Care Home: Grange Park Nursing Home

What the care home does well The home had a generally friendly atmosphere and people were encouraged to personalise their rooms to reflect preferences and tastes. Accommodation was generally spacious, light and airy, especially on Himley unit currently not used; and Kitwood providing care for people with dementia.The majority of people were well presented with clothing, according to their preference and appropriate to the weather. There was an open visiting policy and people were welcomed, so people living at the home were able to maintain important friendships and relationships. Visitors were offered refreshments. A high proportion of care staff had achieved a National Vocational Qualification (NVQ) level 2 in care, which meant that staff should have the knowledge and skills to meet people`s needs. There were improvements to the medication systems, though some further improvements have been required. This is to make make sure that each person receives their medicines as prescribed by their doctor. The staff on duty were friendly and there was improved interaction with people living at the home. What the care home could do better: There were some improvements to care records but all records must be monitored and improved. Care plans, risk assessments and evaluations need to be person centred, up to date, accurate and give clear guidance about how to meet the needs and support each person in the home, especially the most frail and vulnerable people. Appropriate measures need to be put in place to minimise the risks of pressure ulcers. Where damage to skin occurs there must be appropriate records to demonstrate the condition of the wound. The management must make sure that people are offered foods and fluids to maintain their health and well being, with appropriate weight monitoring; and where there are concerns advice sought from doctors and dieticians, without delay. Though some medication practices had improved, administration practices and records must be maintained to be as safe as possible. The management must diligently follow guidance to keep people safe without depriving them of their rights. All staff must be provided with suitable training so that they understand how to protect vulnerable people and know where they should report concerns. The provider must make sure that there are skilled staff in suitable numbers to meet the needs of every person living at the home at all times, especially at night. Robust action must be taken to deal with staff where actions or omissions place people using the service at risk of harm. All staff should receive appropriate induction, training and supervision to support them to develop skills to meet the needs of people living at the home. Random inspection report Care homes for older people Name: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF zero star poor service 21/10/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 0 6 0 7 2 0 1 0 Information about the care home Name of care home: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF 0138423991 Telephone number: Fax number: Email address: Provider web address: grange.park@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Grange Park (Dudley) Nursing Home Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 51 Number of places (if applicable): Under 65 Over 65 0 37 0 dementia old age, not falling within any other category physical disability Conditions of registration: 14 0 10 1. The registered person may provide the following category of service only: Care home only: Code N to service users of the following gender Either whose primary care needs on admission to the home are within the following categories Old age not falling within any other category - Code OP, maximum number of places 37 Physical Disability - Code PD, maximum number of places 10 Dementia - Code DE, maximum number of places 14 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia: Code DE (14) Old Age : Code OP (37) Physical Disability: Code PD (10) Care Homes for Older People Page 2 of 20 2. The maximum number of service users who can be accomodated is: 51 Date of last inspection Brief description of the care home Grange Park is a purpose built care home offering nursing & personal care mainly to older people, though it is able to offer some nursing beds to younger adults. It is situated just outside Dudley town centre and has good public transport links with Dudley and other local shopping centres. There is a car parking area at the front of the premises. To the rear there are patio and lawned areas, bordered by fencing and mature trees in places and presenting a very pleasant outlook. The interior of the home provides single and double occupancy bedrooms on two floors, some of which are en-suite. The ground floor offers a reception area, offices, communal lounges, a dining room, two conservatories, a small smoking room, kitchen, laundry and a range of bathing and showering facilities. Fees stated in the service user guide were £495 per week for nursing care and £395 per week for residential care. People are advised to contact the home for up to date information about the fees charged. 2 4 0 2 2 0 1 0 Care Homes for Older People Page 3 of 20 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit on 5 and 6 July 2010, to monitor compliance with two Statutory Requirement Notices served on 7 June 2010. These related to proper provision for the health and welfare, care and where appropriate, treatment, of all people using the service. This included the prevention and management pressure ulcers and the safe handling and administration of medication. We use Statutory Requirement Notices as part of our enforcement strategy to obtain improvements in the quality of the service provided for the safety and well being of people living at the home. The service received a poor, zero star quality rating as a result of our key unannounced inspection on 21 October had 2009.The organisation provided an Improvement Plan, which gave assurances of compliance to make sure people were cared for appropriately and safely. However at the inspections on 24 February 2010 and 4 and 5 May 2010 we found that the improvements had not been implemented and there were additional serious concerns relating to peoples health and well being. This random inspection was unannounced, which meant the home was not given notice of our visit. Two inspectors and a pharmacist inspector spent two days at the home. We looked at the medication systems, care records, the systems for dealing with safeguarding people, including staff recruitment. We also looked at how people were supported and given assistance to meet their daily needs. We looked at some bedrooms, particularly bedrails and pressure relieving equipment. We talked with people living at the home, staff and visitors. The home has had a recent history of instability and a high number of incidents have been reported as safeguarding referrals. The home was purchased in 2006 by the current registered provider. The home has had a chequered history, with some past improvements. However the improvements have not been consistently maintained. The registered manager left the homes employ in October 2009 but the provider did not notify us of this change as required. The previous acting manager commenced employment on in October 2009 and left the homes employ in February 2010. The current management arrangements were supplied through external management consultants. We were told that the recruitment of a new manager and deputy manager had been placed with a recruitment agency because recruitment through the local press and job centres had not been successful. We had received regular communication prior to this inspection visit from the acting manager about actions taken to changes in peoples health, such as accidents or hospitalisation for deteriorating conditions. There was generally evidence of medical support and appropriate medication administered for the treatment of their conditions. However we noted that a person who was refusing medication had been referred to a specialist consultant six weeks prior to the inspection visit. Although the acting manager had spoken to the GP on a weekly basis, no appointment had been received. Following discussions about other actions the home might take the HealthCare Management Solutions consultant (HCMS) contacted the medical secretary at the hospital to find out about the appointment. The person had also developed a rash and been referred to a dermatologist, again no appointment had been received. The HCMS consultant contacted the hospital during the inspection visit to investigate the reason for the delay for a consultation. This indicated that the staff at the home would not have acted to pursue Care Homes for Older People Page 4 of 20 hospital appointments without prompting, posing risks to the person waiting for specialist attention. We were given information about people at the home with pressure ulcers in various stages of healing including, written pressure ulcer audits. We were told that everyone living at the home was regularly reviewed with body maps used to record any damage to their skin. We saw that all pressure ulcer wounds had been reviewed by a Tissue Viability Nurse with prescribed wound care regimes. This meant that pressure damage to each persons skin was being monitored. The HCMS consultant explained that revised risk assessments, health screening tools and new more person centred care plans were being put in place but this was a lengthy process. The new care records had been completed for the seven people with dementia living on Kitwood unit and two people requiring nursing care in the main home. We were told that team leaders had been appointed to take responsibility for Kitwood and the people requiring residential care and that these staff would be developing more person centred care. This meant that staff would have improved information so that each person could receive individualised care and support. We looked at the care records and care provided for a person living on Kitwood who had developed a pressure ulcer on their heel. This had not initially been noticed by staff and was reported by their social worker as a safeguarding alert in April 2010. We saw that the person had received wound care from the district nurse and the pressure ulcer had healed. The pre-assessment information stated the person had previously developed a pressure ulcer and had been provided with a pressure relieving mattress at the home prior to admission to Grange Park. However we saw that the person had a divan bed with no pressure relieving mattress in place. We spoke to staff on duty who told us that they felt that the person would not develop pressure ulcers when sitting in the bedroom. We were introduced to the person who was sitting in a wheelchair at the dining table, with no pressure relieving cushion or pressure relieving equipment for vulnerable areas of their feet. We were shown a pressure relieving cushion placed on a sofa and a footstool, which staff told us was used to elevate the persons foot. The persons care plan stated, staff to ensure Y sits on a pressure cushion at all times. There were also instructions that the persons position should be changed regularly whilst in bed. We asked to see position change charts, after searching Kitwood unit the staff acknowledged that there were no position change charts being recorded. This meant that the person was not receiving appropriate pressure relief at all times to prevent further damage to their skin. We looked at health screening records, which indicated the person was at high risk. The scores on the records indicated that dietetic advice should be sought. There was no evidence that advice from the community dietician had been sought for this person. The care records stated that daily food and fluid intake should be recorded and though there were charts the entries were, soft diet, all eaten. This did not give sufficient information to show that this person at risk of tissue damage, malnutrition and dehydration, was receiving an adequate dietary intake to maintain their health and well being. Whilst speaking to the person we saw that they had difficulty in seeing our identity badge. We asked staff if the person had visual impairment or had glasses. Staff told us this person did not wear glasses and there were no eyesight problems. The assessment information recorded that the person was blind in one eye and required spectacles for distance vision. The person had a support care plan To Have Access to Health Care Care Homes for Older People Page 5 of 20 Services but there was no evidence that this person had been seen by the dentist, chiropodist or optician since admission to the home in December 2010. As the staff were not aware of this persons visual impairments, this meant the person was at increased risks of disorientation and harm. We discussed the concerns with the HCMS consultant who acknowledged the inconsistencies and omissions. We looked at the care records and care provided for a person nursed in bed and given end of life care. The person had developed a grade 4 pressure ulcer on their hip in February 2010. This was on the site of a healed pressure ulcer wound and was referred to the Local Authority and Primary Care Trust (PCT) as a safeguarding alert at the random inspection in February 2010. The support care plan for the pressure ulcer right hip included a description, which graded the wound using an outdated scale. The dressing charts did not include adequate information to show whether the pressure ulcer was improving or deteriorating. The statement improving was difficult to quantify without adequate records. Staff had recently made a referral to the Tissue Viability Nurse regarding failure of the ulcer to improve, however an earlier referral may have been appropriate. We visited the person in their bedroom to review the change of position / turn charts. The charts confirmed that re-positioning had been carried out at least 10 times each day and that there were rotations of the positions to maximise pressure relief. This meant that though wound records had insufficient information about the persons pressure ulcer, there was recorded evidence that appropriate pressure relief was given to prevent further damage to the persons skin. We had recommended that the home should be using the European measurement guidelines rather than the outdated Sterling system at previous inspections. We discussed these concerns with the HCMS consultant who acknowledged further improvements were needed. We looked at the care records and care provided for a person looked after in bed. We saw a risk assessment and support care plan containing conflicting information about how the person should be assisted to change position and the were no instructions about the number of staff required. This meant that the person was at risk of harm. This was discussed the HCMS consultant who acknowledged improvements were needed to make sure staff were aware of how to provide assistance for the persons comfort and safely. We saw references in the persons care records to aggression, including some instructions for staff. There was no dedicated care plan relating to aggressive behaviour and none of the care records or the daily statements demonstrated that monitoring of aggression was taking place. This meant that the persons behaviours were not being evaluated to recognise the triggers, which could be avoided or minimised. We saw that a person had a rash, which had been assessed by a GP with a referral made to a Dermatologist. We looked at the daily statements to try and determine the current status of the rash and could not find any indication that the rash had been monitored recently. Staff gave us conflicting information about the rash and the written information failed to demonstrate that the home was appropriately monitoring the condition. This meant the persons health needs were not being appropriately met. Health Care Professional Records for a person showed that a Speech and Language Therapy assessment had been carried out in October 2010. It was recorded that a review Care Homes for Older People Page 6 of 20 would be carried out in one months time. There was no indication that the review had taken place or that staff had attempted to make contact to chase this up. This meant that the persons access to health care professions was not being maintained. The pharmacist inspector visited the home on 5th July 2010 to check compliance with the requirements regarding the safe handling of medicines. We looked at medication storage, two peoples care records and all of the Medication Administration Record (MAR) charts. The HCMS consultant told us that a programme of training on the safe handling of medicines was in place. Three staff had completed the training and three more were due to have the training in July 2010.This was to ensure all trained staff were kept up to date with safe practice. We were also informed that there were three defined teams for the three units. One person would be in charge on each unit in order to improve the management structure. An independent check was also completed on medicines. We were shown a document from Healthcare Management Solutions dated June 2010. The check showed that there had been a significant improvement in medicines in the service. This meant that the service was taking positive and immediate action to improve medicine management within the home to ensure people were safe from harm. We looked at the medicine storage of peoples medicines. We saw that medicines were stored neatly and tidily, which made it easy to locate peoples medicines. We found that all medicines were available to give to people as prescribed. We saw that there was a new air cooling system in operation in the medicine store room to ensure medicines were stored below 25 degrees C. We were shown room and refrigerator temperature records for the storage of medicines. The temperatures were all recorded daily and were within the recommended safe storage temperatures for medicines. There was an improvement in the documentation and recording of medicine records. We looked at all of the MAR charts. Overall we found that they were documented with a signature for administration or a reason was recorded if medication was not given. We saw that one person was prescribed a tablet with no clear directions printed on the MAR chart or on the box of tablets. The directions stated as directed, which was not specific or clear for staff to follow directions. It was not clear how many tablets to give or how many tablets were being given from the records. There was no information available to show if advice had been taken from the prescribing doctor or the supplying pharmacy to ensure that the person was being given a safe and correct dose. We discussed this issue with the HCMS consultant who agreed that this should have been discussed with the persons doctor and this would be done. We looked at two persons medicine records and checked that the amount given matched the documented records. The first person was prescribed six medicines. We saw that the date of receipt of all six medicines was recorded. Four of the medicines were tablets and the checks we made were all correct. One of the tablets required special monitoring. We saw records to show that this was being done. Two of the medicines were eye drops. We saw that the date of opening was recorded for both eye drops in order to ensure they were used within the 28 day expiry. The second person was prescribed eleven medicines. We saw that the date of receipt of all eleven medicines was recorded. Five of the medicines were tablets and the checks we made were all correct. Five of the medicines were liquids. It was not possible to accurately check a liquid medicine but we saw that the MAR charts were documented when the medicines were given and the bottles were dated when opened. One of the medicines was a patch. Records were correctly Care Homes for Older People Page 7 of 20 documented. Overall, the records showed that the two people were being given their medicines at the correct time as prescribed. One person was refusing all of their prescribed medicines. At our previous inspection on 4th and 5th May 2010 the medicines were being given to the person hidden in their food, also known as covert administration of medicines. The decision to refuse medicines was the persons own choice and an assessment showed that the person was capable of making that decision. We spoke to the person and they told us that they did not want to take any more medicines by mouth but would consider being given a patch to wear instead. We were told by a nurse that the person had been refusing their medicines for over a month. We observed that the persons physical condition was deteriorating as a result of not taking their prescribed medicines. We saw records which documented that the persons doctor was aware of the situation and a referral had been made to a Parkinsons consultant for advice and possible alternatives. The service was waiting for further medical advice and we saw four dated records indicating that the service had contacted the doctor to find out if the referral was being followed through. Although we had concerns about the persons general health and welfare because they were refusing their medicines we acknowledge that the service was following the persons decision and choice. We could see that the service had taken some action to speak to the GP about the referral to a consultant, without confirmation of an appointment, but in the meantime the persons physical health was deteriorating, which was a cause of concern. Following our discussion the HCMS consultant agreed to contact the hospital and found out that there was no record of the referral. We were told that on receipt of a referral the hospital would make an urgent appointment for the consultant to see the person. The HCMS consultant told us she had contacted the doctor to make sure another referral was made as a priority. We looked at the care plan for one person and found that a doctor had reviewed one of the medicines in June 2010. The medicine was prescribed on a when required or as needed basis for anxiety. We saw recorded information that the doctor had made a change to the medicine and written information which explained when the medicine should be given to the person. This meant that information about peoples medicines were available to safeguard their health and welfare. We looked at the MAR chart for one person who had been on social leave for one week. We saw that the records documented that the person had been on leave. We spoke to two members of staff who explained the system used to ensure the person had their medicines with them. A system of checking all the medicines when they left the home and when they were returned was used. This meant that there was a safe arrangement for medication when people leave the home for social leave occasions. We found that there had been improvements in the management of medicines. We saw that new systems had been put in place to ensure that medicines are given to people safely and as prescribed. We gave feedback to the HCMS consultant and explained that the service had complied with the requirements relating to medicines. The HCMS consultants answered questions specifically about progress made in respect of Kitwood, the Dementia Care Unit. She told us that improvements had been introduced to the environment with a blend of themed areas and there were plans to re-decorate and personalise bedrooms. She stated that two senior carers had left the homes employ and an advertisement had been placed with some new staff recruited and further recruitment Care Homes for Older People Page 8 of 20 was pending. She told us that the intention was to have a senior carer on duty for every shift on Kitwood unit. She told about a planned meeting when the acting manager would be back from annual leave to discuss progress, to review documentation, and to discuss the possibility of having a dedicated senior carer for night duty on Kitwood. During discussion we had been told that the night time cover for the whole of the Home was one registered general nurse and two care assistants. Concerns were raised with us about safety within the home for occasions when two staff would be attending to heavily dependent persons. We noted that there were a signification number of accident records with entries timed in the night and early morning hours, with descriptions, found on the floor. The HCMS consultant confirmed that staff were situated centrally during the night. This meant that there were risks to people, especially those living on Kitwood, which we saw was generally locked at all times during the day. The HCMS consultant acknowledged that the night staff cover had not been formally risk assessed. The HCMS consultant told us that staff had received a lot of training recently and she felt that they had a desire to see the home progress. She told us that the nurses had commented that the home is more structured. This was confirmed in the discussions we had with two registered nurses on duty during the inspection visits. We saw that staff administering medication had received medication training accredited by the National Pharmaceutical Association and the external consultants had conducted comprehensive competency assessments for two nurses and two senior care assistants. We also looked at a sample of two personnel files for staff recently recruited, which were well organised, easy to audit and contained relevant recruitment checks. The HCMS consultant told us that there was an annual development plan for the home and there some audits had taken place relating to medication, care planning and care provision for the most frail and vulnerable people. There were definite improvements, however as highlighted in this report there were still areas where care records and care provided did not entirely maintain each persons health and welfare. We looked at Regulation 37 notifications and accident records, which were audited, analysed and evaluated. We have informed the management of the organisation that we will hold a management review to consider what further action we need to take to secure improvements for the health, well being and safety of people living at this home. We will continue to undertake inspections to monitor the service. Immediately following the inspection visits the HCMS consultant contacted us to inform us a decision had been made to improve the night staffing for Kitwood, with a dedicated senior care assistant on duty each night to take responsibility for the unit. What the care home does well: The home had a generally friendly atmosphere and people were encouraged to personalise their rooms to reflect preferences and tastes. Accommodation was generally spacious, light and airy, especially on Himley unit currently not used; and Kitwood providing care for people with dementia. Care Homes for Older People Page 9 of 20 The majority of people were well presented with clothing, according to their preference and appropriate to the weather. There was an open visiting policy and people were welcomed, so people living at the home were able to maintain important friendships and relationships. Visitors were offered refreshments. A high proportion of care staff had achieved a National Vocational Qualification (NVQ) level 2 in care, which meant that staff should have the knowledge and skills to meet peoples needs. There were improvements to the medication systems, though some further improvements have been required. This is to make make sure that each person receives their medicines as prescribed by their doctor. The staff on duty were friendly and there was improved interaction with people living at the home. What they could do better: There were some improvements to care records but all records must be monitored and improved. Care plans, risk assessments and evaluations need to be person centred, up to date, accurate and give clear guidance about how to meet the needs and support each person in the home, especially the most frail and vulnerable people. Appropriate measures need to be put in place to minimise the risks of pressure ulcers. Where damage to skin occurs there must be appropriate records to demonstrate the condition of the wound. The management must make sure that people are offered foods and fluids to maintain their health and well being, with appropriate weight monitoring; and where there are concerns advice sought from doctors and dieticians, without delay. Though some medication practices had improved, administration practices and records must be maintained to be as safe as possible. The management must diligently follow guidance to keep people safe without depriving them of their rights. All staff must be provided with suitable training so that they understand how to protect vulnerable people and know where they should report concerns. The provider must make sure that there are skilled staff in suitable numbers to meet the needs of every person living at the home at all times, especially at night. Robust action must be taken to deal with staff where actions or omissions place people using the service at risk of harm. All staff should receive appropriate induction, training and supervision to support them to develop skills to meet the needs of people living at the home. Care Homes for Older People Page 10 of 20 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 set out on page 2. Care Homes for Older People Page 11 of 20 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 All pre admission 01/12/2009 assessments must be more detailed and include all areas of risks and needs, and these must be kept under review. This is so that people can be confident that all their needs can be met. 2 3 14 To ensure that each persons 11/06/2010 assessment of needs, carried out by a suitably qualified, trained, competent person, kept under review and appropriately revised whenever necessary. This is so that each persons heath and well being is maintained and safeguarded. 3 7 15 Care plans, which are 11/06/2010 comprehensive, person centred, and identify how all of each persons needs in respect of their health and welfare are to be met. This is to promote the health and well being of each person using the service. 4 7 12 To ensure that there are 01/12/2009 health care assessments, risk assessments and care plans, which include all of each Page 12 of 20 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action persons assessed needs, the active involvement of the person / or representative; and are updated to accurately reflect all changes to health and needs. This is to ensure care for each persons health and well being is properly provided at all times. 5 8 12 To ensure that special care records such as food, fluid balance charts, turn charts, and wound care records are maintained, with care provided appropriately recorded and monitored and updated. This is to ensure peoples health and well being is maintained. 6 8 12 To ensure that people with 01/12/2009 poor nutritional intake and / or weight loss are monitored using a recognised screening tool as frequently as required by their risk assessment and care plan. This will ensure that staff take required actions to promote peoples health and well being. 7 16 22 To diligently record and 01/12/2009 report all complaints, with actions clearly identified to demonstrate robust investigations of all concerns or referrals to other Page 13 of 20 01/12/2009 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action appropriate agencies as necessary; and ensure these records are available for inspection. This is to ensure that the people who use the service are safeguarded. 8 29 19 To ensure that all staff employed at the home are recruited following robust recruitment procedures. This is to safeguard people living at the home from risks of harm. 9 33 24 To implement effective 01/12/2009 quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. 10 38 13 Management systems must 01/12/2009 be implemented to ensure the safe use of bedrails, which includes correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. 01/12/2009 Care Homes for Older People Page 14 of 20 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, 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 8 13 To ensure each person receives advice, treatment and any other service necessary from health care professionals in a timely manner. This is to maintain the health and welfare of each person living at the home. 30/08/2010 2 9 13 The service must seek clarification relating to as directed dosages from the prescribing doctor or the supplying pharmacy, so that staff have sufficient instructions. This is to ensure that people are being given a safe and correct dose. 30/08/2010 3 12 12 To ensure that the number of 30/08/2010 staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person living at the home, at all times including night times. Care Homes for Older People Page 15 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to safeguard the health, welfare and safety of every person living at the home. 4 30 18 All staff must receive training 30/08/2010 so that they have the knowledge and skills to meet the individual and collective needs of people using the service. This is to maintain the health and welfare of each person living at the home. 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 1 The statement of purpose and service user guide should be revised, updated and reissued to people living at the home in easy to understand formats suited to their capabilities. This was a previous Good Practice Recommendation, which was not met. Not assessed at this Random Inspection. Information in the homes documentation about unspecified charges for staff escorts for hospital visits, should be made clear, should be justified and should not be discriminatory. This Good Practice Recommendation was not assessed at this Random Inspection. The contract / terms and conditions of residence should be revised, updated and reissued to each person living at the home to reflect good practice guidance issued by the Office of Fair Trading. This was a previous Good Practice Recommendation, which was not met. Not assessed at this Random Inspection. Each person should receive written confirmation that the home can meet their assessed needs, including their cultural needs. Page 16 of 20 2 2 3 2 4 4 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 This was a previous Good Practice Recommendation, which was not met. 5 7 Daily progress records should be revised to ensure all records are accurate, consistent and up to date. This is previous unmet Good Practice Recommendation. Advice from the diabetic specialist nursing service should be sought for any person with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. This is previous unmet Good Practice Recommendation. The correct pressure setting for pressure relieving mattresses should be recorded in each persons care records with regular documented checks. This is previous unmet Good Practice Recommendation. Advice from community dieticians should be sought for all persons assessed to be nutritionally at risk, with records of support and advice offered and that a record be maintained of staff training in relation to nutrition. This is previous unmet Good Practice Recommendation. Moving and handling risk assessments should reviewed and expanded to include instructions for the level of assistance and named equipment required for all transfers. This is previous unmet Good Practice Recommendation. Care plans, monitoring and management strategies should be put in place for people described as having agitated, aggressive or other challenging behaviours with ways to evaluate the effectiveness of strategies and use of PRN medication. This is previous unmet Good Practice Recommendation. Personal preferences should be accurately recorded for each person and daily routines should be flexible to meet each persons choices. This is previous unmet Good Practice Recommendation. Not assessed at this Random Inspection. Activities and social stimulation must be provided, appropriate to each persons needs, including people care for in bed, and people with sensory disabilities or dementia, with planned and spontaneous activities recorded and evaluated. This Good Practice Recommendation was not Page 17 of 20 6 8 7 8 8 8 9 8 10 9 11 12 12 12 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 assessed at this Random Inspection. Not assessed at this Random Inspection. 13 14 Inventories of personal possessions should be fully completed, signed, witnessed and kept up to date. This is previous unmet Good Practice Recommendation. Not assessed at this Random Inspection. Food options and choices for people from other nationalities and cultures should be frequently reviewed with them and their supporters to make sure they are able to have their preferred meals. This is previous unmet Good Practice Recommendation. Not assessed at this Random Inspection All staff must receive appropriate safeguarding training and the homes and Safeguard and Protect procedures to protect vulnerable people must be implemented and followed diligently at all times. This is previous unmet Good Practice Recommendation. Staff should be given time to read policies and procedures associated with the protection of vulnerable adults, with signatures obtained to demonstrate their awareness and compliance. This is previous unmet Good Practice Recommendation. Plans should be implemented to ensure the environment meets the needs of everyone living at the home in a prioritised timescale. This is previous unmet Good Practice Recommendation. Assessments should be in place to ensure each person is provided with equipment that is suitable to meet their needs, such as nursing profile beds, pressure relieving mattresses and suitable, adjustable chairs. This is previous unmet Good Practice Recommendation. Not assessed at this Random Inspection. The CQC should be notified of any changes to the management of the home, details should include the name, address and qualifications of the person responsible for running the home. A suitably competent, permanent manager must be recruited with an application for registration submitted as a priority. 14 15 15 18 16 18 17 19 18 24 19 31 20 31 Care Homes for Older People Page 18 of 20 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 21 35 There should be signed and dated receipts for every transaction and a clear audit of money used on each persons behalf. Not assessed at this Random Inspection. A structured staff supervision system must be implemented to ensure all staff receive formal supervision at least six times each year to provide them with support and development to meet the needs of people using the service. There should be documentary evidence that maintenance is carried out on all lifting equipment in compliance with LOLER Regs. Not assessed at this Random Inspection. Written confirmation should be provided of compliance with all Legal Requirements in the Environmental Health Officers Food Safety report. 22 36 23 38 24 38 Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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 noncommercial 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. 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