Care Home: Cuerden Grange Nursing Home

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What the care home does well What has improved since the last inspection? Assessment and care planning has improved and ensures assessed needs are produced in the care plans. Staffing levels have improved and now provide more trained staff to meet the more complex needs of some residents. What the care home could do better: Plans of care had been developed and when some minor amendments to review and dating have been completed will ensure the health and welfare of residents is protected. The last wishes of residents should be recorded to ensure the needs of residents are fully met at this difficult time. A written strategy for the actions and equipment necessary for highlighting the assessed risks residents face would ensure best practice and help further meet the needs of residents. CARE HOMES FOR OLDER PEOPLE Cuerden Grange Nursing Home 414 Station Road Bamber Bridge Preston Lancashire PR5 6JN Lead Inspector Mr Patrick Rooney 21 ST Unannounced Inspection November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cuerden Grange Nursing Home DS0000025554.V348208.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. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cuerden Grange Nursing Home Address 414 Station Road Bamber Bridge Preston Lancashire PR5 6JN 01772 628700 01772 628700 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) Mr Keith Lowe Mrs Diane Margaret Dillon Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (6), Terminally ill (4) of places Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 46 service users to include: up to 46 service users in the category of OP (old age, not falling within any other category) Up to 6 service users in the category PD (physical disability) aged 40 to 65 Up to 4 service users in the category TI (terminally ill) The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 19th July 2006 2. 3. Date of last inspection Brief Description of the Service: Cuerden Grange is situated at the edge of the residential area of Bamber Bridge with easy access to local amenities. The motorway network is nearby and the towns of Chorley, Preston and Leyland are all within a convenient distance. Cuerden Grange Nursing Home is registered for elderly persons with a variety of care needs. The accommodation is set out on two floors, the first floor being accessible by passenger lift and staircases. The first floor accommodates service users who require nursing care and the ground floor is designed for service users requiring personal care. A high percentage of places are provided in single accommodation, although a double room is available for married couples or those preferring to share facilities. Although only a few bedrooms have en-suite facilities, a number of toilets and bathing facilities are located in convenient positions throughout the home. The homes fees range from £360 to £425 per week for residential and from £465.50 to £530 per week for nursing. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection, which included a visit to the home, took place on the 21st November 2007 and was conducted by two inspectors, Mr P Rooney and Mr G Oldham. Much of the information gained was obtained from talking to residents, the manager and staff members. One inspector conducted case tracking and the other the inspected the remainder of the key standards. People living within the home allowed the inspector to call them residents. Four residents were case tracked. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking their plans of care, other documentation and talking to staff about the care they gave each resident case tracked. Residents were then asked if the care they received was what they needed. Two residents were able to participate. Two staff members were questioned about the care of the residents case tracked and the training they had undertaken. Some of the views have been reported collectively with specific comments contained within the body of the report. The inspector took detailed notes during the inspection, which have been retained as evidence. Staff were directly and indirectly observed carrying out their tasks and interacting with residents. Paperwork examined included plans of care, assessment documentation, policies and procedures or documents relevant to each standard. A tour of the building was conducted on the day of the inspection. Questionnaires returned to the Commission for Social Care Inspection (CSCI) were used to underpin the evidence found at inspection. What the service does well: One resident case tracked said, “I get a few visitors but my son lives in Watford and he cannot visit very often. He can visit if he wants and there are no restrictions”. Visitors were observed entering to visit their friends or relatives and being greeted warmly by staff. The open aspect of visiting allowed residents to socialise with their families and friends. Resident’s case tracked said, “The girls look after me very nicely. They treat me privately. Its good care and I get what I want” and “The staff look after me really well. I am lucky because I can walk around. I bath myself and can do a Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 6 lot of things for myself but they treat me privately when they do help me”. Residents were comfortable with their personal care and their dignity was maintained. Two residents case tracked said, “I feel safe here. The nurses are around at night if you need anything. I cannot complain about anything here. I would talk to the manager if I had any complaints” and “I feel safe here. I have never had to complain”. Residents felt safe and able to voice their concerns if they wished. Residents case tracked said, “The food is very good and it suits me. There is a choice of food. They look after my diabetes and I get snacks when I need them” and “The food is very nice indeed”. Residents case tracked were satisfied the food served met their nutritional needs and individual tastes. Residents case tracked said, “You can get up and go to bed when you like” and “I think I would get choice if I wanted it for anything”. Residents were offered choices within the routine to promote their independence. Resident’s case tracked said, “I have a nice bedroom. I have a few things of my own and some pictures. It’s nice and warm and the water is hot. I like to watch television – I go for a walk. I read a little. I just like to walk around. There are always plenty of staff around. Everything works – they fix things straight away. They are very regular with my medication. Its all right here, I like it” and “I like it here and recommend it”. Residents case tracked were positive about the care and facilities provided at the home which helped maximise their contentment. The assessment of prospective residents ensured staff had the knowledge to meet the needs of residents when admitted. Residents had access to a broad range of professionals to ensure their health care needs were met. What has improved since the last inspection? Assessment and care planning has improved and ensures assessed needs are produced in the care plans. Staffing levels have improved and now provide more trained staff to meet the more complex needs of some residents. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Cuerden Grange Nursing Home DS0000025554.V348208.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 Cuerden Grange Nursing Home DS0000025554.V348208.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process ensured each residents needs could be met and a plan of care developed. EVIDENCE: Four residents were case tracked. Assessment documentation was contained within the plans of care. There was either an assessment from social services or health care professionals. A member of staff had carried out a preadmission assessment to ensure staff had sufficient knowledge to care for residents admitted. Intermediate care is not provided. Cuerden Grange Nursing Home DS0000025554.V348208.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Plans of care and healthcare assessments contained sufficient information about each individual to inform staff of each residents needs. Medication policies, procedures and staff training protected the health and welfare of residents. The professional attitude of staff protected the privacy and dignity of residents. EVIDENCE: All four residents involved in the case tracking process had a plan of care. Plans of care had been regularly reviewed although some aspects of the plan could be removed more frequently. Two staff members were able to accurately describe the care of resident’s case tracked. Two residents involved in the case tracking process agreed the level of care was what they expected. Plans of care generally provided good detail but occasionally some aspects were missing. Plans of care contained sufficient information for staff to deliver effective care. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 11 Plans of care contained details of attendance to health care professionals and specialists, such as dieticians, tissue viability nurses, opticians, dentists and chiropodists. The local Primary Care Trust provided a nurse who helped staff at the home to provide up to date care and access specialists. Plans of care contained risk assessments for tissue viability, falls and nutritional needs. The risk assessments were not always dated accurately. Access to specialists was arranged to ensure the health care needs of resident’s was met. Resident’s case tracked were satisfied their care was delivered in a way to protect their dignity. The inspection was mainly conducted from a communal area to observe staff interacting and caring for residents. Staff were observed to give care in a pleasant and private manner. The demeanour of staff ensured residents were comfortable with the personal care they received. Since the last inspection there has been an increase in trained staffing levels, due to the dependency of residents with more complex nursing needs. This has improved the standard of care for individual residents. Medication policies and procedures were looked at, all records were correctly maintained and medication stored properly. Only trained staff are allowed ro dispense medication. Cuerden Grange Nursing Home DS0000025554.V348208.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Daily routines are flexible and take in to consideration the individual needs and wishes of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a relaxed atmosphere in the home and staff encourage and enable residents to take part in activities they are interested in. The activities records show there is a wide variety of activities taking place in the home. Relatives may also take part in activities, the home is situated close to the local community and the home is well supported by local schools and services the community has to offer. In house entertainers are booked and feedback from residents says that they enjoy and look forward to these. There is good support from local church ministers and resident s are able to take part in their preferred religious services. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 13 Resident’s families mainly deal with their finances, personal allowances are kept for some residents. These are kept securely and good records are maintained. Information about local independent advocacy services is available in the home both on the notice board and in the service users guide. Residents have access to their personal records; evidence of this was seen on files where residents or their representatives had signed the records. The homes routines are flexible and residents are able to retire and rise when they wish. During the day they are able to choose to remain in their rooms or use the various communal areas. Individual rooms were seen to be personalised and many residents bring items of furniture, ornaments or pictures with them on admission. Residents spoken to said they are happy with the care they receive and felt that they are able to make choices regarding everyday events. Discussion was held with the cook and menus were looked at. Residents are offered a good selection of freshly prepared food. There are always choices available including fresh fruit. Special diets are catered for and the cook has a good knowledge of individual needs. One resident who is vegetarian said that the cook ensures she gets a good varied diet. Regular audits and surveys are carried out with residents and they have an input in to what is on the menus. Residents told the inspector they liked the food and that they are able to choose menus. Cuerden Grange Nursing Home DS0000025554.V348208.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents are protected by the homes policies and procedures regarding complaints and adult protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure, which is available to all residents and their families, it is contained in the service users guide and is on the home’s notice board. Residents told the inspector that they are able to rise concerns with the manager and feel that action is taken regarding any issues. Complaints record showed that complaints are dealt with appropriately and within the requirements of the complaints procedure. Adult protection procedures, including whistle blowing are available to staff, staff spoken to are aware of these procedures as they are include in the induction programme. Staff training records showed that only a few staff have had training in adult protection. All staff should receive training in adult protection. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. The home provides a comfortable well maintained clean environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a maintenance programme in place to ensure the home is kept up to standard. A maintenance man is employed to ensure any repairs are carried out quickly and efficiently. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 16 The home provides spacious communal and dining areas with large window to the rear, which provides good external views. Residents like to watch the many ducks, which are to be found o the small river to the rear of the home. There is very little garden areas for residents to walk outside, this was commented on in two surveys received from relatives. Handrails are installed around the home and in bathroom areas, assisted baths are available to ensure safe bathing. There are procedures in place to ensure the home is kept clean, including good infection control measures. Sufficient domestic staff are employed to maintain cleanliness standards at all times. The inspector toured the home, looked in the laundry and individual resident’s rooms. All areas of the home were seen to be clean, hygienic and well maintained. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. Arrangements for staffing the home ensure there are sufficient skilled staff on duty to meet the needs of residents. Recruitment procedure is good and ensures residents are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector spoke to the manager, staff looked at rotas and staff records. Cuerden Grange has the benefit of a stable staff team, many whom have worked at the home for some years. There are sufficient experienced and trained staff available to meet the needs of residents. Staff spoken to showed a good understanding of resident’s individual needs. Records showed that all staff receive a comprehensive induction using the “skills for care” format. Staff told the inspector they feel well supported by the homes training programmes and there are always course available for them to take part in. There are always trained nurses on duty and more than 50 of care staff are qualified to NVQ 2 and 3. Feedback received from residents and Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 18 relatives said that the home provides good levels of care, which meets individual needs. Rotas showed that there are sufficient staff on duty to ensure appropriate care is delivered. Residents feel that staff are friendly and approachable, good interaction was observed between staff and residents during the inspection. There home has good recruitment polices and procedures in place, staff files showed that all necessary recruitment checks are made, including Criminal Records Bureau clearances. References from previous employers are always taken up and interviews held. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 19 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 and 38 Quality in this outcome area is good. The home is well managed, which ensures resident’s interests are protected and health and safety issues promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is run by an experienced qualified manager, who is well known to residents. Residents said they were able to approach the manager if there are any problems. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 20 Staff said that they feel well supported and that there are clear lines of accountability management is open and inclusive. Staff receive regular supervision and an annual appraisal. Cuerden grange has in place quality assurance procedures and systems, regular audits are carried out including resident, relatives and visitors questionnaires. Examples of these were seen during the inspection and have led to on going improvements being made. The home has attained RDB five star rating. Assessment for this is carried out annually. The home is not involved in residents main finances, however does look after personal allowances. Records for these were seen and are properly maintained and receipts kept. All money kept by the home is stored safely away in the main office. The manager ensures that safe working practices are in place including health and safety policies and procedures. These polices have been reviewed and are up to date. The training matrix showed that most staff have received training in health and safety and first aid. However 10 staff had not received moving and handling training and 15 had not done infection control. All staff should receive this training. Records also showed that very few staff had received training in risk assessment. The inspector was told that a training coordinator had been appointed and that all areas of training would improve. Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 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 3 X X 2 Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 22 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 OP38 Regulation 18(1) Requirement The registered manager must ensure that all staff receive training in moving and handling Timescale for action 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations The registered manager should ensure all aspects of plans of care are reviewed regularly to ensure staff are provided with up to date information. The registered manager should ensure all documents contained within plans of care and risk assessments are dated when they are developed to ensure staff are able to decide when a review is due. The registered manager should ensure the last wishes of residents are recorded to help meet the needs of residents at this difficult time. The registered manager should develop strategies to decide what action needs to be taken when risks are highlighted. This should include the equipment and care DS0000025554.V348208.R01.S.doc Version 5.2 Page 23 3. 4. OP7 OP8 Cuerden Grange Nursing Home 5 6 7 OP18 OP38 OP38 needed for pressure relief in the low, medium and high risk categories, and action staff need when a risk is highlighted in the nutritional assessment etc. All staff should receive training in adult protection. All staff should receive training in infection control. All staff involved in risk assessment should receive training in this Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Cuerden Grange Nursing Home DS0000025554.V348208.R01.S.doc Version 5.2 Page 25 - 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. 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