Care Home: Hatherley Grange Nursing Home

What the care home does well The home is good at obtaining information about prospective residents so that a full assessment can be made of their needs. A good standard of care is provided with attention given to spending individual time with residents and preserving their privacy and dignity. Activities for residents are carefully considered and generally provided on a one to one basis. Resident`s relatives and representatives are welcomed and the home seeks to maintain positive relationships with them in the interests of resident`s needs. The home was well maintained and remarkably clean providing residents with a safe and comfortable environment. The home has achieved a good level of NVQ training among the care staff. The home is well managed with quality checks being made and actions taken in the interests of residents and their safety. There is a good approach to ensuring residents safety particularly in relation to the use of bed rails, fire safety and in the checking of aids used by residents. What has improved since the last inspection? Residents benefit from the use of tactile cushions as an activity suitable for people with dementia. Records are now kept of alternative meals provided for individual residents. Some improvements have been made to the environment of the home with work being carried out on a new laundry. More staff have received training in dementia care. There have been improvements to recruitment procedures. An improved risk assessment for legionella has been completed. What the care home could do better: The home should check that it has written plans of care for all the assessed needs of all the residents. Attention needs to be given to ensuring that resident`s medication is stored at the correct temperature. The storage arrangements for controlled drugs also need to be checked to ensure they meet with legal requirements. Care plans or protocols must be in place to guide staff in the administration of medication prescribed to residents on an `as required` basis. The policy for protecting residents from abuse could be improved by adding the contact details of the local authority adult protection unit. Visits and reports made under the Care Homes Regulations 2001 must be carried out by an appropriate person from the registered provider. Although the home has achieved a two star good rating there are some areas such as medication storage and care planing that need particular attention in the interests of residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hatherley Grange Nursing Home 26 St Stephen`s Road Cheltenham Glos GL51 3AA     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 2 0 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Hatherley Grange Nursing Home 26 St Stephen`s Road Cheltenham Glos GL51 3AA 01242251321 01242574322 hatherley@almondsburycare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Almondsbury Care Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 dementia Additional conditions: Date of last inspection Brief description of the care home 0 This care home specialises in the care of the elderly person with dementia, but has 3 places for those under 65 years suffering from the same illness. It is located on the outskirts of Cheltenham town in a residential area. It is close to many local shops and a church. It can offer both single and double bedrooms, set out over 4 floors accessed via a shaft lift or stairs. On the ground floor there is a large lounge, conservatory dining room and smaller quiet area. Viewed from the conservatory and accessed via a ramp, is a small but safe patio area.The Home has a qualified nurse on duty at all times, with care staff who are experienced in the specialised needs of service users with dementia. Fees range from 583 to 705 pounds per week. Care Homes for Older People Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was carried out by one inspector on one day in May 2009. The registered manager of the home was present for the inspection visit which consisted of a tour of the premises and examination of residents care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a case tracking exercise. Observation was made of the care and supervision of the residents in communal areas. One visitor and two members of staff were spoken to during the inspection visit. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Older People Page 5 of 29 What the care home does well: 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 set out 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 Care Homes for Older People Page 7 of 29 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedure ensures that residents are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. Evidence: The pre-admission assessment forms for four residents were looked at. These included a description of assessed needs with an area to record information if a prospective resident had a history of falls. One resident had been admitted from another care home and the pre admission assessment had been carried out there by staff from Hatherley Grange. Another resident had mental health needs and although the home had obtained sufficient information about the persons needs,the registered provider is reminded that the home is only registered to care for people with dementia. Care plan documents from funding authorities had been obtained, where these had not arrived in the home before the residents admission, the home had obtained a copy of the Care Homes for Older People Page 10 of 29 Evidence: relevant assessment document. A visitor spoken to during the inspection visit described the home as the home of choice for his relative. The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home works well to meet residents health and personal care needs whilst upholding their privacy and dignity. However some attention needs to be given to storage arrangements for residents medication and care planning. Evidence: The care plan files for three residents were looked at. Following the pre-admission assessment a Resident Long Term Need Assessment and Care Plan is completed along with a further care plan document. As at the previous inspection it was noted that for some residents the care plan document had only been completed for selected needs. One resident had a number of assessed needs including one described as can become very verbal and anxious during the day There was no care plan to guide staff in dealing with any needs associated with this. The only care plan in place was for a need described as Unable to walk. This had been kept under review regularly although not each month. More recently admitted residents had care plans for their full range of assessed needs. One resident had a care plan for aggressive behaviour and Care Homes for Older People Page 12 of 29 Evidence: records showed that the home had been liaising with a consultant psychiatrist in how to manage the resident. There were no examples of care plans being signed by residents relatives or representatives. Residents had dependency profiles completed which had been reviewed on a monthly basis. Risk assessments had been completed for moving and handling, pressure sores and nutrition. There was recorded evidence of residents having input from health care professionals such as GPs,chiropodists and a visiting dentist. One resident was having their blood pressure recorded on a monthly basis at the request of a consultant. In addition a GP had written an entry in one residents care notes. Medication administration and storage arrangements were looked at. Since the previous inspection a thermometer had been placed in the main medication storage cupboard and was reading 25 degrees Centigrade. However there was no recording of storage temperatures and so it was impossible to check if residents medication had always being stored at the correct temperature. A discussion with the registered manager revealed that there was no plan in place if storage temperatures were found to be too high. Where medication was stored in a refrigerator, records had been kept and these indicated that temperatures were within the correct range. Three out of four bottles of liquid medication had been dated on opening with a view to establishing the expiry date of the medication. The cupboard for storing controlled drugs was looked at, it was unclear if this met with current specifications for storage under the Misuse of Drugs (Safe Custody) Regulations 1973 and this should be checked. It was noted that another storage cupboard was situated in an adjoining room although was out of use. Handwritten entries on medication administration records included only one signature although the registered manager was aware that two signatures should be present. This is to indicate that the entry has been checked by another member of staff. The medication records were in good order with no gaps in the recording of medication administered.Two residents had been prescribed medication for anxiety and agitation to be given on an as required basis. There was no mention of when this medication should be given in their care plans and there were no separate protocols in place to guide staff in when to give the residents the medication. The registered manager described a different approach between herself and another registered nurse as to whether this medication should be given in the case of one of the residents. A clear plan or protocol would ensure that a consistent approach is followed by all staff in giving the medication. The home has a homely remedies policy and this has been agreed by GPs. Staff were observed treating residents with respect and up-holding their privacy. In the one shared room looked at, a dividing curtain was in place for privacy. In general staff were very attentive to residents needs and able to spend time with individuals Care Homes for Older People Page 13 of 29 Evidence: when required. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes an active part in encouraging residents contact with family, friends and parts of the local community, which provides a good degree of social contact. In addition residents are well supported by staff at mealtimes. Evidence: The home does not organise formal group activities preferring to offer time to residents on a one to one basis which includes attending to residents hair or nails. Music is played in communal areas and a number of residents enjoy watching the television. A number of tactile cushions had been obtained since the previous inspection. These are suitable for the needs of people with dementia and these were seen being used by residents during the inspection visit. Residents interests are recorded on admission in a personal history in their care files. A visitor spoken to during the inspection visit described how they were welcomed when they visited the home and confirmed that flexible visiting arrangements were in place. Residents individual rooms contained various degrees of personalisation. The home had information on advocacy services for residents. Care Homes for Older People Page 15 of 29 Evidence: At lunch time some residents took their meals in other communal areas or in their own rooms if this was their preference. The atmosphere during lunchtime was calm. It was noted that staff were assisting residents with eating where needed and this was carried out in a dignified manner with staff sitting with the residents. Where meals were pureed they were presented in an attractive way with all the portions of the meal identifiable. The menu is changed every week for four weeks with breakfast, lunch and supper offered. Although there is no choice of main course offered for lunch, individual likes and dislikes can be catered for. Supper is usually a cooked snack with a dessert and residents then have hot drinks with cake and biscuits at around eight in the evening. A record of alternative meals provided had been kept. A visiting relative spoke of good communication with staff and that meals seemed very good his relative had put on weight since being in the home. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes a positive relationship with residents representatives providing confidence that any concerns raised on their behalf will be dealt with. In addition residents are protected from abuse through staff training. Evidence: The home has a clearly written procedure for dealing with any complaints or concerns that are raised, with a copy displayed in the entrance hall of the home for relatives and representatives of residents. The Homes AQAA document told us that the home had received no complaints in the 12 months up to its completion in March 2009. The home had established good relationships with relatives and representatives of residents and aimed to initially deal with any concerns on a face to face basis. This was confirmed in discussions with a visiting relative. In relation to residents legal rights, two staff had completed training in the Mental Capacity Act 2005 with others booked to undertake this training which also included the recent Deprivation of Liberty Safeguards. Information supplied by the home shows that the majority of staff have received training in the protection of vulnerable adults and updates are done on an annual basis, the subject is also covered during the induction of new staff. When asked Staff Care Homes for Older People Page 17 of 29 Evidence: were able to demonstrate their knowledge regarding protecting vulnerable adults. The home has a policy and procedure for the protection of the residents that includes directions for contacting external agencies. However this could be improved by adding the contact details for the local authority Adult Protection Unit. The homes AQAA document told us that no safeguarding referrals had been made in the twelve months up to March 2009. A number of staff have also attended training in dealing with violence and aggression. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of living in a well maintained, clean and improving environment. Evidence: A tour of the premises was conducted. The home was well maintained with appropriate and attractive decoration. Residents individual rooms had varying degrees of personalisation and one shared room looked at had a dividing curtain for privacy. To the side and rear of the home is an enclosed patio area with a number of planted areas and pots, this is accessible to anyone using a wheelchair. The best use has been made of the available space and this enables residents to enjoy the outside with minimal risks to their safety. All areas of the home accessible to residents were found to be very clean and smelt fresh. One individual room had an odour and although the home were managing this on a day to day basis an alternative floor covering may need to be considered in the future. It was noted that room 18 did not have the benefit of ventilation through the window in the bedroom, this being sealed shut. This was discussed and it was explained that if ventilation was needed then a window in adjoining bathroom could be opened to provide ventilation. However consideration should be given to providing ventilation directly into this room. Since the previous inspection some improvements had been made to the environment of the home such as the refitting of a shower room on the first floor. Care Homes for Older People Page 19 of 29 Evidence: A new laundry was being fitted during the inspection visit and it was anticipated that this would provide a great improvement over the previous facility. While the work was being undertaken a temporary laundry had been sited in a portable building at the front of the home. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by a generally well trained and consistent staff group with residents protected through robust recruitment practices. Evidence: Staffing levels typically consisted of two registered nurses and four or five care staff for the day and one registered nurse and one member of care staff for the night shift. The home also employs catering, maintenance and domestic staff. The home generally had a low turnover of staff. There is some use of agency staff. Out of ten care staff employed in the home, seven had achieved a NVQ at level two with a further two care staff having started a NVQ. The records for the three most recently recruited members of staff were examined. The correct information and documentation had been obtained for staff prior to employment The home provides induction training to all new staff and uses a booklet to record progress with the training which is clearly linked to national specifications in terms of the Common Induction Standards. New staff work alongside a senior member of staff during the initial induction period. Since the previous inspection there has been an Care Homes for Older People Page 21 of 29 Evidence: improvement in the number of staff attending training in dementia care. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is managed in their interests with actions carried out to ensure their safety and the quality of the service. Evidence: The registered manager has worked at the home in a management capacity for many years. She is a registered mental health nurse and has achieved the registered managers award, she is also a NVQ assessor. Recently the registered manager has attended study days in fire safety and medication. The home has various quality assurance checks in place. Internal audits are carried out monthly looking at different aspects of the service provided. Observations are made regarding practice and reports produced by the registered manager. The home had sent out surveys to relatives of residents regarding the service and had received a number of responses. These should be presented in a report as a measure of how the service is performing. Reports of visits made to the home by a representative of the Care Homes for Older People Page 23 of 29 Evidence: registered provider were looked at. In recent months these had not been carried out by the responsible individual or another representative of the organisation but by the homes deputy manager. This was not in line with the regulations or the purpose of such visits which is to ensure that the registered care home provider makes checks on the quality of the service provided. The home provides secure facilities for residents money and valuables. A check made during the inspection visit showed that accurate records had been kept of amounts held. Generally all finances are handled with the support of relatives. Staff had either received training or training was booked in infection control, first aid, health and safety, fire safety and moving and handling. Food hygiene training had been undertaken by all but one member of staff. This person was not permitted to carry out any work in the kitchen until they had completed their training. The home has ensured the servicing and maintenance of electrical systems and appliances as well as hoists and the lift. A new heating boiler had recently been installed. Regular checks had been recorded and made on hot water temperatures and window restrictors. Since the previous inspection an improved risk assessment had been completed regarding the potential risk to residents from Legionella. The home had a good approach to promoting residents safety with regard to the use of bed rails with risk assessments and regular checks in place. In addition regular maintenance checks were being carried out on wheelchairs and walking frames. An environmental health inspection of the kitchen had produced a four star rating which is the second highest rating obtainable. Accidents in the home had been well documented and audited. A fire risk assessment had been completed and the home had been inspected by the fire safety officer in 2008. A number of fire safety checks were in operation. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents must have care plans for all their assessed needs. This is to ensure that care staff have the correct information to follow. 30/09/2009 2 9 13 Measures must be taken to ensure that residents medication is always stored at the correct temperature. This is to ensure that the potency of residents medication is not adversely affected by storage temperatures that are too high. 31/08/2009 3 9 13 When medicines are prescribed to be administered as required make sure that there are clear written guidelines to staff on how to reach decisions about the administration of such medication. 31/08/2009 Care Homes for Older People Page 26 of 29 This will help to make sure people receive the correct amounts of medication in a consistent way. 4 33 26 Visits to the home made 31/07/2009 under regulation 26 of the Care Homes Regulations 2001 must be made by the responsible individual, one of the directors or another person responsible for the management of the organisation and not directly concerned with the conduct of the care home. This is so that the registered provider can check on the quality of the service provided. 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 3 Residents pre admission assessment documents should be signed and dated by the person carrying out the assessment. A second member of staff should always check and sign handwritten directions on the medication administration records. A daily record should be made of storage temperatures in the medication cupboard to ensure that residents medication is being stored correctly. Check that the cupboard in use for storing controlled drugs meets with the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. The homes policy on safeguarding adults should include the contact details for the local authority adult protection Page 27 of 29 2 9 3 9 4 9 5 18 Care Homes for Older People unit. 6 7 25 33 Give consideration to providing ventilation directly into room 18. The responses to quality surveys should be presented in a report. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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