Inspection on 15/04/08 for Winsford Grange Care Home

This inspection was carried out on 15th April 2008.

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

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

Other inspections for this house

Winsford Grange Care Home 27/10/08

Winsford Grange Care Home 10/04/07

Winsford Grange Care Home 29/06/06

Winsford Grange Care Home 22/09/05

Winsford Grange Care Home 27/04/05

Winsford Grange Care Home 14/10/04

Winsford Grange Care Home 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Winsford Grange Care Home Station Road Bypass Winsford Cheshire CW7 3NG Lead Inspector Wendy Smith Unannounced Inspection 10am 15 and 18th April 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 Winsford Grange Care Home DS0000018743.V361746.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. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winsford Grange Care Home Address Station Road Bypass Winsford Cheshire CW7 3NG 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) 01606 861771 01606 861705 winsfordgrange@c-i-c.co.uk www.c-i-c.co.uk Community Integrated Care Mark Laight Care Home 60 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (30), Physical disability (5) Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include: * * * * Up to 30 service users in the category of OP (old age not falling within any other category Up to 30 service users in the category of DE(E) (dementia over the age of 65) Up to 3 service users age 60 years upwards in the categories of PD or DE 2 named service users under the age of 65 in the category of PD 10th April 2007 Date of last inspection Brief Description of the Service: Winsford Grange is a purpose built care home providing nursing care for elderly frail residents and people with dementia. There are four separate residential units; Dickens and Austen units are for elderly frail residents, and Bronte and Chaucer units are for people with dementia. The home is single storey with good access for wheelchairs. There are 38 single bedrooms and one double room. The home has private enclosed gardens. It has good car parking facilities, is on a local bus route, and is close to rail services. The fees range from £437.86 to £536 per week. Further information about fees can be obtained from the home manager. Winsford Grange Care Home DS0000018743.V361746.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 1 star. This means the people who use this service experience adequate quality outcomes. An unannounced visit took place on 15th April 2008, with a second visit on 18th April to complete the inspection. The home had 56 residents, all except one being over 65 years of age. During the visit the inspector spoke with residents, staff and visitors. Survey forms were sent out prior to the visit to give residents, relatives and staff the opportunity to lets us know their views about the home. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the home manager. Some of the information contained in this report is taken from the Annual Quality Assurance Assessment that was completed by the home manager at the request of the Commission for Social Care Inspection. What the service does well: Surveys were returned by eight residents and three relatives and they contained very positive comments about the home. These included: The care home is very clean. The people that they care for are given good food. Their clothes are changed daily and more often if need be. They are very good in providing entertainment and activities and individual help for the patients and the relatives when they visit are always welcomed. As a regular visitor I find this care home first class in every way. I have never found a care home as good as The Grange. They go out of their way to do as much as possible. All the staff are patient and kind to everyone. The staff seem very caring and capable for my relative’s needs. They are very approachable and always willing to listen. People interested in going to live at Winsford Grange are assessed by a qualified person to establish whether the home will be able to meet their needs. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 6 Some of the care plans had been completed to a very good standard. In particular the monthly reviews had been written in detail and showed clearly that the nurse had taken time to look at how the person had been during the last month and considered whether any change was needed to their care. A programme of social activities and entertainment is provided and residents spoken with enjoyed this. The home receives good support from medical professionals and has close links with a local hospice to ensure good care for people with a terminal illness. Each unit has a choice of areas for people to sit in and there is a choice of armchairs to ensure that people who are physically frail can be supported to spend time out of bed comfortably and safely. All parts of the home visited at this inspection were clean, tidy and free from unpleasant smells. Survey forms received confirmed that residents and visitors always find the home to be clean and fresh. Most of the care staff have achieved a national vocational qualification in care. What has improved since the last inspection? What they could do better: Ensure that when bedrails are used they are properly covered to ensure that a resident’s leg cannot be trapped between the bars. Make sure that bedrails fit closely to the side of the bed so that there is no gap between the rail and the mattress that could lead to entrapment. This needs to be checked regularly. Bring all care plans up to the good standard that has been achieved on some of the units. Handwritten entries on medicine administration record sheets must be signed and dated by the nurse who writes them, and countersigned by a second person to confirm accuracy. The quantity of the medicine received should be recorded, together with any other details on the pharmacy label on the medicine. This will ensure that there is an audit trail of all drugs brought into the home and that staff always give the medication as it has been prescribed. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 7 There were some examples on the medicine administration record sheets of medicines to be given ‘as directed’ or ‘as directed by hospital’. This is not acceptable and needs to be clarified with the supplying pharmacy, and if necessary with the prescribing GP, so that staff always have clear instructions about when medicines should be given. There must be clear instructions on the medicine administration record sheets whether medicines are to be given on a regular basis or ‘as required’. Where medicines are prescribed PRN (as required) there must be guidance for staff about under what circumstances they should be given, how often they could be given, and what is the maximum permitted dose in a 24 hour period. Consider providing a hostess trolley for each of the units so that meals can be served out on the unit and the food can be kept hot. Ensure that all staff have regular updates of training about the protection of vulnerable people from abuse. Ensure that each part of the home has appropriate facilities for the cleaning and disinfection of commode pots and any other equipment that might carry infection between residents. Ensure that all staff are up to date with mandatory training to protect the health and safety of residents. Keep training records to show when staff have attended training and when they are due for an update. The home’s quality systems need to be more robust and pro-active to ensure that everyone is given the opportunity to express their views. The auditing system used within the home should identify shortcomings in care plans, medicines management, and staff training so that these can be addressed. All staff must attend regular fire drills to ensure that they know how to respond appropriately if a fire should occur. 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. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 8 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 Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 9 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): Standard 3 (Standard 6 is not applicable to this service.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People interested in going to live at Winsford Grange are assessed by a qualified person to establish whether the home will be able to meet their needs. EVIDENCE: The home provides four separate living areas, each with fifteen bedrooms. Dickens and Austen units are for physically frail older people and people with a terminal illness. They have links to the local hospice and the Macmillan nurse service. Bronte and Chaucer units provide care for people with dementia. There are two respite care places that are funded by the Primary Care Trust. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 10 The manager said that most new residents are admitted from hospital; some are transferred from other care homes due to a change in their needs. There is a considerable waiting list for dementia care places. Before any new resident is admitted to the home, the manager or the deputy manager goes out to meet them and to assess their needs. Three of the home’s nurses have a mental health qualification which enables them to assess mental health needs. During the inspection the care notes of three people who had been admitted to Winsford Grange quite recently were looked at. Each of these had a good preadmission assessment document completed and there were also copies of assessments that had been carried out by a social worker. On Austen unit a member of staff was spending time with a new resident and helping her to settle in. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal needs of residents are met to a good standard but their health may be at risk from a lack of clear instructions about how their medicines should be given. EVIDENCE: A sample of care plans was looked at on each of the four units. The care plans are very long and complex. Care plans on Austen and Bronte unit had been completed to a very good standard. In particular the monthly reviews had been written in detail and showed clearly that the nurse had taken time to look at how the person had been during the last month and considered whether any change was needed to their care. The care plans looked at on Chaucer unit were also good but did not contain quite as much detail. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 12 A new resident had been admitted to Dickens unit two weeks before the inspection. There was a care plan for eating and drinking that had been written on the day she was admitted, and one for personal hygiene written on the day of the inspection. Pressure sore risk assessment had not been completed and there was no moving and handling plan, no photograph and no record of her weight. The care plan documentation includes a temporary care plan that can be used for new residents until a full assessment is completed, but this had not been put in place for this person. The dependency of residents on Dickens and Austen units is high and a significant number of people were being cared for in bed. They were provided with adjustable beds and pressure-relieving mattresses. Two people have pressure damage to their skin, one had been admitted with a sore area. These were not serious and good wound care records were kept which showed that healing was taking place. There is moving and handling equipment on each unit but the manager said that he would like to replace some of the hoists with more modern equipment. Most of the people cared for in bed had bedrails in place. Although the rails were fitted with protective covers, some of the covers did not fit properly and left uncovered rails where a resident’s leg could get trapped between the bars. Some of the rails were wobbly and did not fit close enough to the bed, leaving a gap between the rail and the mattress that could also lead to entrapment. The manager said that the home receives good support from medical professionals and the care plans looked at confirmed this. The care plans recorded regular visits from dietician, speech and language therapist, chiropodist, optician and others. One GP visits the home regularly but others only visit by request through a triage system which can be problematic. During the inspection the staff were observed to have very positive relationships with residents and to address them politely and respectfully. The residents and relatives who completed comments cards were all satisfied with the way in which care is provided and commented that the staff are helpful and approachable. Residents’ medication on Bronte unit was very well managed, but on the other units there were some issues that need to be addressed. There were a number of examples where handwritten entries had been made on the medicine administration record sheets and had not been signed or dated by the nurse who had written them. They did not record the quantity of the medicine that had been received and did not record full details from the pharmacy label on the medicine. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 13 There were some examples on the medicine administration record sheets of medicines to be given ‘as directed’ or ‘as directed by hospital’. This is not acceptable and needs to be clarified with the supplying pharmacy, and if necessary with the prescribing GP, so that staff have clear instructions about when medicines should be given. There were also a number of examples where medicines had been prescribed to be given on a regular basis but were not being given regularly and appeared to be used as ‘as required’ medication. There was no explanation recorded for the times when the medicines were not given. Where medicines were prescribed PRN (as required) there was no guidance for staff about under what circumstances they should be given, how often they could be given, and what is the maximum permitted dose in a 24 hour period. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Due consideration is given to the social and recreational needs of residents and to maintaining contact with friends and family. EVIDENCE: The home employs an activities organiser four days a week and the care staff also showed awareness of the social needs of residents and said that they have time in an afternoon to spend in social interactions with residents. The manager said that CIC are planning to introduce a life story book to be completed with input from relatives and friends and the activities organiser will be attending training to facilitate this. Residents spoken with said that they very much enjoy the activities and one person enjoys helping with writing quizzes The home has its own vehicle for taking people out and several members of staff drive it. A Church of England minister visits the home weekly, and a Eucharistic minister from a local Roman Catholic church also visits weekly bringing communion to those people who wish to take it. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 15 There is one resident who smokes and arrangements have been put in place for this person to smoke in their own bedroom which is adjacent to external exit door with additional fire precautions in place and supervised by members of staff who have consented to do this. Each of the units has a main lounge and a choice of other smaller comfortable sitting areas. One relative was concerned that sometimes there is no member of staff in the main lounge and an accident may occur. A number of residents from Dickens and Austen unit were having lunch in the main dining room, which is light and bright. They had been taken to the dining room in wheeled armchairs which did not always provide a suitable sitting position for people eating. The lunch on both days was nicely presented and looked very appetising. There is a choice of two main meals with other choices available. There is a kitchenette on each of the units where drinks and snacks can be made at any time of day or night. Carers brought the meals from the main kitchen already plated. They plates were covered and carers did not think there was any problem of food going cold, but it is likely that the meal for the last person is not very hot. It would be better if hot food could be transported to the units in hostess trolleys and served out individually. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s policies and procedures relating to complaints and abuse. EVIDENCE: No complaints have been recorded at the home during the last year. One complaint regarding fees was addressed to the company head office. There is a copy of the company complaints procedure in each bedroom and a copy is provided with the contract for each new resident. The complaints procedure includes contact details for the Commission for Social Care Inspection head office but it would be useful if residents and relatives were given details of how to contact the North West regional office Staff receive training about safeguarding vulnerable people as part of their induction however this needs to be updated regularly to ensure that it is fresh in their minds. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 17 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): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, environment for residents to live in. EVIDENCE: The home is set in its own grounds just outside Winsford town centre. The grounds are maintained by a contractor and were tidy. Each unit has a secure garden outside the main lounge where residents can walk about and sit out. These gardens are maintained by the home’s staff and are very pleasant and well tended. safe, clean and well-maintained Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 18 The home employs a maintenance person for 22.5 hours per week, and he is responsible for the routine maintenance of the home and redecoration of bedrooms as required. Bedrooms are redecorated as they become vacant before new residents move into them and have a new carpet if needed. A number of bedrooms were visited on each of the units and were seen to be comfortably furnished and personalised by the person occupying the room. Each unit has a choice of areas for people to sit in and there is a large communal dining room. There is a choice of armchairs to ensure that people who are physically frail can be supported to spend time out of bed comfortably and safely. The manager said that all of the windows are to be replaced and this work is due to start in May 2008. All parts of the home visited at this inspection were clean, tidy and free from unpleasant smells. There is a domestic assistant on each of the units in a morning. Survey forms received confirmed that residents and visitors always find the home to be clean and fresh. A requirement made at the last inspection regarding the provision of additional sluicing and disinfecting equipment has not been addressed. At the time of the visit the laundry was being altered and improved. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well-qualified to care for residents but records indicated that not all staff have been kept up to date with mandatory training. EVIDENCE: There is a vacancy for a registered nurse, but other than this the home has a full complement of staff. There is some use of agency nurses (average about four shifts a week) and bank nurses to cover for sickness. The staffing rotas show that in a morning there is a nurse and three carers on each unit, in the afternoon and evening a nurse and two carers on each unit, and at night there are two nurses and six carers for the home as a whole. The manager can use additional staff if the dependency of residents is very high. On 18th April only one nurse was on duty to cover the two dementia care units but there were four carers on each. The home employs 51 care staff, of whom 74.5 have achieved NVQ level 2 and some are currently working towards level 3. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 20 The personnel files of three members of staff who had started working at the home since the last inspection were checked. These contained the necessary information and checks to show they had been properly checked before they started working in the home. New staff complete a three part induction through e-learning, a practical session at head office, and working on a unit under the supervision of a nurse. Unfortunately records were not available to show that new staff had completed this process. Training records were poor. There was evidence that some staff have attended a variety of external training courses, for example bereavement, end of life care, falls prevention, but it was not possible to verify whether statutory training is up to date for all staff, and the records that were available indicated that training was very patchy across the whole staff group. A senior member of staff who qualified as a moving and handling facilitator had not attended an update of these skills since January 2005. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality systems need to be more robust and pro-active to ensure that all stakeholders are given the opportunity to express their views and that shortcomings in care plans, medicines management, and staff training are identified and addressed. EVIDENCE: The manager is a registered nurse and he has been in post for five years. He has a management qualification and is working towards a further qualification. There is also an assistant manager and a care and learning coordinator who have some supernumerary hours allocated for their additional responsibilities, however the manager said that when the home is busy they are not always able to take these hours. There are also two administration staff. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 22 Monthly monitoring visits, required by regulation 26 of the Care Homes Regulations, are carried out by the manager of another CIC home. There is a monthly self audit by the manager. The home’s audits do not appear to have addressed medication issues and training issues. Copies of all accident reports are sent to the health and safety department after being signed off by manager. There are quarterly meetings for staff on each of the units, but other than this no staff meetings. There have been no recent meetings for residents or relatives. There have been no recent satisfaction surveys. The manager needs to develop ways of finding out people’s views of the home and where the service can improve. The home keeps a fire log book which contains the fire policy, risk assessment and emergency plans. The fire alarm system is tested weekly. Fire drills were recorded in January 2007 and December 2007. The policy states that all staff must attend a fire drill twice a year, but the records indicated that this is not happening. This means that should a fire occur the staff may not be sure of how they should respond. Small amounts of money may be left at the home by families for their relatives to buy personal items. A separate account is maintained for each person. The home’s administrator checks the balance for each person on a weekly basis. Information provided by the manager indicated that all plant and equipment is regularly serviced and maintained. Some of the home’s policies and procedures have not been reviewed for several years and may be in need of updating. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 23 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 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 2 Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4) Timescale for action Ensure that when bedrails are 01/05/08 used they are properly covered to ensure that a resident’s leg cannot be trapped between the bars. Make sure that bedrails fit closely to the side of the bed so that there is no gap between the rail and the mattress that could lead to entrapment. This needs to be checked regularly. Handwritten entries on medicine 01/05/08 administration record sheets must be signed and dated by the nurse who writes them, and countersigned by a second person to confirm accuracy. The quantity of the medicine received should be recorded together with any other details on the pharmacy label on the medicine. This will ensure that there is an audit trail of all drugs brought into the home and that staff always give the medication as it has been prescribed. Requirement 2. OP9 13(2) Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 25 3 OP9 13(2) 4 OP30 18(1)(c) 5 OP33 24(1) 6 OP38 23(4)(e) There must be clear instructions on the medicine administration record sheets about when medicines are to be given. Where medicines are prescribed PRN (as required) there must be guidance for staff about under what circumstances they should be given, how often they could be given, and the maximum permitted dose in a 24 hour period. Ensure that all staff are up to date with mandatory training to protect the health and safety of residents. Keep training records to show when staff have attended training and when they are due for an update. The home’s quality systems need to be more robust and pro-active to ensure that everyone is given the opportunity to express their views. All staff must attend regular fire drills to ensure that they know how to respond appropriately if a fire should occur. 01/05/08 31/08/08 31/08/08 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations Consider providing a hostess trolley for each of the units so that meals can be served out on the unit and the food can be kept hot. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 26 2 OP26 3 OP33 Ensure that each part of the home has appropriate facilities for the cleaning and disinfection of commode pots and any other equipment that might carry infection between residents. The auditing system should identify shortcomings in care plans, medicines management, and staff training so that these can be addressed. Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North West Region Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Winsford Grange Care Home DS0000018743.V361746.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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