Care Home: Hunningley Grange

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What the care home does well A new assessment document had been produced which if fully completed should provide adequate information to make staff aware of the person`s needs prior to their admission to the service. Some activities were organised. This would create a stimiluating environment and enhance peoples` quality of life. The service had a complaints procedure and it was operating according to company policy. This should provide confidence that complaints were taken seriously and acted upon to address any shortfalls in care or service provision. People lived in a service that had been maintained to a reasonable standard to provide a safe and generally well maintained and homely environment. The manager was able to provide evidence that the majority of staff had received all necessary training which would reflect on the quality of care being delivered to the people. There was a management team in place, they were positive about improving the service and this will contribute to the effective organisation and operation of the service. People who lived at the service expressed their views. Their opinions were: "Its champion here". "It has a lovely atmosphere and it`s really friendly". "We are well looked after". "I like it here, I sit in the entrance and watch the world go by". What has improved since the last inspection? The service had acted upon issues raised at the last 2 random inspections. The issues were relating to medication, first aid and the kitchen refurbishment. It was recognised that the kitchen was not complete, however there had been a considerable amount of work undertaken. What the care home could do better: The care being delivered was not always the care described in the care plans. Inconsistence in care delivery may place people living at the service at some risk. An increase in actitivities would contribute more to the quality of peoples` life. The catering facilities, in the kitchen needs to be finished.All staff need to have fire training. Key inspection report Care homes for older people Name: Address: Hunningley Grange 327 Doncaster Road Stairfoot Barnsley South Yorkshire S70 3PJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ivan Barker     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Hunningley Grange 327 Doncaster Road Stairfoot Barnsley South Yorkshire S70 3PJ 01226287578 01226245348 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): NONE Mr Azad Choudhry Name of registered manager (if applicable) Mrs Julie Scholey Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hunningley Grange is a detached residence with a purpose built extension, registered to provide personal care for 36 residents. All accommodation and services are on the ground floor. The home is located in the centre of Stairfoot, approximately two miles from Barnsley Town centre and situated on a main bus route. The home is within walking distance of a full range of shops e.g. chemist, newsagent, hairdressers, dentist, supermarkets, post office, health centre, cafes and fast food outlets. There is car parking at the front and side of the home. The home provides information to people and their relatives prior to admission into the home. Service User Guides are available in all bedrooms or on request from the manager. The last published inspection report is available on request and a copy is Care Homes for Older People Page 4 of 27 1 7 0 2 2 0 1 0 0 Over 65 36 Brief description of the care home available in entrance for visitors to read. At the date of the inspection the fees were £356.77 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A number of the National Minimum Standards were examined at this inspection (with emphasis on the key standards), and the previous requirements. The person present at the inspection was T England, manager. The person named as the registered manager is no longer in charge of the service. Within this site visit, which occurred over a 6 hour and 40 minute period, we examined requirements relating to the previous inspection. We toured the building, case tracked 3 people (case tracked means looking at the care and service provided to specific people living at the service: checking records relating to their health and welfare: and by talking to specific people; viewing their personal accommodation as well as communal living areas). We spoke with people living at the service and examined assessments, care plans, risk Care Homes for Older People Page 6 of 27 assessments, menus, complaints files, staff records and quality monitoring documents. The history of the service was examined prior to the site visit. This included the AQAA (Annual Quality Assurance Assessment), a self assessment document, telephone contacts, letters and notifications. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The care being delivered was not always the care described in the care plans. Inconsistence in care delivery may place people living at the service at some risk. An increase in actitivities would contribute more to the quality of peoples life. The catering facilities, in the kitchen needs to be finished. Care Homes for Older People Page 8 of 27 All staff need to have fire training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A new assessment document had been produced which if fully completed should provide adequate information to make staff aware of peoples needs prior to admission. Evidence: There had been no recent admissions into the service due to the suspension of the contracts from the Barnsley Local Authority. The manager identified that she would expect to receive written assessments from the care managers or hospital staff, before she would go out and undertake their own assessments. The manager produced evidence that she had reviewed the assessment form used by the service and created a more comprehensive document. Care Homes for Older People Page 11 of 27 Evidence: The manager advised that intermediate care was not provided within the service. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care being delivered was not always the care described in the care plans. Inconsistence in care delivery may place the person living at the service at some risk. Evidence: On examination of the care plans from 3 people, it was established that all 3 care plans were up-to-date, and had been evaluated on a monthly basis. There were daily entries within the care plans. These entries recorded the care delivered on a daily basis. Risk assessments were included within the care plans and included moving and handling, nutrition, skin integrity and other risk factors. Whilst touring the building we observed a person, who was totally immobile, sat in a recliner chair. On entering the room we found they had fluid balance charts and a turn chart, on the table. On examination of these documents it was recorded that the person received adequate amounts of fluids. The information on the turn chart indicated that on the day of the inspection, it stated that care (moving of the position) Care Homes for Older People Page 13 of 27 Evidence: was given at 8 AM and 11:30 AM. On asking the question of when the person should have been turned, we were advised that this should have occurred every 2 hours. On analysing the document further it was established that there were several entries, more than 2 hours apart, on previous days. On discussing the care with the person, they identified that they were comfortable and would call the staff if they were uncomfortable. They identified that the staff visited them often during the day and used the hoist to change their position. Also staff visited them regularly, during the night, to turn them over, so as to provide pressure area relief. On discussing the care of this individual with the staff, we were advised that the information recorded on the turn chart, for the day of the inspection, was correct. They also informed us that, the omissions on the previous records were times that they had not completed the record rather than not delivered the care. One member of staff identified that we are not used to completing these things, so we forget. Having triangulated the information available to us, from the charts, the person receiving the care and the staff, we conclude the following that: The person was visited on a regular basis as indicated by the fluid given, which was recorded on the fluid balance chart, and confirmed by the person. There was a likelihood that the staff did not complete the turn chart at every visit. On the day of the inspection the care had been provided over a 3 and half hour period rather than 2 hours. When this matter had been brought to the attention of the manager and staff, the person received care 2 hourly from the previous intervention, whilst we were at the inspection. It was discussed with the manager that care staff should be responsible and accountable for the care they deliver and the expectation that another member of staff has undertaken the task was not acceptable. The manager identified that she would look at creating an allocation system and to make the senior care staff more responsible for monitoring the overall care, on each shift. Regarding medications, the manager had taken on board the requirement and recommendations from the Random Inspection by the pharmacist inspector. On examination of the medication ordering, storage, administration and disposal. All were satisfactory. Care Homes for Older People Page 14 of 27 Evidence: People who lived at the service expressed their views. Their opinions were: Its champion here. It has a lovely atmosphere and its really friendly. We are well looked after. I like it here, I sit in the entrance and watch the world go by. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities were organised this would create a stimiluating environment and enhance the peoples quality of life. However an increase in actitivities would contribute more to their quality of life. People were able to exercise their rights of choice regarding meals. Evidence: The manager advised that the staff undertake the activities at the moment. On the day of the inspection no activities were observed. When this was discussed with the people living at the service, they confirmed that no activities had taken place. When this was discussed with the staff they advised that they were busy providing care and would try and do activities if they had the time. We were informed by the manager that an activities coordinator is to commence employment and to begin work at the home for three days a week. However the manager is still waiting for a CRB (Criminal Records Bureau) check before the person commences. On discussing the activities with the people who lived at the service we were informed that various activities did take place. Examples given were : singalongs, entertainers, manicure afternoons, regular drinks (spirits) trolley and /or smoothie and ice cream trolley, afternoons sat in the garden, visits into town for coffee. We were aware that a new kitchen was being fitted. On the day of inspection the kitchen was almost fitted but was awaiting a Care Homes for Older People Page 16 of 27 Evidence: cooker and extracter fan. A small domestic cooker located in a staff room at the top of the building was being used as a temporary measure. It was agreed that this small domestic cooker had limited capacity to provide meals and a consistent availabily of choice for 15 people living at the service. We expressed our concerns that the kitchen had not been completed within the timescale of the 1st April 2010. However we had been kept informed of the progress and they had advised us that there had been a delay in the kitchen fitters starting on the project. Since the inspection we have been advised that a kitchen will be fully operational by 1st May 2010. Food was also being provided from outside catering facilities such as the local fish and chip shop. The manager advised, that on the day of the inspection, the main meal was either quiche or fishcakes. We observed the meal being served. On speaking with the kitchen assistant we were shown evidence of a list on which it had the persons name and the choice which they had requested for breakfast, the main meal, and the tea. The kitchen assistant informed us that she asked the people, three times a day, to obtain their wishes and to know what food to prepare. This was confirmed by the people living at the service. Care Homes for Older People Page 17 of 27 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 service had a complaints procedure and it was operating according to company policy. This should provide confidence that complaints were taken seriously and acted upon to address any shortfalls in care or service provision. Evidence: The complaints procedure was available within the Service User Guide. A copy of the procedure was displayed at the entrance. On discussing complaints with the manager, she produced a complaints file. Within the file it showed that 2 complaints had been received and both had been investigated. Regarding Safeguarding Adults, the service had policies and procedures which were available to staff. Staff had undertaken safeguarding adults training and the manager was able to evidence this by showing us the training records. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a service that had been maintained to a reasonable standard to provide a safe and generally well maintained and homely environment. However the catering facilities need to improve. Evidence: On touring the building, it was observed that several of the areas had been refurbished and redecorated. However many of the bedrooms had broken door handles. On examination of the maintenance book, it was found that these breakages had not been reported. It was agreed that the handyman could not make the necessary repairs if he was not aware of the problem. We were advised that this issue would be acted upon within the next week. The rooms had been personalised and contained photographs, personal belongings and some items of furniture which the individual or family had provided. As stated in the previous outcome area, the kitchen remains incomplete and therefore the requirement in this section is repeated. It was repeated because considerable work had been undertaken and the kitchen was not fully completed. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager was able to provide evidence that the majority of staff had received all necessary training which would reflect on the quality of care being delivered to the people. Interventions have been set up to ensure that all staff have received fire training to make them aware what action to take and how to help protect people in the event of fire. Evidence: On examination of the staff rotas and staff on duty, the following was established. AM shift: 1 Senior carer and 2 carers. PM shift: 1 Senior carer and 2 carers. Nights: 1 Senior carer and 2 carers. Plus the manager, domestic, laundry and catering staff. Caring for a present occupancy of 15 people. Care Homes for Older People Page 20 of 27 Evidence: A full assessment of the dependency levels of the people was not undertaken and compared with the indicated staffing levels. The manager was undertaking her management role and also undertaking sleep ins to provide cover should any one need medications. It has been agreed that the manager no longer needs to undertake sleep ins as there are sufficient staff to provide cover for medications over a 24-hour period. On examination of 3 staff files, we found that all contained the required documentation, including the Criminal Records Bureau and Protection Of Vulnerable Adults checks. On examination of the staff training records, it was established that moving and handling, first aid and other clinical training had been undertaken by the staff. On reviewing the fire training records, it was established that all staff except for 3, had undertaken fire training. On raising this with the manager and examining the staff rotas, it was established that all 3 staff were on their days off. It was agreed that they should receive fire training before commencing back on duty. The manager identified that she had the train the trainers course and could instruct the 3 members of staff, before their next working shift. Care Homes for Older People Page 21 of 27 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. There was a management team in place, they were positive about improving the service and this will contribute to the effective organisation and operation of the service. Evidence: There was a manager in post. However she had not registered with the Care Quality Commission. She advised that she had submitted an application and was to undergo the process. She advised that she had the Registered Manages Award (RMA) level 4, Train the trainers qualification. She had also completed a leadership management programme. Regarding quality assurance, we were shown evidence that there had been monitoring of care plans and medication. There were copies of minutes of meetings with people living in the service, relatives and staff. Surveys had been returned from district nurses and other professionals. These surveys had positive comments. Care Homes for Older People Page 22 of 27 Evidence: The service had a credit and debit system regarding personal monies, which they held for safe keeping. Regulation 26 documentation, which were a record of the registered persons monthly visits, were up-to-date. These documents were comprehensive and reflected the views of people who use the service, however it was disappointing that the broken handles had not been picked up during the visit. Regulation 37 notices, which are documents that are sent to the Commission regarding untoward occurrences, including falls, accidents etc: had been received by the Care Quality Commission. The information showed that appropriate action had been taken. The information contained in the AQAA confirmed that all health and safety and maintenance had been undertaken. Care Homes for Older People Page 23 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 26 23 Suitable arrangements must 04/01/2010 be made to ensure good hygiene practices take place. This includes appropriate kitchen facilities, To control the risk of infection and maintain a clean, hygienic environment. (timescale 04/01/10 not met) Care Homes for Older People Page 24 of 27 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 8 12 The care being delivered should reflect the care instructions written in the care plans. So that consistent care is given. 30/05/2010 2 12 16 There needs to be recreational facilities within the service. To ensure a stimulating environment 04/06/2010 3 15 16 There needs to be catering facilities that provide sufficient to offer choice. To ensure that people are not limited by the restrictions of the present catering facilities. 10/05/2010 4 26 23 Suitable arrangements must 10/05/2010 be made to ensure good hygiene practices take place. This includes appropriate kitchen facilities. Care Homes for Older People Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To control the risk of infection and maintain a clean, hygienic environment. 5 30 19 All staff need to receive fire instruction. To ensure that staff are aware what action to take in the event of a fire. 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 10/05/2010 1 31 The manager needs to continue with her application to register. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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