Inspection on 24/02/09 for The Grange Nursing & Residential Home

This inspection was carried out on 24th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

The Grange Nursing & Residential... 18/12/07

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

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Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Abel     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT 01162402264 01162404888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Banesh Laxmilall Bhatoolall care home 52 Number of places (if applicable): Under 65 Over 65 14 52 52 dementia old age, not falling within any other category physical disability Additional conditions: 14 0 12 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. 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 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 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 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 Care Homes for Older People Page 4 of 30 categories/combined categories are already accommodated in this home. No person under the age of 55 falling within category PD (physical Disability) may be admitted to The Grange Nursing and Residential Care Home. Date of last inspection Brief description of the care home The Grange Nursing and Residential Home is registered to accommodate up to 52 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 in a service user guide. The weekly fees range from £334 to £499.80 There are additional charges for hairdresser, chiropodist and escort fees. The most current CSCI inspection report is held in the office and available upon request. 0 9 1 0 2 0 0 8 Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was a Key Inspection that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for Older Persons. Two Regulatory Inspectors Helen Abel and Debbie Williams undertook this visit. The Inspectors spent time planning the areas to focus on before the visit took place. This was based upon information gained from reviewing the homes service history, the last inspection report, complaints and concerns, surveys and the homes Annual Quality Assurance Assessment (AQAA). The people living at The Grange Nursing and Residential Home prefer to be called Care Homes for Older People Page 6 of 30 service users. The primary method of inspection used was case tracking that involved selecting five people and reviewing the care that they received through inspection of the written information available on their care plans. Discussions took place with service users, visitors relatives, staff, and the registered provider/manager. Our visits were unannounced and took place over two days on Tuesday 24th February and Wednesday 4th March 2009. Both visits took place over a period of approximately five hours. Helen Abel arrived first and the second Inspector Debbie Williams arrived shortly after on both days. In addition policies and procedures and records in relation to service users, staff recruitment, complaints and upkeep of the home were viewed. Upon arriving at the home on both days service users were observed getting ready for the day following breakfast. A number of visitors and relatives of service users were present and many people spoke with both the Inspectors. Service users were in the two communal lounges watching television other people were in their own bedrooms reading or watching their own televisions. Staff were observed undertaking activities with service users dancing, and playing catch with large and small soft balls. Service users and people visiting told us. The church people came this week and were reading from the bible, singing and chanting messages and giving communion. My relative didnt like the puppet show but other people liked it. Singers and musicians are sometimes organised on the weekends. This service is rated as 1 Stars. This means the service users who use this service experience adequate quality outcomes. What the care home does well: What has improved since the last inspection? What they could do better: Assessment procedures must be more robust. Admission to the home only takes place if the service is confident that staff have the skills, ability, to meet the assessed needs of the prospective service user. Written information about the home should be provided to existing service users to ensure the home continues to meet their needs and Care Homes for Older People Page 8 of 30 preferences. Care plans should be developed with and owned by the person using the service. It should be based on full and up to date holistic assessment and should address equality and diversity. The care plans must be an up to date working tool and can be used confidently by staff to deliver a personalised and consistent person centred service. Review the risk assessments for one service user administrating their own medication for safety. Improvements to be made with the support of the dietician for special diets around presentation of soft meals, to ensure they are attractive and well balanced for service users. For the identified service user to be kept safe around access to their bedroom a risk assessment to be drawn up to reduce any risks of harm. Ensure robust staff recruitment procedures recognise the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Ensure staff have the necessary skills to meet the assessed needs of service users. Service users should live in a well managed home that strives to consistently provide a high quality service. A suitable person should be considered to be put forward as a registered manager to support the current registered provider /manager. Any results of a quality assurance annual audit should be published and made available to current and prospective service users.This will ensure the views of both people who use the service and staff are listened to, and valued. Service users should be supported by trained and competent staff. Staff meetings should be held regularly with written records held. Service users must be supported by appropriately supervised staff. Staff to receive formal supervising at least six times a year. Further attention to ensure the health and safety and welfare of service users is maintained through more regular checks for the emergency lighting. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Applications for admission to the home are agreed without reference to a proper needs assessment. Service users are not safe as a result of this. Evidence: The Grange offers new service users a current statement of purpose and service user guide. This gives service users written information they need to make an informed choice about the home. The Inspectors suggested this new information is made accessible to current service users in the home. A copy of the home most recent inspection report can be found at reception or requested from the registered provider/ manager Mr Bhatoolall. A relative confirmed to the Inspectors requesting a copy of the last inspection report from the registered provider/ manager and read it together with family members. Care Homes for Older People Page 11 of 30 Evidence: Two new service users did not receive an assessment. A service user had been accepted with a date to enter the home without an assessment taking place. The registered provider /manager confirmed he would be undertaking this assessment soon. He agreed assessment procedures needed to improve. All prospective service users must receive full assessments before entering the home, as outlined in the homes statement of purpose and service user guide. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each individual has a care plan with basic information. Service users privacy and dignity is maintained. Evidence: Five services users were case tracked. Two service users had come into the home as emergency placements in November 2008 and staff were still in the early stages of compiling their care plans. Care plans should be generated in a timely manner following on the assessment and admission to home. The statement of purpose and service user guide confirms emergency admissions will be given the same attention as planned admissions and every effort will be made to carry out pre-admission assessments.This process had not taken place for some of the service users case tracked. This has the potential to impact on the quality of life service users receive. One service user required a pureed diet as agreed by the dietician from written information held in the bedroom. This was not indicated on the service users care plan. Care plans must be reflective of current needs and inform staff of what actions to take Care Homes for Older People Page 13 of 30 Evidence: to meet each identified need. The registered provider/manager confirmed staff need to develop care planning skills and has arranged training. The acting manager confirmed she is currently running care plan workshops for staff with new guidance around all person centred care. Staff from social and health care support agencies have been invited to the home to give guidance to staff on care planning, water lows, and nutritional screening. All this guidance and training for staff will ensure service users individual plan of care is set out in detail, with the action which needs to be taken by staff to ensure all aspects of care needs are met. The key worker of a service user the Inspector was case tracking confirmed the careful daily morning routine undertaken with a service user. Providing additional reassurance and clear explanations at all times. This helped calm the service user and made them comfortable. This confirmed staff are following risk assessments and guidance on the individuals care plan. One service user frequently wanders and can be confused. His care plan not been reviewed since December 2008. Service users plans should be reviewed at least once a month. This will ensure service users changing needs are met. Other risk assessments were seen to be in place for the same service user around nutritional risk assessment, falls and moving and handling. The Inspector noted no pressure relieving mattress was the his bed despite the service users being at high risk. This this discussed with registered provider/manager who agreed pressure relieving equipment is required. There have been visits since our last visit by Pharmacist Inspectors to specifically check medication management. Medication was sampled by both Inspectors for the service users case tracked. Records were well maintained and the drugs return books were completed and up to date. The registered provider/ manager agreed to check out with the Pharmacist the safe storage of an identified drug and make the necessary changes. Staff have recently completed medication training by the Community Pharmacist. Four competent staff undertook a complete audit of all medicines in January to ensure they were in order. The registered provider/manager and acting manager confirmed they are in the process of producing a Homely Remedy Policy. This will ensure services users are safeguarded by a targeted medication policy. A detailed risk assessment is in place for one service user self medicating. Another service user is self medicating. There is a brief risk assessment in place with the service users not consulted about this process. A robust risk assessment undertaken Care Homes for Older People Page 14 of 30 Evidence: with the identified service user will ensure service users are protected by the homes policies and procedures for dealing with medicines. The Inspectors saw service users being supported with dignity and respect and in a caring manner. Service users/ relatives told us on the day of our visit. Staff create a nice atmosphere. Staff are very cheerful, loving and good to service users. They are like our friends. A relative of told us. Staff bed bath my relative and sometimes he has a proper shower. He always looks clean and tidy. Feel happy with the service provided and feels the care is very good. Often arrives to find staff sitting and talking with my relative. One survey from a relative of a service user confirmed since viewing the last inspection report they had requested to read their relatives care plan. They had found this very useful and have since requested monthly meetings to discuss their relatives care with a staff member. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive good daily life and social activities and support with their cultural and religious needs. Meals are varied and nutritious. Evidence: Service users told us. I like it here.I am able to go to church each week. I meditate twice a day and listen to lots of music. I am very busy. Relatives and visitors told us. There is a summer and Christmas raffle. The church people came this week and were reading from the bible, singing and chanting messages and giving communion. My relative didnt like the puppet show but other people liked it. Singers and musicians are sometimes organised on the weekends. Staff were seen dressing up and dancing to service users, playing catch with small and large balls and velcro catch games. One service user was observed walking independently around the garden and commented he was not feeling well enough to do any gardening. This is an interest he is able to undertake with support when well enough.The hairdresser was attending to service users upon the time of our visit. Care Homes for Older People Page 16 of 30 Evidence: The registered provider/manager confirmed he has organised a film show and grapevine sing along as regular events throughout the year. This will ensure service users have a range of entertaining activities to take part in. The registered provider/manager confirmed he is developing a sexuality and Relationship policy. This will ensure personal safety choice and a comfortable lifestyle for all the people living in the home. The Inspectors observed the end of breakfast being served. Service users were seen eating hot porridge and breakfast cereals. At dinner time there were two seatings. Some service users had soft food. It was noted soft food was served as one item. Each food item should be separately presented on the plate in order to provide a more attractively presented and appealing meal for service users and to seek further advice form the community dietician. During our first visit the cook was preparing and cooking pancakes for the service users to celebrate Shrove Tuesday. A service user told the Inspector she would only eat a particular bread and wanted her food prepared in a certain way. She felt this wasnt always done. Staff confirmed they purchased specific food she requested and catered for her individual needs. Relatives and visitors told us. My relative can only eat soup. They give her a variety of soup and lots of drinks, plenty of water, tea and coffee. Visitors are always offered drinks. There is lots of choice at meal times. They eat well here. Things are much better, a named nurse is really good. Staff look after him well. Food has been slow coming lately but is edible and a choice of menu is offered, always a good choice of vegetables. There are much more staff on duty now and they are more thoughtful. Surveys from service users relatives told us. Tea time is very good here. They have a drink and biscuit before they go to bed. Residents and relative surveys confirmed overall they were satisfied with the activities at the home. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user complaints are listened to and taken seriously and acted upon. Evidence: The statement of purpose and service users guide gives clear guidance and information on how to make a complaint within stages and timescales. Information is also available round Advocacy services. Access to such information will ensure service users are confident their complaints will be listened to. Services users and their relatives told us. We could complain to the registered provider or the nursing staff. I once a had a concern about my relatives catheter. Straight away when I told the staff they took her to the bathroom and sorted her out. Surveys from service users relatives confirmed. We talk to the registered provider manager who always listens and tries to put any problems right. We can speak to our local social services if we need to. The complaints book had a complaint from the 13th of February 2009 and around food products. This has since been resolved by the acting manager. A service users relatives confirmed. We did receive a contract and statement of Care Homes for Older People Page 18 of 30 Evidence: purpose and complaints procedure. The owner is always very helpful, very satisfied with the service provided. A concern was received by the Commission for Social Care Inspection (CSCI) around end of life care and support from health agencies. This was discussed with the registered provider following on the inspection. He agreed to consider the issues and learn from them. Palliative and end of life care training for staff is due to take place in March. Staff confirmed training for the Protection of Vulnerable Adults (POVA) is due to take place soon with all staff to attend. Some staff confirmed attending challenging behaviour training. This will ensure staff are trained and can protect service users. The staff recruitment procedures were examined and were not robust around the protection service users. See Staffing outcomes 27-30. There has been ongoing safeguarding issues since November 2007. The registered provider/manager is working with the local authorities, the CSCI and other agencies to resolve this. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have access to comfortable and clean indoor facilities and a well maintained outdoor area. Evidence: Part of the building was toured by Inspectors. All rooms viewed were fresh clean and well maintained. Many bedroom doors have the service users name on and can be easier for service users to identify. One service user requested a new lock and key and gave instructions about when they should be disturbed. To ensure the service users safety and well being clear guidance to staff should be held in her risk assessment and care plan around access in emergencies. Service users told us. My room is always kept clean and tidy. Staff will put up a small list of anything I need discretely in my bedroom for my relatives. Relatives told us. We come twice a week and go into my relatives bedroom at different times. Whenever we go it is always clean spot on. The rooms are pretty good. Nice atmosphere.They open the windows regularly for fresh air. My relatives has been allowed to stay in a double room as she shared that with her husband before he died.There is no pressure to go to a single room. We are happy the registered provider/ manager has agreed to this. Care Homes for Older People Page 20 of 30 Evidence: The laundry area was kept secure and was seen to be clean and well organised. A relative told the Inspector. I brought in a delicate item of clothing for my relative. I worried it would get ruined. That didnt happen, they wash clothes very well here. I have noticed clothes are hung up clean and dry in the wardrobe for the next day. The outdoor are looked well maintained and there was plenty of outdoor garden furniture and a timber decking area for people to use in the warmer weather. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users, their relatives and visitors tell us they are satisfied with the numbers and skill mix of staff . Evidence: The Inspectors observed a good deployment of staff throughout the home. The home employs thirty nine members of staff and there is at least one qualified nurse on duty at all times. Relatives told us. There seem to be alot of staff around to keep people occupied. We sometimes have to wait but there is enough staff here. Staff are happy and caring. Staff are well presented. Nice staff quite good. More staff are available. The registered provider /manager has been seeking a registered manager for over two years. He has recruited a number of a managers who have left over time. There has been a long period of instability for service users and the staff group. The registered provider/manager confirmed a new manager is to be put forward to the Commission for Social Care Inspection (CSCI ) to be a registered manager. Staff confirmed there has been more staff training opportunities and more being planned since our last visit in October 2008 such as- medication update, continence care, back care, emergency first aid. Adult protection, mental capacity act, and deprivation of liberty is due to take place soon. Another staff member confirmed Care Homes for Older People Page 22 of 30 Evidence: receiving food safety and infection control, air mattress care, duty of care, and dementia care training. There was no evidence of staff training planned after April 2009. One new service user has very specific care needs. Staff reported not receiving any additional training to meet these needs. National Vocational Qualification training NVQ at levels 2, 3, and 4 is also available to all care and nursing staff. Training for staff must meet the assessed needs of the service users and will ensure staff provide a better service that meets individuals needs. Staff recruitment records were examined by the Inspector. One staff members staff recruitment records did not include a current criminal records bureau check (CRB). Staff confirmed a new CRB was in the process of being obtained. The registered provider/manager should refer to the CRB website for the most current guidance. Robust staff recruitment procedures must be maintained to ensure the protection of service users. Staff meetings are not regular and often take place after visits from social and health care staff to support the home. Written records of the last meetings were not available for inspection. Staff meetings should be held regularly with written records held. This will ensure staff are well supported and are knowledgeable to care for service users. The same aspect was noted during our last visit. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider/ manager is improving and developing systems that monitor practise and compliance with policies and procedures of the home. More work is needed in this area to ensure the home is run in the best interests of service users. Evidence: The quality of care has been influenced by the absence of a permanent manager to support the registered provider/ manager. Staff have lacked consistent leadership and direction. An organisation structure is set out in the statement of purpose service users guide. In practise the structure does not work in this way. There are unclear lines of accountability within the home. The registered provider manager told us he works in the home on a daily basis and makes himself accessible to service users their relatives and staff group. His contact number is displayed in the statement of purpose and service users guide. He is also a key worker to a service user but has limited contact and input into their daily care Care Homes for Older People Page 24 of 30 Evidence: needs. The statement of purpose states an annual audit is also carried out to assess whether any improvements can be made to the service. Service users and or their representatives and staff are asked for their views. It is unclear if this has taken place yet. Any results of the audit should be published and made available to current and prospective service users. This will ensure the home is run in the best interests of service users. All sections of the homes own annual quality assurance (AQAA) were briefly completed and the information gives a reasonable picture of the current situation within the service. The AQAA gives limited detail about the areas they need to improve on. The ways they were planning to achieve this are also confirmed with minimal evidence. Setting up effective quality assurance and quality monitoring systems will measure success in meeting the aims and objectives and statement of purpose of the home. The registered provider/ manager and staff group understand person centred planning and thinking, but have difficulty translating this theory into practise. The acting manager is leading in this area to improve outcomes for service users. See also outcomes for 7- 11 Health and Personal Care. The service users case tracked did not have any money held by the home. Secure facilities are provided for the safe keeping of money and valuables on behalf of the service user. Staff files examined had no evidence of regular supervision. Staff confirmed the same. One staff member had supervision six months ago. This is due to the ongoing changes in leadership of the home and inadequate management planning. Health and safety checks confirmed checks take place and are largely undertaken by the registered provider/manager.The homes emergency lighting checks should be undertaken monthly. The registered provider manager confirmed the heated trolley used by staff to serve hot meals from will be repaired. A visit from the local environmental health authority took place prior to our visit and the home is attending to one requirement. All these checks will ensure the health and safety and welfare of service users and staff. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 New service users should be assured that their needs will be assessed before moving into the home. No sevice user moves into the home without having his or her needs assessed and been assured that these will be met. 08/12/2008 Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Assessment procedures must be more robust.This will ensure service users are not admitted to the home without their needs being assessed, and assured their needs will be met No service users will be admitted into the home without having had a full assessment and been assured that these will be met. 04/04/2009 2 7 14 Care plans must be reflective of individual current service users needs. Care plans must inform staff of what actions to take to meet each identified need. 30/04/2009 3 7 15 Ensure each service users 30/04/2009 plan of care are produced from a comprehensive assessment and kept under review.This will ensure service users needs are met. Care Homes for Older People Page 27 of 30 The service users plan sets out in detail the action which needs to be taken by staff to ensure that all aspects of care needs are met. 4 23 12 To ensure the identified service user is kept safe around access to their bedroom. Any unnecessary risks to the health or safety of service users are identified and and so far as possible eliminated. Service users own rooms suit their needs. 5 36 18 Service users must be 31/03/2009 supported by appropriately supervised staff. Staff to receive formal supervising at least six times a year. Staff must be appropriately supervised and supported. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 7 The statement of purpose and service user guide should be made accessible to current service users in the home. Service users care plans should be reviewed at least once a month. This will ensure service users changing needs are met Ensure care plans formats are person centred and include reference to an individuals particular needs regarding gender, age, sexual orientation, race, religion or belief or disability or address any needs in a person centred way. Service users must be kept safe with their medicines. The identified service user, following assessment as able to self Page 28 of 30 3 7 4 9 Care Homes for Older People administer medication. 5 14 When serving pureed food, each food item should be separately presented on the plate in order to provide a more attractively presented and appealing meal for service susers and to seek further advice from the community dietician Service users should live in a well managed home and receive quality care. A suitable person should be considered to be put foward as a registered manager to support the current registered provider/ manager. Any results of a quality assurance annual audit should be published and made available to current and prospective service users.This will ensure the home is run in the best interests of service users To ensure the health and safety and welfare of service users the homes emergency lighting checks should be done monthly. 6 31 7 33 8 37 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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