Inspection on 18/12/07 for The Grange Nursing & Residential Home

This inspection was carried out on 18th December 2007.

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

Other inspections for this house

The Grange Nursing & Residential... 24/02/09

The Grange Nursing & Residential... 15/10/08

The Grange Nursing & Residential... 31/10/06

The Grange Nursing & Residential... 25/05/06

The Grange Nursing & Residential... 04/01/06

The Grange Nursing & Residential... 16/06/05

The Grange Nursing & Residential... 11/01/05

The Grange Nursing & Residential... 23/08/04

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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 The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT Lead Inspector Helen Abel & Debbie Williams Unannounced Inspection 18th December 2007 02:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange Nursing & Residential Home DS0000060078.V356526.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 Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Nursing & Residential Home Address Smeeton Road Saddington Leicester Leicestershire LE8 0QT 0116 2402264 0116 2404888 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) Mr Banesh Laxmilall Bhatoolall ** Post Vacant *** Care Home 52 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (52), Physical disability (12), of places Physical disability over 65 years of age (52) The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No person under the age of 55 falling within category PD (physical Disability) may be admitted to The Grange Nursing and Residential Care Home. No one falling within category OP may be admitted into The Grange Nursing and Residential Care Home where there are 52 persons of category OP already accommodated within this home. No one falling within category PD(E) may be admitted into The Grange Nursing and Residential Care Home where there are 52 persons of category PD(E) already accommodated within this home. No one falling within category PD may be admitted into The Grange Nursing and Residential Care Home where there are 12 persons of category PD already accommodated within this home. No person to be admitted to The Grange Nursing and Residential Care Home in categories OP, PD, PD(E) or DE(E) when 52 persons in total of these categories/combined categories are already accommodated in this home. No one falling within category DE(E) may be admitted into The Grange Nursing and Residential Care Home where there are 14 persons of category DE(E) already accommodated within this home. 31st October 2006 6. Date of last inspection Brief Description of the Service: The Grange Nursing and Residential Home is registered to accommodate up to fifty-two older people, within the categories of older persons and physical disability. The home is located in the village of Saddington, Leicestershire and is approximately 12 miles from Leicester City centre. It is accessible by public or private transport and there is car parking at the home. The home is a large, traditional style house with bedrooms on two floors. The upper floor is accessible by stairs, stair lift or the passenger lifts. The home has 38 single rooms and 7 double rooms. Bathrooms and toilet facilities are located close to the bedrooms and the communal areas. There are two large comfortable lounges and the dining area is situated off the main lounge. All areas of the home are accessible to people using mobility support, aids and equipment. Information about the service is provided to prospective and current residents The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 5 in the ‘service user guide’. The monthly fees are £327 to £441, which was provided by the Registered Person. There are additional charges for hairdresser, chiropodist and escort fees. The CSCI published inspection report is available at the home. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspected the Grange Nursing & Residential Home against the Care Standards Act 2000. The inspection method used was ‘Inspecting For Better Lives’, which is based on outcomes for the clients. Planning for the inspection included reading the notifications of significant events sent to the CSCI and the last Inspection Report. One complaint has been received by CSCI since the last inspection in October 2006 and has been resolved in consultation with CSCI and Social Services. The registered provider is in the process of responding to some concerns raised by the Healthcare leads, and Social Services. Please refer to the Complaints and Protection section of this report. The Annual Quality Assurance Assessments (AQAA), which provides information as to the services the home provides was not available in time for this inspection but will be made available to the CSCI in January 2008. The visit took place on Tuesday 18th December with two Inspectors at 2.45 pm and lasted over four hours. The senior nurse and registered provider assisted the Inspectors during the visit. The method called ‘case tracking’ was used to determine the standard of care provided in the home surroundings. This involved identifying six clients with varying levels of care needs and looking at how these are being met by the staff at the Grange Nursing & Residential Home. Discussions held were clients themselves and other clients, speaking with staff providing the care and nursing tasks, checking records relating to their health and welfare, viewing their personal accommodation (with their consent) as well as communal living areas used. Observations were made of how the care staff supported clients participate in the daily activities and decision-making. Records relating to health and safety, staff records, and training records were checked. Clients were happy about the care given by staff. They felt the home was comfortable and they have what they need. The information below is based only on those aspects checked in this inspection. Individual details have not been included in the report, to ensure confidentiality. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: One requirement to be met:- Staff must have Criminal Record Bureau Checks (CRB’s) in place before they commence employment. Such checks show that staff are recruited properly, and that the registered provider makes sure checks are carried out so that he can be confident that staff are safe to work with clients. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 8 Different risk assessments are carried out, to make sure that residents are looked after properly and are able to be safe in the home. These should be reviewed more frequently to keep clients care up to date. Each client has a consent form around resuscitation; there appeared to be some uncertainty around the legalities of clients/relatives giving consent. The registered provider is advised to seek legal advice around the use of the consent forms and take any action accordingly. This will ensure each client’s wishes are respected and protected. Continue to ensure bedrails are available for residential clients in consultation with the community nurses. This protects the client and the home. Care records confirmed clients with pressure sores were well cared for by the staff and input from the community nurses. To ensure clients health care needs are fully met we suggest further consultation with community nurses regarding pressure-relieving mattresses required for clients who are high or very high risk of developing pressure sores. More attention should be given to client’s health and personal care to ensure their privacy and dignity is respected around personal care giving. The comments book held in reception is a good initiative. The book should be checked and responded to regularly and any actions taken promptly by managers. Responding swiftly to such comments can help alleviate any anxieties and help maintain good relations with clients and their families. The complaints procedure needs updating, including the summary in the statement of purpose. In line with the latest procedure, the complaints procedure needs to be altered to give the complainant the choice of the initial stage to go to the investigating body the local Social services Department now the lead agency for investigating complaints- as well as the home. A complaints record should be obtained to record complaints received and any action that was taken in response. This will ensure client’s complaints are taken seriously and acted upon. The front door should be made more secure in order to safeguard clients, staff and visitors and ensure clients benefit from living in a safe home. The registered provider should ensure a registered manager is provided to manage the home. This would ensure clients have a suitable person to run the home who is fit to be in charge. Clients/relatives meetings- are not regular although referred to as, in the homes statement of purpose. The registered provider should ensure clients/relatives meetings are held regularly. This would ensure the home is run in the best interests of the clients. Staff meetings should be held regularly to continually measure the aims and objectives of the home through the care The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 9 and support staff perform daily with clients. Records of staff meetings should be kept. 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 Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 11 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): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a good admissions procedure to the home. EVIDENCE: The home has produced a statement of purpose setting out its aims and objectives, the range of facilities and services it offers to residents, and the terms and conditions of the home. It was noted that regular residents /relative meetings are included as part of the service but currently are not taking place. This entry needs to be reviewed and updated. This document was in an easy to read style and located in the reception area with a copy of the most recent inspection report. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 12 Reference to the complaints procedure should include more information around dealing with complaints. New and existing residents can then be assured their complaints are listened too and taken seriously. The registered provider confirmed he would be updating the complaints policy and procedure soon and the statement of purpose. Each resident has her/his needs assessed before entering the home and were evident for all residents case tracked. Clients can be assured their assessed needs will be met. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 13 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. Care is provided in accordance with the clients care plan in place. EVIDENCE: Care plans gave information about clients and about their needs and how staff in the home will meet them. There are regular reviews of care plans some accompanied by signatures of relatives, who were also involved in the clients review. Different risk assessments are carried out, to make sure that residents are looked after properly and are able to be safe in the home. We suggest these could be reviewed more frequently to keep clients care up to date. Staff make sure that clients see a GP or other health professional if they are unwell. Staff also make sure clients have other healthcare support, for example dietician, speech and language therapist, eye care and dental care. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 14 Some clients had a consent form around resuscitation with some completed by relatives. There some uncertainties around clients/relative consent and the registered provider was advised to seek legal advice around the consent forms. Following on the inspection some good practice guidance information was forwarded onto the home. Bedrails were available for client’s case tracked and records confirmed this. Nursing staff had assessed bed rails for a residential care client. Confirmation should be sought around who authorises the provision of bedrails for residential residents. The Inspectors suggested the registered provider consults with the community nurses regarding this issue. A regular weighing programme for clients is carried out starting from the first day clients enter the home. This is followed through by a nutritional risk assessment where required, and visits to clients by the dietician. Care records confirmed clients with pressure sores were well cared for by the staff and input from the community nurses. To ensure clients health care needs are fully met we suggest further consultation with community nurses regarding pressure-relieving mattresses required for clients who are high or very high risk of developing pressure sores. Staff who give out medication are nurses who have had appropriate training. An Inspector observed staff giving out teatime medication and appeared to follow safe procedures and dispensing correctly. Medication administration records seen appeared up to date and accurate. A client was observed in the lounge he looked unkempt with greasy hair and dirty fingernails this was despite having a bath earlier that day. More attention should be given to client’s health and personal care to ensure their privacy and dignity is respected. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 15 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. Meals offer clients a balanced and varied diet. Clients are enabled to have a good lifestyle in the home. EVIDENCE: One client told the Inspector, “The staff at the home are very good and there is usually enough staff on duty.” A visitor said “Very caring, very charming staff. There are enough staff to assist with feeding people at mealtimes.” There are regular newsletters with current information about the home in large print displayed on the notice board in reception. A comment book is available in reception and both negative and positive comments are welcomed. There is a space in the book for management to respond to any comments, but recently managers had stopped responding. The Inspector suggested managers continue to check the comments and take any actions as and when required. A recent example was where some of the client’s families had made reference to The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 16 safety and access issues to the home over the months, but there had been no progress made. By managers responding swiftly to such comments this may alleviate any anxieties and help maintain good relations with clients, their families and the home. Staff reported clients are encouraged to keep close contacts with their faiths. One client goes to regular religious festivals with family members. There is a Roman Catholic service in the home the first Monday of the month. An Activity Organiser leads with providing activities for clients but was not avaible to speak with on the day of inspection. Clients were seen reading papers, watching televisions, listening to music and speaking to staff and other clients. A Christmas party was scheduled for the 20th of December for all the clients with special entertainers brought in. A visitor told the Inspectors, “ My mum has made new friends. Staff that support her do so with care. My mum was very disorientated at first but the provider was very caring and helped to settle her.” The Inspectors observed teatime in the lounge and found this to be well organised. Clients were offered choice and variety of sandwiches and staff were familiar with individual clients likes and dislikes. Staff were observed being very attentive whilst assisting clients, and the mealtime was unhurried and relaxed. Staff reported soft diets, vegetarian, allergy free and culturally appropriate diets are all provided. The menu reflected this and offered balanced meals with variety. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 17 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients are mostly protected by procedures and good staff awareness regarding complaints and adult protection procedures. EVIDENCE: The complaints procedure was displayed in the reception area. In line with the latest procedure, the complaints procedure needs to be altered to give the complainant the choice of the initial stage to go to the investigating body-the local social services department - now the lead agency for investigating complaints- as well as the home. The registered provider said this would be changed. The registered provider was unable to locate the complaints record but agreed to obtain a new one. Staff have received training around safeguarding adults and understood about procedures to follow where a complaint is raised. Staff spoken with had a good understanding of their responsibility and procedures to follow if they suspected abuse was happening. The Commission received one complaint for Social Care Inspections (CSCI) since the last inspection around Admissions and Staff Training and Staff The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 18 Competence. This has been resolved by working directly with the registered provider and via social services. The registered provider is in the process of responding to some concerns raised by the healthcare leads, and social services around past investigations and actions undertaken by him the registered provider. The CSCI is being kept informed of developments. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 19 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): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident benefit from a mainly clean, well maintained environment. EVIDENCE: During the visit, the Inspectors looked around some parts of the home. A sample of bedrooms, bathrooms and toilets were checked. The Inspectors noted an odour was present. The registered provider agreed to look into the odour found in the bedroom. A visitor commented the cleanliness of the home is the same each day, regardless if Inspectors were present. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 20 Some bedrooms had attractive name cards displayed on their bedroom doors other had sticky pieces of paper poorly displayed. The registered provider agreed this would be promptly resolved. The lounge area seating was arranged into small groups to support clients who enjoy watching television, listening to music or talking with other clients. The front door latch was open throughout the day. The Inspectors spoke with the registered provider around safeguarding clients, staff and visitors and suggested this door is made more secure. This would ensure clients benefit from living in a safe home. The issue was repeatedly raised by visitors in the home’s comment book. The registered provider agreed to re- consider the issues. There are systems in place for making sure the laundry is done efficiently. Staff told the Inspector about safety precautions for controlling the spread of infection, and there are procedures in the home to make sure that staff work safely. One client used a wheelchair all day and Inspectors spoke about any opportunities for the client to utilise other seating arrangements. The registered provider agreed to review the wheelchair arrangements with the client and their family members and hoped to encourage the client to use easy chairs. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 21 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- 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment processes need to be strengthened to ensure the protection of residents from unsuitable staff. Resident’s benefit from a well trained staff team. EVIDENCE: There was sufficient staff on duty on the day of inspection. A client told the Inspectors, “The staff at the home are good and there are usually enough staff on duty.” A visitor commented, “There is s high ratio of staff to residents. The number of staff in the lounge helping residents is the same number I see when ever I come to the home.” Upon the Inspectors arriving at the home a moving and handling training session was taking place with a group of staff run by an external trainer. A staff member told the Inspectors they had received training around – infection control, food safety, POVA and care of dying. A staff member told the Inspectors, “I am happy working at the home. Things have improved and now the owner provides all the equipment and resources they ask for. I feel there is plenty of The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 22 training and management support.” Such training will ensure clients are in safe hands. The Inspectors checked a sample of staff records. A sample of nurse’s qualifications was checked and was accurate. One Criminal Record Bureau (CRB) check was not up to date. Such checks show that staff are recruited properly, and that the registered provider makes sure checks are carried out so that he can be confident that staff are safe to work with clients. A client was returning from a hospital appointment and was shouting and screaming and not wanting to be transferred back into a chair. Staff were heard reassuring the client and eventually persuading her to sit ain an easy chair. Later the client appeared to be made relaxed and comfortable sitting in the lounge. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 23 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, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally run in the best interests of the clients. Clients and staff’s health, safety and welfare are being promoted and protected. EVIDENCE: Currently the registered managers post is vacant and has been since August 2007. The registered provider is covering this post and is in day- to- day control of the home. He intends to apply for registration as manager of the Grange as indicated in the statement of purpose. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 24 The registered provider provides the clinical supervision to the trained nurses. All staff spoken with said they were clear lines of responsibility and accountability for all staff. For example care staff assist client with appointments, assist with bathing clients and serve and assist with mealtimes. The registered provider should ensure a registered manager is provided to manage the home. This would ensure clients have a suitable person to run the home who is fit to be in charge. A clients/relatives meeting was scheduled for before Christmas to organise the forthcoming festivities. These meetings are not held regularly but are referred to as being held regularly in the homes statement of purpose. The registered provider should ensure clients/relatives meetings are held regularly. This would ensure the home is run in the best interests of the clients. The last staff meeting minutes could not be located from December 2007 or any other previous minutes of staff meetings. The registered provider spoke of staff meetings being as and when required. It is recommended staff meetings are held regularly to continually measure the aims and objectives of the home, and through the daily care and support staff perform with clients. Records of staff meetings should be kept. Clients have the use of lockable cabinets in their bedrooms. The clients finance records for the small amount of money held at the home are kept locked with their money, which is overseen by the Administrator at the home. Care files contained all the key information but were not always well presented or in good order. The registered provider accepted this and after a recent staff training audit is aware of a staff training need around: written and oral English skills, fire training, and effective communication. The registered provider confirmed work would be done with staff to improve record keeping practice and the quality of care provided. The registered provider agreed in December 2007 the Annual Quality Assurance Assessment (AQAA) would be completed and returned to the Commission for Social Care Inspection in January 2008. This will include any site visits details, the regular maintenance of health and safety systems within the home, including fire systems and equipment, environmental health visits, central heating systems and emergency call systems. All these aspects will be checked at the next inspection. All fire exits were clear of obstructions and clearly signposted. The accident book was up to date, detailing the incidents and the actions taken. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 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 17 18 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x x x 2 3 3 x 3 The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement Staff must have Criminal Record Bureau Checks (CRB’s) in place before they commence employment. Such checks show that staff are recruited properly, and that the registered provider makes sure checks are carried out so that he can be confident that staff are safe to work with clients. Timescale for action 18/12/07 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 OP1 Good Practice Recommendations Reference to the complaints procedure in the statement of purpose should include more information around dealing with complaints. New and existing residents can then be assured their complaints are listened too and taken seriously. The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 27 2 OP7 Different risk assessments are carried out, to make sure that residents are looked after properly and are able to be safe in the home. Ensure these are reviewed more frequently to keep clients care up to date. Some clients have a consent form around resuscitation. There appeared to be some uncertainty around the legalities of clients/relatives giving consent. The registered provider is advised to seek legal advice around the use of the consent forms and take any action accordingly. This will ensure each client’s wishes are respected and protected. Continue to ensure bedrails are available for residential clients in consultation with the community nurses. This protects the client and the home. Care records confirmed clients with pressure sores were well cared for by the staff and input from the community nurses. To ensure clients health care needs are fully met we suggest further consultation with community nurses regarding pressure-relieving mattresses required for clients who are high or very high risk of developing pressure sores. A client was observed in the lounge he looked unkempt with greasy hair and dirty fingernails this was despite having a bath earlier that day. More attention should be given to client’s health and personal care to ensure their privacy and dignity is respected around personal care giving. The comments book held in reception is a good initiative. The book should be checked and responded to regularly and any actions taken promptly by managers. Responding swiftly to such comments can help alleviate any anxieties and help maintain good relations with clients and their families. The complaints procedure needs updating, including the summary in the statement of purpose. In line with the latest procedure, the complaints procedure needs to be altered to give the complainant the choice of the initial stage to go to the investigating body-the local social services department - now the lead agency for investigating complaints- as well as the home. A complaints record should be obtained to record 3 OP7 4 OP8 5 OP8 6 OP10 7 OP13 8 OP16 The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 28 complaints received and any action that was taken in response. This will ensure client’s complaints are taken seriously and acted upon. 9 OP19 The front door should be made more secure in order to safeguard clients, staff and visitors and ensure clients benefit from living in a safe home. The registered provider should ensure a registered manager is provided, fit to manage the home. This would ensure clients have a suitable person to run the home who is fit to be in charge. Clients/relatives meetings- are not regular although referred to as, in the homes statement of purpose. The registered provider should ensure clients/relatives meetings are held regularly. This would ensure the home is run in the best interests of the clients. Staff meetings should be held regularly to continually measure the aims and objectives of the home through the care and support staff perform daily with clients. Records of staff meetings should be kept. 10 OP31 11 OP33 12 OP33 The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Grange Nursing & Residential Home DS0000060078.V356526.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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