Care Home: Minster Grange

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What the care home does well The health and personal care needs of service users were met, and comments from people living at the home confirmed they felt they were well cared for, and that their privacy and dignity were maintained. The management of the home were responsive to the needs of the service users, and choice was promoted. The involvement of family and friends was encouraged. The food was observed to be of a good standard and service users said they enjoyed it. The home was comfortable, clean and tidy and there was no malodour. The registered manager considered that staffing levels were adequate for the needs of service users and the rotas indicated that an appropriate number of staff were on duty. A commitment to the National Vocational Qualification (NVQ) training was evident, and the home is commended for having well exceeded the requirement for 50% of the staff to achieve this competence. The servicing and maintenance of equipment at the home is undertaken consistently. The management of the home have been responsive to the recommendations of the inspectors and there has been evidence of significant improvement in many aspects of the service during the past few weeks. What has improved since the last inspection? Since the last inspection many of the requirements and recommendations had been implemented and a new registered manager had been appointed. The Statement of Purpose, the Service Users Guide and the Contract of Residence have been reviewed and amended to ensure that service users were given relevant information. Care planning had been further developed to include risk assessments and more detail is recorded in the initial assessments of the service users. Medication administration had improved, and accredited training had been provided for all staff. There had been some development in regard to in-house activities. Two staff had been designated to organise and implement a programme, and the range and frequency of social activities had increased. A key worker system had also been introduced. Safeguarding procedures have been reviewed and help to ensure the protection of the people living at the home. The repair and upgrading to several areas of the property is helping to improve facilities in the home for the comfort and safety of the service users and staff who live and work at the home. A training programme for staff had been implemented. Core training and the more specialised care related training had also been developed, and staff had undertaken training on abuse awareness. The number and frequency of service user meetings and staff meetings has also increased and individual staff supervision sessions are now being held regularly. The system for the handling and safekeeping of the money of the people living at the home has improved. A quality assurance system is being implemented and Regulation 26 visits are now made to the home, and a report is submitted to the Commission. The procedures relating to the recording and reporting of accidents had been implemented appropriately for the protection of the service users. What the care home could do better: The privacy and dignity of the service users will be further enhanced when fixed screening has been fitted in the shared bedrooms. More opportunities for service users who wish to undertake social activities outside of the home should be made available to ensure that a good quality of life is maintained. A more satisfactory procedure for investigating complaints should be introduced at the home to ensure that service users know they will be listened to and treated fairly.A maintenance programme for the renewal and redecoration of the premises, and the ongoing improvements to the property will help to maintain suitable services and facilities for service users and provide a pleasant environment in which to live and work. The recruitment procedures need to be more robustly implemented for the support and protection of the service users. The ongoing development of the quality assurance system should mean that the home is run in the best interest of the service users. CARE HOMES FOR OLDER PEOPLE Minster Grange Minster Grange Minster Road Stourport on Severn Worcs DY13 8AT Lead Inspector Nic Andrews/Rachel McGorman Key Unannounced Inspection 29 and 31 October 2007 & 14 January 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 Minster Grange DS0000063833.V347429.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. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Minster Grange Address Minster Grange Minster Road Stourport on Severn Worcs DY13 8AT 01299 826636 01299 827180 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) Mrs Monica Arjan McGlynn Trading as Minster Grange Residential Home Mr Arjan Bhoja Odedra, Mrs Shanta Arjan Odedra Helen Dawn Davies Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26), of places Physical disability over 65 years of age (26) Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age (DE(E) 26 Physical Disability over 65 years of age (PD)(E) 26 Old age not falling within any other category (OP) 26 The maximum number of service users to be accommodated is 26 2. Date of last inspection 30th October 2006 Brief Description of the Service: Minster Grange is a large, detached building situated on the main Stourport to Kidderminster road approximately one mile from Stourport town centre. The town provides a good range of social and civic amenities. The home is registered to provide residential i.e. personal, care to a maximum of 26 older people above the age of 65 years who may also be physically disabled and/or have a dementia illness. The property has been adapted for its present use as a care home. There is a small, enclosed garden at the rear of the premises and car-parking facilities at the front of the premises. The people living at the home are accommodated in 16 single bedrooms and 5 double bedrooms. All of the bedrooms except three single bedrooms have an en suite facility. The home has both a passenger lift and a stair lift to enable the people at the home to have easy access to the accommodation on the first floor. At the time of the inspection there were twenty-two people in residence, one person was in hospital and there were three vacancies. The home’s fees range from £1372.00 to £1600.00 per month. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The home was inspected against the key National Minimum Standards with the help of the registered manager and other members of staff. Time was also spent assessing the home’s response to the requirements and recommendations that were made as a result of previous inspections. Various records and policies and procedures that the home is required to maintain were inspected. A tour of the premises was also made. Individual discussions were also held with several people living at the home and some members of staff. Survey forms were issued to the relatives and representatives of the people living at the home. Some of the comments that were included in the survey forms are reflected in this report. The care of four people was case tracked. What the service does well: The health and personal care needs of service users were met, and comments from people living at the home confirmed they felt they were well cared for, and that their privacy and dignity were maintained. The management of the home were responsive to the needs of the service users, and choice was promoted. The involvement of family and friends was encouraged. The food was observed to be of a good standard and service users said they enjoyed it. The home was comfortable, clean and tidy and there was no malodour. The registered manager considered that staffing levels were adequate for the needs of service users and the rotas indicated that an appropriate number of staff were on duty. A commitment to the National Vocational Qualification (NVQ) training was evident, and the home is commended for having well exceeded the requirement for 50 of the staff to achieve this competence. The servicing and maintenance of equipment at the home is undertaken consistently. The management of the home have been responsive to the recommendations of the inspectors and there has been evidence of significant improvement in many aspects of the service during the past few weeks. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The privacy and dignity of the service users will be further enhanced when fixed screening has been fitted in the shared bedrooms. More opportunities for service users who wish to undertake social activities outside of the home should be made available to ensure that a good quality of life is maintained. A more satisfactory procedure for investigating complaints should be introduced at the home to ensure that service users know they will be listened to and treated fairly. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 7 A maintenance programme for the renewal and redecoration of the premises, and the ongoing improvements to the property will help to maintain suitable services and facilities for service users and provide a pleasant environment in which to live and work. The recruitment procedures need to be more robustly implemented for the support and protection of the service users. The ongoing development of the quality assurance system should mean that the home is run in the best interest of the service users. 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. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 8 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 Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 9 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): 1,2 and 3 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering admission to the home have their needs assessed and they are provided with relevant information to enable them to make an informed choice. EVIDENCE: Copies of the home’s statement of purpose and service users’ guide were made available for inspection. Both documents contained relevant information to enable people considering admission to the home to make an informed choice. Two requirements had been made in regard to Standard 1 as a result of the previous inspection. The first requirement was that the statement of purpose must be amended so that it includes all the information detailed in Regulation 4 and Schedule 1. The requirement had been implemented. The second requirement was that the service users’ guide must be amended so that it includes all of the information detailed in Regulation 5 and Standard 1, and copies given to all current, and any prospective service users. A copy of the service users’ guide had been placed in all of the bedrooms, and this document now includes the relevant details. The requirement had been implemented. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 10 Standard 2 was not fully assessed on this occasion. However, the home’s response to a recommendation that was made as a result of the previous inspection was assessed. The recommendation was that the statement of terms and conditions of residence (contract) should be amended, and a copy retained in the individual files of the people who use the service. The inspector was informed that all service users now have a copy of the terms and conditions of residence. The recommendation had been implemented. The registered manager and acting deputy manager normally carried out the assessments of people who were considering admission to the home either at the person’s home or in hospital. The form that was used included a reference to all of the aspects of care listed in Standard 3.3. Two of the three recent admissions to the home were admitted in an emergency. The third person was admitted to the home in accordance with the normal procedure and this included a weekend stay prior to the person’s admission. Care plans had been provided for all the people living at the home and the two recent emergency admissions had care plans that were based on the information included in the community care assessments. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The basic health and personal care needs of the people living at the home are being met. Medication procedures now help to ensure the protection of service users EVIDENCE: It was evident that, since the last inspection, the staff had worked hard to improve the care plans. All of the people living at the home had a care plan that was based on an assessment of their needs. The care plans included risk assessments on mobility and nutrition. Service users were weighed every month and a record of their weight was maintained. All of the people living at the home were registered with a local GP. The district nurse was visiting the home daily to attend to one person with an ulcerated leg and to other people with diabetes who were insulin dependent. None of the people at the home had pressure sores. The staff followed the advice given by the district nurse in regard to the sleeping arrangements of one person. The continence adviser visited the home when necessary. None of the service users required their food or fluid intake to be monitored and the registered manager had no serious concerns about any of their healthcare needs. The optician visited the home twice a year and dental checks were being carried out as and when necessary. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 12 Ten requirements and two recommendations were made in regard to the administration of medication as a result of the previous inspection. It was pleasing to note that the home had responded positively to these issues and that many of the requirements and both of the recommendations had been implemented. A new refrigerator used for storing medication that required cold storage had been provided and this was kept locked. However, the temperature of the refrigerator had not been set at the correct level, and the readings were outside the normal range. Subsequently, this was corrected, and when checked again by the inspector the daily recordings were within normal limits. The date of opening of all medication was now being recorded, and the balance remaining at the end of the 28-day cycle was being carried over to a new MAR (Medication Administration Record) chart. The medication given to the service users was written on the MAR chart or an appropriate code was used if medication was not administered, and the exact amount given when the directions are for a variable dose e.g. one or two tablets, was now being recorded. Hand written additions to the MAR charts were checked and signed for by two members of staff. Any known or ‘none known’ allergies were being recorded on the medicine charts. Currently, only one person living at the home was known to have an allergy. The staff had access to a current and up to date reference source for medication in the form of a BNF (British National Formulary) guide. The registered manager stated that, since the last inspection, no errors or incident involving the administration of medication had occurred and, therefore, there had been no cause to report any such matter to the Commission in accordance with Regulation 37. The registered manager also confirmed that following the last inspection, all the staff involved in the administration of medication had been given advice and guidance to prevent the occurrence of any further medication errors, and they have now also completed accredited training. A procedure had been introduced to ensure that the correct medication is available and is provided in the original pharmacy container for people in receipt of respite care. The procedure involved two members of staff checking the medication at the point of admission and contacting the relevant pharmacy and/or district nurse, if necessary. Photographs had been taken of the people living at the home and placed on the MAR charts in order to ensure that the staff administered the correct dosage to the correct people at the correct time as prescribed by the clinician. The senior care staff were being asked to sign the administration record in respect of cream that had been applied by the care staff. The registered manager said that, on occasions, the senior staff had forgotten to sign the medication record, or they were reluctant to sign because they had not witnessed the cream being applied. The Pharmacist Inspector gave the registered manager advice over the telephone on this matter during the inspection, and this has since been implemented. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 13 The staff with whom discussions were held displayed a good understanding of the importance of ensuring the privacy and dignity of the people living at the home. The staff received instruction during their induction on how to treat the people living at the home with respect. A mobile telephone was available to enable the people at the home to make and receive telephone calls in private. Some of the people had their own telephones. The staff referred to the people living at the home by use of their preferred names. A supply of clothing was kept for use in an emergency but an assurance was provided that the people living in the home always wore their own clothes. The home had five double bedrooms. A requirement was made as a result of previous inspections that fixed screening must be provided in all shared bedrooms in order to enhance the privacy and dignity of the people accommodated in these rooms. The requirement had not been implemented. The requirement now becomes a recommendation. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home were able to exercise their right of choice over a range of issues and maintain contact with their relatives and friends. They received a balanced diet and their personal preferences were respected. EVIDENCE: A senior care assistant and one care assistant had recently been designated to coordinate social activities. A record was maintained of the activities and the people who participated. A range of activities was provided that included art and craft, exercise classes, a music workshop, ‘Let’s Talk’ card game and board games. The hairdresser visited every week and a pianist visited every month. Members of a local church visited monthly to hold a service and the Salvation Army also visited every few months. Details of the activities provided were displayed on the notice board in the dining room. An ‘open day’ had been held at the home on 25 August 2007 to which the relatives and friends of the people living at the home had been invited. However, no organised outings have taken place during the past year. The daily routines are flexible and can be adjusted to suit the individual needs of the people living at the home. No unnecessary or unreasonable restrictions were placed on visitors to the home. Visitors were expected to sign the visitors’ book near to the main entrance as part of the home’s security procedures. The relative of one of the Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 15 people living at the home visited every Sunday and stayed for lunch. The service users with whom discussions were held said that their visitors were always made welcome. The service users’ guide contained clear information about the home’s policy on maintaining the relatives and friends’ involvement with the people who live at the home. The people living at the home said that they were able to exercise choice in regard to a range of issues that affected their daily care. The choices included the time they went to bed and the time they got up, the clothes they wore, the food they ate, where they ate their meals and the activities in which they participated. The people living at the home were aware that they could bring personal possessions with them when they were admitted. The bedrooms reflected the personal preferences and the choices of the people that were accommodated. None of the people living at the home were currently in receipt of an advocacy service. However, details of the local advocacy service were clearly stated in the service users’ guide. The service users described the standard of food as ‘good’ and ‘very good’. The meals were served at appropriate times throughout the day and drinks and snacks were served between meals. Most of the people living at the home ate their meals in the dining room. However, some of the people ate their meals in the lounge and a small number preferred to eat in their bedrooms. A full English breakfast was available provided that the cook was given prior notice. Lunch always included soup, a main course and a dessert. There was a choice of a hot meal or sandwiches at teatime. If the main meal was not to anyone’s liking an alternative meal was provided. The people living at the home were consulted about the menu approximately every two months. Fresh fruit was available and details of the meals for the following two days were displayed in the dining room. The food that was observed during the inspection appeared wholesome and nutritious. The part-time cook said that the home tried to follow the ‘five portions of fruit and vegetables each day’ rule. The home catered for the individual needs and preferences of the people who were accommodated for example, people who are diabetic and one person who required her food to be cut into small pieces. Birthdays and other special occasions and events were celebrated. The home had embarked on the ‘Safer Food Better Business’ initiative and the staff said that they had found it ‘helpful’. The registered manager said that she did not feel that the people living at the home would be able to serve themselves to food and, therefore, a system that encouraged them to do this had not been introduced. The registered manager also confirmed that snack meal including sandwiches and/or cakes was offered in the evenings. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 16 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): 16 and 18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users felt confident about making a complaint, although a review of the procedures should ensure complete transparency in future investigations. Staff had been trained in abuse awareness and the safeguarding procedures help to ensure protection for service users. EVIDENCE: The home had a complaints procedure that was also referred to in the service users’ guide. The people living at the home said that they felt confident about making a complaint, if necessary. Since the last inspection the home had received two complaints. The registered manager of another home owned by the same providers had responded to the complaints, and copies of the letters sent to the complainants were available for inspection. However, one of the letters was not dated and details of the complaints were not available. It was not possible, therefore, to form a complete picture of the concerns that had been raised or to determine whether the complaints had been dealt with appropriately. It was also noted that the person who had responded to the complaints had been referred to in one of the complaints. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 17 The registered manager stated that no incidents of alleged or suspected abuse had been reported to her or had otherwise come to her attention since the last inspection. Similarly, she had had no reason to make any referral to the Department of Health for the name of any member of staff to be considered for inclusion on the POVA register. The recommendation made as a result of the previous inspection that the home should obtain a copy of the Department of Health guidance ‘No Secrets’ had been implemented. A leaflet on the Protection of Vulnerable Adults from Abuse was displayed on the notice board. Further copies have since been obtained and staff issued with a copy of the leaflet. The registered manager, acting deputy manager and a senior care assistant had undertaken training on the protection of vulnerable adults from abuse in March 2007. Training for twelve members of staff on abuse awareness had also been undertaken recently. In addition, the registered manager and the staff had undertaken training on dealing with aggression in July 2007. Two requirements were made in regard to Standard 18 as a result of the previous inspection. The requirements related to the need to amend the home’s policies and procedures for responding to suspicion or evidence of abuse or neglect, whistle blowing and management of violence. These requirements had both been implemented. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 18 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): 19,20,21,24 & 26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in comfortable and homely surroundings. However, the maintenance of the home and the facilities provided did not fully ensure their privacy, safety and protection, although improvements have now been made. EVIDENCE: The home occupied a level site and was conveniently situated for access to local amenities. The home was accessible to people who use wheelchairs. A passenger lift and a stair lift had been installed to enable the people living at the home to gain easier access to the accommodation on the first floor. One requirement and one recommendation were made in regard to Standard 19 as a result of the previous inspections. The requirement was that as part of the programme of routine maintenance a new underlay should be provided for the carpet in the extension. The registered manager explained that the present carpet does not lend itself to having an underlay as it was fixed to the floor with adhesive. The carpet had been cleaned recently which had improved the appearance, and the inspector was told that replacement carpet for all the corridors was on order and that this work will be undertaken in the near future. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 19 The previous recommendation was that a programme of routine maintenance and renewal of the fabric and decoration of the premises should be introduced and implemented. It was noted that the registered provider had identified some items for repair and renewal in the reports prepared in accordance with Regulation 26, and other issues were referred to in the maintenance book. The registered manager confirmed that a programme would be produced following discussion with the providers. The recommendation had not been fully implemented and still stands. Two areas of the home had been severely affected following a leak in the roof as a result of recent torrential rains - bedroom 4 on the first floor and also the small lounge on the ground floor below. The bedroom had been redecorated and the lounge was currently being done. The last recorded visit by the Fire Safety Officer was May 2005, and the Food and Safety Officer had visited the home in December 2006. The registered manager said that there were no outstanding issues arising from these visits. The potholes in the driveway observed on the initial inspection had posed a potential hazard to both the service users, staff and other visitors to the home. The drive had since been re-tarmaced to a high standard. There were no handrails in some parts of the corridor on the first floor, and in bathroom 1 on the first floor there was no grab rail near to the toilet. Bedroom 5 had no wash hand basin or opening restrictor on the window. The store that contained cleaning substances had been left unlocked. The registered manager stated that she would deal with the areas over which she had control and that the other matters would be referred to the registered providers for their immediate attention. A requirement was made in regard to Standard 24 as a result of previous inspections. The requirement was that all of the items of furniture specified in Standard 24 must be provided in rooms occupied by the people living there. It was noted that some bedrooms had only one comfortable chair, or no bedside lighting, or the bedside drawers and bedroom chairs were worn, or there was no table. The requirement had not been fully implemented and now becomes a recommendation. If the provision of any item poses an unacceptable risk to the service user or they decline the provision, details of the discussions and the decision about this should be recorded in their care plan. The home was clean and tidy and there were no unpleasant odours. The laundry was appropriately sited and contained a washing machine and a tumble dryer. The washing machine had a sluice facility. The laundry had a wash hand basin and a liquid soap dispenser but no paper towel dispenser. However, this item was installed during the inspection. The floor had an impermeable finish and the floor and walls were readily cleanable. The home was not using red alginate bags for the disposal of soiled linen, and the registered manger was advised to seek the advice of the Environmental Health Officer. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at the home receive care from staff that are appropriately trained and deployed. However, the service users had not been fully safeguarded by the recruitment procedures. EVIDENCE: A copy of the staff duty rota and a list of the staff who were employed to work at the home was made available for inspection. The duty rota indicated that the home was adequately staffed. In addition to the registered manager and acting deputy manager the home employed six senior care assistants, eight care assistants, three senior night care assistants and two night care assistants, catering and domestic staff and a part-time maintenance man. Two waking night staff were on duty at all times during the night. The home was in the process of recruiting staff to fill a vacancy for a care assistant for one night a week, and also a part-time care assistant to cover the weekends. In order to acknowledge the work and commitment of the staff, the home had introduced an ‘Employee of the Month’ award scheme. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 21 A requirement was made in regard to Standard 28 as a result of the previous inspection. The requirement was that the arrangements for staff to receive training that will enable a minimum of 50 of the care staff to attain a qualification at NVQ level 2 or equivalent must continue. The requirement had been implemented. It was pleasing to note that 13 of the 21 members of staff employed in the provision of personal care had completed the NVQ level 2 training, therefore the 50 ratio of trained staff had been exceeded. It was also pleasing to note that a further three members of staff were nearing the completion of NVQ level 2 training and two other members of staff were nearing the completion of NVQ level 3 training. The files of two, recently appointed members of staff were inspected. The files contained relevant information including an application form, two written references, proof of identity and copies of training certificates. There were also copies of staff contracts that were due to be issued following the successful completion of the staff induction/probationary period. However, one member of staff had commenced working at the home without the results of a CRB or PoVA first check having been received. The registered manager was given advice about the rules governing the ‘non-portability’ of CRB checks obtained by other employers/agencies. The registered manager gave an assurance that this matter would be dealt with appropriately and that the correct staff recruitment procedure would be adhered to in the future. The registered manager confirmed that a CRB check had been obtained in respect of all the other staff employed at the home. It was also confirmed that the staff had been issued with a copy of the Code of Conduct and Practice set down by the General Social Care Council. The registered manager said that newly appointed staff ‘shadow’ a senior member of staff for the first three shifts. They were given a copy of the inhouse induction training pack to read and were shown where staff copies of all the home’s policies and procedures were kept and asked to make sure that they read them. Each new employee had to complete an induction checklist that was also countersigned by the registered manager to confirm that the induction had been fully completed. There was evidence to show that all the staff received a minimum of three paid days training per year and had an individual training and development assessment and profile. A requirement was made in regard to Standard 30 as a result of the previous inspection that the individual staff training records must be completed. The requirement had been implemented. The notable progress in developing the training programme was acknowledged and further training that needed to be organised for staff in other care related areas was discussed with the registered manager, who confirmed that this was being planned. Ten staff had done Dementia Awareness training, and another seven are to do it. In addition, training for all staff in Person Centred Care and for senior staff in doing Risk Assessments was also to be provided. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 22 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): 31,33,35,36,37 and 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is focussed on the best interests of the people who live at the home, and the ongoing development of quality monitoring, and the new management arrangements have enabled the service to be more effective. EVIDENCE: The registered manager had relevant experience and had been involved in care work with older people since 1996. She had worked at the home in a senior capacity for the past two and a half years, and her application to become the registered manager of the home was approved in September 2007. She had previously completed the NVQ level 4 training in September 2004 and was doing the Registered Managers’ Award training currently. In addition she had also undertaken various other training to update her knowledge and skill which included PoVA, dementia awareness, health and safety, fire safety, accredited medication training, stress management, dealing with aggression and the Mental Capacity Act training. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 23 One requirement and two recommendations were made in regard to Standard 31 as a result of the previous inspection. The requirement was that the acting manager must make an application to the CSCI to become the registered manager. The requirement had been implemented. The first recommendation was that a suitable job description for the registered manager should be provided and made available for inspection. A copy of the registered manager’s job description was handed to the inspector, and the amendments that were identified have since been completed. The second recommendation was that the lines of accountability within the home and with the external management should be reflected accurately in the organisational structure and included in the home’s statement of purpose. These recommendations had both been implemented. One requirement and four recommendations were made in regard to Standard 33 as a result of the previous inspection. The requirement was that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. The home had a quality assurance manual and the registered manager had begun to introduce monthly quality audits. The requirement had not been fully implemented and now becomes a recommendation. Further development of the quality assurance system and review of the quality assurance manual are needed to ensure compliance with this standard. The first recommendation was that there should be an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. The second recommendation was that the results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. A copy of both documents was handed to the inspector. These recommendations had both been implemented. The third recommendation was that written evidence should be provided to demonstrate the home’s commitment to lifelong learning and development for each service user linked to the implementation of their individual care plans. The fourth recommendation was that the views of family and friends and of stakeholders in the community should be sought on how the home is achieving goals for service users and the information used to enhance good practice. These recommendations were both now being implemented. A recommendation was made in regard to Standard 35 as a result of the previous inspection that the way in which the records of the service users’ money was maintained should be changed in order to ensure that the actual balances always agree with the amounts held in safekeeping. The recommendation had been implemented. The registered manager confirmed that no one employed by or connected with the running of the home acted as the agent or appointee on behalf of any of the service users, and that the provider also carried out periodic checks of the money that was held in the home for safekeeping. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 24 A requirement was made in regard to Standard 36 as a result of the previous inspection, that supervision of all care staff must take place at least six times a year and include all aspects of practice, philosophy of care in the home and career development needs. The requirement had been implemented. Standard 37 was not fully assessed on this occasion. However, the home’s response to the two requirements that were made in regard to Standard 37 as a result of the previous inspection was assessed. The first requirement was that the statement of the procedure to be followed in the event of accidents must be amended. The second requirement was that visits to the home by the registered provider must take place at least once a month in accordance with Regulation 26 and a copy of the written report on the conduct of the home supplied to the registered manager and to the CSCI. These requirements had both been implemented. Two requirements and one recommendation were made in regard to Standard 38 as a result of the previous inspection. The first requirement was that training for all the staff in all of the core areas must be undertaken. The requirement was being implemented. There was evidence that training in Fire Awareness, Moving and Handling, Basic Food Hygiene, Health and Safety, Basic First Aid training, and Infection Control training had already been done or arrangements had been made for staff to undertake these courses. The second requirement was that work to fit thermostatically controlled mixer valves to all of the hot water outlets used by the service users must be completed in order to prevent the risk of scalding. The requirement had been implemented. The recommendation was that the staff training matrix containing the dates when all of the staff training was undertaken should be completed and kept up to date. The recommendation had been implemented. The home had a satisfactory health and safety policy, and safety procedures were posted in various places around the home. The records showed that regular servicing and maintenance of the equipment at the home was undertaken, and risk assessments on all safe working practice topics were now being been carried out and the significant findings were being recorded. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 25 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 3 2 X 2 X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 3 Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 13 Requirement The risk to residents from open windows which are not restricted must be assessed and appropriate action taken to prevent injury from falling. No member of staff must be employed at the home without all of the specified recruitment checks being undertaken and determined as satisfactory. This will help to ensure that the service users benefit from competent staff and are protected from abuse. Timescale for action 29/02/08 2 OP29 19(1) 29/02/08 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 Refer to Standard OP12 Good Practice Recommendations The opportunities for service users to engage in individual and small group social and leisure activities outside the home should continue to be developed to ensure that they DS0000063833.V347429.R01.S.doc Version 5.2 Page 27 Minster Grange 2 OP19 3 4 5 6 7 8 OP20 OP22 OP24 OP24 OP24 OP26 9 10 11 OP33 OP38 OP16 experience a lifestyle that satisfies their social interests and needs. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be introduced and implemented, to ensure that the service users live in an environment that is comfortable, safe and well maintained. The carpet in the main corridor in the extension should be replaced to ensure a satisfactory environment continues to be maintained for service users. For the safety of service users handrails should be provided in the corridor on the first floor, and a grab rail fitted in bathroom 1. Fixed screening should be provided in all twin bedrooms, to enhance the privacy and dignity of the people who live in a shared bedroom. All of the items of furniture specified in Standard 24 should be provided in rooms occupied by service users, to ensure the well being of the service users. A wash-hand basin should be provided in all bedrooms for the comfort and privacy of the service users The advice of the Environmental Health Officer should be sought regarding the use of red alginate bags to prevent staff from having to handle soiled linen, and to reduce the risk of cross infection. Consideration should be given to further development of the quality assurance system to ensure that the home is run in the best interests of the service users The ongoing provision of core training for all the staff should be maintained to ensure the safety and wellbeing of the service users. A system should be introduced to show that investigations of any complaint made against the home are seen to be open and transparent and the action taken is recorded, to ensure service users know that their complaints will be dealt with appropriately. Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Minster Grange DS0000063833.V347429.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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