Inspection on 09/01/08 for Uphill Grange

This inspection was carried out on 9th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Uphill Grange 18/06/08

Uphill Grange 25/07/07

Uphill Grange 29/08/06

Uphill Grange 28/11/05

Uphill Grange 23/05/05

Uphill Grange 16/09/04

Uphill Grange 20/07/04

Uphill Grange 27/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Uphill Grange Uphill Road South Weston Super Mare North Somerset BS23 4TX Lead Inspector Kathy Marshalsea Unannounced Inspection 09:00 9 & 11th January 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Uphill Grange DS0000020290.V355376.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. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uphill Grange Address Uphill Road South Weston Super Mare North Somerset BS23 4TX 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) 01934 635422 01934 419384 uphill.grange@fshc.co.uk Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Ms Emma Stevenson-Maternity leave Temporary manager Lynne Doyle Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 26 persons aged 50 years and over requiring nursing care May accommodate up to 18 persons aged 65 years and over requiring personal care Manager must be a RN on parts 1 or 12 of the NMC register. Staffing Notice dated 03/12/2001 applies Ms Stevenson successfully completes Level 4 NVQ in Care and Management by 30th September, 2006. 25th July 2007 Date of last inspection Brief Description of the Service: Uphill Grange is registered to provide personal care for up to 18 residents and nursing care for 26 residents. The home is a converted older property in the small village of Uphill, on the outskirts of Weston Super Mare. Accommodation is provided in single and two double rooms. The majority of these have en suite facilities, but have had the hot water taps removed from each bath. A large dining room, with a small lounge area, is situated on the lower ground floor. The two main lounges are on the ground floor, and overlook the large garden and surrounding countryside. Two small passenger lifts ensure level access throughout the home. Acegold limited, a wholly owned subsidiary of Four Seasons Health Care, owns Uphill Grange. Miss Emma Stevenson was appointed home manager in November 2004 and has since become the home’s Registered Manager after the CSCI Fit person process was successfully completed. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use the service experience poor quality outcomes. This visit was unannounced and took two days to complete. Before the visit survey forms had been sent to the home for people living there and their relatives to complete. Information from these was used to help us form judgments about the quality of the service provided. The home continues to be managed by the temporary manager, Lynne Doyle, who has been at the home covering the registered managers maternity leave since August 2007. She was present for both days of the visit, and was joined by the new regional manager for the second day. There have been some improvements in aspects of life in the home since the last visit in July 2007. These are described in the sections below. The home had been served with a Statutory (legal) notice in October 2007 due to their failure to meet with requirements made about the after care of falls/accidents/incidents. This will be described in further detail under the section What they could do better. Part of this visit was to concentrate on checking whether the home had met the requirements of this legal notice. It was found that they had failed to meet these requirements so two things happened. The first was us issuing an immediate requirement notice so that home took speedy action to reduce the risk of people falling. The second is a referral to our Regional enforcement team so that they can consider what action should be taken. The home and company have failed to properly assess the skills and competence of the registered nurses who are in charge of shifts. There was no evidence that concerns raised by us at the last inspection visit been taken seriously and acted upon. Unfortunately there have been further concerns about two of the registered nurses, which were described to me during this visit. The new regional manager took immediate steps to deal with the more serious of these concerns. A management review at the Commission for Social Care Inspection will take place to discuss the above concerns and what action will be taken. All of the findings of this visit were given to the manager and regional manager at the end of the two day visit. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Some of the requirements made at the last 3 visits have been met. These are: The GP is now informed if someone living in the home keeps refusing to take their medication. People have now been consulted about their social interests and a programme of activities arranged. There are now more bathing facilities including an assisted bath and shower plus some en suite baths. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 7 The company now send a copy of their own unannounced visits ( Regulation 26 reports) to the Commission for Social Care Inspection. There has been the same manager at the home since August 2007.This has had some positive outcomes for staff and people living in the home. The company arranged for a staff training programme in September 2007 which should have helped the staff become more competent and skilled. Staff say that they feel able to talk to the manager about any concerns they have and that she listens to them. What they could do better: It was very disappointing that the home failed to meet the requirements in statutory notice about the reviewing of risk following a fall/accident/incident. The notice should have been met by the sixth of November 2007. Three people had a fall, or more than one fall since our last visit, and there was no information in the relevant records to show that the risk of having a similar fall had been reduced as much as possible. It was also disappointing to find the Four Seasons had not acted upon concerns raised at the last inspection visits and by their training officer, about the competence and skills of one of the registered nurses. Their investigation showed deficits in their practice which were not followed by any disciplinary action. There were no goals set in supervision for this person to improve in the areas of concern. During this visit three allegations of abusive behaviour were described to us and these allegations were all about this same registered nurse. The temporary manager knew about two of the allegations and had begun to investigate these matters. She was informed about the third and more serious allegation on the day of our visit. There was insufficient evidence that care plans are being written in consultation with the person themselves or their representative. It was also evident that some of the reviews had not been done appropriately, for example after a fall and also following a change of treatment. There are some staff who still do not show treat people living in the home with respect, so compromising their dignity. This was seen during the observation of a meal. There is no liaison between the care staff and cook about any special diets requested in the care plans. This means that special diets have not been catered for professionally. Complaints received since the last visit have not been recorded despite the fact that this was a requirement at the last visit. We were told about complaints Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 8 anecdotally but it was not possible to verify that any actions that had been taken to satisfy the complainant. While staff commented that they do feel more supported and listen to this has been achieved generally, as the supervision sessions have not been constructive or as often as they should be. For those staff who have areas of weakness this should included structured goals and more regular sessions to make sure that their practice improves. 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. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 9 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 Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an assessment of each person’s needs before a decision is made by the home about whether those needs can be met. EVIDENCE: The Statement of Purpose has not been amended recently to show the change in the management of the home. We discussed the fact that they now need to include the categories of people they were able to care for in the home. It was agreed that when these had been amended they would be forwarded to the local Commission for Social Care Inspections office. There is a “Welcome to Uphill Grange Care Home” document giving a lot of useful information to new people about how the home runs. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 11 The pre-admission assessment for someone who had moved to the home a couple of months ago was checked. This was to make sure that there was a full assessment of their needs and then a considered decision made about whether the home could meet their needs. The assessment tool used for this is quite comprehensive, and encourages staff to think about a persons every needs. This assessment was fully completed and gave a lot of useful information to staff. This information was supplemented by the social services home assessment and care plan. This also gave some useful family background. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 12 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): 7,8,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was a complete absence of written evidence for the review of risk after falls in three instances. The care plans have improved in some areas but are still not always being written accurately enough, nor reviews used, to consider whether anything needs to be changed in the plan. Not all staff treat people living in the home with enough respect so compromising their dignity. EVIDENCE: On the 16th of October 2007 a Statutory notice was sent to the Operations Director of Four Seasons. This legal notice was served after the home failed repeatedly, since July 2007, to reduce unnecessary risks to the health and safety of people living in the home. This was because staff were not ensuring Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 13 that if a person living in the home had a fall or accident that this risk was reviewed, nor actions taken to reduce the risk. The notice should have been fully met by the sixth of November 2007. I looked at the care records of three people who had had falls in October, November and December 2007. Two of these people had rolled out of their beds; one person had done that four times. There were no available records of any safety checks after they had been put back into bed, to try and prevent this occurring again. The care plan and falls risk assessment did not show this increased risk. For another there was a delay of 10 days while bed rails were fitted to the bed. The other person who had rolled out of bed also did not have any safety checks and there was also a delay of 3 days while an appropriate bed was found for one of them, which had integral bed rails. The other incident involved a person losing their balance as they were walking. Their care plans and falls risk assessment did not show any evaluation of this fall. In none of these instances was there a review of this risk in their care plan or risk assessment to re-assess their safety. the care plans state that the risk must be reviewed after a fall. Most of the incidents had been recorded in the evaluation section of one of the care plans relating to safety. This had not prompted the staff to look at the actions already recorded about this problem, and decide whether they needed to do anything differently to reduce the risk of this problem. An Immediate requirement notice was left on the ninth of January 2008, which means that from that time the home had to deal with these types of incidents differently. It is expected that they would have to look at this risk and decide how best they can keep the person as safe as possible, and show this in the care records. As this is a breach of a legal notice this matter will be referred to the Regional enforcement team so that a decision can be made about what action will be taken. The care plans were checked to make sure that there were improvements since the last major inspection. The first was for the person whose admission process was checked; the plan covered a comprehensive range of physical needs, but did not include any social care. Some sections had some very good detail about the persons preferences for example for the problem of sleeping and needing to drink more. This person is identified as having a poor diet and having some specialist need in their diet. It was unfortunate that this person had developed a pressure sore since their admission to the home. It was a concern as this person spent a lot of time Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 14 sitting the same position and was reluctant to lie on their side in bed, that a specialist mattress had not been provided. The need for a different mattress was mentioned in their care plan but had not been actioned. The risk assessment for the development of a pressure sore was not re-done when this happened so didn’t show this increased risk. This was discussed during the feedback session at the end of the visit and the regional manager asked for the right mattress to be found for this person immediately to try and prevent the deterioration of the pressure sore. The second care plan was for someone whod been living in the home for some time. There was a lot of information about their physical needs and plans for communication and social care. Most of this plan had been written in September 2007. One concern had been the persons reluctance to eat and drink, staff are instructed to encourage the person to drink 1500 mls of fluid today. Having checked the charts in the room for this person it was evident that for the previous week the amount taken in varied between 400 mls and 930 mls. There was no information in the care plan about what would be an acceptable amount of fluid or what action staff should take if they were concerned. On one day it was recorded in their notes that they had refused fluids and the recorded amount of the same day was only 185 mls. This information was passed to the manager. There were three plans for the person’s difficulty with their walking and the risks that posed. The mobility plan also was supplemented by a moving and handling risk assessment and profile which had been reviewed monthly. The safety plan instructed that this needed to be evaluated monthly or “as required”. The last review for this was done on the 20th of December 2007 despite the fact that this person had a fall on the 29th of December 2007. The plan for the risk of falls had been written in September 2007 and reviewed monthly since then. The fall on the 29th of December 2007 was noted on the evaluation sheet for this problem and also that two days later was no bruising seen. There was no other information to instruct staff about how to prevent this person rolling out of bed or even the fact that the bed needed to be changed. The long-term care falls risk assessment, which staff had been instructed to evaluate monthly or after an incident had not been done after this fall. The plan for communication did not reflect the short-term memory problems that this person experiences. The social care plan did detail previous interests that it was disappointing to see in the review that very little had happened for this person in relation to these interests. The same was true for the key worker diary. There was evidence that this plan had been discussed with the persons relative as some documents had been signed by them. There was no record of the family being informed about the fall mentioned previously nor the GP. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 15 The third plan was again for someone whod been living at home for some time. There was good information about this persons physical needs plus how communication could be a problem and previous problems with aggressive behaviour. There was some social information for example about which type of films they preferred to watch in their room, but no other social interests or previous hobbies were mentioned. This is one of the people who had a series of falls and then had an unreasonable delay of 10 days, after they rolled out of bed, before an appropriate bed was given to them. Despite the fact that staff are instructed to do hourly checks both day and night records of these checks could not be found. In another part of a care plan staff were asked to check them every 15 minutes at night for three days, these checks could not be found. The care plan for risk of falling was completed in August 2007 and then no new instructions for staff until the ninth of October 2007 when the correct bed was installed with integral bed rails. I went to meet this person who was able to answer some questions about isssues, for example having been moved from upstairs they preferred this bedroom, but said that staff were not giving them the exercises which are recorded in their care plan as being necessary. They agreed that they saw the activities organiser periodically and that they enjoyed this time. One of the improvements noted in the care plans was that short-term health problems such as chest infection are now recorded. There was evidence in the care records of referrals to health care professionals such as GPs, district nurses and physiotherapists. Various health care assessments are done to identify those people who may be a risk of developing problems such as pressure sores. It is then expected that this is accompanied by care plan so there is evidence of the reduction of that risk. In most instances this had happened. Wound care plans were present and were accompanied by wound assessment forms, which allow an assessment of the size and condition of the wound. These gave a sufficient baseline for other staff to gauge any improvement or deterioration in the wound. Nutritional assessments are completed for each person. It was not possible to check that instructions for people to be weighed monthly had always been done. I was later informed that this is now recorded separately and then transcribed into the care plan later. Information about people who are having difficulty in eating or who will need a special diet is written in their care plan, but this information is not given to the cook.(See standard 15). There has been a general improvement in staff treating people with respect and upholding their dignity. Some staff were observed to be very courteous, Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 16 this was particularly so for a senior carer on duty and the manager and deputy manager. Unfortunately once again (this also happened at the July 2007 visit) during an observed meal two care assistants did not treat people they were helping with respect so did not uphold their dignity. One member of staff tried to assist two people with their first course at the same time, and while one person was fully helped the other wasnt. Despite the fact that other staff were then present this person was not offered the help they needed. The course was taken away as it became cold. Two staff were then with the same two people and chatted to each other but said very little to the people they were helping. They did not describe what meal they were helping them with. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 17 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): 12,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a better provision of meaningful occupation. Mealtimes are not organised to make it a sociable and pleasant time. Some people who needed to be helped with their meal did not have the one to one help they needed so did not have a complete meal, or were given an explanation of what the meal was. The cook has not been made aware of any special diets. EVIDENCE: There was a new activities organiser present at the home for this visit. They had been working at home for a few months. They described how they assessed peoples abilities, likes and dislikes so that they could decide how best to plan their time. They were able to give me several examples of people we met and what interests they had. From this assessment they had produced a plan for Monday to Friday.This shows a variety of activities such as soft catch ball, skittles, hoops, painting, walking around the grounds, films, card making Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 18 and spending time with people who are in their rooms. During the visit we saw people being taken out for a walk in their wheelchair around the grounds and a game of skittles. The organiser admitted that their records of what they were doing were not up-to-date. It was possible to talk with people about the activities programme and some commented positively about having something to do and how kind the organiser was. As mentioned previously the lunchtime meal on the first day of the visit was observed. This was still being served in the basement of the building where there is a very spacious dining room. We were informed that everyone had chosen cottage pie for the main meal. The cottage pie was served with fresh leeks and broccoli although unfortunately mine were cold (as was the plate). The cottage pie was very tasty. At the beginning of the meal there only two staff to assist the 12 people in the dining room. The tables were laid with tablecloths and condiments but unfortunately everyone had plastic glasses. The menus were not displayed in the main dining area. As mentioned in the previous section the assistance given was not adequate and did not preserve two peoples dignity. We met the cook who has been working at home for four years. The menus are given to them from Four Seasons which are then adapted to meet the needs of the people in the home. The kitchen was spotless despite the fact that the lunchtime meal had only just been finished. The fridges were very clean and and the storage area clean and tidy with everything being stored in airtight containers. The cook confirms that they are not given information about people special needs in regards to their diet. They have achieved their Level two National Training Vocational in catering, but have not any done any training relevant to their role since then. They could recall having one relatively recent supervision session with the current manager. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Complaints are not recorded and so it is not possible to see what actions have been taken to resolve them. There is no feedback given to complainants so that they are not sure if anything has been done. Allegations of an abusive nature were not reported to the relevant agencies and were going to be investigated internally. EVIDENCE: No complaints were recorded in the complaints file since July 2007. The manager said to that she had not received any complaints, when this was discussed. It was of concern that we were told about complaints and concerns before and during our visit, which had been raised with the manager since July 2007. These included complaints about the food, cleanliness, bathing facilities, a registered nurse with poor infection control techniques, comments from staff about cultural differences between England and their country of origin, and missing items. One person who had made some complaints was unhappy about the way this had been dealt with because they receive no information back from the manager. One relative stated they raised a number of concerns but no longer felt confident to do that. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 20 On the day in between the inspections we received a call from someone living in the home who had concerns they wanted to discuss with us. On the second day of the visit time was spent with this person discussing lots of issues that had been and were of concern to them. It was clear that the manager had been told about many of these concerns yet the person did not know if any actions have been taken. These concerns included two serious issues about one of the registered nurses conduct. Due to the serious nature of these allegations and according to the homes own protocols, this nurse was suspended from duty while these matters were investigated. The manager stated during the feedback that she had been made aware the day before about two issues and was going to deal with them by having a chat with the nurse. It was the intervention of the Regional manager who reacted appropriately to the situation, that made sure that the people living and working in the home were protected from any other further incidents. . The subject abuse is now covered in the new induction workbook but would not have been done in this way for existing staff. It was a requirement from the July 2007 visit that all staff were trained in the protection of vulnerable adults. The manager stated that she had tried to get staff booked onto the local social services training in this subject but had been unsuccessful. She stated that there was quite a waiting list but did not put any staff down on this list. It wouldve been useful for her to have done this so that staff were trained in local procedures and protocols. It will be a repeated requirement that staff receive training in the protection of vulnerable adults. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 21 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): 19,21,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a new bath and shower installed, so that people now have a choice of bathing facilities. The home was not being kept as clean as it could have been due to there being a shortage of cleaning staff, this is now resolved. EVIDENCE: It was pleasing to see the installation of the new assisted bath and shower in the home. These are placed on floors where people in the home are living. There is still a parker bath in a small bathroom on the top floor which is not currently being used as a residential area. The home are taking advice about how best to move this to another bathroom. The manager reported the delight Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 22 of some of the residents in being able to have a bath as there had been a period of a few months when they couldn’t. Following a requirement of the last inspection visit some of the hot water taps have been reinstalled in ensuite bathrooms. This has only been done for those few people who are able to use the bathroom independently, and who could be made aware of the risk of scalding. The manager stated that safety valves ( to reduce the hot water temperature) have been installed to all hot water taps in the sinks throughout the home. There had been concerns raised on some survey forms about the standard of cleanliness in the home. On the whole it is fresh and clean. The standard of cleaning in my relatives room often falls below standard. I have had words about the cleaners as most of the time they been short of them and the housekeeper has to try and do it all on her own. The rooms are cleaned but not to a high standard. Some relatives use freshness and open windows to end the rooms. The smells in corridors are noticeable at the top of the stairs quite often. The sheets have seen better days. My relatives room is often left untidy by the staff, eg papers left on the dressing table. The manager stated that new sheets had been purchased for the home. During this visit it was noticed that there was a new member of the cleaning staff who was very diligently cleaning individual bedrooms. Checking the environment was not a focus of this inspection as it was done in more detail at the July 2007 visit. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty can meet the dependency levels of the people living in the home but the skills of the trained nurses have not been assessed. This has put people living in the home at risk of nurses who have poor practice and are not competent. EVIDENCE: At the last main visit concerns were raised about the skills of some of the trained nurses, which were not adequate to direct care, or deal with new heath care problems, putting people at risk. Details were also given of one registered nurse who the inspector considered had behaved neglectfully towards two people living in the home at the time. As a result of this the home were asked to investigate these concerns which were detailed in the July 2007 inspection report. The content of this investigation was not sent to the inspector as agreed. We read this investigation report which showed that statements had been taken from the staff on duty on the day the concerns were expressed, including the registered nurse themselves. In our opinion there was sufficient evidence of the neglect of attending to a person living in the home who was in pain to warrant some disciplinary action. For example it was stated by the Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 24 nurse that “ no pain relief was given as I was talking with the inspector”. Then went on to give contradictory information about whether they knew that this person had been in pain all morning. The manager stated that a copy of the investigation report had been sent to the then Regional manager and the Operations Director. She took their advice about taking no action. The supervision records for this nurse were checked from the August to December 2007. There were no structured goals to support this person to improve their practice. They did complete the training which was given to other members of the staff team in September 2007. These included administration of medication, care plans and documentation, person centred care and moving and handling. It was recorded that an assessment was done by the company skills coordinator, regarding communication for overseas personnel. Training in first aid for this nurse was also to be sourced by the manager. There was very little content in the most recent supervision notes, and no indication of any shortfalls in this persons competence. One of the people living in the home raised concerns about another trained nurse not following correct infection control procedures. It was not clear how this had been dealt with or checked. Another registered nurse had been the subject to a disciplinary meeting due to the quality of their records. It was a requirement at the last main visit that the registered person should ensure that staff are trained and competent to do their job. There is no evidence to show that this has been done therefore the requirement will be repeated. Due to the nature of the concerns raised about some of the registered nurses a warning letter will be sent directly to the company about our concerns about the trained staff. At the time of the visit there were only 18 people living in the home. To meet their needs one registered nurse is always on duty, four care staff in the morning, three in the afternoon, and two at night. The manager stated that the dependency levels are much less than at the July 2007 inspection. 10 of those 18 people need two carers to care for them. There were also less people who needed help to eat their meal. The manager stated that there were no staff vacancies. We discussed the fact that the key worker role seems to be emphasising caring for peoples possessions as supposed to caring for them. This is emphasised in the home’s service user guide. We discussed the fact that the key worker notes reflected this and did not show any one-to-one quality time. The manager stated that they recognise this and that she intended to have a meeting with the staff about the key worker role, which should improve quality time the staff are able to spend with their residents. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 25 Some comments in survey forms included, Staff dont listen to what you say, dont remember and dont pass on information to the next shift. Some overseas staff find it difficult to understand me and the GP. Staff do listen but I visit so make sure that things happen as they should do. My relative is not able to always make themselves understood by staff. It is of concern that those staff lacking understanding may not act appropriately. The home continues to use a comprehensive and detailed induction booklet which is given to new staff to work through when they start. The book contains sections on principles of care, safeguarding adults, person centred care and safe systems of working among others. An induction sheet for the first day was also seen that the staff member completes to show they familiarise themselves with daily living routines, meet with people living in the home and receiving instruction in essential health and safety matters such as fire safety. The recruitment records seen at the July 2007 visit were satisfactory and met the requirements of the Care Home Regulations. The file of a person recently recruited were checked to make sure that the same principles were still being applied. The file held a fully completed application form, two written references, a statement of health and fitness to work, interview notes, proof of identity and the persons qualification. There was evidence that the home sought confirmation from the criminal records bureau of the persons suitability to work with vulnerable people before they started work. This disclosure form was seen in the file. The home has a new deputy manager who had been in the post about six weeks at the time of the visit. Staff reported that morale had improved and they felt more confident under a stable management. They appreciated the new deputy manager who was seen (during the visit) to be working very well with the staff and people living in the home. Despite the fact that they were the only nurse on duty on the first day of the visit, their priority was consistently with the care delivery and making sure the staff were doing what was expected of them. They are to be commended for coping so well with a stressful day as they received an immediate requirement notice, and also the paperwork to allow us to seize documents. Copies of staff minutes were seen from August to December 2007. In the minutes of October 2007 it was recorded that the manager had been told by relatives about some of the overseas staff commenting on how people waste money buying gifts/items etc comparing prices in England to those in their home country. This has left some people feeling uncomfortable and guilty. Staff are reminded this is the persons home and they in their family should be treated with respect. There was also some information about there being negative tensions in the home and rumours being spread about individual staff. Staff were asked to Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 26 approach the manager if they had concerns about colleagues work ethic, attitude to residents. It was also reported “ that a member of staff had observed at the care staff taking sweets out of residents bedrooms without their consent, this is an unacceptable and is theft and abuse.” This information was passed to the Regional manager to investigate. The home is working towards improving the percentage of staff who have a National Vocational Qualification in care. There is 13 full-time staff; two care assistants were doing their Level 2, and two doing their Level 3 NVQ in care. It was unclear how may staff actually have already achieved this qualification. It is accepted that the company has provided the necessary training, particularly for the registered nurses, to make sure that the staff improve their practice and/or up-to-date in specific areas such as dementia care. This training needs to continue and be supported through staff supervision sessions. The nurses could show how they have developed by completing reflective practice as part of their professional registration. The evidence gathered during our inspection shows that if there are still deficits in the knowledge base and competency of some of the registered nurses. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 27 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): 31,32,33,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is stable and has been complimented by employment of a Deputy manager. There is insufficient evidence that staffing problems and complaints have been dealt with competently. Supervision sessions are not sufficiently structured to show that goals are set for poor practice. EVIDENCE: The registered manager Emma Stevenson was still on maternity leave during our visit. The peripatetic (temporary) manager Lynn Doyle has been caretaking the home since August 2007. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 28 There was also a new Regional manager who had been in post for approximately 6 weeks at the time of our visit. They are responsible for monitoring the home and doing the monthly Regulation 26 visits, a copy of which is sent to the local Commission for Social Care Inspection local office. They were present for day two of this visit and received all the findings of our visit during the feedback session with the manager. There are some aspects of the management of the home which have improved under the leadership of the manager. This is recognised by staff, relatives, the Commission for Social Care Inspection and some people living in the home. There have also been areas highlighted in this report which had not been dealt with but had not yet been recorded. These include dealing with complaints, staff’s poor practice and allegations. The manager herself thought that morale had improved, staff were better at completing charts, communication was better, care plans had improved particularly in relation to short term problems, staff seemed more motivated and were taking more responsibility for their actions. The manager said that she had not held a residents/relatives meeting since being in post. However, she said that she sees relatives often and sees each resident every day. It is hard to see that the home is run in the best interests of the people living in the home when complaints are not responded to as they should be. People we spoke with agreed that the manager had made some improvements but that there were still lots of areas which needed to be worked upon. Staff spoken with felt able to approach the manager and feel that they will be listened to. It was evident that staff spoken with felt supported and have had regular meetings as a staff group. One to one supervision sessions with the manager have not taken place as often as is recommended, six times a year. The content of these sessions did not cover the areas recommended in the National Minimum Standards for Older people. These are all aspects of practice, philosophy of care in the home and career development needs. It also needs to be appropriate so if there have been concerns about someone’s competence it would be expected that this would be explored in these sessions, and goals set to demonstrate any progress and an assessment of their competence. Some health & safety records were checked. The manager had done a thorough audit recently; she stated that no actions needed to be taken as a result of this audit. We were told that there was also a fire risk assessment and that the safety checks of the fire fighting equipment and alarms are done regualry. Staff are Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 29 updated in fire safety with the night staff having three monthly and the day staff six monthly updates. The deputy manager is to attend a train the trainers moving and handling course so that they will be able to train staff and audit their equipment. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 1 X X Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 31 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 OP8 Regulation 13(4)© Requirement The registered person shall ensure that unnecessary risks to the health & safety of service users are identified and so far as is possible eliminated. All falls/accidents/incidents should be recorded, safety checks done where needed, the care plan and relevant risk assessments reviewed after any incident. Care plans should show that the home is doing all it can to minimise the risk of a fall/accident/incident occurring or re-occurring. Repeated requirement and Statutory Notice- Regulation 43. The registered person shall ensure that the care plans are written in consultation with the service user or their representative, revise the plan where appropriate and notify the service user of those changes. The plan should cover all of a persons health, social and personal care needs. Repeated requirement DS0000020290.V355376.R01.S.doc Timescale for action 09/01/08 2 OP7 15(1)(2)( d) 30/03/08 Uphill Grange Version 5.2 Page 32 3 OP10 12(4)(a) 4 OP8 12(1)(a) 5 OP16 22 The registered person shall 31/01/08 ensure that all service users are treated with respect and their dignity upheld by all staff at all times. Repeated requirement The registered person shall 31/03/08 ensure that health care assessments are accurate and that actions needed to be taken to meet that need are recorded. Repeated requirement The registered person shall 31/01/08 ensure that any complaints are fully investigated and shall within 28 days after the date on which the complaint is made, inform the person who made the complaint of the action (if any) to be taken. Repeated requirement The registered person shall ensure that service users are safeguarded from neglect and degrading treatment. Repeated requirement The registered person shall ensure that all senior staff are trained in the local procedures for the Protection of Vulnerable Adults. The registered person shall ensure that restrictive valves are fitted to all hot water outlets in the bedrooms. The registered person shall ensure that staff are trained and competent to do their job. Repeated requirement The registered person shall ensure that all staff are appropriately supervised. Repeated requirement The registered person shall ensure that the cook is notified about any special diets so that they can provide enriched diets DS0000020290.V355376.R01.S.doc 6 OP18 13(6) 31/01/08 7 OP18 13(6) 31/03/08 8 OP21 23(2)(j) 31/03/08 9 OP30 18 28/02/08 10 OP36 18(2) 28/02/08 11 OP15 16(2)(i) 31/01/08 Uphill Grange Version 5.2 Page 33 where necessary. 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 Refer to Standard OP12 OP30 OP36 Good Practice Recommendations Activities which have taken place need to be recorded. There should be an assessment of practice following any training to ensure a positive outcome Staff should have a one to one supervision session with their manager at least six times a year. Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Uphill Grange DS0000020290.V355376.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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