Care Home: Bedale Grange Nursing Home

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What the care home does well The home provides a good standard of care in a pleasant environment. One comment was “the care is exceptional”. One person said, “the staff know exactly what to do to make sure I get everything I need, it’s as if I am royalty’ A health care professional commented, “I have always found this home provides a high level of care”. People are cared for and spoken to by all staff in a respectful manner. Staff listen to what they have to say. One person said ‘the staff are very good to me they’re very obliging’. Staff make sure people’s privacy and dignity are always respected. There is a range of activities for people to participate in; this enhances people’s quality of life. People are cared for by staff that are competent and well trained. One survey comment was “staff are well trained they know what to do, I can trust them’.Bedale Grange Nursing HomeDS0000064737.V376989.R01.S.docVersion 5.2 What has improved since the last inspection? Since the last inspection the manager has reviewed all of the care plans and work is still ongoing to improve them further. The primary care trust pharmacist visited the home to look at how the home managed people’s medication. She made some minor requirements about this and the manger has made the changes. All staff files now have the evidence to prove that staff have been recruited properly. The files contained references and CRB checks. If the member of staff was a registered nurse the manager had checked to make sure they were registered with the Nursing and Midwifery Council. The provider continues to refurbish and redecorate areas and has recently bought some new bedroom furniture. Some new digital weighing scales have been purchased and a medical drugs fridge obtained. What the care home could do better: The manager needs to continue improving the recording in people’s care plans, trained staff and care assistants must also take some responsibility in this. People must have access to a nurse call bell so they can summon help quickly or when they require assistance. The manager told me that the system was old and replacement parts were becoming difficult to source. The registered provider needs to consider updating or renewing the system to ensure people are kept safe. Fire training for staff is out of date and needs to be done straight away, so that staff are properly trained and clear on what to do in the event of a fire. Key inspection report CARE HOMES FOR OLDER PEOPLE Bedale Grange Nursing Home 28 Firby Road Bedale North Yorkshire DL8 1AS Lead Inspector Bridgit Stockton Key Unannounced Inspection 09:00 23rd July 2009 DS0000064737.V376989.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedale Grange Nursing Home Address 28 Firby Road Bedale North Yorkshire DL8 1AS 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) 01677 422980 01677 427535 bedalegrange@fisherpartnership.com Bedale Grange (TFP) Ltd Mrs Julie Atkins Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th July 2008 Brief Description of the Service: Bedale Grange is a care home registered to provide Nursing and Social care for up to 21 residents. It is located just west of the small market town of Bedale and was first registered as a Nursing home in September 1985. The home is a large detached pebble-dashed building with three floors including ground and single storey extensions have been added. There is an electric chair lift from the ground to the first floor and people are accommodated on the ground and first floors only. The front elevation facing south overlooks a large garden area that has a pergola with lawn, mature trees and shrubbery extending beyond. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to assess the quality of the care and support received by the people who live at Bedale Grange Care Home. The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. I looked in detail at the care and records of four people, examined other records and looked around the home. I spent six hours at the home. The manager also completed some paperwork for us called an annual quality assurance assessment. This provides valuable information to help me form a judgement about the quality of service offered at the home What the service does well: The home provides a good standard of care in a pleasant environment. One comment was “the care is exceptional”. One person said, “the staff know exactly what to do to make sure I get everything I need, it’s as if I am royalty’ A health care professional commented, “I have always found this home provides a high level of care”. People are cared for and spoken to by all staff in a respectful manner. Staff listen to what they have to say. One person said ‘the staff are very good to me they’re very obliging’. Staff make sure people’s privacy and dignity are always respected. There is a range of activities for people to participate in; this enhances people’s quality of life. People are cared for by staff that are competent and well trained. One survey comment was “staff are well trained they know what to do, I can trust them’. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. People’s needs are properly assessed prior to admission to the home We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care plans I looked at showed that pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the person’s needs. A senior member of staff (usually the Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 9 manager) visits the person at home, or in hospital to discuss their care needs. Social Services assessments are also used to determine this as well; these were also available to look at. People are welcome to visit the home before reaching a decision. One person told me that their family had looked around the home on their behalf and thought it would be ‘perfect’ for them. They said that although they had been in the home some time, they could remember how friendly and cheerful staff had been when they were first admitted. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. Systems are in place to ensure that health care needs of the people are met. People can be confident that their privacy and dignity is protected and that they are treated with respect. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: I looked at three care plans in detail, to make sure that people’s health and personal care needs are being met in the way the person prefers. The manager told me that she had reviewed the care plans of all the people who live at the home. Whilst the recording has improved the manager needs to continue to Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 11 audit the plans to make sure that information and risk assessments are up to date and reviewed regularly. There was evidence of involvement of specialist healthcare people such as the community psychiatric nurse, the dietician and continence nurse. During the inspection a doctor visited the home and a care manager. During my visit I looked at how people’s medication was looked after by the staff at the home. Administration of medication is carried out properly and audited by the manager on a regular basis. The local primary care trust pharmacist had recently audited the home and asked the manager to make some minor alterations to how peoples medication was managed. Staff were seen to be treating people with respect and dignity and this was also reflected within the care plans. One person said that the ‘girls are nice and jolly’, another said ‘we want for nothing, I am helped to do the things I like to do by the staff, they know exactly what to do for us all’ Staff were seen knocking on people’s bedroom doors before entering, and addressing people by their preferred names. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People were seen to be supported by staff to do as they wished. One person was being assisted to get ready to go into the bath, another person told me they were having a sleep in before they went into the bath. People’s daily routines were respected and staff tried as far as possible to maintain people’s independence and choice. There was a varied activity program in place including sing a longs, quizzes and outside entertainers. The local vicar was also visiting on the day of inspection. The manager told me that an activities organiser had been appointed to the home to work part time and that she hoped may also bring some new ideas about what people may want to do. People were reading papers, watching television and chatting and laughing with each other. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 13 The home also has a cat that people some people enjoy looking after. Everyone said the food was good, and a choice of meals was offered. One person said ‘we can have what we like to eat’ another said the food is ‘super nicely cooked’. Most of the food that is provided is locally sourced. The cook was knowledgeable about dietary needs of people and choice of what people liked to eat was recorded in the individuals care plan. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told me they would speak to the manager or any of the staff if they had any concerns or complaints. Staff told me that training has taken place in the protection of vulnerable adults in abuse and was due again at the end of the month. I looked at three personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 15 The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Staff said they had confidence in the manager to deal with any safe guarding issues. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. Whilst the home is clean, tidy and homely some refurbishment needs to take place to make sure that it is properly maintained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is fresh, clean and comfortable. One person commented ’my room gets cleaned everyday; the staff do a very good job’. Some redecoration of bedrooms is taking place, some new carpets have been fitted and some bedroom furniture replaced. However, some of the bedroom furniture that is in use is looking ‘tired’ and in need of replacement. In addition some nurse call bells from people’s bedrooms were missing and some held into the sockets with tape. The manager explained that replacements parts were no Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 17 longer available for this system. This means that some people are unable to summon help when they are in their bedrooms. One person who did not have a call bell said they shouted for assistance. Their bedroom was located some distance from the main areas of the home and staff at time struggle to hear this person. I looked at the fire safety records, the servicing of equipment such as fire extinguishers and emergency lighting is up to date as is the fire alarm test; however fire training for all staff was out of date. This training needs to be done to make sure staff are aware of what to do in case of a fire. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People can be confident that staff are trained and on duty in sufficient numbers to meet their assessed needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new member of staff starts work until a POVA register check had been completed. Then, if the CRB check had not been received, they would work only under the supervision of an experienced staff member. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 19 The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. The manager showed me a training matrix that indicated that staff were trained and updated in how to move and transfer people properly, in first aid and infection control. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. The home is safe and well managed and people who live and work at the home can contribute to the decision-making processes. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has the qualifications and the skills to manage the home effectively. Residents and relatives meetings are held, although they are not very well attended. The home sends out questionnaires to relatives, in order to Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 21 gain information about how people view the service and what improvements they would like to see. The operational manager visits the home and carries out audits, to make sure the home is operating to company policy. The manager showed me audits that had been completed on tissue viability, accident analysis and a new audit form she had devised for auditing peoples care plans. Staff at the home told me that the manager was very supportive. One member of staff said ‘she is the best manager I have ever worked for’. Another person said ‘very supportive and kind’. Residents told me that the manager was ‘always around’ and ‘very approachable’ I looked at the records held at the home regarding people’s personal allowance. All transactions are recorded correctly and receipts are kept. One person’s money was counted and matched the total on the record. Policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people who live at the home is promoted and safeguarded. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X x x x 3 Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Records of assessment of care need, care plans and reviews should be developed further to ensure staff are able to deliver care in a planned way. Unless risk assessment states otherwise people should have access to nurse call bells, in order that they can summon help quickly. All staff must be brought up to date with fire training, the frequency of which is deemed by the fire and rescue service. Timescale for action 01/11/09 2 OP8 13 01/12/09 3. OP19 23 01/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 24 Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 26 Bedale Grange Nursing Home DS0000064737.V376989.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!