Inspection on 07/11/06 for Wolston Grange

This inspection was carried out on 7th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wolston Grange 04/11/09

Wolston Grange 12/02/09

Wolston Grange 22/01/08

Wolston Grange 16/08/07

Wolston Grange 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 Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ Lead Inspector Sandra Wade Key Unannounced Inspection 7th November 2006 07:40 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.V316604.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.V316604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wolston Grange Address Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ 02476 540482 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Pinnacle Care Ltd Ms Andrea J Hall Care Home 33 Category(ies) of Dementia - over 65 years of age (33) registration, with number of places Wolston Grange DS0000062012.V316604.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 21st March 2006 4. Date of last inspection Brief Description of the Service: Wolston Grange is one of seven homes owned by Pinnacle Care Limited. It is a large detached dwelling set in extensive grounds. The building was formerly a hunting lodge and there are a number of small outbuildings surrounding the main courtyard. The home is set in a rural location, a short drive away from Rugby Town Centre and the villages of Dunchurch and Bilton. The home is located along a country lane with smaller domestic dwellings as neighbours. There are no local facilities or public transport close to the home. It is registered to care for up to 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 also 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. At the time of the inspection the fees for the home ranged from £400 – 498 per week. Extra charges are made for hairdressing (from £5), Chiropody (£8.50) and bus trips which vary in cost according to the distance involved. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Wolston Grange care home for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 7.40am and 7.40pm. Two 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 (if 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. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, staff duty rotas, health and safety records and medication records. Before the inspection a pre-inspection questionnaire was sent to the home with some questionnaires to send out to a random selection of residents and relatives. These were not received before the inspection to enable this information to be incorporated into the report. The Registered Provider has since confirmed this information was not received by the home. Due to the dementia diagnosis of residents in this home, some residents were unable to hold meaningful conversations to confirm their views of the care and services provided. Observation of residents therefore formed part of the inspection processes to identify signs of wellbeing and contentment within the home. What the service does well: The home is set in extensive and attractive grounds which can be assessed by residents and plans are in place to develop the gardens to benefit the residents further. Generally the home is well maintained with good quality furnishings and fittings and residents have the advantage of spacious communal areas. Staff were caring and supportive to residents and were knowledgeable in regards to the residents likes and dislikes. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 6 Residents were positive in their comments regarding staff; one said that staff were “friendly, caring and professional”, another said that they could rely on staff to call a doctor if they were not well. All bedrooms have ensuite facilities and specialist equipment and aids are available to support residents as required. Staff training is supported on an ongoing basis and nearly half of the staff have now achieved a National Vocational Qualification II in care to enable them to provide more effective care to the residents. Residents said they liked the food provided and are given a good choice. Meals observed were home cooked and looked appetising. What has improved since the last inspection? What they could do better: Information provided to residents before their admission needs to be more detailed and residents need to receive written confirmation that the home can meet their assessed needs. Care plans need to be reviewed to ensure they contain clear information about resident’s needs and how these are to be met. Medication management is in need of further review to ensure all practices are managed appropriately to safeguard residents. Records in relation to social activities need to be maintained to demonstrate that all residents are being given the opportunity to undertake social activities specific to their needs and preferences. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 7 The environment needs to be improved to make it more suitable for people with dementia in particular in terms of finding their way around the home and addressing poor lighting. Effective systems need to be in place to manage cleanliness and infection control within the home. A review of staffing is required to ensure there are sufficient numbers of staff to provide effective care and services to the residents. The home must also comply with their Condition of Registration in regard to this matter. Recruitment records must contain all of the required information to demonstrate recruitment is being managed in a way that safeguards residents. The supervision of staff six times a year needs to be demonstrated to show that staff are deemed competent and are able to provide effective care to the residents. Doors which are kept open need to be fitted with an appropriate device linked to the fire alarm to ensure these close in the event of a fire and prevent residents from being placed at risk. 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.V316604.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is not clear that residents are receiving detailed information about the home to enable them to make an informed choice about whether to stay at the home. All residents are assessed before their admission to identify their needs but they do not receive written confirmation that the home can meet these needs. EVIDENCE: A Statement of Purpose and Service User Guide, which details the care and services provided has been developed. A full copy of the Service User Guide was not available in the home to confirm that this contains sufficient information to assist prospective service users in making a decision to stay in the home. This includes a copy of the contract and summary inspection report. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 10 Residents sign a form upon admission to confirm acceptance of the Service User Guide or Statement of Purpose. Assessments are carried out by the home out to identify resident needs and copies of these were available on care files viewed. Assessments are also carried out by the Social Workers where applicable and copies of these were also available on files. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not clearly set out to enable the health care needs of residents to be easily identified which could result in an oversight in care and put residents at risk. Records for medicine management were generally good with the majority of medicines being administered as prescribed, some actions are required to ensure all medicines are stored and managed appropriately. EVIDENCE: The inspection process identified that those residents who were able to communicate felt well cared for and supported by staff. A full review of two care plans was carried out and care issues relating to a further two residents were followed up. Care plans read held a lot of information but this was mainly focused around assessing the continued abilities of people with dementia. A number of different monitoring tools were in use. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 12 Care plans were difficult to use in that a lot of information had to be read to identify a residents care needs and the document did not flow in a way that makes it easy for staff to clearly identify what the residents care needs are and what role they need to play to meet these needs. Staff confirmed that they tended to use the care plan file when a resident was admitted but discussions with staff suggested they are not referring to care plans or using them, as they should because they find they are not easy to use. Care plans should identify the residents care needs, actions on how these are to be met and confirm how care needs have been met. Daily records read were mainly related to sleeping, eating, mood and what they had been doing. It was not clear that their care needs were being fully supported. The manager had identified that staff were not finding care plans ‘user friendly’ and had developed an “important each day” sheet for incorporation into residents files. This details the resident’s daily routine and how they like their care to be given. The manager said she had only just started to do this so not all files contained this information. The admission documentation for one resident confirmed the resident had depression, a hearing impairment, a sight impairment and vascular dementia. Staff had identified that one of the main reasons for the depression of this resident was being separated from their partner. To support this resident, various actions had been taken to allow the resident to spend more time with their partner and care records showed this has had a positive impact on the resident. The care plan showed that the resident’s partner was assisting the resident in lots of ways reducing the need for care staff support. The file contained an “important each day sheet” which stated the resident liked ballet and opera. During discussions with this resident in their room it was evident there were numerous DVDs and CDs to support this interest. The resident said that they were happy in the home and said “its fun” on numerous occasions. The resident said that they regularly went for walks in the gardens including early in the morning and the care staff would make sure they were given their medication before they went out. A second care plan file viewed showed in the assessment records that the resident had previously suffered a fractured femur, had a history of falls, had Parkinson’s Disease symptoms and could be argumentative. The care records were not clear on staff support required, for example, it stated for “mouth care” – staff assistance required. It was not clear what assistance the resident needed and whether they had their own teeth or dentures. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 13 For “foot Care” it stated “via chiropody”, it was not clear if the resident had any problems with their feet and how often chiropody needed to be accessed. It was not clear from records in place how this persons personal care needs were being met. Records stated this person was doubly incontinent and staff were to “give all assistance as required”. Care records did not clearly state how this care need should be managed. The medical sheet on file stated that the doctor had visited but referred the reader to the daily records. As daily records sheets can be filed away due to the volume generated, it was advised to keep the medical sheet up-to-date with the reasons of the doctor’s visit and the outcomes so that staff could refer to this when required. A “strengths and abilities” sheet on file stated “help resident to recognise their achievements”, “encourage sense of humour through gesture, action and opportunity”. It was not clear from daily records if this was being done and if so how. The risk assessment section of the care plan was blank despite this person having a history of falls and Parkinson’s disease symptoms which could result in further falls. Fall risk assessments were discussed with the manager and advice given. It was established during the inspection that one resident had not been taking their medication. The Medication Administration Records (MARs) confirmed this resident had refused medication over a three-day period. It was not evident from viewing the care plan records that staff had developed a risk assessment stating how this risk should be managed. Daily records did not indicate whether staff were returning to the resident to try to encourage them to take their medication. They did say that the doctor should be called if the resident continued not to take their medication on the fourth day. It was noted from the daily records that this person also was refusing personal care; no risk assessment had been developed advising how this should be addressed. During the inspection a resident was found in their room in a urine soaked bed. The odour in this room was extremely strong and unpleasant. Staff assisted the resident to get up and dressed while they changed the bed. Staff advised that this resident did have a problem with incontinence. It was not evident that this was being managed effectively. A review of medication was carried out. Generally medications had been administered correctly and had been signed for to confirm they had been given. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 14 One gap was noted on the MAR for ‘prednisolone’ so it was not clear this had been given. Twenty-eight Zopiclone tablets had been prescribed for one resident. There were 22 signed for and 7 left. This suggests the MAR chart had been signed when the medication had not been given. The same was also found for Omeprazole. According to the records ten tablets should have been remaining but there were twelve left, again suggesting the medication has been signed for but not given. It was not evident that the home has resolved the issue of repeat medications no longer required being removed from the MARs. Numerous medications had lines through them stating “discontinued”. The home are now carrying over balances of medications so that it is clear at the beginning of the prescribing period how many medications are available. The manager advised that she obtains copies of the prescriptions prior to them being dispensed by the Pharmacist so that she can check the medications to be received are correct before delivery. MAR charts had been signed to confirm those residents on supplements were receiving them. It was observed that a small trolley with medications stored in it had been left in the corridor area while a member of staff gave out a resident’s medication. This was observed twice in between giving out medications. This was pointed out to the manager who advised the member of staff to make sure they were put away. Staff continue to use open ‘medipots’ to give out medication as opposed to taking the blister pack to the resident which is a safer way of administering medication. The medication round for the morning medications was completed by 10am which is an improvement from the last inspection visit when they were not completed until midday. A medication trolley is not available in the home as the Registered Provider does not wish medications to be given in this way. The registered provider has stated that she has removed the medication trolleys as a step away from “institutionalised practice”. At the time of inspection there were 23 residents in the home and two in hospital. When the number of residents increase the manager will need to consider how medications can be managed effectively if they are to be administered without a trolley. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 15 A controlled drugs cabinet is still not available in the home and as a result, a controlled drug was not being stored appropriately. Not all staff have completed medication training but the manager had identified those staff who will be doing this. The privacy and dignity of residents was being respected in many ways such as staff addressing residents by their preferred names and knocking doors before entering and residents wearing appropriate clothing. One resident confirmed that staff respected their private time and knew they preferred to stay in their room for most of the day. In other ways privacy and dignity was not being respected such as residents wearing food stained clothes and a resident being found in their room in a urine soaked bed. One resident was observed to ask to go to the toilet twice and on the third time staff arranged for the resident to be taken. Staff were noted to be busy constantly in the home attending to residents and other duties, which may have contributed to these matters not being addressed. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents find the lifestyle experienced in the home mostly matches their expectations but further work is required to support their social care needs to promote their feelings of wellbeing. EVIDENCE: The manager said that an Activity Organiser was employed at the home but they left to take up another position within the company. The Activity Organiser has not been replaced and care staff were providing some activities when they could. During the inspection some residents participated in a painting session in the lounge. Some residents chose to stay in their rooms. One resident in the communal area had a visitor and others were either watching television or were walking around the corridors. Residents are able to participate in trips arranged by the organisation and a mini bus is available to collect them each Friday. Staff said they usually take the residents out for a meal somewhere. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 17 An Activity Schedule was on display on the notice board in the entrance hall of the home but it was not evident activities are always carried out in accordance with this. Staff confirmed that social activities do not take place every day. Music was played in the lounge areas during the day but it was noted that the tape played several times over without staff noticing this. The inspector mentioned it to a member of staff who then changed it. Staff said that when the Activity Organiser was in post she used to record the activities that residents took part in. A copy of these records were requested but staff were unable to locate them to confirm residents are regularly participating in social activities. Daily records detailed some information on activities carried out by residents but it was not clear they have access to regular social activities, which are both suitable, and of interest to them each day. The manager acknowledged that this was an area requiring further development. Relatives are free to visit when they wish and the manager advised that they are always invited to care reviews so that they can be involved in decisions in how their relatives care is to be provided. Resident choices are being respected and information relating to resident choices is kept on care plans. This information includes food likes and dislikes and an “Important each day” form which give clear information on how residents like to spend their day. During the morning a resident asked what was for lunch. Care staff did not know but Menus were on display on the wall. These were in small print which would make it difficult for some residents to read. As four weeks were on display it was not clear which week the home were working to so residents could not check for themselves what they would be having. It was also noted that the meal served in the dining room was not the meal displayed on the menu in the lounge. This was discussed with the cook. The cook said that she was a ‘relief’ cook for the company and was only working in the home because the usual cook was on holiday. The cook said that she had followed the menus in the kitchen. The manager said that the menus had recently changed and the one on display in the lounge had not been changed. The cook was asked how she knew which residents were diabetic or which ones would need a soft or liquidised diet. She advised that she relied on staff to tell her. There were no clear records available in the kitchen showing any special dietary needs to assist the cook and to ensure residents received appropriate meals. Staff confirmed there was a diabetic resident in the home and it was observed that ‘thick and easy’ was being used in the home to thicken fluids due to residents having swallowing problems. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 18 It was observed during mealtimes that residents were asked where they would like to sit and what they would like to eat. The food on the day of inspection was freshly prepared and transferred to a heating trolley which was taken to the dining room. Meals were served from the trolley and looked appetising. Residents were given three choices at lunchtime including chicken kiev, meat pastie or cheese potato and leek pie. All were served with vegetables. The desert was bread and butter pudding, sponge pudding or custard or ice cream. When residents were asked what they would like some hesitated or did not answer possibly because they could not think what the meals were. It was observed that staff did not show the residents the food to help them make a decision and there were no pictoral aids such as photo menus to help residents make choices. The manager agreed to look into this matter. Tables were laid with table clothes, cutlery and napkins and most residents were able to eat independently. During lunch one resident upset another resident by taking their squash, staff defused the situation by suggesting to the resident that they move to another table. Staff assisted some residents by cutting up their food and those who did not eat were assisted or prompted. Once residents were settled staff also ate their lunch in the dining room with residents. If residents required assistance staff stopped eating their meal to assist them. Residents spoken to said that they liked the food. Two commented that sometimes the meat could be “tough” and hard to eat. It was established that the cook works in the home between 8am and 2pm and there are no kitchen assistants to provide any support. This results in carers preparing cereals and helping with breakfast and also preparing the evening meal. Residents spoken to said that sometimes cooked items were available at breakfast but they did not have a fully cooked breakfast, which they would like very much. They felt that due to the number of staff available, they would not have time to prepare a fully cooked breakfast. It was observed at breakfast time that residents were only offered cereal or toast. No cooked items were offered. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are listened to, taken seriously and acted upon and systems are in place to help protect residents from abuse. EVIDENCE: The Commission has not received any complaints for this home since the last inspection. The home had received three complaints. One relating to a resident being found in a urine soaked bed and two from the same person relating to staff attitude. The manager had investigated these matters and had taken actions in response to these matters. It was established during the inspection that a relative had raised concerns regarding an odour in their relative’s room. Staff were taking actions on the day of inspection to clean the carpets in this room. A complaints procedure is available in the home and there is also a policy and procedure in regard to the prevention of abuse so that staff know what they should do if this is reported to them or is identified by them. The manager advised that all staff had completed training in the identification and prevention of abuse. Staff spoken to said that they would report any abuse to the senior person in charge. Systems were in place for the senior person in charge to follow which included details of the reporting process and actions that should be taken to protect any resident involved. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a generally well maintained and pleasant home. Some issues relating to resident orientation around the home and hygienic practices need to be addressed to ensure residents can maintain some independence and be cared for safely. EVIDENCE: The home is furnished and decorated to a good standard but carpets, curtains and chairs in communal areas are highly patterned which has the potential to disturb or confuse residents with dementia. Staff confirmed that some residents try to pick the “flowers” off the carpet, this could increase their risk of falls. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 21 Since the last inspection bedroom doors have been painted different colours and fitted with door knockers to help residents identify their rooms. Staff confirmed that residents were asked what colour and door knocker they would like. Despite this, there is still a lack of prompts and clues around the home to assist residents to find their way. The majority of rooms are not marked with the person’s name, or a familiar object and there are no pointers around the corridors to give clues to residents of their location. The registered provider should ensure that the environment enables the residents with dementia to make use of their remaining abilities, and minimise factors that are contributing to an individual’s difficulties. The manager said that they had attempted to improve the signage on the doors but residents kept removing anything stuck onto the door. The manager said it was planned to introduce memory boxes containing items familiar to the resident, which can be fixed onto their doors to help them locate their room. Bedrooms were spacious and some were furnished with lots of personal items to make them homely, others were not although the registered provider said residents are encouraged to bring personal items in with them. Rooms seen were dusty and the floors were in need of vacuuming. Cobwebs were seen around some of the lights. Each of the bedrooms has an ensuite toilet and there are also communal toilets which residents can access on each floor. There are shower rooms and baths with chairs to assist those residents with limited mobility. Several of the toilets did not have any toilet roll and some had no hand towels. Hand towels can harbour infection but the Registered Provider has chosen not to use paper towels because they give an institutional feel to the home. Alcohol gel is available in cabinets within the communal bathrooms so that staff can use this to maintain hand hygiene when needed. The manager advised that hand towels are checked twice a day and changed if necessary unless it is noticed they are soiled and they are changed straight away. The manager advised that she has devised records to show when towels have been checked and replaced. These had not been commenced at the time of inspection. In one bathroom there were two pairs of glasses and several pairs of pants belonging to residents. There were also two pots of named creams in the bathroom cabinet and several toiletries. It was not evident that the bathrooms were being checked regularly to remove any personal items to return them to resident’s rooms and prevent them from being used by others. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 22 Not all bedrooms were viewed during this inspection but an unpleasant odour was identified in one of the bedrooms seen. The manager advised that a new carpet cleaner is available in the home and this is used regularly to clean carpets. The kitchen was viewed early in the morning before food was prepared. This was clean and well organised with the exception of the floor which was in need of a clean. There were two lap trays with padded bottoms, which were food stained, and in need of cleaning. A separate hand washbasin and liquid soap was available for staff to wash their hands but there were no paper towels available in the holder for staff to dry their hands. During the tour of the home a large number of lights were not working due to needing new light bulbs. In one room, the main light, ensuite light and lamp light did not work. A visitor to the home confirmed that light bulbs were not always working. During late afternoon it was identified that several lights in one part of the building were not working. The manager discussed with a contractor working at the home whether this was due to an electrical fault. It was eventually established that the failed lighting was due to several light bulbs needing replacement. Discussions with staff suggested that light bulbs are always needing to be replaced in the home. The manager advised that she had asked the maintenance man recently to purchase some light bulbs and over 50 were replaced but they still needed more. In the evening, the inspector observed that the outside car park area was dark with no lighting to help or assist any visitors to the home. This could include the emergency services or residents who may come back to the home from hospital. A review of the laundry was undertaken. This was found to have limited space and only one washing machine to complete the laundry for potentially 33 residents. The manager advised that if the machine should break down the contractors would come out the same day to address the problem. There were two tumble driers available and some space for hanging clean items. There was no space identified in the laundry for individual baskets of clothes to store when they were ready to be returned to the rooms. During the morning it was noted that small baskets of clothes had been placed outside the doors of rooms. Staff confirmed that the night staff would have completed this laundry. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 23 Records in the home showed that there had been problems with some items of clothes being washed on a cycle that was too hot and with some items not being returned. The manager had placed notices in the laundry reminding staff not to use the hot cycles for some clothes. It was noted from the duty rotas there are no specific staff identified to do the laundry for the home. Carers stated that they were doing the laundry when they could between caring for the residents. There was no soap at the hand-wash sink for staff to wash their hands and there were no gloves or aprons seen in the laundry to support good infection control practice. Wolston Grange DS0000062012.V316604.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. This judgement has been made using available evidence including a visit to this service. Staffing arrangements are not sufficient to ensure the care needs of residents are met consistently. Staff training is ongoing to ensure the needs of residents can be met effectively. EVIDENCE: Staffing levels remain below the required standard for this home. There is a Condition of Registration placed on the home for staffing ratios to be one member of staff to five residents during the day and a minimum of three care staff at night. In addition, it has been made a requirement that there are dedicated staff to do catering, laundry and cleaning duties and these duties are not to be carried out by staff who provide personal care. On the day of inspection staff confirmed there were 25 residents but two of these were in hospital. Duty rotas showed that the home has been operating with three or four carers during the day, which is below the agreed staffing levels, and two at night. Throughout the inspection staff were observed to be busy, when they had finished one task they were needed to complete another. Sometimes staff were not able to meet resident requests immediately because they were busy with other residents. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 25 Duty rotas also showed that the home have been working without a dedicated person to do the cleaning on some days. Staff confirmed that the person who usually did the cleaning had been called upon to work caring shifts. A cook usually works in the home between 8am and 2pm. On the day of inspection, care staff were observed working between the kitchen and the dining room during the morning preparing toast and serving cereals. In addition, care staff confirmed that they cooked any items needed at tea time. Carers should not be doing catering duties for the home as this takes them away from providing care to the residents and reduces the staffing ratios for the home below the required standard. The manager advised that there were some staff off sick and some on maternity leave and at times it was proving difficult to cover the home with existing staff. Care staff had already picked up extra shifts but due to this not being enough, the manager had been using agency staff. The manager had been actively trying to recruit to the vacant posts but said this was taking longer than she would have hoped due to delays in receiving employment checks. The manager confirmed that there are twelve carers employed by the home and five of these had achieved a National Vocational Qualification in Care to enhance their caring skills and help them provide more effective care to the residents. A further two staff had almost completed this and others were due to start. New carers complete an induction to the home and records of training completed are kept on their files. As part of this training care staff must demonstrate their competency through assessments, which are confirmed as sufficient by senior staff. Other training in the home such as first aid, dementia, food hygiene, moving and handling is arranged on an ongoing basis. The manager had devised a training schedule showing those staff who were due to complete this. There was only one person who had not done the dementia care training and this was due to them being new to the home. Records showed that all staff needed to complete training in infection control and several needed to complete training in the management of medication. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 26 A review of staff records was undertaken to confirm that safe recruitment practices are carried out. Two written references had been sought and a criminal records bureau check was available in one file. In the other file there was no criminal record check or check against the protection of vulnerable adults register. Records were in place to confirm the criminal record check had been sent for and the manager advised that a check had been completed against the protection of vulnerable adults register but this had not been put in the file. Due to problems with the computer the manager was not able to print a copy of the check. In this same file there was a gap in employment history, which was not explained. The manager gave a reason for this but records should explain any employment gaps so that it is clear these have been considered as part of the employment process. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to allow the home to be managed in the best interests of service users but some actions are required to address health and safety and the formal supervision of staff to ensure the welfare of service users is protected. EVIDENCE: The manager of the home was recruited to the home in October 2005 and became registered with the Commission in July 2006. She has experience of working in a caring environment and has also gained nursing and management qualifications including the Registered Managers Award. In addition to these qualifications the manager hopes to commence training to obtain a Dementia Care qualification in the near future. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 28 Staff spoken to said that they felt well supported by the manager. The manager advised that systems have now been set up to allow care staff to receive formal supervision six times a year in addition to daily supervision. This will allow the manager to discuss their role in the home and identify any training needs and address these as required. The manager carries out regular audits to check that staff are following the policies and procedures of the home. Audits seen included room audits, checks on medication management, care plan completion numbers and types of accidents in the home. The manager had also sent out questionnaires to relatives in August 2005 to obtain their views of the home and identify any areas they felt needed to be improved. Three monthly meetings are held with relatives to enable them to be consulted on issues relating to the management of the home and the manager provides feedback about issues raised at the previous meeting. Copies of the notes of these meetings are kept in the home. One of conditions of registration for the home is that residents with a sight impairment do not occupy two named rooms within the home. This is because one of the rooms has steps leading to the door and the other has a low sloping roof which a resident could bump into. It was found during the inspection that a resident with poor sight was occupying one of these rooms, the care plan confirmed this. This is a breach of the registration requirements of the home. The manager said that they had carried out a risk assessment for the person in this room and due to the poor mobility of this resident it was felt they were not at risk and could be cared for safely. Resident care plans were noted to be stored in the residents lounge in an open bookcase. These records should be stored in a secure location as they contain personal information relating to residents. The manager advised that they do not handle resident’s money in the home as this is managed by relatives. The organisation invoices relatives as required for any other expenses incurred. Health and safety checks are being carried out. Records viewed showed that hot water temperatures had been checked in October and two were above the recommended level. The manager advised she had requested the maintenance person for the home address these to prevent any burn risks to residents. The electrical wiring had been checked for the new areas of the home in May 2006 and the original part in February 2005. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 29 Records showed that hoists had been serviced in October 2006. The manager said that the window restrictors are checked regularly but records are not kept to confirm these. A fire risk assessment had been completed. During the tour of the home it was found that various doors including the kitchen door had been propped open with different items such as a candlestick, vase and washing up liquid. This would mean in the event of a fire the doors would not automatically close which could compromise the safety of the residents. Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 X X 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 2 X 3 X X X 2 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 2 Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (1) Requirement The Registered Person must ensure the Service User Guide for the home contains all of the required information prior to making this available to service users. The Registered Person must confirm in writing that following the assessment of a resident, the home can meet their needs. The Registered Person must take action to ensure care plans are suitably structured to be able to clearly identify care needs, how these are to be met and staff actions carried out to meet these needs. Risk assessments must support these plans as appropriate. (Previous time scale 31/08/05 still not met) The Registered Person is to ensure safe systems are in place to safely transport medicines around the home. Timescale for action 31/01/07 2. OP4 14 (1) (d) 31/01/07 3. OP7 15 28/02/07 4. OP9 13(2) 31/12/06 Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 32 5. OP9 13(2) Prescribed creams must be stored appropriately and not kept in communal bathrooms. The Registered Person is to provide a Controlled Drug cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 is required and all Controlled Drugs must be stored within it. Outstanding from March 06 inspection. The Registered Person must ensure that all staff are trained in drug information for all the medicines they administer. Outstanding from March 06 inspection. The Registered Person must be able to demonstrate that the social and recreational needs of residents are being met. A review of social activities within the home is required. The Registered Person must address issues regarding the physical design and layout of the building to meet the need of service users. This includes ways of distinguishing the hallways and passageways and signage around the home assist people with dementia. The Registered Person is to review lighting in the home to ensure this is both suitable and is in full working order. Effective systems need to be in place to monitor lighting and replace any bulbs as necessary. The Registered Person must be able to demonstrate that Environmental Health have agreed systems within the home to manage infection control. DS0000062012.V316604.R01.S.doc 31/01/07 6. OP9 13(2) 28/02/07 7. OP12 16(2) 28/02/07 8. OP19 23 (2) 31/01/07 9. OP25 23(2)(p) 31/12/06 10. OP26 13(3)(4) 28/02/07 Wolston Grange Version 5.2 Page 33 The Registered Person is to address issues contained within the body of this report relating to the management of infection control. Resident personal items such as underwear, glasses and toiletries must be stored in a suitable location to prevent these being used communally. The Registered Person must 31/12/06 ensure that all areas of the home are kept clean and free from unpleasant odours consistently. Above outstanding from March 06 inspection. All equipment used by residents must be kept clean consistently. The Registered Person must 28/02/07 comply with the Condition of Registration in regard to staffing. There must be designated staff to undertake all ancillary duties. This includes catering, cleaning and laundry. The Registered Person must 31/12/06 ensure that sufficient staff are available to meet the residents’ needs at all times. Above outstanding from March 06 inspection The Registered Person must be able to demonstrate that all recruitment records as required have been obtained before the employment of a member of staff. The Registered Person must ensure that care staff are appropriately supervised. The supervision arrangements in place must now be implemented. DS0000062012.V316604.R01.S.doc 11. OP26 13 12. OP27 18 (1) 13. OP27 18 14. OP29 19 31/12/06 15. OP36 18 (2) 28/02/07 Wolston Grange Version 5.2 Page 34 16. OP37 17(1) 17. OP38 13 The Registered Person must ensure that all records relating to service users are kept in a secure location within the home. The Registered Person must ensure that any doors which are to be held open are fitted with appropriate devices which are linked to the fire alarm to maintain the safety of the home. Immediate action must be taken to address the door closure on the kitchen door. The Registered Person must ensure a risk assessment is in place until such time this is addressed. The Registered Person must ensure that the Condition of Registration relating to occupancy of room 5 is complied with consistently. 31/12/06 31/01/07 Wolston Grange DS0000062012.V316604.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that the use of body charts is introduced to record pressure areas or any damage to the skin. This will allow staff to easily identify wounds and monitor the healing process as required. Care plans for people with dementia should be a detailed plan of action related to specific goals to promote a persons well being. It should describe what is to be done, when and by whom. Staff should be familiar with the content of the plan and make use of it in their day-to-day care giving. Systems should be devised for ensuring residents personal items left around the home such as underwear, glasses and toiletries are located and returned to their rooms. Bathroom and communal areas should be regularly checked to ensure these are removed. Consideration should be given to introducing pictoral aids to assist residents in making choices about their care such as photographic menus. The cook should be provided with details of all residents in the home with specific needs in regard to their food such as diabetics, soft diets etc to ensure food can be prepared appropriately. Residents should have a full choice of breakfast including a fully cooked breakfast sometimes. The way meat joints are cooked should be explored to ensure they are tender enough for residents to enjoy. The registered provider is advised to consider how a designated area for staff to take a break can be organised as well as a secure and sufficient storage area for staff belongings. Overlap time should be built into the changeover of shifts to brief and update all staff coming on duty of any changes and the current needs of the residents. Duty rotas should demonstrate any handover time allocated. DS0000062012.V316604.R01.S.doc Version 5.2 Page 36 2. OP7 3. OP10 4. OP15 5. OP19 6. OP27 Wolston Grange Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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.V316604.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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