Care Home: Abbey Grange Nursing Home

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What the care home does well The activities provided were good, the activity co-ordinator was enthusiastic and got people involved. The Chef was knowledgeable on nutritional requirements of the elderly and associated conditions to ensure peoples needs were met. Staff recruitment was robust and protected people. Many other areas have improved and are detailed in what has improved. What has improved since the last inspection? We identified many improvements at this visit and the overall quality rating has improved. The care plans had improved people`s needs had been identified and measures in place to meet them. Although the acting manager acknowledges there is still a way to go to ensure everybody living at Abbey Grange has a fully completed plan of care. People were listened to and protected. Staff were reporting safeguarding issues and the acting manger was acting on any information to ensure people were protected. The cleanliness had improved considerably and infection control measures were in place to ensure people were protected from infection. The staff complement had improved, with additional hours allocated to cleaning at weekends and the acting manager is looking at staffing levels to ensure people`s needs are met. The ethos of the home has improved staff told us the atmosphere was much improved they were working as a team and communicating to each other to ensure people received better care and had their needs met. What the care home could do better: Care plans should include detailed information guiding staff how to use medicines prescribed to be given `when required`. Risk assessments should be in place for self-administration of medicines. Medication storage area temperatures should be checked regularly. Further work with care plans should continue so that each person has a care plan that is comprehensive and current. People`s changing needs must be identified in their plan of care. Meal times must be improved to ensure people receive a varied, nutritious and appetising meal in a congenial setting. Improvements to the environment should continue to ensure people live in a well maintained home. Continue to develop the staff training files and ensure people have attended the appropriate training for them to perform the job they are employed to do. Maintenance of equipment and systems must be carried out to ensure that the safety of the service is maintained and people are protected. Key inspection report Care homes for older people Name: Address: Abbey Grange Nursing Home Cammel Road Firth Park Sheffield South Yorkshire S5 6UU     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: Sarah Powell     Date: 1 4 0 6 2 0 1 0 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Abbey Grange Nursing Home Cammel Road Firth Park Sheffield South Yorkshire S5 6UU 01142560046 01142617962 abbey.grange@btconnect.com None Larongrove Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Abbey Grange is a care home providing personal care and nursing care. Accommodation is provided for 87 people. The home is currently in administration but still trading as Larangrove Limited. It is situated in the Firvale area near to the Northern General hospital a short walk away from the main bus route to the town centre. The nearest shopping area is situated at Firvale. The home is a converted property with extensions, accommodation is provided on Care Homes for Older People Page 4 of 32 Over 65 37 50 0 0 2 9 0 4 2 0 1 0 Brief description of the care home three floors that are accessed by a lift. The original property has been extended to provide 87 beds for nursing and personal care with 65 single and 11 double bedrooms. The grounds are accessible and well laid out, the garden sitting areas are attractive and well maintained. The previous inspection report was made available to people and their families, details of this was on the homes notice board. The current fees at Abbey Grange ranged from £327 to £361 for residential care, £479 for nursing care including nursing care component, and £369 for EMI (Elderly mentally Infirm) care per week. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Care Homes for Older People Page 5 of 32 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: This report follows the visit that took place on Monday 14 June 2010. Sarah Powell and Sue Turner Compliance Inspectors and Steve Baker Pharmacist Inspector carried out the visit. The visit lasted from 09:00 until 16:00. The home remains in administration although a sale is proceeding. We also carried out a random visit on 28 April 2010 to determine progress with the requirements we saw an improvement at that visit. The purpose of this visit was to make sure that the improvements had continued and the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include; Reviewing information that has been received about the home since the last inspection. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Care Homes for Older People Page 6 of 32 Details of complaints and allegations raised by people connected to the service. At the site visit three inspectors spent 7.0 hours at the home. This inspection visit included talking with people living at the home, their relatives, the acting manager, Chef, Activities coordinator and five care staff. We also gained information from visiting professionals, contracts officers and safeguarding managers. During the visit we also walked round the building to gain an overview of the facilities. We also checked a number of records. The home is still in administration and RSM Tenon Recovery are the appointed administrators. Feedback was given to the acting manager and the consultant employed by the administrators during and at the end of the inspection. We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should include detailed information guiding staff how to use medicines prescribed to be given when required. Risk assessments should be in place for self-administration of medicines. Medication storage area temperatures should be checked regularly. Further work with care plans should continue so that each person has a care plan that is comprehensive and current. Peoples changing needs must be identified in their plan of care. Meal times must be improved to ensure people receive a varied, nutritious and appetising meal in a congenial setting. Improvements to the environment should continue to ensure people live in a well maintained home. Care Homes for Older People Page 8 of 32 Continue to develop the staff training files and ensure people have attended the appropriate training for them to perform the job they are employed to do. Maintenance of equipment and systems must be carried out to ensure that the safety of the service is maintained and people are protected. 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 32 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 32 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. Peoples needs were assessed to ensure they were met. Evidence: We looked at four peoples plans of care, in each of these was an assessment of needs. This had been generated for each person since our last visit. This ensured all peoples needs were identified and could be met. The acting manager had also requested that peoples reviews, which were carried out by officers from Sheffield Council were bought forward, to ensure peoples changing needs were identified. The reviews had been carried out and the acting manager told us they were awaiting the review documentation. When this was received it would be placed in peoples plans of care for staff to see and be able to meet peoples needs. Care Homes for Older People Page 11 of 32 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. Most peoples needs had been identified and were met, however changing needs were not always followed up and some plans lacked detail. Therefore did not always ensure staff were aware of how to meet peoples needs. Most medicines management systems follow best practice. Evidence: We checked four care plans and we found that each persons health, personal and social care needs were set out in individual care plans. Two care plans seen were thorough and up to date. However two others seen had gaps and inconsistency in the information recorded. Care plans had been updated each month, however when peoples needs had changed, this was not always reflected in their care plan. We spoke to the manager about this. She acknowledged that there was still further work required to ensure that each persons plan of care was up to date and current.We acknowledge, that since the last inspection, staff had worked hard to make improvements to the care plans. Staff Care Homes for Older People Page 12 of 32 Evidence: now need to continue with this, so that each person has a plan of care that is up to date and comprehensive. In the care plans we saw a document called My Life. These provided helpful and interesting details about the persons life, family and likes and dislikes. They also enabled staff to review peoples health and wellbeing and change plans of care as needed. Unfortunately they were only completed in two of the four care plans seen. The care plans we checked showed evidence that people had the opportunity to see the G.P as required as well as support from other specialist community health teams such as district nurses, opticians, dentists, social workers and other specialist geriatric health support etc. There were wheelchairs, aids and equipment provided to meet peoples moving and handling needs. We checked to see whether people had risk assessments in place to protect their health and welfare. Although there were risk assessments, there were some gaps in the information that should have been recorded, to ensure that any identified risks to people were reduced or eliminated. Whilst observing lunch we saw one person seated in an easy chair which was not allowing them to sit upright in a supported and comfortable position. Staff were struggling to assist the person to eat, which could have had a negative impact on the persons health care needs. The persons freedom of choice and movement was potentially also limited. The person would have benefited from being able to look around and see what was going on around them. This would enhance the persons well being. We were told that a new chair had been ordered for the person which was suitable for their needs. We observed staff interactions with people and at all times saw how people were treated with positive regard. Staff were professional yet informal and friendly with people who used the service. This was very good to see and people we spoke to told us they were treated well by staff. A pharmacist inspector spent five hours in the home assessing compliance against a medication requirement issued at a previous inspection. This involved looking at the medication administration, ordering, storage, and disposal arrangements, examining medication administration record charts (MARs) and speaking to staff about medicines management arrangements in the home. We examined the 46 current MARs for accuracy and completeness and found no Care Homes for Older People Page 13 of 32 Evidence: significant gaps in the records. This indicates that people living in the home can expect to receive their medicines correctly. We found that two people were responsible for taking some of their own medicines on a regular basis, but that no agreements that this would happen or details of how these arrangements would be checked could be found. Each persons care plan should indicate their wishes about self-medication and all self-medication processes should be subject to a regularly reviewed assessment of the risks to the person themselves and to others living in the home. We found no records for people prescribed regular pain killing skin patches describing the skin location used each time a new patch is applied. In order to reduce the risk of skin irritation, it is important not to apply patches to the same skin location time after time. We also noted that two peoples records indicated that they each had an allergy to a named medicine. In each case, the accompanying MARs provided by the supplying pharmacy failed to state the presence of this allergy. Peoples known allergy status should be confirmed with key healthcare professionals to ensure all their linked personal medication records are accurate and consistent. Further improvements in record keeping could be made by ensuring that each persons care plan includes a detailed and up to date description of the circumstances in which medicines prescribed to be taken when required are to given and also information about when and how people living in the home prefer to receive their medicines. Such guidance helps staff to give medicines correctly as directed and also helps to reduce the risk of refusals or omissions. Medication ordering, receipt, and disposal arrangements in the home are good, and the GP prescriptions are checked by staff each month when the medicines are delivered. This good practice helps to make sure that the home is aware of any prescription changes and that staff will know that sufficient quantities of everyones medicines have been prescribed each month. Records of temperature checks of some the medication storage areas, including refrigerators, are not always being made sufficiently regularly. One store room was very warm and we were unsure if one medication fridge was working correctly. Staff should check and regularly record all medication storage area temperatures to show that all medicines are kept at temperatures recommended by the manufacturer. We found the systems for medication ordering, receipt, checking and record keeping to be generally good. Although most medicines management processes in the home Care Homes for Older People Page 14 of 32 Evidence: now follow best practice, some additional improvements in record keeping are recommended to ensure a complete record is maintained of how all medicines are used in the home. All previously issued medication requirements were found to be met at the time of this inspection. Care Homes for Older People Page 15 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were varied and met some peoples needs although more hours could be provided to ensure all peoples needs were met. Community contact with family and friends was maintained. Meals did not provide people with a varied diet taken in a congenial setting. Evidence: Two activity co-ordinators were employed by the service. They worked 40 hours each week in total. People told us they enjoyed the activities and they were very varied. We observed an activity during our visit it was attended by 5 people who were all joining in and enjoying the activity. We discussed activities with the acting manager and it was agreed when the service has more people the allocated hours for activities would not be sufficient to meet all peoples recreational needs. People we spoke to told us they were able to keep in contact with families and friends and that visitors were made to feel welcome and could call at any time. This helped to support people to maintain important relationships. We asked three people who lived at the home whether they were helped to exercise choice and control over their lives. This is what they told us, Care Homes for Older People Page 16 of 32 Evidence: Well we do have some choices, we can do activities if we want. We can choose when we get up and go to bed. Staff are always asking us what we want to eat and if we want a drink. These examples showed that people were offered basic choices and opportunities to control their lives. We asked people who lived at the home about the meals offered to them and this is what they told us, Breakfasts are good they made me porridge and toast this morning. The food is good. We get asked what we want and if we dont like the choices we can have something different. We observed lunch being served in one of the dining rooms at the home. Seven people were in the dining room. Six were sat in wheelchairs and one person was in an easy chair. No one had been transferred into a dining room chair. This did not promote peoples well being and safety. (Further information about this is in Outcome two of this report). Tables were set nicely with table cloths, vases and crockery. Staff asked people if they wanted to put on a tabard, to protect their clothes from spillages. Some people chose to and others said no. Staff respected their decision. People were offered a choice of blackcurrant juice or tea. The meal arrived on a heated trolley. The trolley was placed outside the dining room and staff served from it. Staff spent a lot of time outside the dining room, plating up meals and taking them to people who were having lunch in their own rooms. This meant there were no staff in the dining room for periods of time. One person was brought into the dining room who had been agitated and upset throughout the morning. The person continued to be unhappy in the dining room, which then caused others to become unsettled. This resulted in the ambiance in the room being very unpleasant. The radio was playing, which was adding to the noise. Care Homes for Older People Page 17 of 32 Evidence: Staff said that they didnt like having the radio on but had been told, by senior staff that it had to be on. There was no consideration about if people living in the home wanted the radio on or not. During the time that staff were not present in the dining room, one person threw away their drink. The same person also pushed their meal to the other side of the table. When staff returned to the dining room the persons meal was given to someone else and the staff thought that the person had finished their drink. Staff were unaware that the person had neither had a drink or any food. Lunch was sausage, chips, beans and scramble egg.People on soft diets were served mashed potato, egg and beans. We asked the cook why they had not been given sausage that had been liquidised. We were told that the egg was their protein and they hadnt thought about giving them sausage. We believe that the meal served to people , who were on soft diets was inferior to what others on a normal diet were served. We discussed our observations of lunch with the acting manager and business consultant, who agreed to look at this and make improvements so that peoples experience at meal times was enhanced. Care Homes for Older People Page 18 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were listened to and protected. Evidence: We saw that the service had a complaints policy and procedure, which was on display in the entrance hall. Since the last inspection the home had not received any complaints. We spoke to three people to see if they knew the complaints procedure and would feel confident to use it. They said they had never needed to complain, but were aware of the complaints procedure and felt able to use this if necessary. They said any issues or concerns they had were quickly resolved by the staff or manager. This showed that peoples rights were promoted and protected and their concerns were adequately addressed. There was clear evidence that since the acting manager had been in place, staff, relatives and people felt more confident in raising any issues. People said, If I had any concerns or worries I would speak to the staff. My family would sort out any problems for me. Im very happy here, theres nothing to complain about. Care Homes for Older People Page 19 of 32 Evidence: Policies and procedures for adult safeguarding were available at the service and staff told us they were aware of these and where to find them. Staff had received training in adult safeguarding and were aware of the importance of reporting an alleged incident to protect people. Two referrals had been sent to Sheffield safeguarding since the last key inspection in March 2010. These had been dealt with appropriately by the acting manager and staff to ensure people were protected. Two safeguarding issues identified before the last key inspection were still being investigated. The management and staff were assisting these investigations to be able to reach a conclusion. This ensures people are protected. Care Homes for Older People Page 20 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The cleanliness of the environment had much improved and infection control measures had been implemented to protect people. The general environmental standards remained poor as the home was in administration and money was not available for all environmental improvements. Evidence: During this visit we looked around the home, at the last key inspection the environmental standards and infection control measures had been poor putting people at risk of cross infection. At the random visit in April 2010 we saw an improvement, but some areas still posed a risk including use of mops and cleaning of equipment. At this visit we saw a vast improvement the toilets, bathrooms and equipment were clean and well maintained. Bedrooms were cleaner, however some floor coverings were still to be changed to ensure people lived in a well maintained environment. The laundry and sluice rooms were tidy and clean ensuring cross contamination was minimised to protect people. The acting manager told us that she had sought advice from an infection control Care Homes for Older People Page 21 of 32 Evidence: officer at Sheffield PCT. The advice given had been followed to ensure correct procedures were in place to ensure control of infection. The acting manager told us she had reviewed cleaning hours and now provided the same hours at weekends that was provided during the week. This had previously not been in place. This had improved the cleaning at weekends and ensured the service always maintained a clean environment for people to live in. The general environment was still poor as furniture and carpets were stained and worn. Some money had been allocated to renew some floor coverings however this was limited as the home was in administration. The acting manager and staff had done what they were able to improve the environment however some areas were still requiring attention. The mattresses were very old and were only covered by a plastic sheet, this did not enable them to be thoroughly cleaned and did not stop ingress of bodily fluids into the fabric of the mattresses. The acting manager agreed to look at this and see if some could be replaced. The bedding was very old it was washed out and very thin, some new sheets had been purchased however all bedding was required. The acting manger told us she had identified new bedding was required, however this would probably be once new owners had purchased the home. Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most staff were appropriately trained and recruitment procedures protected people. Evidence: The care staff employed by Abbey Grange had completed NVQ training, which ensured the levels with the agency staff included, were always maintained above 50 . This ensured staff could meet peoples needs. We looked at two staff training files one was a new recruit, evidence of training was seen in the file with certificates available that tallied with the training matrix that we were given. However the other file we looked at was a member of staff who had worked at the service a number of years and evidence of recent mandatory training including fire safety, health and safety, infection control, moving and handling and adult safeguarding was not available in the training file. The acting manger told us that they were still working through existing staff files to up date them and a new training officer had been appointed to do this. We spoke to the training officer who was aware of what training was required. Methods of keeping records was discussed and it was agreed that a more robust system would be introduced. This would ensure all mandatory training was completed when it was required to ensure staff were appropriately trained to meet peoples needs. Care Homes for Older People Page 23 of 32 Evidence: We looked at two staff recruitment files they contained all the relevant information to ensure people were protected. Care Homes for Older People Page 24 of 32 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. The home had a suitably qualified manager and management procedures were being improved to ensure people were protected. Evidence: Since our last key inspection in March 2010 the registered manger had left. The deputy manger had been appointed acting manager, she is a registered nurse with many years experience and was suitably qualified to manage the service. The consultant employed by the administrators was also overseeing the service. The acting manager had started to recommence quality monitoring to ensure the home was run in the best interests of the people living there. Regular staff and residents meeting had commenced and questionnaires were being developed to send out to relatives, residents and professionals to gain some feedback on how the home is achieving outcomes for people who live at Abbey Grange. Peoples financial interests had not been safeguarded, we had taken further Care Homes for Older People Page 25 of 32 Evidence: enforcement action. Following a number of meetings with Sheffield Council, the police and the administrators this was still being rectified. The records had been so disorganised when the home went into administration it had taken some considerable time to start to comprehend the extent of the irregularities and mis-management of finances. The administrators were working with other agencies to resolve the situation as speedily as possible. A further meeting has been arranged for July 2010 when it is envisaged they accounts will be available for the people who the company held appointeeship for. A maintenance person was employed by the home and he was responsible for the maintenance records, health and safety and environment checks. These were all up to date and safeguarded people. Accidents, injuries and alerts since the appointment of the acting manager had been reported properly and people were safeguarded. Various maintenance records including the electrical certificate, heating system service documents and portable appliance tests were not available in the home. The acting manger told us she had looked for these but was not aware if these had been kept by the previous manager, or where they would have been stored. The administrators assured us they are being followed up and will be completed whether they were due or not within the next two months. This will ensure people are protected. This also included the fire risk assessment which has been arranged with a consultant and a date fixed for this to be carried out. Care Homes for Older People Page 26 of 32 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 27 of 32 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 13 All risk assessments should be reviewed to ensure that any risk identified has been fully considered and where necessary action taken to reduce or eliminate the risk. To ensure risks are managed and people are protected. 01/08/2010 2 7 15 Further work with care plans 01/08/2010 must continue so that each person has a care plan that is comprehensive and current. Including peoples changing needs, which must be identified in their plan of care. This will ensure peoples needs are met. Care Homes for Older People Page 28 of 32 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 3 8 12 Chairs must be provided for people, that enable them to sit upright in a supported and comfortable position whilst they are eating. To protect people from risk and safeguard peoples rights and choice. 01/08/2010 4 15 16 People must receive a varied, appealing and nutritious diet that is suited to their individual assessed requirements. So that their health and well being is promoted and protected. There must be staff present in the dining room, so that they are aware of each persons dietary intake. 01/08/2010 5 19 23 The premises and equipment 01/12/2010 in the care home must be kept in good state of repair and condition. To ensure people live in a well maintained environment. 6 30 18 All staff must receive training that is appropriate to the work they perform. 01/09/2010 Care Homes for Older People Page 29 of 32 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 To ensure peoples needs are met. 7 35 20 Peoples finances must be 01/08/2010 correct and maintained in an account, which is separate to the running of the business and continue working with Sheffield council to ensure the accounts are accurate and up to date. To ensure peoples financial interests are protected. 8 38 13 Maintenance of equipment 01/08/2010 must be carried out, including electrical certificates, heating systems serviced and portable appliance testing. To ensure unnecessary risks to peoples health and safety are so far as possible eliminated. 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 9 Each persons medication allergy status should be checked and confirmed so that their records of allergy status can be updated. Where appropriate, care plans should include risk assessments for self-administration of medicines. Page 30 of 32 2 9 Care Homes for Older People 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 3 9 Care plans should include detailed information guiding staff how to use medicines prescribed to be given when required. Medication storage area temperatures should be checked regularly. As numbers of people living in the home increase more activity hours will need to be provided to meet peoples needs. People should be able to exercise autonomy and choice in all aspects of daily living at Abbey Grange. People should be asked if they would like the radio on during meal times or at any other time. People should not be taken into the dining room, when it is clear that they do not want to be there and by being there the ambience in the dining room would be detrimental to the person and others. Continue to look at staffing numbers in relation to peoples needs and layout of the building to ensure enough staff are on duty at all times to meet peoples needs. Continue to implement the quality monitoring systems to ensure the home is run in the best interests of the people living there. 4 5 9 12 6 7 14 15 8 15 9 27 10 33 Care Homes for Older People Page 31 of 32 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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