in the care records, ensuring that the home could meet the needs of residents. However, residents had not received written confirmation of this from the home. EVIDENCE: The care records of five residents were examined. All of the records had satisfactory assessment information, including the Community Care Assessment and the assessment of the manager prior to the admission of the resident. None of the records seen had a copy of a letter confirming to the resident that the home was able to meet their needs. The manager said that there was now a standard letter to use, but this had not been put into practice. This was a requirement at the last inspection and has been carried forward in this report. Grange, The Nursing And Residential Home DS0000002082.V276952.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): 7 and 8 Generally, residents’ health and personal care needs appeared to be well met with good liaison with other healthcare professionals. Improvements had been made to the care records since the last inspection. However, there were still some gaps identified in the records. EVIDENCE: The five care records examined included two residents requiring nursing care. The care records included assessments such as the risk of developing pressure sores, continence, risk of falls, mobility, and nutritional needs. All the assessments seen had been reviewed monthly. Information was also included about the resident’s personal and social history. Each of the records seen had a care plan produced from the assessment of the resident’s needs. Generally, the care plans were good with details of the action required by staff to meet residents’ needs. There were some omissions on the care plans seen. None of the care plans included details of the oral care required by residents. One care plan did not include a plan for pressure area care even though the resident had been assessed as at high risk of developing pressure sores. Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 10 The care records included details of the input of other healthcare professionals, such as GP, District Nurse, and chiropodist. Residents and a visitor spoken with said that the GP was contacted without delay when necessary. One care record seen showed that the GP had been contacted promptly when the resident began to have symptoms of a chest infection. Another care record showed that the District Nurse had been contacted soon after the admission of a resident to check and advise on skin care. Residents and a visitor spoken with were pleased with the standard of care at the home, commenting that they were “well cared for”, and that the staff were “friendly and caring”. The manager and staff at the home had made improvements to the care records since the previous inspection. Staff spoken with were familiar with the care plans and were knowledgeable about the needs of residents. There was some confusion over the use of care plan evaluation records and daily logs and this was discussed with the manager. Although Standard 9 was not assessed at this inspection, requirements made at the previous inspection were followed up. Three of the four requirements made had not been met and have been carried forward in this report. These three requirements were about the safe and correct storage of medication. Grange, The Nursing And Residential Home DS0000002082.V276952.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): 12, 13 and 14 Residents were offered a range of activities to meet their social and cultural needs. The recent appointment of an activities coordinator should improve the service offered. EVIDENCE: Residents spoken with were pleased with the social activities offered by the home. One resident preferred not to join in with activities and was pleased that staff respected this. A programme of activities was displayed in the main entrance with photographs of previous activities. The home had recently appointed a new activities coordinator working for 20 hours per week. The activities coordinator was enthusiastic about the role and was looking forward to putting ideas into practice. One resident spoken with said that visitors were always made welcome and the visitor spoken with confirmed this. There were several visitors in the home during the inspection. Residents were encouraged to bring their own possessions into the home. The bedrooms seen were personalised with photographs and personal items. The care records included details of residents’ preferences regarding their daily routines. Grange, The Nursing And Residential Home DS0000002082.V276952.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): EVIDENCE: These standards were not assessed at this inspection. Grange, The Nursing And Residential Home DS0000002082.V276952.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): EVIDENCE: These standards were not assessed at this inspection. A requirement made at the last inspection to decorate two ground floor toilets had been met. Grange, The Nursing And Residential Home DS0000002082.V276952.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): 29 and 30 Generally, residents were protected by the home’s recruitment procedure, although some staff records did not all contain the required items. It was not clear from the staff training records that staff had received recent training to ensure competence in their work. EVIDENCE: Staff personal records and staff training records were examined. The staff personal records were well organised and generally had all the required information. Two records seen did not have a photograph or identification information for the member of staff. A requirement has been made in this report that all staff files must include a recent photograph and some form of identification. The training records seen were not up to date and so it was not clear what recent training had taken place. Staff spoken with said they had received fire safety and moving and handling training in the last year. A nurse spoken with had attended a wound care training day and care assistants spoken with had attended in-house training about wound care and continence. A requirement has been made in this report that all staff must have individual training records which are kept up to date. Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 15 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): 33 and 38 The quality assurance system was robust to ensure that the home was run in the best interests of residents. Residents and staff were protected by the health and safety policies and practices in the home. EVIDENCE: Evidence was seen of the home’s quality assurance system. This included a monthly audit carried out by the manager and a questionnaire sent out to residents and relatives. The responses to the questionnaire had been received and had been analysed. Positive responses included satisfaction with the environment of the home and with the care provided. Negative responses included comments on the lack of social activities and shortage of staff. The home had a comprehensive health and safety policy. The home had recently set up a health and safety committee which had met in November Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 16 2005 and would be meeting every two months. Health and safety records were examined. Maintenance of the building and equipment appeared well organised and well documented. Records of fire drills, fire alarm tests, and emergency lighting checks and maintenance were all well kept and up to date. The accident book was seen. An audit of accidents was included on the agenda of the health and safety committee meeting. There were records of visits by the Environmental Health Officer and Fire Officer. Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 17 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 18 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 OP3 Regulation 14(1)(d) Requirement The registered person must confirm in writing to the resident that the care home is suitable to meet the assessed health and welfare needs of the resident. Original timescale 31/10/05 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 ensure that the storage facilities for medication are secure. Original timescale 31/10/05 The registered person must ensure that medication is stored according to the directions stated on packaging, i.e. at the correct temperature. Original timescale 31/10/05 Daily maximum and minimum temperatures must be recorded for the medication fridge on the first floor and must lie between 2 and 8 degrees C. Original timescale 31/10/05 For each member of staff employed at the home, there must be proof of identity DS0000002082.V276952.R01.S.doc Timescale for action 28/02/06 2. OP7 15(1) 19/02/06 3. OP9 13(2) 28/02/06 4. OP9 13(2) 28/02/06 5. OP9 13(2) 28/02/06 6. OP29 19(1)(b) 31/03/06 Grange, The Nursing And Residential Home Version 5.1 Page 19 7. OP30 13(3) 8. OP30 19(1)(b) including a recent photograph. Staff at the home must 31/03/06 undertake suitable training in the control of infection. Original timescale 31/12/05 For each member of staff 31/03/06 employed at the home there must be a record of all training undertaken. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP9 OP19 Good Practice Recommendations The use of the care plan evaluation forms and the daily record sheets should be reviewed Code letters used on Medication Administration Records, (MARs), should be explained in the key on the record 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 ground floor drug storage room should be repaired or replaced Grange, The Nursing And Residential Home DS0000002082.V276952.R01.S.doc Version 5.1 Page 20 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. 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