Care Home: Leeming Bar Grange

What the care home does well The home`s pre-assessment processes help to make sure that Leeming Bar Grange will be able to provide the care people need before they move in. People`s needs are assessed and written down in their care records and staff care for people in a friendly and dignified way. Comments made by relatives we spoke to or who returned surveys included "residents are well treated", "friendly, patient staff", "oh yes, she`s always clean and tidy when we come" and "I`ve no complaints about the staff at all, very patient and very kind". There are regular organised events and the care staff provide activities on a day to day basis. Visitors told us that they are made to feel welcome. Regular meals, drinks and snacks, such as fruit, biscuits and buns, are provided each day. Comments made to us about the food at Leeming bar Grange included "the food is usually very good, with drinks and cakes/biscuits provided mid morning and afternoon" and "I come on a Sunday and have tea with him. The food is excellent, I think so, they are well fed". People are protected by the home`s safeguarding procedures and know how to raise any concerns that they have. Relatives we spoke to felt able to approach the home`s staff and management if they had any problems, with comments including "yes, they are very good if you have anything to say" and "I`ve never had anything to worry about. They are all very good, even the boss". The home is nicely decorated and generally provides people with a well maintained place to live. There are two pleasant garden areas providing secure outside space. Staff are provided in appropriate numbers at the home. People who we spoke to and who returned surveys spoke well of the staff at Leeming Bar Grange. Comments included "I would say they (the staff) want a medal", "the staff are very good", "I`ve no complaints about the staff at all, very patient and kind" and "they`ll (the staff) come without a grumble if I ask them too". People we spoke to during our visit also told us that the new manager was approachable, with comments including `the staff are very good, including the boss`. What has improved since the last inspection? Since our last inspection a lot more people have come to live at Leeming Bar Grange and the home now has good occupancy levels. The home has developed a stable staff team, with a number of staff who have worked there since the home opened. The home is now reporting safeguarding incidents to the local authority and notifying us of appropriate events. Staff we spoke to were aware of safeguarding reporting procedures and had received relevant training. What the care home could do better: We did find some examples where the care plans should have contained more detail about people`s needs. For example, one person had been assessed as being at risk of pressure damage, but their care plans did not contain enough information about the preventative care that was to be provided. The person actually uses a special mattress and should sit on a special cushion to help prevent further pressure damage, but these things weren`t mentioned in their care plan and the person wasn`t using their cushion when we visited them in the home. We found that medication is not always being managed in the most appropriate or safe way. For example, staff were sometimes giving medication to people that had actually been prescribed for another person. This isn`t a safe practice. The complaints records we looked at showed that complaints are not being responded to within appropriate timescales. For example, one person complained to the home in October 2009, but didn`t receive a formal, written response from the area manager until February 2010. On the day of our visit some aspects of cleanliness could have been improved. However, the relatives we spoke to during our visit told us "his rooms always nice and clean" and "it`s clean and never smells". We found that safe recruitment checks are not always being completed on new staff before they start work in the home. This is very important because the home needs to make sure that it`s staff are suitable to work with vulnerable people. Some of the home`s staff haven`t received all of the training that they need to do their jobs effectively. For example, according to the home`s training records some staff have not completed training in dementia care, infection control, food safety or fire safety. The new manager isn`t currently registered with us and isn`t receiving formal supervision sessions from the area manager, although the area manager does visit the home regularly to provide support. We have also made a number of requirements and recommendations in this report that should have already been picked up by the home`s internal quality assurance systems, if they were working effectively. For example, the shortfalls in recruitment, training and medication. Key inspection report Care homes for older people Name: Address: Leeming Bar Grange Leeming Bar Grange Leeming Lane Leeming Bar Northalleron DL7 9LT     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: Rachel Martin     Date: 2 5 0 2 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 31 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 31 Information about the care home Name of care home: Address: Leeming Bar Grange Leeming Bar Grange Leeming Lane Leeming Bar Northalleron DL7 9LT 08452710791 01677426681 stgeorgeslodge@orchardcarehomes.com www.orchardcarehomes.com Orchard Care Homes.Com Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home only - code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia - Code DE, maximum number of places 60 Date of last inspection Brief description of the care home Leeming Bar Grange is a purpose built care home. The building of the home was completed in 2007 and it was registered with us in November of the same year. Leeming Bar Grange is registered to provide residential care for up to 60 people with dementia. It is not registered to provide nursing care. The home is owned by Orchard Care Homes Limited. Care Homes for Older People Page 4 of 31 Over 65 0 60 Brief description of the care home The home is located on the edge of Leeming Bar and has a pleasant, rural outlook. The home provides purpose build accommodation on two floors, with modern lift access. All of the bedrooms having en-suite toilet, washbasin and shower facilities. Communal bathrooms with specialist bathing equipment are also available for people who prefer to have a bath. Communal toilets are available at convenient places around the building and a number of communal lounges, seating areas, dining rooms and a conservatory are provided, so that people have a choice of where to spend their time. The home has two secure garden areas and a car park. At the time of our visit the weekly fees ranged from £375 - £575. This does not include additional items and services, such as hairdressing, personal toiletries and chiropody. Up to date information about fees and terms and conditions should always be sought directly from the home. Care Homes for Older People Page 5 of 31 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: This was an unannounced inspection, which was undertaken by one inspector and took place on 25th February 2010. A follow up visit was made to the home on 2nd March to talk to the homes manager. During our visits we followed up the requirements and recommendations we made at the last inspection, looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. Before our inspection visit we reviewed all of the information we had received about the service since the last inspection. This included information about events in the home, changes to the homes management, information about complaints and safeguarding incidents and the self-assessment (Annual Quality Assurance Assessment) that the home had completed and submitted to us. We also sent out a selection of surveys to people who live at the home and their Care Homes for Older People Page 6 of 31 relatives, the homes staff and health and social care professionals who visit and work with the home. Two people who live at the home and two staff completed and returned these surveys to us. The survey results have been included in this report where appropriate. Since the last key inspection we have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement has to be repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We did find some examples where the care plans should have contained more detail about peoples needs. For example, one person had been assessed as being at risk of pressure damage, but their care plans did not contain enough information about the preventative care that was to be provided. The person actually uses a special mattress Care Homes for Older People Page 8 of 31 and should sit on a special cushion to help prevent further pressure damage, but these things werent mentioned in their care plan and the person wasnt using their cushion when we visited them in the home. We found that medication is not always being managed in the most appropriate or safe way. For example, staff were sometimes giving medication to people that had actually been prescribed for another person. This isnt a safe practice. The complaints records we looked at showed that complaints are not being responded to within appropriate timescales. For example, one person complained to the home in October 2009, but didnt receive a formal, written response from the area manager until February 2010. On the day of our visit some aspects of cleanliness could have been improved. However, the relatives we spoke to during our visit told us his rooms always nice and clean and its clean and never smells. We found that safe recruitment checks are not always being completed on new staff before they start work in the home. This is very important because the home needs to make sure that its staff are suitable to work with vulnerable people. Some of the homes staff havent received all of the training that they need to do their jobs effectively. For example, according to the homes training records some staff have not completed training in dementia care, infection control, food safety or fire safety. The new manager isnt currently registered with us and isnt receiving formal supervision sessions from the area manager, although the area manager does visit the home regularly to provide support. We have also made a number of requirements and recommendations in this report that should have already been picked up by the homes internal quality assurance systems, if they were working effectively. For example, the shortfalls in recruitment, training and medication. 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 31 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 31 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 pre-assessment processes help to make sure that Leeming Bar Grange will be able to provide the care people need before they move in. Evidence: In the homes self-assessment they told us If an assessment has already been done though the local authority/hospital, our pre-assessment process requires us to obtain a copy of the assessment and care plan before the client can be admitted. We still conduct our own pre-assessment as the needs of the individual may have changed and The pre-assessment usually is conducted by the manager or senior member of staff. The individual and the family are encouraged to participate and to be involved in the pre-assessment process. During our visit to the home we looked at a number of peoples care records. These records contained assessments of the persons needs, which had been completed before they moved into the home. They also contained information that had been Care Homes for Older People Page 11 of 31 Evidence: provided by other professionals where this was appropriate. We also discussed the admissions process with the manager and deputy manager. They both confirmed that people can come to look around the home and have their needs assessed before they move in. Care Homes for Older People Page 12 of 31 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. Peoples needs are assessed and written down in their care records and staff care for people in a friendly and dignified way. However, medication isnt always managed in the most appropriate or safe way. Evidence: Comments made by relatives we spoke to or who returned surveys included residents are well treated, friendly, patient staff, oh yes, shes always clean and tidy when we come and Ive no complaints about the staff at all, very patient and very kind. During our visit we observed staff being polite to people and assisting people in a respectful way. For example, talking nicely to people while assisting them and explaining what was happening. In their self-assessment the homes manager told us we believe that our care plans are vitally important as they are critical to us being able to administer safe and efficient care. A detailed plan of care is created for residents following admission. This is created using pre-assessment information, information received from other professionals and continual assessment of the resident. We looked at a selection of Care Homes for Older People Page 13 of 31 Evidence: peoples care records during our visit. These records contained assessments, risk assessments, care plans, evaluations and records of the care given by staff and other professionals. Generally we found that they were up to date and provided some good information about peoples care needs and their preferences. Staff were regularly evaluating peoples assessments and the information in the care plans. The records showed that the home involved other professionals, such as doctors, nurses and psychiatrists if they were needed. However, we did find some examples where the care plans should have contained more detail about peoples needs. For example, one persons care plan said that they needed an appropriate diabetic diet, but gave no information on what this actually meant for this particular person. Another persons care plan did not contain enough information about the recent changes in their mental health or how staff should manage their challenging behaviour. One person had been assessed as being at risk of pressure damage, but their care plans did not contain enough information about the preventative equipment that was to be used. The person actually uses a special mattress and should sit on a special cushion to help prevent further pressure damage, but these things were not mentioned in their care plan and the person wasnt using their cushion when we visited them in the home. It is important that information about these things is available in peoples care plans and that staff are ensuring that the assessed care needs are actually being provided for. We spent time with one of the senior care staff, who is responsible for administering medication in the home. The carer confirmed that she has received training on medication administration. The home uses the Boots Monitored Dosage System (MDS) and medication was being stored appropriately in locked cupboards in a secure treatment room. A medication fridge is available if needed and staff monitor the fridge and room temperatures daily. However, we noticed from the temperature records that the treatment room was regularly reaching 24 degrees Celsius and had been 26 degrees on the day before our visit. Most medication manufacturers recommend that their medication should be stored below 25 degrees Celsius and we made a recommendation about this same issue during our last inspection visit. The home has moved the medication storage room since our last visit to try and improve things, but this hasnt fully solved the problem. We checked a number of peoples medication administration records against the medication stock balances and blister packs. This showed that people were usually receiving the medication they needed in accordance with their prescription. However, we found a number of practices around the administration of medication that need to be improved. A number of people had creams in their en-suite bathroom Care Homes for Older People Page 14 of 31 Evidence: that had originally been prescribed for someone else. This is very poor practice, as prescribed medication belongs to the person it has been prescribed for and should only ever be used for that person and in accordance with the prescribers instructions. One person had three creams that were prescribed for their use in their en-suite bathroom. However, when we checked the persons medication administration record we found that two of these creams were not written on it. When we asked staff about this they didnt know if they were supposed to be using the medication or not. This means that the person may not have been getting the medication they needed, but also might have been given medication that they no longer need. We also found that some recording practices need to improve. For example, the way changes in peoples warfarin doses are recorded and witnessed to prevent confusion and administration errors and how medication that is given by the district nurses is recorded on peoples medication administration records. Care Homes for Older People Page 15 of 31 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. There are regular organised events and the care staff provide activities on a day to day basis. Regular meals, drinks and snacks are provided each day. Evidence: The home does not currently employ a dedicated activities coordinator, but care staff provide social interaction and activities on a daily basis. The company has a centralised activities coordinator who helps to organise events and activities in the companys homes. We were shown the homes calendar of events, which showed the main events that were planned for the next six months. The plan showed around three or four events each month, including fish & chip suppers from the fish & chip van that calls every six weeks, a mothers day tea party, a grand national day sweep stake, a garden party and several BBQs. Additional regular events include a motivation/exercise to music class each week, an reminiscence entertainer who visits two or three times a year and a six weekly church service. During our visit we saw staff reading to one person and another staff member doing a quiz with a group of people. Comments made to us by peoples relatives included they do try to do activities on an afternoon, they do use the gardens when the weathers better and had a garden fete a while back. However, when we asked what the home could do better, one relative commented a dedicated member of staff or someone to come in Care Homes for Older People Page 16 of 31 Evidence: and do activities. During our visit we saw visitors coming and going throughout the day. Relatives we spoke to told us that they could visit when they wanted to and were made to feel welcome. People we spoke to during our visit told us that there were regular drinks and snacks provided. During the morning of our visit we saw people being offered a drink and a selection of biscuits and freshly cut up melon, apple and grapes. In the afternoon we saw people being offered drinks, along with a selection of cakes and buns. Some of the relatives we spoke to told us that they could have meals with their relative if they wanted to and made comments like if they bring the coffee round when youre here its always do you want a cup? and I come on a Sunday and have tea with him. The food is excellent, I think so, they are well fed. A relative who completed a survey told us the food is usually very good, with drinks and cakes/biscuits provided mid morning and afternoon. We observed the lunchtime meal in one of the homes dining rooms. The tables were nicely set and care staff served the meal from a hostess trolley. There was a choice of shepherds pie, with carrots, turnip, mashed potatoes and gravy or jacket potato with tuna mayonnaise and/or cheese. Staff asked people what they wanted, but could have made it easier for people to make up their minds by showing them the different foods that were on offer. The food looked nice and we tried some of the shepherds pie and vegetables. The food we tried was fine, but it wasnt very warm, having been stood on top of the trolley for some time while staff served it. Care Homes for Older People Page 17 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes safeguarding procedures and know how to raise any concerns that they have. However, complaints are not being responded to within appropriate timescales. Evidence: In their self-assessment the homes management told us All residents, representatives and visitors to the home have access to the complaints procedure which is clearly documented and displayed in the foyer and in each residents bedroom within their service users guide. Relatives we spoke to felt able to approach the homes staff and management if they had any problems, with comments including yes, they are very good if you have anything to say and Ive never had anything to worry about. They are all very good, even the boss. The two people who completed surveys told us that there was someone they could speak to at the home if they were unhappy and that they knew how to make a formal complaint if they needed too. We have received one formal complaint about the home since the last inspection. This complaint included dissatisfaction with the way the home had responded to the persons concerns. This complaint was investigated by the home, with some involvement from the local authority. During our visit we looked at the homes record of complaints. The home has received four formal complaints since our last visit and Care Homes for Older People Page 18 of 31 Evidence: the records showed what had been done in response to them. However, we found that the home was not always responding to people within appropriate timescales or keeping good records of the work that had been done to respond to peoples concerns. For example, one person had made a formal complaint on 8th October 2009, but had not received a written response until January 2010. Another person had made a complaint on 9th October 2009, but had not received a written response until the beginning of February 2010. The manager was able to tell us what had been done about the concerns before the written responses were sent, but these actions were not recorded in the complaints record to evidence this work. Since our last inspection there had been some concerns raised by the Local Authority, because the home did not appear to be reporting the number of safeguarding incidents that would be expected in a dementia care home like Leeming Bar Grange. However, we now find that any issues are being reported to the local authority and to us appropriately. The local safeguarding coordinator has confirmed to us that the home is reporting and handling any safeguarding issues well. On the day of our visit there was a safeguarding incident between two people who live at the home. The deputy manager reported this to the local authority at the time and completed the appropriate safeguarding alert forms. This shows that staff are aware of local safeguarding reporting procedures and are using them appropriately. Care Homes for Older People Page 19 of 31 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. The home is nicely decorated and generally provides people with a pleasant place to live. However, on the day of our visit some aspects of cleanliness could have been improved. Evidence: We looked around the building and gardens during the inspection. Leeming Bar Grange is a new, purpose built care home. The homes self-assessment told us how the rooms are spacious, provide en-suite toilet, shower and washbasin facilities, and that each room has a fridge, TV and DVD player. These facilities were seen during our inspection. Peoples rooms contained their own possessions and were comfortable and homely. The homes furnishings and decoration are of good quality and provided a comfortable and pleasant place for people to live. The home was decorated in soothing colours and there were plenty of accessories that created a homely and comfortable feel. The new manager had started to make the environment more dementia care friendly, by adding accessories that people could pick up, feel and use, providing more sensory stimulation. There were also pictures and information put on peoples bedroom doors, to help them recognise their own room and reduce confusion. Communal space is divided into a number of smaller lounges, dining rooms, seating areas and kitchen areas where staff, residents and visitors can make snacks and drinks. The Care Homes for Older People Page 20 of 31 Evidence: conservatory provides a pleasant seating area, with views over the main garden. There are two secure garden areas, with seating so that people can enjoy the outside space. Plants that offer sensory stimulation (nice smells and touch) have been planted. The homes laundry is modern and fully equipped, with appropriate maintenance arrangements in place. We were told that the home employs a laundry assistant who works Monday to Friday and also has two domestic staff on duty every day. The two people who returned a survey told us that the home was always and usually kept fresh and clean. The relatives we spoke to during our visit told us his rooms always nice and clean and its clean and never smells. However, during our visit we found some aspects of cleanliness that needed to be improved. When we looked around the home between 10am and 11am some of the en-suite bathrooms we looked were not very clean. For example, some of the en-suites smelled unpleasantly, some of the toilets were dirty and two en-suite doors were soiled with faeces. We also found that some of the bedrooms and some of the communal areas did not smell very fresh. We spoke to the manager about this, who explained that only one cleaner had been on duty on the day of our visit. Staff have also now been asked to prioritise cleaning so that any problem areas or soiling gets cleaned up more quickly. The staff training records that we were provided with during our visit showed that some care and domestic staff have completed infection control training, but that others have not. Care Homes for Older People Page 21 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in appropriate numbers, but safe recruitment checks are not always completed on new staff and some of the homes staff have not received all of the training that they need to do their jobs effectively. Evidence: People who we spoke to and who returned surveys spoke well of the staff at Leeming Bar Grange. Comments included I would say they (the staff) want a medal, the staff are very good and Ive no complaints about the staff at all, very patient and kind. We looked at the staff rotas and spoke to the management and staff about staffing levels at Leeming Bar Grange. The manager works in the home on a full time basis. Her main hours are provided Monday to Friday, but she does work at weekends and evenings when needed. During the day there is also a deputy manager on duty, with a senior carer and three carers on each floor. Sometimes an additional floating member of staff is also on duty, to help if there are a lot of meetings planned or the manager isnt on duty. Two staff returned surveys to us. When we asked if there are enough staff on duty to meet peoples individual needs both answered always. Comments made to us by peoples relative include theyll (the staff) come without a grumble if I ask them too. During our visit we observed that there was a good staff presence available in the communal areas. Care Homes for Older People Page 22 of 31 Evidence: At the last inspection we made a requirement telling the home to ensure that the appropriate checks and references had been received before staff started to work there. This is important because it helps to ensure that the staff who work in the home are of good character and suitable to work with vulnerable people. During this visit we checked the recruitment records for two recently recruited staff. We found that both staff had started to work at Leeming Bar Grange before any written references had been received. Both staff also started work before the full Criminal Records Bureau (CRB) disclosure had been received, using the PoVA First check system. This is allowed, but only in exceptional circumstances and when all of the other recruitment checks and references have been received, which was not the case for these two staff. These practices show that the home has not been following robust recruitment systems. Because of this we have repeated the requirement we made during our last inspection. The staff we spoke to confirmed that training is being provided on an ongoing basis by Orchard Care. The training records we saw confirmed that some staff had recently received manual handling and safeguarding training and that other staff were undertaking national vocational qualifications (NVQs) in care. The staff who returned our surveys told us that they were given training that was relevant, helped them understand peoples needs, kept them up to date and gave them enough knowledge about health care and medication. Their comments included provides staff with right training and regularity. The homes self-assessment told us that 21 out of the homes 26 permanent care staff (81 ) have already achieved an NVQ in care. However, the overall training matrix that was given to us during the inspection (showing all staff and the training they have received) showed that a number of staff had not received all of the training that they needed. For example, not everyone had completed dementia care, fire safety, food hygiene or infection control training. We also found that some additional training needs to be provided. For example, the people who live at the home can sometimes behave in a challenging or aggressive way towards the staff and other residents. Because of this there have been a number of incidents at the home and staff would benefit from receiving specific training on managing challenging behaviour. Staff also need to receive training on the Mental Capacity Act and deprivation of liberty safeguards. Care Homes for Older People Page 23 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate management structure is in place, but the new manager needs formal supervision and support to ensure that the home is run safely and in the best interests of the people living there. Evidence: Since the last inspection there has been a change of management at Leeming Bar Grange. The previous manager has left the home and the deputy manager has now become the permanent manager. The new manager has achieved qualifications in care and management, but has not yet applied for registration with us. People we spoke to during our visit told us that the new manager was approachable, with comments including the staff are very good, including the boss. The manager is enthusiastic about her role and able to tell us about the changes she is making in the home and her plans for the future. However, she is also aware that this is her first job as a home manager and that she needs guidance and support to ensure that she is fulfilling her role. A senior manager visits the home regularly to Care Homes for Older People Page 24 of 31 Evidence: provide support and records of these visits were available. However, the new manager is not currently receiving formal, recorded supervision sessions from her line manager, which should be taking place at least six times a year. We talked to the manager about the training and procedures that the home has in place to ensure that the Mental Capacity Act deprivation of liberty safeguards and authorisation conditions are being met by its staff. There are no people currently living at the home who are subject to a deprivation of liberty authorisation. However, although the homes previous manager had completed some training in this area, the current manager and staff have not completed any relevant training. Staff we spoke to didnt feel that they had the necessary skills and experience in this area and felt that training was needed. The home uses the Orchard Care companys quality assurance system. This is a system of audits and checks that the manager and area managers complete, to make sure the home is providing a safe and good service. Records of the completed audits were available and seen during the inspection. The system includes resident and relatives surveys. The manager confirmed that family meetings take place twice a year and we saw the records from the most recent meeting. These showed that the new manager had explained the changes that were taking place at the home and given people chance to express their views. However, the requirements and recommendations weve had to make in this report suggest that the homes internal quality assurance systems could be improved. For example, we would have expected the homes internal quality checks to have picked up and corrected the poor medication and recruitment practices and to have identified and rectified the issues that we found around training and complaints. The home only helps people to manage small amounts of personal money, with other financial affairs being managed by peoples family, solicitor or the local authority. We checked the records and arrangements for three people. These records included appropriate receipts and were up to date and correct. The homes self-assessment told us that appropriate servicing and inspection arrangements are in place for the safe maintenance of the homes equipment. The home employs maintenance staff and records were available to show that equipment was regularly serviced and checked. However, some of the maintenance and safety records could be better organised. For example, there were two different files containing fire records, some of which were in use and some that were no longer being used. Care Homes for Older People Page 25 of 31 Evidence: The local Fire Authority last visited the home in May 2008 and one of the things they wanted the home to improve was fire training and drills. The manager told us that regular fortnightly fire drills were being completed and that all staff covered basic fire safety during their induction training. However, the recording of the fire drills needs to improve because they do not clearly show when the drill took place, which staff were involved or any improvements that are needed. The staff training records we were provided with included fire training, but they also showed that some staff hadnt completed this yet and that others needed their training up dating. We were told that some staff had completed fire training in November 2009, but this training was not included on the training records we were given. Care Homes for Older People Page 26 of 31 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 29 19 & Schedule 2 All of the required 30/04/2010 information specified in the care homes regulations must be obtained before staff start work in the home. This requirement was made at the last inspection and the previous compliance timescale of 30/06/08 has not been met. The home must make sure that all care staff who are employed in the home are suitable and safe to work with vulnerable people. Care Homes for Older People Page 27 of 31 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 9 13 All medication must be stored within the manufactures recommended safe temperature parameters. If medication is stored at unsafe temperatures it may loose its effectiveness. We made a recommendation about this at the last inspection and have now made it a requirement. 30/04/2010 2 9 13 Safe systems need to be put 30/04/2010 in place to ensure that changes to peoples prescribed medications are accurately recorded and witnessed on the medication administration records. This helps to ensure that people always receive the correct dosage of medication. This is very important, for example, warfarin dosages. Care Homes for Older People Page 28 of 31 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 3 9 13 Medication must only be used for the person it has been prescribed for and used in accordance with the prescribers instructions. Medication that has been prescribed for one person can not be safely or legally used for someone else. 30/04/2010 4 16 22 Complaints must be responded to promptly and in accordance with the homes complaints procedures. Complaints must be taken seriously and responded to promptly. 30/04/2010 5 38 23 All staff must receive appropriate fire safety training and fire drills, in accordance with the homes fire safety risk assessment and the requirements of the local fire authority. Staff must be suitably trained and aware of what to do in the event of a fire. Clear training and fire drill records should be available to demonstrate this. 30/04/2010 Care Homes for Older People Page 29 of 31 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 7 Where people have been assessed as having a particular need (for example, being at risk of pressure damage), their care plan should clearly set out what action is being taken to manage these risks. For example, the equipment that is to be used and the actions staff must take to meet the persons needs. Systems should also be in place to ensure that this care is actually being provided in practice (for example, checks that equipment is being used). Peoples medication administration records should provide an accurate record of all medication that has been administered to that person. For example, it should include all creams, injections, supplements and dressings that are currently prescribed and when they have been offered/administered. The deployment of domestic staff should be reviewed to ensure that the home is kept hygienically clean at all times. All care staff should receive in depth dementia care training, including specific training on understanding and managing challenging behaviour. Appropriate training arrangements should be put in place to ensure that the Mental Capacity Act deprivation of liberty safeguards and authorisation conditions are understood by staff and met by the home. The home manager should receive regular, formal and recorded supervision sessions from an appropriate person. The person who is managing the home should apply for registration with us without further delay. The homes quality assurance systems should be reviewed, to ensure that any areas of weakness or poor practice are recognised and acted upon by the homes management. 2 9 3 4 26 30 5 30 6 7 8 31 31 33 Care Homes for Older People Page 30 of 31 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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