Inspection on 04/11/09 for Wolston Grange

This inspection was carried out on 4th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wolston Grange 12/02/09

Wolston Grange 22/01/08

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Flanaghan     Date: 0 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ 02476540482 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: wolston@pinnaclecare.co.uk Pinnacle Care Ltd care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 39 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 39 Date of last inspection Brief description of the care home 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. A new Barn Annexe has been added to accommodate or five further people. 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 39 older persons with dementia. The accommodation is over two floors. In the main home there are two lounges, a dining room, a large sun terrace and a conservatory. All bedrooms have ensuite Care Homes for Older People Page 4 of 37 1 2 0 2 2 0 0 9 39 Over 65 0 Brief description of the care home 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. Up to date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home on Wednesday 4 November 2009 between 9:15am and 6:45pm. We did not tell the home we were coming on that day. The last key inspection visit to this service was on 12 February 2009. Before the inspection, we looked at all the information we have about this service, such as information about concerns, complaints or allegations, incidents and previous inspection reports. We looked at the homes Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. We spent time in different areas of the home, speaking with people who live there, observing staff working, looking at documentation to show how peoples needs are met Care Homes for Older People Page 6 of 37 and speaking with staff. We also had opportunity to speak with some relatives. We conducted a short observational exercise in the main lounge, when we observed reactions from a group of people and observed interactions between them and staff. These observations were used alongside other information gathered to assess the quality of care. A pharmacist inspector undertook a review of medication management in the home. Two people living in the home were case tracked. This involves establishing the individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We sent surveys to the home for people and staff to complete. We received six completed surveys from people living at Wolston Grange, seven from relatives and one from a staff member. Their comments are included within this report. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The person managing the home must apply to register with the Care Quality Commission to manage a registered service as without being registered is a breach of the Care Standards Act 2000. Medicine management must improve to protect peoples health and well-being. Care plans must provide enough information about peoples needs so staff know how to meet individual needs. This will make sure that people receive the care they need and help staff to meet the needs of people in their care safely and in their care. The home needs to make sure that risk assessments completed for people who are identified as being at high risk of falling provides staff with the action they must take to minimise the risk of the person falling. This will help to reduce the risk of the person being harmed through injury. Specific training is needed for staff on the Mental Capacity Act and Deprivation of Liberty (DOLS). This will ensure staff have the knowledge and skills to protect people from harm and are working in the best interests of individuals. The home should keep accurate written records of activities it has provided, so they can find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. Care Homes for Older People Page 8 of 37 A clear system for staff to record any complaints received should be devised so that any concerns can be easily identified and followed up accordingly. Communal areas should not have any offensive odour. This is to ensure that people live in comfortable and hygienic surroundings. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a full assessment identifying their needs and abilities. This ensures that the home can meet their needs and care can be planned before the person moves in. Evidence: We looked at the care records for two people to assess the pre-admission process. Both files contained a pre admission assessment of each persons needs and abilities. Care files also contained information from other health and social care professionals to supplement the information gathered by the manager during her assessment. This means that sufficient information was available so that the home could confirm they could meet each persons needs and develop care plans. One person told us their family visited the home on their behalf to help them make a decision about whether it was suitable for them. A relative commented in their survey that the family had visited a number of homes before viewing Wolson Grange, they Care Homes for Older People Page 11 of 37 Evidence: commented; It was by far the best (home) and I feel we made the right decision. My (relative) has settled in very well and seems content. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs and risks are not always fully identified for people which means they could be put at risk of not receiving appropriate care. The medicine management was poor and did not fully support peoples clinical needs and their health and wellbeing. Evidence: The AQAA told us what the service consider they do well in this outcome area. We devise individual support to the best possible level by providing individual informative care plans involving relatives (where possible) and other professionals. Assess according to each persons strengths rather than focusing on areas of dependency giving us an approach to build the strengths further. Promote privacy and dignity at all times and discover individual preferences and routines for personal care. A clear policy highlights the required method of administration. All responsible staff have received accredited medication training, as well as a majority of care staff. The managers are trained to assess competency and medication handling and administration. We case tracked two people and part of this process involved looking at their care Care Homes for Older People Page 13 of 37 Evidence: plans and risk assessments. Each person had a range of care plans which inform staff of individual needs together with what care and assistance is required from staff to meet these. We saw a range of care plans that covered washing, dressing, physical abilities, mental health, eating and drinking and sleeping. A separate file describing the action staff have to take to meet peoples needs is kept in each persons bedroom, along with daily records. We saw on both files reviewed that there were care plans reflecting the persons choices and maintaining their independence whilst assisting them to meet their daily needs. This is generally known as person centred care and means that peoples care will be planned in a way that is personal to them and reflects the individual care and attention they need. For example, a care plan informed staff that the person was able to wash their own hands and face and staff should help the person to choose their own clothes. The sleeping care plan for the person recorded that they liked regular checks throughout the night as they sometimes feel anxious. We saw this was happening as staff had recorded on the persons night care log the times they had made such checks and if the person was awake and chatted or asleep. The person told us that staff are very good and always ask how you are. The care records for the second person case tracked also contained good information about their needs and how staff could support them. For example, the person told us that they had been poorly and staff kept a record of what they ate and drank. We saw a dietary intake sheet in the file for the period of their illness. We also saw the persons personal preferences were recorded, for example, they prefer the blinds closed at night, but like the room to be softly lit. The person told us that this was done and also said they have a key to their room, as they like to lock the door. We saw this information was recorded on the care file. We looked at some of the care records and risk assessments for three other people. A risk assessment on one file stated that the person was incontinent of faeces and directed staff to maintain hygiene needs. There was no guidance for staff on how this should be done. The toileting preferences and ability plan was blank, so there was no system in place for staff to make sure the person was attended to. The manager told us that the person habitually removes their incontinence materials and smears faeces in their room. We noted the persons hands were smeared with faeces on two occasions during the day. On both occasions staff attended promptly to the persons hygiene needs. We observed that the person liked to walk around the home and staff persuaded them twice to sit at a table to eat lunch. Each time the person left the table and returned to Care Homes for Older People Page 14 of 37 Evidence: the corridor near their room to ask for sweets. We could not see a nutritional risk assessment and although there was an oral health care plan there was no information about how eating a large number of sweets would affect their oral health. The manager told us that it was the organisations policy that people should have free choice and their wishes respected. There was no evidence on file that the service had considered any diversional activities to ensure the person eats a balanced diet to maintain their health. We saw a person coming to the dining room for a late breakfast at 11:15. It is positive that people can choose to get up when they wish. The person asked for and was given an alcoholic drink before their breakfast. We looked at their care records later in the day to see if this was recorded and what risk assessments were in place. We found no record had been made, so could not determine how staff would know how much alcohol had been consumed. We discussed this with the manager who told us that the bottle of alcohol is kept in the kitchen and staff try to limit the amount consumed. Without clear records it is difficult to see how staff could determine how much had been consumed on a day to day basis. We saw a risk assessment for falls due to dizzy spells which detailed X suffers from dizzy spells, staff to be vigilant and assist X as required. As X does enjoy a drink of alcohol, staff should not mistake these dizzy spells as X having too much to drink. The risk assessment was reviewed on 28/08/09, but did not provide staff with the action they must take to minimise the risk of the person falling. There was a mobility care plan which recorded, Able to walk unaided. X will tell you that they feel dizzy. This does usually result in a fall. We looked at the medication for this person. We saw that an anti depressant medication had been prescribed at night. Alcohol is usually avoided with this medication as it can enhance the sedative effects. The medication can also increase dizziness. Another drug was prescribed for hypertension, which can also cause dizziness. The person also had medication prescribed for high cholesterol and a daily aspirin, which may indicate they have heart condition. We could not find any evidence that the service had consulted with the GP on the interactions of alcohol with the medication prescribed. We discussed this with the manager who told us that the organisations policy is for people to make choices about their daily lives. However, the home should be acting in the best interest of the individual and ensure that their needs are met in the best way, based on information available. The service must demonstrate that they have assessed the persons capacity to make a decision, informed them of the side effects and possible outcomes, or made the decision for them through multi-disciplinary discussion. In both cases it is appropriate that the person concerned is listened to and their Care Homes for Older People Page 15 of 37 Evidence: wishes considered, however, the service has a duty of care and must demonstrate that they are acting in the best interest of the individual. Peoples records show they are supported to access other health and social care professionals such as GP, optician, chiropodist and district nurses. We received concerns from a person who wished to remain anonymous about the personal care received by their relative. They were also concerned that their relative had had a significant weight loss and that no action had been taken by the home. The records we looked at and our discussions with people living at Wolston Grange indicated that they were bathed according to their wishes. People looked clean and well groomed on the day of the inspection visit. This had also been observed by the inspector who conducted the observational visit at the home on the previous day. We also saw weight charts in the files of the two people we case tracked and one of the people told us that they were weighed by staff, commenting, couldnt tell you what I weigh, I dont really want to know at my time of life. We spent some time observing how staff interact with people. We saw that staff were kind in their approaches with people and attended to any care needs promptly. Two relatives spoken to during the inspection were positive about the care being provided. One person commented, yes, my relative has settled in well, I think the staff are caring, if a little busy at times. We received a survey from a healthcare professional. They indicated that peoples social and health care needs are properly monitored and met by the service. No additional comments were received. The pharmacist inspection lasted two and a half hours. Six peoples medication was looked at together with their Medicine Administration Record (MAR) charts and care plans. One senior carer undertaking the medicine round was observed and spoken with. All feedback was given to the acting manager and area manager. All the medicines were kept in a walk in cupboard. Whilst the temperature had been recorded daily no action had been taken even though the temperature was too high to safely store medication in compliance with their product licences. This means that their stability was not guaranteed and so may not work as intended. There was no separate lockable cabinet within to safely store the medicines. Anyone gaining entry to the walk in cupboard would have access to all the medicines held inside. Medicines requiring refrigeration were kept in a separate refrigerator. Whilst the temperature Care Homes for Older People Page 16 of 37 Evidence: was within range, the medicines were found on a tray in a pool of water. This may have contaminated the medicines and may cause an unwanted effect when used. The medicine round was observed. Each persons medicine was selected and placed in a bag and taken to the person in the home. No reference was made to the MAR chart before the preparation. This increases the risk of not selecting all the prescribed medicines. The senior carer showed respect to the person whilst administering the medicines. Following the transaction the MAR chart was then signed. The medication round took a long time and finished at 11.30. We, the commission were assured that it usually finished at 10.30. The lunchtime round started at 12 noon. Not enough time had elapsed between round to reduce the risk of potential overdose. At least four hours should be left between medication rounds to reduce this risk. This did not happen. Currently the home has no robust quality assurance system to identify individual staff practices. The area manager visits the home usually every six months and the last audit was in September. This audit did not raise any significant problems. However audits undertaken during the inspection found many serious errors in the administration and recording of medicines. Not all the quantities of medicines received or balances carried over from previous cycles had been recorded so in these instances audits were difficult to undertake to demonstrate that the medicines had been administered as prescribed. Where quantities had been recorded it was identified that medicines had been signed as administered when they had not been. Some gaps were seen and it could not be demonstrated exactly what had occurred, whether the medicines had been administered and not recorded or not administered and the reason for nonadministration not recorded. Sub therapeutic doses had been administered as staff had administered one not two tablets as prescribed. During the observed round on medicines on the MAR chart was signed as N, offered not required but it was noted that the medicine was not actually offered. Other reasons for non-administration had not been accurately recorded. Two inhalers had been prescribed for one person. Staff had signed the MAR chart to record that they had administered them but on inspection neither had been used. One medicine had been prescribed for moderate pain relief. This had been Care Homes for Older People Page 17 of 37 Evidence: administered alongside the lower strength resulting in one day the dose exceeding the maximum daily dose with could have been potentially harmful to the person. Staff had not administered this medicine as the doctor intended. In addition staff had failed to obtain a further supply and the person had been without additional pain relieving medication. A strip of paracetamol was found with the persons other medicines. This was unlabeled and some had been administered. There was no record of this administration. This is of serious concern. In addition this medicine, which had not been prescribed, was less effective at relieving pain than the prescribed medication the service had failed to obtain. Some medicines had been bought into the home for a person staying for respite care. No checks had been made with their doctor to confirm his current medicine regime. Some of the medicines were unlabeled and staff had been administering them. No checks had been made to confirm they were actually for this person. One cream had been signed as applied twice a day for the last twelve days but the tube of cream had hardly been used. In addition the tube and box were both unlabeled so again it could not be demonstrated that it had actually been prescribed to the person or when or at what dose. The hand written MAR chart was poor. Two medicines had incorrect doses written, resulting in both being administered incorrectly and not in accordance with the dose on the pharmacists label. This is of serious concern. All controlled drugs (CD) on the premise were correctly stored in a cabinet that complied with current regulations. Entries had been made in the CD register for one pain relieving patch, but these did not match the dates or times on the MAR chart. From the signed entries in the register the patch had not been changed every three days as prescribed, to provide continuous pain relief but varied from two to five days apart. The person would not have any pain relieving medication for up to two days until a new patch was applied. As there was an inadequate quality assurance system in place, the manager had failed to identify this issue. The care plans lacked information about all the peoples clinical conditions. Without such written information it would be difficult for care staff to fully support the peoples clinical needs. The senior care assistant spoken with had a very limited knowledge of the medicines she handled. Further training is required to ensure that the staff understand what the medicines are for and their common side effects in line with the regulations. Care Homes for Older People Page 18 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to maintain their independence and enduring interests which enhances their quality of life. Meals are well balanced and nutritious. Evidence: The AQAA told us We do not have a strict programme on activities but we do provide a variety of activities throughout the day, such as folding laundry, washing up, gardening, setting tables. We have trips out in the company mini bus to various locations such as garden centres and public houses. As at the last inspection care staff are responsible for providing occupation to the people. In addition, there are organised activities provided by outside contractors, including movement to music, reminiscence sessions and musical entertainers. The manager said that social activities are provided every day although some people were happy to observe rather than join in. Records in the home confirmed which activities had been undertaken on a daily basis, for example, music, games, hand massage. It was not clear which people had participated in the activity and if they had enjoyed it. Some entries recorded watched film. Again, it was not clear if the (unnamed) film had been chosen by people to watch, how many had watched it and if Care Homes for Older People Page 19 of 37 Evidence: they had enjoyed the film. This makes it difficult to find out how many people have been provided with opportunities to enhance their well-being and whether the opportunities are based on what they want to do. We saw in the care records of the two people we case tracked that a life history had been completed which detailed their interests, important relationships and personal preferences. This gives staff information about people and gives them something to talk with people about which is meaningful to them and should also assist in providing person centred care. The manager showed us a recent newsletter containing details of the homes recent garden party which raised funds for further entertainment. We also saw photographs of people helping in the homes vegetable garden. The manager said she had arranged a bonfire and fireworks party in November and people will also have a Christmas party in December. A relative had raised concerns at the last inspection visit that people were being charged for outings without consultation. They were also provided with a poor breakdown of the charges incurred. We discussed this with the manager who advised that people are made aware what the charge will be for any outings prior to it being booked. We saw this information was available on the newsletter displayed on the notice board in the home and a relative told us they had been made aware of charges for outings. We reminded the manager that the home should be able to provide a break down of the charges if this was requested by people or their relatives. We conducted a short observational exercise in the main lounge, when we observed reactions from a group of people and observed interactions between them and staff. We saw that staff were kind in their approaches to people. We also observed that staff were good at offering choices and supporting people in decision-making, for example asking people what they want to eat and where they would like to sit. There is a flexible visiting policy enabling people to maintain contact with friends and relatives at a time that suits them. This helps people to maintain relationships that are important to them. Relatives and friends were observed around the home during the inspection and staff were welcoming and friendly to them. We spoke with a visitor who confirmed that they can visit the home at any time and are always made welcome. Those people living at the home who are able to express an opinion also confirmed they could receive visitors at any time. Comments in the surveys received from people and their relatives include ; Care Homes for Older People Page 20 of 37 Evidence: I would like more stimulating things like games, music and visitors who involve and entertain. Staff are, in general, friendly and competent. The home is welcoming and usually clean and tidy. There is a bus that takes residents out on visits one day a week and I think this is much appreciated. There are some visitors now who organise activities, but I wonder if this is enough? Stimulate the various needs of the residents through more regular stimulation techniques, such as music, art therapy, games and quizzes. My relative loves it when staff have time to sit and chat and listen to her. We had received a concern that there was poor provision of wholesome well prepared and presented food. We saw meal times in the home during this visit. The tables had been laid and the dining room looked like a pleasant place to eat. Staff were seen to assist people in a discreet and sensitive manner. The home operates a four weekly menu and there is always at least two choices for each meal. Lunch was a three course meal with a starter, beef stew, pork steak or stuffed tomatoes with potatoes, carrots and cabbage. People were also offered a choice of dessert of lemon meringue pie or ice cream and fruit. Overall, the mealtime experience was observed to be a positive one with people enjoying their meals. People were also offered tea and cold drinks throughout the day. Comments received from people on the day included: The meat was a bit tough, but otherwise it was a nice lunch. The food is good, I dont know if we have a choice, but I always have something I like. Care Homes for Older People Page 21 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to raise concerns, although they are not always confident that they action will be taken to put things right. Processes are in place to help protect the vulnerable people who use this service from harm. Evidence: Information supplied in the AQAA tells us We display our complaints procedure in a prominent place in the home and it is within our Statement of Purpose giving details of who to contact, where and what to expect, including contact details of CQC. We manage a complaints file for documentation of complaints received and contact made The complaints procedure is displayed on a notice board in the reception. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. People told us in their surveys that they know how to make a complaint. We received six surveys from people living at the home. We asked if managers and staff listen and act on what they say. One person responded never four people said sometimes and one person said usually. Of the seven surveys received from relatives, five people said staff usually act on what they say and two people said sometimes. Comments received in the surveys and on the day of the visit include: Id tell my daughter if I had concerns. Care Homes for Older People Page 22 of 37 Evidence: They (staff) try to help, but they are sometimes too busy to listen. I dont like to complain, as it makes more work for them. Id speak up, but Im not sure it would do any good. Yes, the new manager has listened and made me feel happier that my concerns will be acted upon. The manager told us at the time of completing the AQAA that the home has received four complaints in the past twelve months. We wanted to see the method used by the home to record and respond to complaints, to demonstrate there is a process in place. The organisation had recently re-organised the managers office and the manager was unable to find the current complaints log. We could not therefore be confident that the home has recorded all the complaints it received during the last year. We recommend that the home also keep a log of concerns raised with them that they do not consider formal complaints. This is good practice as would help the home to understand issues that concern people who live there. We received a concern from a relative who wished to remain anonymous. They had also raised their concerns with the local authority who are currently conducting an investigation. We looked at the issues raised in so far as they may impact on other people living in the home. We found that the issues raised had, in the main, been resolved. Specific concerns are detailed under the applicable outcome area in this report. The AQAA told us that all staff are given the company employee handbook and asked to read the government document, No Secrets. Staff are inducted and issued with the homes safeguarding policy and examples of abuse. The manager has also attended a local authority safeguarding adults trainer course and will ensure all staff in the home are fully trained on recognition and prevention of adult abuse. There is a whistle blowing policy and staff have guidance to recognise when people with limited communication express dislike or anxiety so that they can enquire further. Discussions were held with three members of staff about their understanding of suspected abuse. Each member of staff was aware of the correct reporting procedure if they suspected abuse. They confirmed that they had undertaken training regarding protection of vulnerable adults and were aware of the homes whistle blowing procedure. Care Homes for Older People Page 23 of 37 Evidence: The manager told us she has had training on the Mental Capacity Act and Deprivation of Liberty Safeguarding (DoLS), training so that she is aware of her responsibility in supporting people who lack mental capacity to make decisions. This examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. The manager should make sure that this training is made available to all care staff, as a significant number of people living in the home have some form of cognitive impairment. Over the past twelve months, five referrals have been made by the home and other professionals to the local safeguarding adults team about concerns which have arisen regarding people who live at the home. None of these remain outstanding and the local authority consider that the home have put appropriate action plans in place as a result. Care Homes for Older People Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained and comfortable home. Evidence: The manager showed us around the home and we found it to be clean and tidy. Concerns were raised by a relative that the the home often smelt bad. We noted an unpleasant odour in a corridor on the ground floor. The manager said that although carpets were cleaned regularly, the smell could not be totally eradicated. She agreed that it was not pleasant for people living in rooms along that corridor and she will investigate the source of the odour and arrange for further cleaning, as necessary. Ongoing renewal and maintenance of the home ensures that the service provides an environment that is well maintained for people who live at the home. People spoken with were all generally happy with the cleanliness of the home, especially their own bedrooms. We looked at the rooms for the people we case tracked, which were clean and well-maintained. We saw that people are able to bring in items which are important to them, such as photographs, pictures and small items of furniture. The home is set in pleasant grounds and in nice weather can be accessed by people if they wish to sit and walk around the garden. One person told us that they enjoyed going for a stroll in fine weather in the garden, commenting it is such a pleasant place to sit and relax. A visitor told us that the gardener is exceptional, he always Care Homes for Older People Page 25 of 37 Evidence: keeps the grounds looking lovely. It is so pleasant to go for a walk or a sit down with my relative when the weather allows. Staff were observed to follow good practice with regard to infection control systems in order to minimise the risk of spreading infection within the home. We observed staff washing their hands between procedures and using protective clothing, such as aprons and gloves. The laundry was clean and tidy. The manager told us that a laundry assistant had been recruited which should mean that care staff will not have to perform this task, thereby giving them more time to spend with the people living there. It should also improve the quality of laundry provision for people. People commented on the laundry provision in their surveys, saying: Dealing with laundry always seems a problem. Clothes go missing or are badly washed. I believe the new manager is trying to put this right. The laundry always leaves a lot to be desired. I am pleased to see improved cleanliness in the home. Care Homes for Older People Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are met by the numbers and skill mix of staff and staff training is accessed on an ongoing basis to ensure people receive effective care to meet their needs. Evidence: There were 25 people in total living at Wolston Grange at the time of this visit. We were told that the current staffing arrangements for the home on a daily basis consisted of four care assistants during the working day and two care assistants during the night. The manager works in a supernumerary capacity. There were two people living at The Barns, which is staffed separately with one care assistant. On the day of inspection, no concerns were identified in regards to staffing numbers available to support the needs of people. Staff were observed to be busy, but were friendly and supportive and shared a good rapport with people. The manager has an effective process to show when staff are up to date with training and when training is needed. This demonstrates that regular staff training takes place, which should ensure staff have the skills and knowledge to meet the needs of people living at the home. Training which has been provided recently includes training in safe working practices such as fire safety, infection control, food hygiene as well as more specific training including dementia care. The staff we spoke with told us they are Care Homes for Older People Page 27 of 37 Evidence: provided with good training opportunities and gave us examples of the training they have done at the home. The AQAA told us that 12 of the 20 care staff working the home have achieved a recognised qualification in care (National Vocation Qualification). This should mean that people are cared for by competent staff. We saw documentation which shows that new staff are provided with an induction when they first start working at the home. We looked at the process used by the home to recruit two members of staff who have started working at the home since the last key inspection. All the necessary preemployment checks had been obtained for both people. These robust recruitment procedures should safeguard vulnerable people using the service. Peoples comments about the staff included: Staff are vigilant, kind and caring. Would like staff to be more permanent and maybe the staffing level could be improved. The staff are incredibly kind and understanding. Frequent changes of staff worry me. There may have been many changes of staff, but my relative has always received the greatest care, attention and affection. The expertise and patience of the staff is impressive. This not only applies to the carers, but to the chef and gardener. Care Homes for Older People Page 28 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home do not benefit from having a registered manager in post therefore they cannot be confident that the service is managed in their best interests. Evidence: The home is currently without a permanent manager and is being managed by an acting manager from one of the organisations other services. She is supported in this role by the area manager. She has a National Vocational Qualification (NVQ) in care and is working towards obtaining a Certificate in Leadership and Management. The organisation must apply to register the manager with us so that people are protected and appropriately cared for, and staff are supported and supervised. We saw that people living at the home were comfortable in the presence of the manager and could speak to her at any time. One of the visitors spoken with said the manager was very approachable and kept them up to date on their relatives life in the home. The staff spoken with during the inspection spoke highly of the manager and felt that they could approach her for help in any area. Care Homes for Older People Page 29 of 37 Evidence: Prior to the inspection we asked the manager to complete an Annual Quality Assurance Assessment (AQAA). We did not receive the AQAA from the home when we asked for it and had to send a reminder. The AQAA was completed to a satisfactory standard and gave us information about the home, staff and people who live there, improvements and plans for further improvements. We saw that questionnaires are sent out to people, their relatives or representatives to obtain their views about the service. Meetings are also held with relatives throughout the year. A representative of the company monitors quality at regular intervals with monthly unannounced visits. We observed the reports produced as a result of these visits which show the visits look at a wide range of matters to ensure the service is operating well and that people are pleased with their care. Systems for managing peoples money are in place. The system has not altered since the previous inspection. Any purchases made or services provided are invoiced monthly to the person responsible for the residents finances. These records are held at the organisations head office and were not inspected on this occasion. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. We looked at a selection of maintenance and servicing records, all were up to date and demonstrate that systems are in place to ensure the home and equipment is safe. We saw that staff have regular training in health and safety, which ensures they are provided with the knowledge and skills to help people keep safe. Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must provide staff with detailed information on what they need to do to meet the care needs of people living in the home. This will make sure people get the care they need. 31/12/2009 2 8 13 Risk assessments completed 31/12/2009 for people who are identified as being at high risk of falling must clearly identify the action staff must take to minimise the risk of the person falling. This will help to reduce the risk of the person being harmed through injury. 3 8 12 All prescribed medicines must be available at all times to administer to the service user 31/12/2009 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that the service user has prescribed medication administered as the doctor intended 4 8 12 The care plans must include the clinical conditions for each service user. This is to ensure that staff have clear information to fully support the service users clinical needs. 31/12/2009 5 9 13 The quantity of all medicines 31/12/2009 received and any balances carried over from previous cycles must be recorded. This is enable audits to take place to demonstrate the medicines are administered as prescribed 6 9 13 All medicines that are 31/12/2009 administered must be stored correctly in accordance with their product licences in a locked cabinet within a locked room and be labelled by a pharmacist. This is to ensure that the correct medicine is administered to the right service user and their stability is not compromised. Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 9 13 All dose regimes must be 31/12/2009 clearly written on the medicine chart, checked by a second member of staff for accuracy. This is to ensure that the staff have clear directions to follow. 8 9 13 A system must be installed to check all new service users medication with their doctor. This is to ensure that they are administrated their current drug regime All staff must be further trained in the indications and side effects of the medicines they handle. This is to ensure that they can fully support the service users clinical needs. 31/12/2009 9 9 13 31/12/2009 10 9 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. 31/12/2009 Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that individual care staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that they do not administer the medicines as prescribed. 11 9 13 The medicine chart must 31/12/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 The service should should ensure that they assess peoples capacity to make a decision to ensure that the home is acting in the best interest of the individual. The service should consult with peoples general practitioner to ensure that any alcohol consumed by an 2 9 Care Homes for Older People Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations individual does not contra interact with their prescribed medication. This is to ensure staff are aware of the persons clinical needs and medication is adminstered as the GP intended. 3 4 9 9 It is advised that at least four hours elapses between medicine rounds to reduce the risk of potential overdose. It is advised that regular audits are undertaken to check the entries in the Controlled Drug register reflect the entries on the MAR chart and action is taken if discrepancies are found. Arrangements should be in place to ensure that all people living at the home are provided with opportunities to enhance their social well being. The system of recording activities undertaken should be further developed so that the home can demonstrate how it has provided these opportunities. The effectiveness of these opportunities should be evaluated on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. The service should consider making nutritional snacks available and accessible to people throughout the day for people with poor appetite or those who do not eat well at set meal times. Clear recording systems should be in place to allow staff to record any concerns or complaints raised by people living in the home. This is to ensure that any complaints can be easily identified and the home can demonstrate appropriate action has been taken to address concerns and safeguard people. Steps should be taken to remove the unpleasant odour in the corridor identified to the manager during the inspection visit. Thsi will ensure people live in clean and comfortable surrounding. 5 12 6 15 7 16 8 26 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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