Care Home: Le Grand Nursing Home

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What the care home does well A visit to the home by prospective residents is welcomed, and transport is available to help people do this if needed. We saw people being shown around the home by senior staff, discussing the facilities available and the routines of the home. "As a relative I was shown around and had a talk with the owner" was a comment on a survey. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 7We saw that a standard pre-admission assessment is used by management for all prospective residents, to check that staff can give suitable care to each person, before the manager agrees that the home is the right place for the person to live. Individual care plans are available, identifying the areas of need for each person, and with clear instructions for staff for what they must do to meet that need. The systems have again been reviewed and further improved since the last visit. On the three files viewed we saw that monthly reviews were clearly carried out, and the care plans updated if needed. Risk assessments are carried out to enable residents to be safe while helping them to be as independent as possible. We found that the system used made it easy to follow the progress of the care and treatment of each person, noting improvements or otherwise. A relative said, "There are attentive nursing and care staff, who always have time to explain. The home has very happy staff and residents. Regular GP visits are arranged to review medical needs and then discuss with family" Residents can choose to go where they wish in the home. Some sit in one of the lounges, and some prefer to stay in their own rooms. Residents commented that visitors called often, and they could use one of the lounges to chat, or go to their own room for privacy. "Staff are constantly available and call into the room very regularly, even just to say hello", said a resident. Staff were seen to be respectful and polite to residents, giving them time to do things at their own pace, and listening when asked to. A nurse oversees the medication processes, from ordering and storage, to use and disposal. This has improved the procedures, making them more efficient and correct. Staff address any diverse and individual needs to make sure each person is treated equally and feels as much at home as possible. "All residents are happy and enjoy life there", said a relative. We saw a daily programme of activities, which staff try to follow. At the visit staff were singing in the lounge with residents loudly joining in. Residents who wished to stay in their rooms could also be heard joining in. There was lots of talking and laughter during the activity.The menus are on a new 5 week menu rota, produced following a residents meeting to discuss meals. We sampled some of the lunch and found it well cooked and tasty. The residents all said they had enjoyed it, and most left empty plates. Residents said they usually liked the meals. All of the home was fresh and clean at the visit. Recruitment procedures are followed and full employment and police checks are made before new staff start working at the home. Staff have a good induction and training plan. The home has achieved the Investors In People Award, showing that staff are effectively developed through good training, support and guidance. The owners said they encouraged an `open house`, for staff, residents and their relatives to feel able to approach them with any issues. What has improved since the last inspection? Medication procedures have improved with a named nurse overseeing and monitoring them. "It`s very important that all medication procedures are followed correctly. Everyone involved needs to be clear on the right way to do things. I recently attended a refresher course and we are making sure orders and returns are done correctly. Of course we are only human, and occasionally a record gets missed, but we pick it up when we audit either the same day or at least every week", said the nurse. The recruitment procedure is followed more thoroughly, and full checks are made and received before staff are able to start working at the home. We saw a daily programme of activities, which staff try to follow. The owners told us that daily activities programme is reviewed every 3 months. What the care home could do better: The social history and life background of residents should always be included in their assessment information, to enable more person centred support. An up to date photograph of each resident should be on file. This is available on all of the medication records, but not in place on several personal files as required.The management should develop activities to include stimulation for people with dementia. The recording of people`s minor concerns should be carried out. These would identify any patterns that may lead to formal complaints if not addressed at an early stage. The record could also be used as part of the home`s quality assurance processes. General maintenance needs, as recorded by staff, should be carried out as soon as possible after they have been noted. Redecoration of tired and worn areas of the home should be carried out to maintain a pleasant environment for residents to live in. Staffing levels should be monitored regularly to ensure residents are assisted to live the lives they choose. For example staff numbers may need to increase at busy times of the day, or during activity sessions, to support people appropriately. A suitably qualified person must be appointed to manage the home and to register with the Commission for Social Care Inspection. CARE HOMES FOR OLDER PEOPLE Le Grand Nursing Home Le Grand Nursing Home Preston Old Road Freckleton Preston Lancashire PR4 1HD Lead Inspector Ms Jenny Hughes Key Unannounced Inspection 5th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Le Grand Nursing Home Address Le Grand Nursing Home Preston Old Road Freckleton Preston Lancashire PR4 1HD 01772 679300 01772 679669 legrandnursing@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Maganlal Khimchand Vachhani Mrs Nootalkumari M Vachhani Manager post vacant Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - 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 The maximum number of service users who can be accommodated is: 28 Date of last inspection 1st August 2007 Brief Description of the Service: Le Grand is a purpose built, single storey, care home, set in its own grounds, with outside seating for use in warmer weather. It is situated in the centre of the village, with all its facilities, and there is easy access to transport links. The home has its own car park. The home provides personal and nursing care for older people, and is well equipped to suit the needs of its residents. For example, there are assisted baths, hoists, grab rails, and ramps. All rooms are single and en-suite. They are all appropriately furnished, and the personal possessions of each resident are welcomed. Toilets and bathrooms are conveniently situated. There is sufficient communal space, with three lounges and a dining room, and seating areas around the entrance to the home. Three meals a day are provided, with varied choices, and snacks and any dietary needs are also catered for. Qualified nursing staff and care staff are provided over 24 hours, every day of the year. There is a Statement of Purpose and Service Users Guide available; this is a set of written information that tells you about the care service that is offered, who the manager and staff are and what the resident can expect if he or she decides to live at the home. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 5 As at August 2008, the fee scale ranges from £366 to £530.50 per week, with additional charges for chiropodist and hairdresser visits, and any extra newspapers and toiletries requested. Further details regarding fees can be obtained from the owners. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 star. This means that people using this service experience good quality outcomes. This was an unannounced site visit to the home, in that the owners were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. Before the visit took place, the registered providers were asked to complete an Annual Quality Assurance Assessment, where they outline the services being delivered and any developments that have been made. Surveys were received from staff and from people who live at the home and their relatives. During the site visit, some staff records and peoples’ care records were viewed, alongside the policies and procedures of the home. The home does not have a registered manager at present, and a named qualified nursing staff member was in charge of the day-to-day running of the home at the time of the visit. Each shift has a named qualified person in charge. The registered providers, referred to in this report as the owners, were also present, and they visit and help with the running of the home most days. The owners, nurse in charge, people who live at the home, and care staff, were spoken to and their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: A visit to the home by prospective residents is welcomed, and transport is available to help people do this if needed. We saw people being shown around the home by senior staff, discussing the facilities available and the routines of the home. “As a relative I was shown around and had a talk with the owner” was a comment on a survey. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 7 We saw that a standard pre-admission assessment is used by management for all prospective residents, to check that staff can give suitable care to each person, before the manager agrees that the home is the right place for the person to live. Individual care plans are available, identifying the areas of need for each person, and with clear instructions for staff for what they must do to meet that need. The systems have again been reviewed and further improved since the last visit. On the three files viewed we saw that monthly reviews were clearly carried out, and the care plans updated if needed. Risk assessments are carried out to enable residents to be safe while helping them to be as independent as possible. We found that the system used made it easy to follow the progress of the care and treatment of each person, noting improvements or otherwise. A relative said, “There are attentive nursing and care staff, who always have time to explain. The home has very happy staff and residents. Regular GP visits are arranged to review medical needs and then discuss with family” Residents can choose to go where they wish in the home. Some sit in one of the lounges, and some prefer to stay in their own rooms. Residents commented that visitors called often, and they could use one of the lounges to chat, or go to their own room for privacy. “Staff are constantly available and call into the room very regularly, even just to say hello”, said a resident. Staff were seen to be respectful and polite to residents, giving them time to do things at their own pace, and listening when asked to. A nurse oversees the medication processes, from ordering and storage, to use and disposal. This has improved the procedures, making them more efficient and correct. Staff address any diverse and individual needs to make sure each person is treated equally and feels as much at home as possible. “All residents are happy and enjoy life there”, said a relative. We saw a daily programme of activities, which staff try to follow. At the visit staff were singing in the lounge with residents loudly joining in. Residents who wished to stay in their rooms could also be heard joining in. There was lots of talking and laughter during the activity. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 8 The menus are on a new 5 week menu rota, produced following a residents meeting to discuss meals. We sampled some of the lunch and found it well cooked and tasty. The residents all said they had enjoyed it, and most left empty plates. Residents said they usually liked the meals. All of the home was fresh and clean at the visit. Recruitment procedures are followed and full employment and police checks are made before new staff start working at the home. Staff have a good induction and training plan. The home has achieved the Investors In People Award, showing that staff are effectively developed through good training, support and guidance. The owners said they encouraged an ‘open house’, for staff, residents and their relatives to feel able to approach them with any issues. What has improved since the last inspection? What they could do better: The social history and life background of residents should always be included in their assessment information, to enable more person centred support. An up to date photograph of each resident should be on file. This is available on all of the medication records, but not in place on several personal files as required. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 9 The management should develop activities to include stimulation for people with dementia. The recording of people’s minor concerns should be carried out. These would identify any patterns that may lead to formal complaints if not addressed at an early stage. The record could also be used as part of the home’s quality assurance processes. General maintenance needs, as recorded by staff, should be carried out as soon as possible after they have been noted. Redecoration of tired and worn areas of the home should be carried out to maintain a pleasant environment for residents to live in. Staffing levels should be monitored regularly to ensure residents are assisted to live the lives they choose. For example staff numbers may need to increase at busy times of the day, or during activity sessions, to support people appropriately. A suitably qualified person must be appointed to manage the home and to register with the Commission for Social Care Inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information the home gives to people about the services available, and the way it gathers information about people who want to live there, means that proper choices can be made about the suitability of the home. EVIDENCE: A ‘Prospectus’ for the home gives detailed information, and has been reviewed since the last visit. We discussed how it could be improved to make it more user friendly. All the residents’ surveys returned to us said they had a contract, and had enough information about the home to be able to make a decision on whether to stay there. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 12 Individual records are kept for each of the residents, and there is a set procedure for admitting someone to the home. A checklist is used to make sure nothing is missed. The manager informed us that they plan to concentrate further on gaining as much information as possible on the history of falls a potential resident may have suffered in the past. This will help to inform the nursing staff on the amount of supervision required, and may influence the choice of room and lounge so that they can be intensively supervised if needed. Detailed information about the care needed by the residents was seen on three selected files. All the information held a signed agreement from the resident. We noted that some people had better social history information than others, and advised that it is important to ascertain people’s background, interests and hobbies as this helps towards more person centred care. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs for everyone living at Le Grand is well organised, meaning people benefit from individualised care and support. Medication procedures are good and protect the welfare of the people living there. EVIDENCE: Assessments and consent forms were all signed by the resident or their family in agreement. Consent forms are in place for such as self medication, the use of cot sides and wheelchair restraints, and whether the resident would like a door lock. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 14 On the three files viewed we saw that monthly reviews were clearly carried out, and the care plans updated if needed. There is good detail on pressure area care, and the records show the care provided was very successful, with good further prevention guidance given. Records are kept of nutritional needs, and weight gains and losses. According to daily records one resident had experienced a couple of falls which had been also recorded on an accident form, with what further action was taken to try and prevent more similar incidents. Diverse and individual needs are addressed, the staff adjusting the care to suit the person. Risk assessments are carried out to enable residents to be safe while helping them to be as independent as possible. One resident likes to help in the home, and specific tasks are given to them so that staff can be monitoring their welfare at all times. We saw good medical information and detail on physical needs, although the information on social history and interests was not always complete for all. Some files had an up to date photograph of the resident, and some had none. The management need to ensure all files follow the same standard. Healthcare visits from, for example, the GP, dentist, chiropodist, dietician, and physiotherapist, are recorded, and show their visits made are regular. “They always call the GP if I need them” said one resident. A ‘Handover Data’ sheet is used for all residents every day for staff at shift changes. “We have shift by shift handover in a relaxed atmosphere which allows full exchange of relevant information on all sides” There are three lounges, so some residents preferred to sit quietly in one lounge, while others sat with a television on in another. One resident received a visitor who sat with them in the lounge to chat. Some preferred to stay in their own rooms. Residents constantly visited the managers office, asking questions and simply chatting. Staff were seen taking time to listen to a resident as they provided personal care tasks. Medication was stored in a lockable trolley within a secure designated medication room. Procedures have improved with a named nurse overseeing and monitoring. The home liaises regularly with the local pharmacy. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents daily lives and social activities are generally well catered for, and all people benefit from living in a home that works to ensure that people are provided with opportunities to live lives that are fulfilled. EVIDENCE: Most of the individual care plans include information on each person’s life history, their religious needs, and what activities they like. Not all plans included a social history of residents, with notes of interests past and present. This should be further developed. “You get company when you want it, privacy when you don’t. It’s a very happy place to be. I’m in bed a lot of the time, but the staff asked me if I’d like them to refresh my bed because it would make me feel better. You wouldn’t get that anywhere else you know”, said a resident. Visitors call regularly, a visitors book giving good evidence of this. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 16 The activities programme includes armchair exercises, bingo, a quiz, singing, hair and manicure sessions, darts, aromatherapy, videos and visits from church ministers. The owner said that they were happy to try and do whatever the residents wanted. Most enjoyed trips to the local large garden centre, to Fairhaven Lake, or just shopping. Outings tend to be generally monthly, but not all residents are able to go, due to mobility problems. Some residents have planted flowers and have the job of looking after their pots and watering the plants each day. One resident said they liked to read, and opportunity was given to get books from the library, while another liked it when staff read stories and articles to them. We advised addressing the specific needs of the people with dementia, and having activities that would be suitable for their stimulation, including 1:1 time. We suggested The Alzheimer’s Disease Society as a good source of information. We saw that a new patio was in the process of being built, which would have a fountain, garden furniture, bird tables, and raised garden beds. This will provide a pleasant outside area for people to sit in better weather. Some residents visited the garden centre and helped choose the colour of the patio stones and the type of fountain. The cook on duty at the visit was organised and enthusiastic, and held records in the kitchen of special diets people may have. She was able to discuss people’s likes and dislikes. Staff served food in the pleasant dining room, helping tactfully when needed. One survey commented that the food was too bland and they would like more variety, which was passed onto the owner to consider. The menus we saw were varied and nutritious and all residents said they enjoyed the meals. Since the last visit new dining furniture has been purchased, making a cosier atmosphere and easier access for wheelchairs. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a complaints procedure in place, with a complaints book to record any complaints, which may come to the manager’s attention. The home’s complaints book has no records of complaints. The complaints procedure needs to include timescales of responses to the complainant. We discussed the benefits of recording minor grumbles with the owner, which are useful to identify underlying problems which may be causing some dissatisfaction, for example issues around the garden needing maintaining, and the meals being more varied have been noted on the CSCI surveys. All of the residents spoken to said they would tell the staff or Dr or Mrs Vacchani if they were unhappy. Several ‘thank-you’ cards and letters of compliment from family and friends were seen. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 18 There is advocacy information available for anyone who is without relatives and who might need someone to speak on their behalf. Long term staff were on duty and they had attended training in Adult Protection procedures (known as Safeguarding), and what to do if they had any concerns. They said they would always act if they thought a resident was at risk. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a mostly well-maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a pleasant, safe, and homely place to live. EVIDENCE: The home is set in its own grounds, with a protected garden area with a lawn, and flowerbeds. The grounds are starting to look as though they need some maintenance, along with the need to complete the new patio and water feature area to provide an attractive outside area for residents to sit. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 20 Residents said they enjoy sitting outside in the better weather. Presently most people like to sit near the front door and watch the comings and goings to the home, and there was evidence of this at the inspector’s arrival at the home, with a few chairs and an umbrella just outside the porch area. A comment from a relative was “Pleasantly surprised with the environment. Decorating needed to spruce up some areas, but always clean and tidy”. The bedrooms, all ensuite, were furnished and decorated, and were full of resident’s personal belongings, such as photographs and pictures, ornaments and flowers. At the visit the home was fresh and clean, although there were areas that appeared tired and worn, with cracks in walls and marked paintwork. Roof fixes had been done where needed, but the interior décor had not been completed where watermarks showed. A chest of drawers in one room was broken but being used by a resident. Other rooms were clean and nicely decorated. Rooms should be audited for work needing doing, and tasks completed, usually before the room is used if possible. A general maintenance book is used for staff to record jobs needing doing around the home, and at the visit there were a large number of jobs not yet addressed. These need to be attended to as soon as possible after being entered into the record. The owners said that a new maintenance person is soon to be appointed. New dining room furniture has been purchased since last visit. There is plenty of communal space with three lounges, a dining room, and ample space to sit in the large entrance hall. People can choose where they want to be, and were seen moving from one place to another as they wished. Grab rails, assisted baths, lifting and bathing hoists, and raised toilet seats all go towards helping the mobility of people around the home. Call systems in every room are regularly checked. The laundry room was clean and tidy, with an organised system being used to protect against cross infection, and to make sure there is no misplaced clothing. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is properly staffed, which means that the residents are usually supported by sufficient numbers of well trained and appropriately qualified staff. EVIDENCE: Two staff files were selected and we saw that recruitment procedures were followed with them both, ensuring the protection of residents. References and Criminal Bureau checks were available. Professional qualifications are also confirmed. The management ensure all of the information is complete before the new staff start work. All new staff have induction training and are given a staff handbook, which gives guidance on working practices in the home. “New care staff shadow the senior carer when they start work. She can then assess that they are competent”, said the owner. Some staff felt the induction only partly covered all they needed to know, but some staff said “Very comprehensive induction and we are always reassured about not being worried to ask for further help or clarification on any matter”. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 22 A staff rota of trained nurses, care staff, and domestic staff showed who is on duty at any time. The owners confirmed they monitor the assessed needs of residents, and accordingly staff numbers. They were advised to always ensure there are enough staff to cover busier periods in the home, for example in a morning to help people get up. Staff also commented that resident’s needs were such that several often needed two staff to assist in tasks, leaving only one staff to monitor the other people in the home. Also several people needed help to actually participate in the activities when they were taking place, when again more staff were needed to be available. There are a few long-term staff at the home “I really like working here. It’s a good team, with approachable employers” The owners said that the staff team is multi-cultural, and have found it enriches the home and encourages discussion and conversation with residents. We saw a training matrix for nurses and care staff, which showed between them they had attended courses in the following; NVQ, fire safety, food safety, health and safety, moving and handling, Infection control, nutrition, continence, and training is agreed for more safeguarding awareness. Nurses have also attended courses on more clinical issues such as catheterisation. 55 of care staff hold NVQ qualifications, which just exceeds the 50 stated in the Care Homes Standards as required. The management should continue to ensure care staff attend this training. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The owners and senior staff work to improve services and to protect the health and safety of residents. However, there is no registered manager to lead and support the staff as a role model, and to help further develop quality services. EVIDENCE: The home does not have a manager at present, the last appointment leaving the home in April 2008 after a few months in post, before being registered with The Commission for Social Care Inspection. There has been an appointed manager since the last visit, so a new time scale has been made to allow the owners time to recruit and appoint a new manager. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 24 Until the new manager starts working at the home the day-to-day running of the home is carried out by a named member of staff who is a Registered Nurse, and who is on duty that day. The owners of the home are also present at the home most of the time. The owners must appoint a suitably qualified person to manage the home and to register with the Commission for Social Care Inspection. The owners said that the lack of manager has meant that other staff have learnt about, and have more of an understanding about, the management role and responsibilities. A senior carer is now the named Care Coordinator, developing her role to coordinate care staff and ancillary staff, and carry out one to one supervisions and audits. The staff are aware that their experience and abilities have helped the owner manage the situation until a manager is appointed, and commented “I think we’ve done well to carry on without a manager in place, and we are missing that leader to pull everything together. But in the meantime the proprietors meet with us and discuss how we work” We saw minutes of meetings for both staff and residents. Care staff meetings included issues such as instruction on making sure staff did not rush people at meal times, a discussion on confidentiality and examples of what this means in practice, and information on the reintroduction of key workers for the residents. Nursing staff meetings included discussion on completing care plans and reviews, a prompt on the receipt and disposal of medication, and ensuring the register of those people assessed as competent to carry out clinical tasks was up to date. Residents meetings included a discussion on the meals, which most said they found enjoyable, but suggested some changes they would like. Questionnaires from the home to relatives and residents all gave positive responses. There is regular and ongoing communication within the small staff group, with a handover session being done at shift change. We saw memo’s to staff to stress particular points. Supervision of staff in the form of regular one to one meetings take place, with full records made. These are targeted to each staff member’s individual needs, and identify training needs and confirm correct working practices. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 25 The home is not responsible for handling any residents’ finances, and they either manage them themselves, or family help in this area. Procedures in the home are regularly reviewed and updated if needed, and the management team are open to suggestions on ways to improve systems. The owners confirmed in their pre-inspection information that all maintenance services on any equipment in the home were up to date. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 9 Requirement Timescale for action 30/11/08 2. OP19 23(2) The service must employ a suitably qualified and experienced manager who is registered with the CSCI (Timescale of 31/10/07 not metAppointed person left employ) General maintenance as 30/09/08 recorded by staff must be carried out as soon as possible after it has been noted. Redecoration of tired and worn areas of the home must be carried out to maintain a pleasant environment for residents to live in. Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP12 OP16 Good Practice Recommendations There should be full information on all resident’s backgrounds, social history and interests to help staff achieve person centred care. Activities should be developed to include stimulation for people with dementia. The management should develop the recording of resident’s dissatisfactions within their complaints procedure to identify any patterns, which may lead to formal complaints in the future, and to use as part of their quality assurance process. Staffing levels should be monitored at all times to ensure residents are assisted to live the life they choose. For example staff numbers may need to increase at busy times of the day, or during activity sessions. Photographs of residents should be on their file. 4. OP27 5. OP37 Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Le Grand Nursing Home DS0000006054.V370117.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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