Inspection on 21/03/06 for Wolston Grange

This inspection was carried out on 21st March 2006.

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

Wolston Grange 04/11/09

Wolston Grange 12/02/09

Wolston Grange 22/01/08

Wolston Grange 16/08/07

Wolston Grange 07/11/06

Wolston Grange 23/05/05

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

CARE HOMES FOR OLDER PEOPLE Wolston Grange Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ Lead Inspector Christy Wannop Unannounced Inspection 21st March 2006 09:30 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 Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wolston Grange Address Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ 02476 540482 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) Pinnacle Care Ltd Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Rooms numbered 5 and 16 should not be used to accommodate service users with a sight impairment. The registered manager should undertake the NVQ Level 4 and the Registered Managers Award by April 2006. (This applied to the previous manager) 23rd May 2005 Date of last inspection Brief Description of the Service: Wolston Grange is one of seven homes owned by Pinnacle Care Limited. It is a large detached dwelling set in extensive grounds. The building was formerly a hunting lodge and there are a number of small outbuildings surrounding the main courtyard. The home is set in a rural location, a short drive away from Rugby Town Centre and the villages of Dunchurch and Bilton. The home is located along a country lane with smaller domestic dwellings as neighbours. There are no local facilities or public transport close to the home. It is registered to care for up to 18 older persons over the age of 65yrs with dementia. The accommodation is over two floors. There are two rooms that are large enough to be shared rooms. These will be used as single rooms unless two residents request to share a room e.g. a married couple. There are two communal lounges, a dining room and a large sun terrace running along the front of the home. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the third visit to the home this year. This report should be read in conjunction with the reports of inspections carried out in July and October 2005. This inspection was announced to the Acting Manager two weeks prior to the visit. Two inspectors carried out the inspection. They spoke to residents, relatives, and staff as they worked and spent time with the Manager going through requirements made at the last inspection. CSCI’s Pharmacist Inspector made a visit to the home on 29th March to follow up on medication matters. Those requirements and advice given are incorporated into standard 9 of this report. There were 16 residents living at the home at the time of the inspection. The Manager was appointed in October 2005 and was not in post at the time of the last full inspection in June 05. An application for her to register with CSCI has been received. The home has been in operation under new owners for over one year. The service has applied to increase the size of this home and building work has begun on an extension to create additional bedrooms and a day unit, specifically for people with dementia. An immediate requirement was made to ensure there are enough staff on duty and that medication systems are safe. The owner has responded promptly and with assurances for action taken to make safe the situation. What the service does well: What has improved since the last inspection? Has introduced a “monitored dosage” system for medication and changed their pharmacist. Has made safe exits to the home Is making the kitchen safer for service users to have supervised access. Has made a safe enclosed garden Has introduced a cleaning schedule Has provided bins for disposal of used continence products Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 6 Has created a staff space for storage and breaks in an unused bedroom What they could do better: 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. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Prior to admission, senior staff undertake an assessment to satisfy themselves that the home can meet a resident’s needs. EVIDENCE: 3 assessments were read during the inspection. One gentleman admitted recently to the home, had arrived in an emergency situation, and the staff are in the process of completing a care plan based on his assessed needs, post admission. The manager of the home completes all the assessments for prospective residents. Assessments read covered all of the areas required in the standards, and included the completion of some risk assessments where there are identified areas of risk. Some family members had written “personal profiles’ and these assist staff with a life history to provide valuable information about previous life styles, and important events from the past. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 9 Residents admitted via social services have a copy of a Care Management assessment on their file. A relative spoken with confirmed that his wife had been assessed prior to admission, and that he had had an opportunity to visit the home and choose a suitable room to meet her needs. Correspondence from a relative of a different resident showed there had been debate about suitability of a room. This room has three short steps outside and was referred to in a previous requirement. No risk assessment was in place for this. Information gained at assessment particularly in regard to health care needs, and action plans related to risk assessments, had not been transferred sufficiently into the care plan, for monitoring longer-term outcomes, and this could put residents at risk. A requirement and a recommendation are made later. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,9,10 Care plans used in the home hold a significant amount of information primarily focused on assessing the abilities of people with dementia. There is insufficient detail to support staff in meeting the health needs of residents, with the result that health care needs are not always met, putting residents at risk. The home demonstrated that the records for medicine management were generally good and the majority of medicines had been administered as prescribed. The inspection showed that new systems must be installed to ensure the medicines are administered as prescribed in a safe and timely manner. EVIDENCE: Care plans read held a great deal of information; this is mainly focused around assessing the continued abilities of people with dementia. A number of different tools have been used and staff should be commended for the amount of time and effort used to gather this information and to attempt to make it personal. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 11 The document itself however, is very long and does not flow in such a way that makes it easy for staff to clearly identify what role they need to play to assist individual residents to retain those abilities, to achieve positive outcomes. The lay out of the care file is confusing, and the manager confirmed, not ‘user friendly’. The scoring rating tool used for an assessed skill is at one end of the document, the text which holds the information is at another end, and has so much detail that the inspectors struggled to find information they required. Further information is in between, and there is an amount of duplication in some plans. Staff spoken with said they did not have much to do with the care plans other than to record daily events. Daily records read were mainly related to sleeping, eating and personal hygiene, and did not indicate that staff had a clear idea of how to assist residents in a person centred way, or know where they may be at risk. One care plan read indicated that the needs of a resident with diabetes had not been met. The assessment document had identified a risk as the resident had a history of unstable diabetes, prior to admission, and the direction in the care plan read ‘ Give appropriate diet and monitor blood sugars weekly or as required’. The care plan for her nutritional needs had not been reviewed since December 2005. Only one record was found of a recorded blood sugar where a significant fluctuation had been recorded in a 24hr period, but this had not been followed up the following day. The manager said that the district nurses were monitoring her condition, but no records could be found. The Manager had stated earlier that district nurses were not providing a service to any current residents. Speech and language therapists and occupational therapists had given advice for some residents with swallowing and mobility difficulties. . Weight records indicated significant weight loss, and a food supplement had been subscribed. Medication records showed that this had not been given on a number of occasions, but this was not indicated in the care plan. Records showed that a review had taken place with the family to discuss continued care needs, but there was no detail on the care plan. Weight charts in another resident’s care plan showed significant weight loss, and the scoring tool used indicated that change had been identified. However again there was no documented action plan for staff to monitor this weight loss, or indication of what care may be required. Care plans generally did not indicate that risk assessments undertaken led to a plan to guide staff how to minimise risk. Assessments are not undertaken on tissue viability to indicate potential risk of developing pressure areas. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 12 One resident who uses bed rails, had not had a risk assessment completed. One relative said that whilst invited, he did not get involved in care planning, as he was happy to leave that to the staff. The majority of audits undertaken demonstrated that the medicines had been administered as prescribed if they had been dispensed in a Monitored Dosage System. Not all the medicines had been administered as prescribed if dispensed in traditional boxes or bottles. From observation of the medication round, the care staff on duty at the time did not refer to the Medicine Administration Record (MAR) chart before the administration of medicines. Medicines were prepared with no reference to the MAR chart into a medi-pot and then carried around the home and administered to each service user. Following the administration the MAR chart was signed to reflect administration and all reasons for non-administration were accurately recorded. This practice resulted in the medication round taking a very long time. The morning drug round was still being completed at midday. This is cause for concern as the home plans to increase the number of service users living in the home. Staff interviewed understood the need to wait four hours between the administrations of medicines. The Director has subsequently reported that she will study the way staff do the drugs round and see if it can be made more efficient without there need for a drugs trolley, which she sees as an institutional feature. The late administration of medicines resulted in many service users not receiving the night time medication, as they were asleep. The practice of transporting medicines to the service users in open pots is considered potentially dangerous as they cannot be secured in a locked facility in the event of an emergency and may be left unattended and potentially a service user may take them. The medicine cabinet was congested and as the MAR chart was not referred to before the administration some medicines had not been administered as prescribed, if they had not been dispensed in a Monitored Dosage System. Medicines dispensed by the pharmacist had been inadequately checked into the home but all quantities received had been recorded. Balances carried over from previous cycles had not been recorded so audits could not be undertaken to confirm correct administration and recording. The Controlled Drug storage was inadequate and the box was unlocked at the time of the inspection and not all CDs had been stored in the CD box. There were no written protocols for “when required” prescribed medication. The lead inspector identified that the staff had a poor knowledge of the medicines they administered but the manager planned to install information sheets about all the medication on the premise and give staff training. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 13 All the staff that handle medication were currently undertaking a distance learning accredited course in the safe handling of medicines. The manager was keen to improve practice within the home and this is commended. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The home ensures that residents’ maintain contact with their family and friends but could do more to demonstrate where residents have choice and personal autonomy. EVIDENCE: The Manager said she was committed to ensuring that residents enjoy their lives. She reported that the needs of the current residents mean that there can be good levels of interaction between staff and residents and that independence is encouraged. Staff had had training in carrying out meaningful activities relevant to people with dementia. On the day of the inspection it was noted that staff could be more person centred in their approach, to ensure that residents are exercising choice and have some control over their lives. There was no information “posted” about activities. The manager and staff reported that there was usually information available but acknowledged that none was on the board at that time. Care plans had some detail about individual activities enjoyed. The manager reported there were weekly trips out and reminiscence activity. Some residents were having a manicure from a member of staff during the morning. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 15 There was no other evidence of activity beyond care tasks and general interaction. There is an activities organiser, but this person was on sick leave on the day of inspection. Inspectors note that programmed group activities may not be the best way of encouraging residents with dementia to be active. The inspectors joined the residents for lunch. The food on offer was plentiful, served hot, and was of very good quality, but there was not a menu displayed, and residents were unaware of what was for lunch. Whilst it is the policy of the home NOT to have a fixed menu, food is an important feature of the day and preparing for the main meal can be an activity in itself. The manager reported her view that people “eat with their eyes” however, there was no visual choice offered for the main meal, or for drinks, and gravy was put all over the meal before it was served. A piece of cheese on toast was handed to one lady without asking if she would like it or what it was. She looked at it with a level of confusion and asked if it was fish. A gentleman wanted some salt and pepper, he said ‘ I ask for salt and pepper at every meal, all they have to do is put it on the table for me.’ Inspectors recommend that the manager consider how mealtimes and life in the home can be made more meaningful for residents with dementia and consider their specific needs, particularly in how they are helped to choose and make their way about the home. The manager was clear that residents are offered choice and autonomy encouraged but this was not evident from observations of care. This is considered later in the report under standard 19, the environment. A number of family members were seen visiting the home on the day, joining their relatives for lunch. They spoke positively about the home and said that they were made to feel welcome. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home has a policy and procedure for both protecting vulnerable adults and for making complaints. Neither has been needed or used. EVIDENCE: There is a complaints file and this shows there have been no formal complaints. There was a copy of a response made by the owner to issues raised in the last residents and relatives meeting in September 05. Residents’ personal files showed an example of how the manager had resolved several issues for one resident’s family. The inspector recommends that the Manager consider a method of capturing this work as part of the home’s quality review or complaints procedures as it demonstrates the approach taken to responding to concerns raised by relatives and how they have been put right. There have been no incidents of abuse. The company’s Area Manager has carried out abuse training for staff and the Manager has attended CSCI/ Social Services training on POVA (Protection of Vulnerable Adults). Inspectors recommend that the Manager investigate training provided at minimal cost specifically for managers by Warwickshire Quality Partnership in the interests of promoting best practice within Warwickshire’s procedures for protecting vulnerable adults. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The layout of the home is complex and confusing and is not best suited to people with physical / sensory or mental impairment. Further improvements need to be made to improve good hygienic practice. EVIDENCE: Furniture, fixtures and soft furnishings are all fairly new and of good quality, but the home’s layout, style of decoration, and lack of physical prompts does not make it a suitable environment to promote positive dementia care. Bedroom doors and corridors are painted all the same colour, there are very few physical prompts to assist independence, carpets, curtains and chairs are highly patterned, and the use of chandelier type lighting on the top floor of the home casts shadowy patterns over the walls which has the potential to disturb or confuse residents with dementia. There is generally a lack of prompts and clues around the home to assist residents to find their way. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 18 Resident’s bedrooms are lacking many personal items, each one, whilst furnished to a high standard, very similar to the other. Bedrooms are well furnished and comfortable. A number of bedrooms do not contain many personal items such as chairs, ornaments, cabinets, or anything to indicate to someone with dementia that it is their room. The Director of the organisation reported subsequently that residents are encouraged to bring in personal items. The majority of rooms are not marked with the person’s name, or a familiar object and there are no pointers around the corridors to give clues to residents of their location. One resident spent over twenty minutes trying to locate his bedroom, becoming quite agitated in the process. A requirement made in June has not been met to provide clues for people to make their way around the building. This personalisation and orientation could be a focus for activities within the home. The registered provider should ensure that the environment enables the residents with dementia to make use of their remaining abilities, and minimise factors that are contributing to an individual’s difficulties. Some work has been undertaken which was identified during the last inspection to make the environment safer, and locks have been fitted to the doors identified and a ‘dorguard’ on the kitchen door. Some work has been done to provide more security in the garden. The grounds are well maintained, and good views are available over the fields and local farmland. More could be done to make the garden suitable for residents with dementia to walk about with a sense of purpose, by the provision of more objects of interest and pathways. The home has been recently refurbished and the manager said that there was not a plan to make any changes to the interior of the home in the near future. Policies for infection control are in place and training has been undertaken, however practice varies from this. Old cracked bars of soap and hand towels were seen in communal toilets. These can harbour infection. The inspector respects individual choice for residents in whether they use hygienic soap dispensers and paper towels and recommends that a choice is offered. Whilst there is a cleaning regime, there was an odour of urine in corridors. Requirements have been made. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Current staffing levels are not sufficient to supervise residents given the layout of the building, other duties and care needs. The management of staff has not ensured safe, competent and qualified staffing. Whilst many staff have been able to attend a number of training courses, systems for the management of staff development are unsatisfactory and have the potential to affect the standard of care provided. EVIDENCE: Staffing levels have remained unchanged throughout the period following June’s inspection. The organisation’s area manager reviewed staffing levels in September. Three staff are on duty during waking hours and the manager reported that ratio of 1 staff to six residents is a guide for minimum staffing levels. There are no laundry staff and this means that care staff have to carry out domestic duties that take them away from direct work with residents and has a negative impact on the staffing levels. On a daily basis Monday to Friday, there is the Manager, a cook, someone cleaning and an activity organiser to supplement the three carers. Two staff stay awake during the night. The rota showed that a seventeen year old had been working as part of the complement of three staff over the previous weekend. The national minimum standards state that under 18’s should not be used to give personal care, though they can play a positive role in the home. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 20 The use of underage staff who are not familiar with the residents in the home puts residents at risk. An immediate requirement was made to staff the home satisfactorily. Previous inspections have made requirements about improving staffing levels and improving cleaning regimes. Carpets had not been cleaned and there was a noticeable odour. This suggests that there are not enough staff to ensure these tasks are done. A requirement had been made in June that the manager was not to admit any further residents until medication systems were safe, the home’s security improved and staffing levels improved. The previous manager admitted a new resident three days after this immediate requirement was made. Action has still not been taken to rectify this situation as evidenced by the immediate requirements made on the day of inspection. There is a senior staff member on shift. Shifts have no overlap and so staff do not have a formal opportunity to exchange important information about residents’ care between morning and afternoon or evening. Some staff are very committed and arrive early in their own time to do just this. A requirement was made at the last inspection to build in an overlap time. This should be considered. There has been a review of staffing levels by the Area manager for the company. The report of this review has been supplied. The inspector asked to see recruitment records but was told these are not kept in the home. The Acting manager reported that these were unavailable to her at the time being and were locked in the organisation’s head office next door. A requirement has been made to ensure that these are available for inspection at the home. Other staff files accessed showed that whilst the amount of training staff have attended is good, there was little evidence of how staff are selected for training, or how training is evaluated. The Manager said she was not involved in supervision and that this is carried out by the Area Manager. The manager reported that the home was on the borderline of being able to ensure that 50 of staff have NVQ 2. Five of the sixteen staff have achieved NVQ 2, three of whom have gone on to do NVQ 3. Staff spoken with confirmed that they had plenty of opportunities to attend training, and felt the training on offer was suitable to the needs of the residents. They could not say how they changed their practices after attending training, or how they may be able to implement new ideas. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 21 Four induction files were read and were seen to contain very little information. There was nothing to indicate that the induction had been completed, and that staff who are new to caring for people with dementia had the necessary skills to offer support to people with dementia and have an understanding of its possible effects on an individual. One resident said of staff; “ they are lovely people” and a relative would appreciate if staff wore name badges as he struggled to know who was who. Minutes of meetings with relatives showed that they had expressed that three staff were only sufficient when the home was not fully occupied. Another resident said about staffing “ It varies, some really excellent girls and some who really shouldn’t be here” Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 The Home has had a registered manager for one month since it opened. The current appointed manager has applied to become registered. There are beginnings of quality assurance systems which when developed further should ensure that the home is service user focussed. Further action is needed to ensure that the health, safety and welfare of service users are promoted and protected. EVIDENCE: The Manager reported that a key focus in the early days of her leadership had been to manage six disciplinary investigations and to establish a cohesive staff group. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 23 There are five male residents and one member of staff, a senior, who is male and also lives in. Preferences for which staff residents want to carry out their personal care are not detailed in care plans. The Manager is confident that she and staff know each individual preference without documentation. There have been some improvements in health and safety matters. However reports by the Manager showed that there have been incidents where residents have been put at risk of harm. A resident drank some cleansing fluid left unattended by a staff member called to other duties. There had been a small fire in the autumn, following which staff had been disciplined for not following procedures. Carpets in some areas smelt strongly of urine. Risk assessments for bedrails needed by a frail resident are not in place and generally mobility risk assessments do not have sufficient detail about how someone is to be moved to give safe direction to carers. A risk assessment had been required for the residents using the two rooms accessing stairs. This was not done, despite the issue also being raised by one family. The COSHH cupboard in the kitchen was unlocked during the inspection and the breakfast bar, which had been installed to allow safe access to the kitchen, propped up. The Registered Person must carry out a full audit of health and safety practice in the home to ensure that safety is promoted. The organisation makes clear written statement in staff guidance that staff will not wear protective gloves when carrying out general personal care unless they are dealing with bloods or continence matters. This is specified in the personal care policy and The Director is confident that this a demonstration of good person centred care. Toilets immediately outside the kitchen did not have hygienic supplies of soap and hand drying stuffs for use by staff. There are many instances where the positive principles promoted by the home in providing homely, non-institutional care are compromised by practice, which then introduces areas of unnecessary risk or confusion for residents without the benefits of a meaningful outcome, which enhances their life. This is true of the attitude to the decorative environment in the home, the approach to presentation of food, low number of domestic staff, lack of hygienic hand washing equipment and lack of a “drugs trolley.” The Manager uses a monitoring form, standardised throughout the company’s homes, which contributes to the quality audit system. It is recommended that the home incorporate the Alzheimer’s Society standards for residential care within its audit as a recognised quality tool. There have been four reports received under regulation 26 by the provider out of a possible 12. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 24 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 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x x x x 2 Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 25 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 OP7 Regulation 15 Requirement Care plans provide more detailed information when residents have specific health needs including management of medical conditions such as diabetes, promotion of continence and management of incontinence, and management of bowels, nutritional need, pressure area care and any other specific health concern. Risk assessments must support these plans. (Previous time scale 31/08/05 not met) The registered provider and manager must ensure that all exit doors are locked at night to prevent residents exiting the building when there is less staff on duty. Previous timescale 31/10/05 (Not assessed at this inspection) All prescriptions must be seen prior to dispensing, checked and a system installed to check the dispensed medication and Medicine Administration Record (MAR) chart for accuracy Timescale for action 01/08/06 2. OP8 13(a)-(c) 26/05/06 3. OP9 13(2) 29/04/06 Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 26 4. OP9 13(2) 5. OP9 13(2) 6. OP9 13(2) The quantities of all medicines received and balances carried over must be recorded on the MAR chart to enable audits to take place to demonstrate staff competence in medicine management The MAR chart must be referred to before the administration of medication to ensure that all the prescribed medication is administered The purchase of a medicine trolley is required to safely transport all the medicines around the home. The practice of transporting medicines to the service users in open medi-pots must cease The morning medicines must be administered more efficiently and must be completed by mid morning to ensure that all the prescribed medication can be administered in the waking hours of the service user The purchase of a Controlled Drug cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 is required and all Controlled Drugs must be stored within All staff must be trained in drug information for all the medicines they administer Ways of distinguishing the hallways and passageways must be found and signage around the home improved to benefit people with dementia. 12/04/06 31/03/06 30/04/06 7. OP9 13(2) 30/04/06 8. OP9 13(2) 30/04/06 9. 10. OP9 OP19 13(2) 23 30/06/06 30/06/06 Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 27 11. OP19 23 12. OP26 13(3)(4) (a)-(c) 13. OP26 13 14. OP27 18 15. OP27 19 16. OP27 12 17. OP27 18 18. OP33 18 A risk assessment must be undertaken on the two bedrooms on the upper floor that are accessed by three stairs leading of a hallway. Residents for which the stairs are identified as a risk must not be accommodated in these bedrooms. (Previous timescale not met) A choice of hygienic hand washing facilities for residents and staff must be available in toilets; bathrooms and sluice areas, to include pump action soap and either paper towels or driers. (Previous timescale not met.) The registered person must ensure that the home is satisfactorily clean and free from odour. The Registered provider must ensure that sufficient staff are at work to meet the residents’ needs at all times. Staff information must be available in the home to evidence Schedule 2 of the Care Homes Regulations 2001. Overlap time must be built into the change-over of shifts to brief and update all staff coming on duty of any changes and the current needs of the residents. (Previous timescale 31/08/05 not met) The amount of domestic staff must be reviewed to ensure there are sufficient to keep the home clean and that staff are not diverted from direct care duties. The Registered Provider must ensure that all staff are properly inducted as part of their probationary period. DS0000062012.V289877.R01.S.doc 15/08/06 31/10/05 30/04/06 21/03/06 30/04/06 26/05/06 30/06/06 30/06/06 Wolston Grange Version 5.1 Page 28 19. OP33 26 20. OP38 12, 13 21. OP38 13 The Registered Provider must 30/04/06 ensure that regulation 26 visits are carried out on a monthly basis and that reports are kept in the home and sent to CSCI. The Registered Person must 30/04/06 carry out a health and safety audit to ensure that all assessed risks are considered as part of a risk management approach that recognises healthy risk taking to promote independence but which identifies the action necessary by the provider to create a safe environment, sufficiently staffed and resourced to provide for specialist dementia care. A full range of risk assessments 30/04/06 must be in place for individuals, activities and places as detailed in this report. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 29 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 OP7 Good Practice Recommendations Care plans for people with dementia should be a detailed plan of action related to specific goals to promote a persons well being. It should describe what is to be done, when and by whom. All staff involved with the resident with dementia, should be familiar with the content of the plan and make use of it in their day-to-day care giving. “When required” protocols must be written for all “prn” prescribed medication clearly recording the indication and dosage. It is advised that a British National Formulary is purchased for staff to access drug information about the medicines they administer It is advised that the medicines that have not been dispensed in a Monitored Dosage System are segregated in the cabinet. The manager should ensure that residents are involved in the choosing, preparation and all social aspects of eating with dignity. The registered provider is advised to consider how a designated area for staff to take a break can be organised and more storage area for staff belongings. Inspectors recommend that the Registered Provider put into practice current guidance for the furnishing and layout of homes and gardens for people with dementia. http:/www.dementia.stir.ac.uk/publications/designpubs.htm http:/www.alzheimers.org.uk/Research/Library/reading_lists /Reading 20list_architecture.pdf 2. 3. 4. 5. 6. 7. OP9 OP9 OP9 OP15 OP19 OP19 8. 9. 10. OP37 OP38 OP38 The registered provider is advised to ensure that the staff member living on the premises has an agreed tenants agreement Training needs should be subject to a formal review process, whether in supervision or in appraisal. It is recommended that the home incorporate the Alzheimer’s Society standards for residential care within its audit as a recognised quality tool. Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wolston Grange DS0000062012.V289877.R01.S.doc Version 5.1 Page 31 - 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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