Inspection on 22/01/08 for Wolston Grange

This inspection was carried out on 22nd January 2008.

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

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 16/08/07

Wolston Grange 07/11/06

Wolston Grange 21/03/06

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 Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ Lead Inspector Lesley Beadsworth Unannounced Inspection 22nd January 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wolston Grange DS0000062012.V358363.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. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wolston Grange Address 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) wolston@pinnaclecare.co.uk Pinnacle Care Ltd Care Home 33 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (1) of places Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Rooms numbered 5 and 16 should not be used to accommodate service users with a sight impairment. All staff, including the manager, must undertake a minimum of one day each year refresher training at a level that accords with their role and responsibilities within the home. During the residents waking hours care staffing levels must be at a minimum ratio of 1:5 residents. There must be a minimum of three waking night staff. Cleaning, catering and laundry duties must be covered by designated staff (not staff also carrying out personal care) seven days a week. Wolston Grange may, within its existing places care for the person named in the application for variation dated 23/08/06 The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:dementia - over 65 years of age, DE(E), 32; old age, not falling within any other category, OP, 1. The maximum number of service users to be accommodated is 33. 4. 5. 6. Date of last inspection 16th August 2007 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 33 older persons over the age of 65yrs with dementia. The accommodation is over two floors. There are two lounges, a dining room, a large sun terrace, a conservatory and a sitting room upstairs. All bedrooms have ensuite facilities and there are two communal toilets on the ground floor and one on the upper floor. There are two assisted bathrooms and three shower facilities (one shower room not being used) within the building. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 5 The Service User Guide stated that fees were £508.00 a week and that additional charge are made for chiropody and hairdressing. The body of the Service User Guide also refers to charges for the labelling of clothes and any requests for special newspapers and magazines not provided by the home. The Service User Guide advised that the accommodation fees were £508.00 a week. Extra charges are made for hairdressing, chiropody and bus trips. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 6 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. The inspection included a visit to Wolston Grange. As part of the previous inspection process the previous manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, information from previous reports, complaints or concerns and notified incidents made to us and any other information received has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 12.40pm and 09.30pm. What the service does well: The home offered clean, attractive and comfortable surroundings. Pre-admission assessments are carried out to ascertain if the prospective resident’s needs can be met at the home prior to a decision being made about their admission. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. A random audit was carried out of medication in use and all balances were correct, indicating that the correct medication was given at the correct times. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 7 All residents observed or spoken with during the visit were well groomed and looked well cared for, although some of the female residents looked as though they needed their hair styling or trimming. They were appropriately dressed and no soiled clothing was seen. Terms of preferred address are on the residents care plan and heard to be used by staff. Residents are cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Visitors spoken with said that they were always made welcome, being offered tea and biscuits each time they visit. This was confirmed by observations made during the visit. Lunch was a social affair with residents being offered sherry or other beverages and chatter and banter taking place between staff and residents. All residents demonstrated that they had enjoyed their meal, which looked tasty and nutritious, and were offered a choice of what they had. Anyone with limited understanding was shown the two choices in order to make choosing easier for them. According to training records viewed, the majority of the staff had undertaken recent training related to protection of vulnerable adults thereby giving them the knowledge to be able to identify abuse and to protect people at the home from abuse. All bedrooms were ensuite and those viewed were appropriately furnished and decorated. They had been personalised with the occupants’ belongings such as pictures, ornaments and photos. The home is on target for 50 of the care staff to achieve National Vocational Qualification (NVQ) Level 2 in Care, with most of the staff having achieved this qualification or in the process of undertaking the relevant training. Recruitment procedures safeguard residents from the employment of inappropriate people. There has been a series of health and safety related training for staff in the past year. This will make the home a safe place to live and to work. The home does not handle residents’ money and any purchases made for them, including chiropody and hairdressing, are invoiced by the organisation to the person responsible for their finances. This ensures that the residents’ financial interests are safeguarded. Staff supervision is on target to be given six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 8 basis to discuss work and personal issues and an opportunity for staff to contribute to the way that the service is delivered. What has improved since the last inspection? What they could do better: Whilst the majority of staff had attended training related to dementia care this has been only a one-day session for most of them. Serious consideration should be given for more staff to undertake the three-day course attended by Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 9 a small number of staff in order for them to have more knowledge and skills to be able to meet these specific needs of the people living at the home. Care plans had not been signed by residents or their representatives to show that they had been involved in drawing up the plans. The plans viewed had not been reviewed at least monthly and therefore the home could not ensure that plans were up to date and appropriate. Action plans put into because of risk assessments were not consistently followed, thereby not ensuring that the risk was prevented. There were shortfalls related to medication that did not safeguard the health and welfare of residents and/or the security of the medication held at the home – • The administration process was time consuming and created the risk of errors being made. • On some medication ‘rounds’ more than one member of staff were responsible for the administration of medication creating further risk of mistakes being made and for medication keys not being kept in a secure location. • There was not a safe system for residents being able to receive home remedies for minor ailments. • Medication Administration Record Sheets did not clearly show how many tablets had been given when the directions were for one or two tablets to be given. There was no clear indication as to what determined how many tablets should be given. • One member of staff’s signature was a single and illegible initial that was less clear than the sample signature and which could be mistaken for one of the codes. • Temazepam was stored in the controlled drug but had not been included in the controlled drug register, as the home had been advised that it was not necessary. However we recommend that this medication is recorded and administered as a controlled drug as well as being stored as one. • The store cupboard was very warm; the temperature of the room should also be taken and recorded daily to ensure that medication is stored at temperatures below 25°C. There continues to be no way of preventing flies and other flying insects entering the kitchen when doors and windows are open, thereby creating the risk of contamination and cross infection. Fabric towels are still in use in communal hand washing areas and as these cannot be changed after each use they are a source of cross infection. Disposable towels must be available in a suitable dispenser where staff and residents would be expected to wash their hands. The visitors signing in and out book is kept in the office and staff have to complete it for visitors. It was evidenced that this is not always done and Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 10 therefore there is no record of who is in the building in the event of a fire or for reasons of security. The home no longer employed a designated activity organiser. Although the home was quite lively there was no organised activity seen at the time of the visit. A relative said that there were no problems at all with the home apart from “not enough activities”. Particularly as the home is registered to accommodate people with dementia it is important that appropriate and regular stimulating activity is provided to meet their needs and wishes. Religious needs of people living at the home should be reviewed and action taken to ensure that any identified need is met. Staff rotas do not show the names of agency staff, the hours worked by most of the staff, or provide a key to the abbreviations used. The rota needs to show the capacity of all the workers, what hours are to be worked and whether these hours were worked or not. There are only very few domestic hours creating the risk of care staff carrying out domestic tasks thereby taking them away from time with the people living at the home. This could create the risk of needs not being met. Training related to needs common to older people, such as sensory and physical impairments, continence management and Parkinson’s disease should also to be considered in order for staff at the home to be able to effectively meet these specialist needs. The in-house monthly emergency light checks were not up to date. This could create a risk of there being inadequate emergency lighting in the event of fire. 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. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 11 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.V358363.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is adequate. Information required to make a decision about choice of home is available when needed but with some shortfalls. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the Service User Guide was provided. This had been updated in May 2007 in order to give residents and prospective residents the information they need in order to make a choice of home but although giving information about the home continued to be without terms and conditions, in respect of accommodation, and the most recent inspection report (or information on how to access it). The section related to fees did not clearly identify all the charges that are not included in the fees, for example the cost of labelling clothes and of any personal newspapers. Although they are mentioned elsewhere in the document this could be misleading. A copy of the Statement of Purpose was not provided. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 13 Prospective residents are visited prior to admission and assessed as to whether the home is able to meet their needs. A copy of the assessment was included in care files and was in sufficient detail to be able to make a decision about whether the home could meet the person’s needs and from which to formulate a care plan. It covered all the required areas of assessment. A letter is sent to the person to inform them of the outcome of the assessment but a copy was not seen on the care file. Staff have undertaken training related to dementia, having attended a one day course. A few staff have attended a three day course given by external trainers but serious consideration should be given for more staff to undertake this in order for them to have more knowledge and skills to be able to meet these specific needs of the people living at the home. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Care plans are in sufficient detail but there are shortfalls in the reviewing process creating the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. There are concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the three care files looked at included a care plan giving staff the information they required in order to provide the appropriate care for the residents. Each area of need in the care plan was headed with a code that related back to the codes on the assessments. Care plans are written in a positive style, which is good practice although instructions were not always clear or direct. The care plans included evidence that mental health was monitored and behaviour patterns recorded. The plans seen showed no evidence of the resident or their representative being involved in the care plans. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 15 Care plans had only been reviewed every few months, for example in May, August 2007 and January 2008. These must be reviewed at a minimum of monthly intervals and revised as necessary, to ensure that plans are up to date and appropriate. Risk assessments were in place related to pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area), moving and handling, nutrition and individual risks such as orientation within the home, leaving the building unaccompanied and those risks related to diabetes. These were in place to enable appropriate action to be taken to prevent or minimise these risks. However in one risk assessment for a person with diabetes the risk assessment identified the need for the person’s blood sugar to be tested every two to three days. However the most recent recording for this having been tested was August 2007, thereby creating the risk of unacceptable blood sugar levels going undetected until adverse symptoms present themselves. Equipment for the prevention of pressure sores such as pressure relieving mattresses and cushions were in use. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for, although some of the female residents looked as though they needed their hair styling or trimming. They were appropriately dressed and no soiled clothing was seen. Medication was assessed. A multi dose bubble pack system was in use, although some tablets and all liquids cannot be dispenses in this way and were dispensed from their original containers. The procedure remains as previously with medication stored in a locked cupboard in the home and taken by a member of staff for one person at a time to wherever the person is. This is time consuming and can create the risk of the medication being given to the wrong person, particularly if the member of staff is distracted. Furthermore the deputy advised that in the mornings care staff who have undertaken medication training, are also responsible for giving them their medication when getting them up. This could increase the already at-risk procedure by there being more than one person accountable for the administration process and the medication keys. The keys were kept in an insecure location in order that staff could access them easily, rather than kept with the responsible person. This creates further risk. The organisation has a homely remedy policy regarding medication that can be purchased over the counter for minor ailments. However the policy states that the home will only administer prescribed medication “so as to avoid the risk of Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 16 contraindications or accidental overdose” but that “clients are able to choose to purchase non-prescription drugs to self-administer should they wish to.” Therefore there needs to be a risk assessment drawn up for each resident to assess if they are able to manage this safely. There also needs to be a system for residents who are not able to do so to ensure that they safely receive treatment for minor ailments. Risk assessments were in place for residents self-administering their own prescribed medication but apart from one person who applied their own cream all medication was administered by the staff. Medication Administration Record Sheets were examined. There were no unexplained gaps or inappropriate codes used but some medication stated that “one or two tablets to be given as required”. It was not clear what determined how many tablets should be given or from the records how many had been given. One member of staff’s signature was a single and illegible initial that was less clear than the sample signature and which could be mistaken for one of the codes. More care needs to be taken with this. A random audit was carried out of medication in use and all balances were correct, signifying that the correct medication had been given at the correct times. Temazepam was stored in the controlled drug but had not been included in the controlled drug register, as the home had been advised that it was not necessary. However we recommend that this medication is recorded and administered as a controlled drug as well as being stored as one. Medication received into the home is recorded on the Medication Administration Record Sheets and discharge of medication is entered into a dedicated book before being returned to the pharmacist. The medication fridge was in the same store cupboard as the other medication and temperatures were taken and recorded daily, remaining within appropriate levels. However the store cupboard was very warm; the temperature of the room should also be taken and recorded daily to ensure that medication is stored at temperatures below 25°C so that medication remains stable. Terms of preferred address are on the residents care plan and heard to be used by staff. Residents are cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Observations of staff practices found staff responded promptly and sensitively to the needs of residents and conversations between staff and residents were respectful whilst including a little jovial banter. Although the majority of residents were unable to give their opinion about the care they received, one resident spoken with said that staff were respectful and “were very good.” Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 17 As a result of Protection of Vulnerable Adult referrals under the previous management a new procedure had been devised regarding the checking of residents during the night in order to monitor their well being. Improvements were made in relation to the procedure for informing relatives of an unexpected death. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home no longer employs a designated activity organiser. The atmosphere in the home was quite lively with staff interacting well with residents. No organised activity was seen to be taking place during the visit but one resident was completing a jigsaw puzzle; visitors were present in the lounge and were happily chatting with several residents as well as the person they had come to see; the home has two kittens and some of the residents were enjoying their antics. The notice board displayed information about regular planned events, which included an organist visiting the home, Fizzical Fun (movement to music), and a weekly trip out for lunch but no evidence of occupation on a regular daily basis. One relative spoken with said that there were no problems at all with the home apart from “not enough activities”. People living at the home need to Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 19 be given regular opportunities for stimulating occupation that meets their wishes and needs, particularly those with dementia and sensory impairment. A Catholic priest had previously made regular visits to residents in the home but had not been able to do so recently. A Church of England vicar visits one resident. The registered manager said that she is in the process of looking at how religious needs can further be met. Visitors spoken with said that they were always made welcome, being offered tea and biscuits each time they visit. This was confirmed by observations made during the visit. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Residents are also able to bring in their own possessions with which to personalise their bedrooms when moving into the home and this was shown by the ornaments, pictures, photographs and small items of furniture seen in bedrooms. The manager had rearranged the living accommodation and the dining area was much more suitably located in the middle room with the existing pillars creating smaller sitting areas. Residents, staff and visitors spoken with all showed their approval of the changes and the manager said that the changes had been discussed with residents beforehand. The room is attractive and in good decorative order, although as in other areas of the home the floor covering had a busy pattern that is not suitable for people with dementia. Staff notices had been removed from the oak panelling thereby giving a less institutional appearance and showing off the original features at their best. Lunch was a social affair with residents being offered sherry or other beverages and chatter and banter taking place between staff and residents. All residents were offered a choice of food and demonstrated that they had enjoyed their meal, which looked tasty and nutritious,. Anyone with limited understanding was shown the two choices in order to make choosing easier for them. The kitchen was visited and was clean and looked well organised. Although there was an electrical fly killer in the kitchen, there were no fly screens to prevent flying insects from entering the kitchen and causing contamination or cross infection. There are no restrictions to residents and visitors entering the kitchen area and this can create a high risk of contamination and to residents’ safety. There needs to be clear guidelines regarding hand washing and protective clothing worn by anyone entering the kitchen to prevent cross infection and residents need to be supervised if they are to enter the kitchen. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 20 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 adequate. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home keeps a record of complaints and of any action taken to resolve them. These showed only one complaint since the last inspection, which was related to daily records incorrectly showing that personal care had been carried out. This had been appropriately addressed. However there had been two complaints to us. One was regarding omissions of personal care. The second was an anonymous letter regarding environmental issues and there was no evidence of the complaint having any credence. No requirements were made as a result of investigating these complaints during this visit as practices had since improved. According to training records viewed, and to discussion, the majority of the staff had undertaken recent training related to protection of vulnerable adults thereby giving them the knowledge to be able to identify abuse and to protect people at the home from abuse. Two Protection of Vulnerable Adults referrals had been made since the last inspection. The first had been addressed by Social Services and related to the behaviour of one resident to another. The relatives of the victim of this referral were unhappy with the lack of information from the adult protection panel, and Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 21 what they considered to be the delay, in any action taken. The outcome of the other, which was also referred on to Social Services, was not known at the time of this report. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 22 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): 19,20,21,24,26 Quality in this outcome area is adequate. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained but with shortfalls related to infection control. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As previously mentioned the lounges and dining room had been reorganised and provided more appropriate living space. The ‘library’ was returned to its previous use as a sitting area, and the bright and attractive appearance, the period fireplace, other original features and large windows offered a pleasant and peaceful place for residents to use away from the main lounge. Visitors said that they also like to use it when visiting the home. The dining room and main lounge were spacious, bright and mainly well decorated. Although armchairs were in reasonable condition these were said to Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 23 be due for replacement. There were some areas of paintwork in the main lounge that needed attention but otherwise the home offered clean, attractive and comfortable surroundings. The residents’ living space is no longer used for displaying staff notices. These are displayed in the manager’s office, although this is a very confined space. Staff have lockers in the staff toilet although they do not have a designated area where they can take a break. All bedrooms were ensuite and those viewed were appropriately furnished and decorated. They had been personalised with the occupants’ belongings such as pictures, ornaments and photos. There was no offensive odour in the home for most of the visit but the lounge was found to have a strong odour later in the day. Staff made every effort, and succeeded, in locating the source and to clear the smell. Visitors spoken with said that they only occasionally noticed any odour in the home. The kittens’ litter tray was kept in an annexe off the main lounge and was in need of cleaning by late afternoon. The organisation continues to use fabric towels in communal hand washing areas. Unless these are changed after each use they are a source of cross infection. As it would be unrealistic to expect there to be time and opportunity for this, particularly with the limited domestic staff hours, disposable towels need to be available in a suitable dispenser where staff and residents would be expected to wash their hands. Laundry facilities were inspected and found to be well organised, clean and hygienic. Appropriately programmed laundry equipment was in place in order to maintain infection control. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 24 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 adequate. There were sufficient care staff available to meet the needs of the current residents but the low numbers of ancillary staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas do not show the names of agency staff, the hours worked by most of the staff, or provide a key to the abbreviations used. The rota needs to show the capacity of all the workers, what hours are to be worked and whether these hours were worked or not. The home aims to have four care staff throughout the day, and two care staff each night, but on the day of the visit, and on other days according to the rota, there were only two care staff and the manager and/or deputy manager providing care. As there were eight vacant rooms at the time of the visit there were sufficient staff to meet the needs of the residents, although other than for emergencies the manager should be supernumerary to the rota to enable her to fulfil her role. The number of care staff available must be monitored There is also a cook and two part time domestic staff. Although another cook covers the cook’s rest days the rotas did not show who covered whilst the cook was at college three days a week. A further five domestic hours were available Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 25 but not being used at the time of the visit. Given the size of the premises, the needs of the residents and the lack of designated kitchen and laundry assistants there are only very few domestic hours. Although there was no evidence at the time of the visit there has to be the risk of care staff needing to carry out domestic tasks, taking away time to provide care to the people living at the home and therefore being insufficient staff to meet those care. One member of staff was on long-term sick leave and there were three vacancies. The manager was hoping to fill the vacancies in the near future. The home is able to cover absences with agency staff if other permanent staff are unable to do so. The home is on target for 50 of the care staff to achieve National Vocational Qualification (NVQ) Level 2 in Care, with most of the staff having achieved this qualification or in the process of undertaking the relevant training. This qualification shows that they had been assessed as competent to carry out their role. One member of staff was undertaking NVQ Level 3 in Care and the deputy manager and a team leader are undertaking the Registered Managers Award. Four staff files were looked at. These included two written references, the appropriate Criminal Records Bureau disclosures and the Protection of Vulnerable Adults checks showing that recruitment procedures safeguard residents from the employment of inappropriate people. One Criminal Records Bureau had been obtained by the organisation but for a different service. Criminal Records Bureau checks are not transferable between care services although it is appreciated that in the relatively small organisation this could create difficulties. Training undertaken by staff in the last year included dementia training, with the majority of the staff attending a one day course and four staff having also attended a three day course, Protection of Vulnerable Adults training, infection control and the mandatory training of health and safety, moving and handling, food hygiene, first aid and fire training. One member of staff has also undertaken training related to diabetes. As the home is registered to cater for people with dementia there needs to be serious consideration for all care staff to undertake more than the one day course on the subject in order to enable them to have adequate knowledge and skills to meet these specialist needs. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. A person with the appropriate qualification and who has previous management experience manages the home. The service and practices are monitored to ensure that all services operate in the best interests of residents. The home is a safe place for people to live and work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager at the home has held the post since September 2007 having previously been the registered manager of another similar home in the organisation. She has completed the Registered Managers Award and is therefore suitably experienced and with an appropriate qualification for this role. She is awaiting her interview with us in order to be registered manager of Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 27 Wolston Grange. The manager and the deputy were present at the inspection and both were knowledgeable about the residents living in the home. A deputy manager and two team leaders, who work a week-by-week rota for on calls, support the manager. The manager is available at all times if needed. Staff spoken to said that the manager supported them, that they had learned a great deal from her and that whilst she maintained discipline did so without ‘bearing a grudge.’ A resident with said that there was a better atmosphere and staff seemed happier since the new manager started in September. Relatives spoken with also said that they thought things had improved in the home’s environment and liked the changes that she had made. The organisation routinely carries out audits of systems and practices in the home and can therefore show that it is monitoring the service in order to enable growth and improvement. The home does not handle residents’ money and any purchases made for them, including chiropody and hairdressing, are invoiced by the organisation to the person responsible for their finances. This ensures that the residents’ financial interests are safeguarded. Staff supervision was on target to be given six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss work and personal issues and an opportunity for staff to contribute to the way that the service is delivered. Staff had undertaken training related to health, safety and welfare as discussed in the previous section, in order that the home be a safe place for the people living and working there. No doors were wedged open on this occasion thereby reducing the risk of the spread of fire and smoke in the event of a fire. The home has a visitors’ book that is meant to be completed by the staff so that there is a record of who is in the building in the event of a fire. However this is not routinely carried out and once again had not been completed when we visited. Whilst the registered provider intends to reduce institutionalisation by not having a visitors’ book it would be more effective if left for visitors to complete themselves in the more conventional manner. As previously mentioned in the section related to Daily Life and Activities there were concerns regarding contamination and cross infection in the kitchen. uidelines need to be in place regarding the access of residents and visitors to the kitchen area in order to maintain infection control and their health and safety; although there was an electrical fly killer in the kitchen, there were no Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 28 fly screens to prevent flying insects from entering the kitchen and causing contamination or cross infection. Random health and safety checks were looked at. Fire prevention equipment had had an annual service in July 2007 and all in house fire alarm checks had been carried out each week. However there was no evidence that in house monthly emergency light checks had been carried out, which could create further risk in the event of a fire. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 30 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 Where practicable care plans need to be signed by the resident and/or their representative. This will demonstrate that they have been involved in the drawing up of the plans. The previous timescale of 15/10/07 was not met. Care plans must be reviewed at a minimum of monthly intervals or sooner if there is a change in circumstances. This will ensure that they are up to date and the needs of the residents met. Proper provision must be made to ensure that appropriate action is taken to reduce risks, as identified in risk assessments, to the health and welfare of the people living at the home. A safe and effective procedure for administering medication to the residents must be implemented. This will protect the welfare of the people living at the home. The previous timescale of 30/11/07 was not met. DS0000062012.V358363.R01.S.doc Timescale for action 30/03/08 2. OP7 15 30/03/08 3. OP8 12 30/03/08 4. OP9 13(2) 30/04/08 Wolston Grange Version 5.2 Page 31 5. 6 OP9 OP9 13 13 7. OP26 16(2)(j) Medication storage keys must be 30/03/08 kept securely. This will safeguard the residents’ medication. The temperature of the 30/03/08 medication storage cupboard must be monitored, and a record maintained, to ensure that medication is stored below 25°C. this will protect the stability of the medication and the welfare of the people living at the home. Steps must be taken to ensure 30/04/08 the prevention of cross infection in the communal hand washing areas of the home. This will safeguard residents. The previous timescale of 15/11/07 was not met. Systems must be in place to prevent the contamination of flies and other insects in the kitchen. This will safeguard residents from the risk of disease. The previous timescale of 15/11/07 was not met. There needs to be clear guidelines regarding people entering the kitchen in order to safeguard against cross infection and to protect residents’ safety. There must be sufficient and appropriate staff provided to ensure that care staff are able to meet residents’ needs. 30/04/08 8. OP26 16(2)(j) 9. OP26 16(2) 30/03/08 10. OP27 18(1) 30/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000062012.V358363.R01.S.doc Version 5.2 Page 32 Wolston Grange 1. 2. 3. 4. 5. Standard OP1 OP4 OP9 OP9 OP12 6. 7. 8. 9. OP26 OP27 OP38 OP38 The Service User Guide should include all the necessary information, including clear details regarding any extra charges. The staff should undertake training in subjects related to conditions common to older people. A home remedy policy that enables the safe administration of treatment for minor ailments should be considered. Temazepam should be recorded as a controlled drug by being entered in the controlled drug register and on the Medication Administration Record Sheets. Regular and organised stimulating activity and occupation should be provided that meets with the needs and expectations of the people living at the home, in particular those people with dementia. Systems should be in place to prevent flies and other flying insects from entering the kitchen areas to prevent contamination and cross infection. The staff rota should show the capacity of the employee and the hours worked. Emergency lighting should be tested monthly in order to protect residents in the event of a fire. There should be an effective system in place for recording who has entered and left the building in order to safeguard people in the event of a fire. Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Wolston Grange DS0000062012.V358363.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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