Care Home: Ogwell Grange Care Home

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Ogwell Grange Care Home Rectory Road East Ogwell Newton Abbot Devon TQ12 6AH Lead Inspector Graham Thomas Unannounced Inspection 11th December 2007 09:30 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 Ogwell Grange Care Home DS0000032352.V352634.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. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ogwell Grange Care Home Address Rectory Road East Ogwell Newton Abbot Devon TQ12 6AH 01626 354576 01626 354576 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) Ogwell Grange Ltd Sylvia Betty Kay Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for max 20 (OP) Registered for max 20 DE(E) service users 65 years and over Date of last inspection 1st March 2007 Brief Description of the Service: Ogwell Grange is registered as a Care Home that offers personal care for up to twenty people who are of retirement age, some of whom may have a diagnosis of dementia. Intermediate care and Nursing care are not provided. Situated is in the village of East Ogwell, the home is a short distance from the market town of Newton Abbot in South Devon. The premises comprise a large former rectory that has been used as a residential care home since late 1994. Accommodation is arranged on two floors and a mezzanine level. A small shaft lift provides access to the first floor and a stair lift runs to the mezzanine level. Individual Accommodation includes 14 single rooms and 3 shared rooms, all with en-suite toilet facilities. There is a large lounge and a separate dining room. On the ground floor there are shared facilities which include a walk-in shower room and a bathroom with an assisted bath. There is level access to the extensive, well-maintained grounds which provide wide ranging countryside views to Dartmoor National Park on the horizon. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before our visit The Registered Manager returned an Annual Quality Assurance Assessment to the Commission. Questionnaires were sent to groups of people with an interest in the home. These were returned by five people living in the home, six relatives or friends, seven staff and two health professionals. We visited the home and spent a total of one and a half days there. For part of this time we were assisted by an “expert by experience” who was an independent employee of “Help the Aged”. During our visit we toured the premises, spoke with people living in the home, staff, and a visiting relative. We also spoke with an independent trainer who was providing training for staff on the first day of our visit. A sample of records was examined. These included care plans, staff records, medication records and other documents about the running of the home. What the service does well: What has improved since the last inspection? • • There have been significant improvements in fire safety Measures have been taken to improve the control of infection and standards of hygiene • The Manager met requirements we made at the last key inspection to improve the privacy and dignity of people living in the home. DS0000032352.V352634.R01.S.doc Version 5.2 Page 6 Ogwell Grange Care Home • Incidents affecting the welfare of people living in the home are reported to the Commission for Social Care Inspection in accordance with regulation. What they could do better: 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. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 7 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 Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 8 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, 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Ogwell Grange have enough information to make an informed decision. The home properly assesses peoples’ needs before they move in to ensure those needs can be met. EVIDENCE: Four of the five people living in the home who returned questionnaires stated that they had received enough information before moving into the home. This was confirmed by people with whom we spoke during our visit who stated that they had received a detailed guide. Where possible opportunities had been offered for people to visit before deciding to move in. One person commented, “The Manager visited me in Newton Abbot Hospital with a member of staff 3 times and brought brochures and information on Ogwell Grange” Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 9 All the people living in the home who returned questionnaires said they had received a contract. This was confirmed in the individual files we examined which contained copies of contracts between the individual and the present provider of the service. Individuals’ needs had been assessed before they moved in to make sure these could be met by the home. Assessments were found in all six individual files that we examined though some were unsigned and undated. The files of people who had been referred by local authorities also contained these agencies assessments and plans. People who had been offered a place in the home had not received letters confirming that the home could meet their needs. The Registered Manager confirmed that Ogwell Grange does not offer a service to those who need only intermediate care. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Ogwell Grange receive a generally good standard of care. Whilst improvements have been made in the system for administering medicines, it is not yet sufficiently safe. EVIDENCE: In questionnaires returned to us relatives and people living in the home made positive comments about the care they received. People receiving the service commented, “I am happy with care”, “I receive excellent care. The staff are very kind to me” “Could not be better. All staff very helpful” Relatives stated, “We have been very happy with the care our mother has received” Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 11 “Mum always seems well dressed and clean. Good personal care, staff appear affectionate and caring towards residents.” “On the whole … the care is very satisfactory” The “Expert by Experience” who assisted with this inspection recorded “People were totally satisfied with the laundry arrangement. There appears to be a weekly rota for bathing but several service users said this was not rigid and “extras” were usually available on demand. All residents were cleanly attired and appeared well cared for.” Six individual files were examined which all contained a plan of care. The plans contained information including a personal profile and details of the person’s. social, physical and mental health needs. The organisation of some files made it difficult to locate specific information or find out who had provided the information and when. For example, some files were sub-divided while others were not. Many documents were unsigned and undated. Recording sheets in the care plans files were not being used in a consistent way. There was not a clear link between the original assessments and the plans of care which had been produced. However, daily routine care needs were, clearly set out for carers in a separate file with the daily records. Some of the entries in the daily records contained useful, detailed information though other entries such as “all care given” did not. In discussion, the Registered Manager stated that the individual files were being reorganised and that this task was partially completed. We discussed the possibility of placing all the information about one person in a single, subdivided file for ease of reference and access to information. People with whom we spoke during our visit stated that they always had access to health professionals when needed. Similarly, four of the five people who returned questionnaires stated this was always the case. Two health professionals stated that the home always sought health advice and acted upon it and that health needs were always met. With regard to continence care, it was noted that, “The home are excellent at contacting us as soon as a client is aware of a bladder/bowel problem” Individual files contained evidence of both routine and specialist healthcare treatments. During our visit one person was assisted to attend an appointment. A relative commented that “Sylvia Kay is so caring, my mum was admitted to hospital twice in November and she accompanied her on both occasions” Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 12 Nutritional assessments were seen in individual files with records of weight and fluid intake. A falls diary has recently been introduced so that falls can be more closely monitored. The system for administering medicines was examined. One person was identified who administered her own medicines. A risk assessment had been produced and the person had suitably secure storage facilities available in her room. Other medicines were securely stored in a locked cupboard and secure refrigerator in the home’s office. The Registered Manager stated that a new medicines trolley was on order for the storage of medicines. A monitored dosage system was in use. This means that most tablets are organised into pre-packed individual doses by the supplying pharmacy. Some other tablets were supplied in boxes and bottles. At the time of this visit, no controlled drugs were in use though the Registered Manager was aware of the additional storage and recording requirements for these drugs. A list of homely remedies had been obtained that had been approved by an appropriately qualified professional. The medicines administration record contained a photograph of each person and useful information for staff about the purpose of each medicine. Recording of the administration of medicines was generally sound. However, one person had returned from hospital with a home medication pack. One day’s tablets had been signed for but remained in the pack and it was not possible to establish the reason for this. This was discussed with the Registered Manager who agreed to investigate the matter. The supply of a medicine for one person had run out. The Registered Manager stated that this was on order and that a prescription was being collected. This difficulty was referred to in a questionnaire by one relative who, though generally satisfied with care in the home, commented “My (..relative’s..) medication has run out once or twice and there sometimes seems to be a lack of communication between staff” A record was available of those staff qualified to administer medicines together with evidence that they had received training. During the visit people’s privacy and dignity was respected by staff. The “Expert by Experience” reported, “Without exception the staff on duty at the time of the inspection displayed a very caring attitude, taking time to assist people in a kindly gentle manner. Genuine affection was clearly demonstrated. Good humour was in evidence.” Staff were observed knocking on room doors before entering and closing doors to preserve people’s dignity when personal care was being given. One person Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 13 reported that they had been distressed by other people wandering into her room at night. However, this had been discussed with staff and she was able to lock her door at night. Agreements to share a room signed by the person or their representative were seen in the files of people doing so. Screens had been provided in these rooms to preserve people’s dignity during personal care. Ogwell Grange Care Home DS0000032352.V352634.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): Standards 12, 13, 14, 15, and 16 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ogwell Grange provides a full and active lifestyle which meets people’s needs and expectations. EVIDENCE: All the groups of people who responded to our questionnaires made positive comments about the lifestyle which is supported by the home and its staff. All the people living in the home were satisfied with the activities and all but one enjoyed the food. One wrote, “I love the activities here and it has helped me to feel less frightened. I like jigsaw puzzles and felt work. And my neighbour …… visits regularly. I love Poppy, the Yorkshire Terrier here. I’ve always wanted a dog. I like exercise, quiz and singing.” A visiting health professional noted, “I always find entertainment of some description on when I call and clients all actively encouraged to ‘join in’” Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 15 The “Expert by Experience” who assisted with this inspection paid particular attention to this area of the service. He reported: “Visiting services include an optician, hairdresser and chiropodist. Many of the ladies take advantage of the house “make-up” trolley. There is a bookcase serviced by Devon County Council Library Special Services containing both normal and large print books. Soft drinks were available in the lounge in which there was a television with a large selection of videotapes and a music centre with a range of CDs. This bay windowed room was well lit, warm and comfortable with footstools and side-tables available. Everyone spoken with said they had total freedom on retiring at night and rising in the morning, and one person that very morning had taken advantage of a “lie in” following a late night, with the carer saying she would return later to assist with washing and dressing.” and “There is a four weekly menu with the current week on display outside the lounge. There is no listed choice but the Cook is aware of likes and dislikes and will always prepare an alternative if necessary. Special diets are catered for. On the day of the visit gammon, egg and chips followed by trifle had been substituted for the listed items, as the kitchen was preparing for a visitors and residents Special Christmas Buffet the following day. Meals are taken in the dining room unless the resident is unwell. A wide choice is available for breakfast, and in the evening drinks/snacks, including biscuits/sandwiches, can be had every hour on the hour. Service users were taken or directed to the dining room shortly prior to the lunch being served. The more able diners sat at a 12-seat table whilst others sat at one of 3 smaller tables, where personal assistance could be given discreetly by the three carers in attendance. Cranberry juice and water was already on the table, which was suitably decorated for the season. Most diners enjoyed the food and cleared their plates. Tea and coffee was then available. There was no delay in returning people to the lounge or their rooms as requested. One resident expressed dissatisfaction with the food. An outside activities organiser was in full flow in the morning and most residents were seen to be enjoying themselves. Residents are encouraged to partake in activities every morning and afternoon run by outsiders or staff. Regular weekly events include skittles, bingo, musical movements, card/board games, quizzes and films. One person commented “There’s always something going on here”. The time of the evening meal is sometimes varied to accommodate favourite television programmes and several ladies will stay up quite late to watch together. There is a “Tasks and Hobbies” list, which include assisting in preparing the tables for meals and other small but meaningful duties. The list also serves to remind carers of hobbies to be encouraged. A very full agenda of outings and events involving many outside entertainers has been planned up to Christmas. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 16 The local Vicar visits every week and takes a Communion Service in the dining room. His photograph is included on a board with those of the staff. The manager takes people to see local developments and places of interest. Several people mentioned that their relatives also take them out for trips. Visitors are actively encouraged and three arrived shortly after lunch. The bedrooms visited both had a chair for the use of visitors. Some people have telephones in their room” A separate telephone is also available for shared use. People living in the home with whom we spoke said that their relatives and other visitors were always made welcome. Most relatives who responded to our questionnaire felt that they were kept informed of significant developments though one stated “Input from the care home could improve regarding health problems of my mother. We are not always kept up to date on her medical state and condition” Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Ogwell Grange can feel confident that staff will listen to and act upon their concerns. There are robust procedures in place to protect people from abuse. EVIDENCE: All five people living in the home who returned questionnaires felt that staff listened to them and acted on what they said. One person stated “The staff always listen to me – Sometimes I feel frightened and they comfort me and reassure me” All said that they always or usually knew a person to whom they could speak if they were not happy and all knew how to make a complaint. Of the relatives who responded, half said that they did not know how to make a complaint though one remarked that this had never been necessary. However, the home does have a clear complaints procedure. This was clearly displayed in the hallway during our visit and included contact details for the Commission for Social Care Inspection. Since our last key inspection in March 2007 the Commission has received no complaints about the home. There were no complaints recorded as being made Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 18 directly to the home and the Registered Manager said that there had been none. Staff have received training in the safeguarding of vulnerable adults from abuse. The staff we interviewed were generally clear about responding to any abuse they might witness or suspect. However there was some uncertainty about referring matters to outside agencies should this be necessary. However they were aware that the home had policies and procedures about abuse and said that they would refer to these. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ogwell Grange provides a comfortable and attractive home for people who live there. Improvements in fire safety measures and other facilities have increased the levels of safety and convenience for staff and residents. EVIDENCE: Situated is in the village of East Ogwell, the home is a short distance from the market town of Newton Abbot in South Devon. Accommodation is arranged on two floors and a mezzanine level. A small shaft lift provides access to the first floor and a stair lift runs to the mezzanine level. Individual Accommodation includes 14 single rooms and 3 shared rooms, all with en-suite toilet facilities. There is a large lounge and a separate dining room. On the ground floor there are shared facilities which include a walk-in shower room and a bathroom with an assisted bath. These have been fully Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 20 refurbished since the last key inspection. The furnishings in all areas are comfortable and homely and the home is well-decorated in a traditional style. Commenting about the home’s environment, the “ Expert by Experience” who assisted with this inspection stated, “The ambience was good with Christmas decorations in the common areas, which were homely and clean. There was a total absence of unpleasant odours. The two bedrooms visited were well appointed with personal items in evidence. One was a shared room and the occupier commented that although she could not name the other lady ‘she was very nice and we share newspapers’”. The five people living in the home who returned questionnaires stated that the home was always fresh and clean. This was confirmed in our tour of all parts of the premises. Since the last key inspection there have been substantial improvements to meet requirements made by us at that time and changes in the fire regulations. An independent assessment of fire safety had been conducted. Fire safety measures had improved by such measures as the easing of fire exit doors, improved fire signage and the fitting of fire-safe devices to hold open fire doors. Risk assessments have been produced for free standing electric heaters in individual rooms. Some door handles had been incorrectly fitted compromising the privacy of some people living in the home. These have been re-fitted correctly During this visit we noted that a trip hazard was presented by holes in the dining room carpet. These were immediately taped over by the home’s maintenance staff. The Registered Manager stated that this carpet was due to be replaced in the near future Other improvements to the home had been made such as the refurbishment of individual rooms and upgraded kitchen and laundry facilities. Infection control measures had also improved. Antibacterial gel was available for the use of visitors in the home’s entrance. Creams in individual rooms were labelled with the name of their user. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Ogwell Grange are supported by caring and committed staff who receive appropriate training. Recruitment procedures remain insufficiently robust to protect people living in the home. EVIDENCE: The “Expert by Experience” who assisted with this inspection reported “Very complimentary comments were made about the staff e.g. ‘would do anything to help me’, ‘will stay in my room for a short chat’ and ‘they look after you very well’” This was echoed in the comments of relatives, one of whom, for example, remarked on the “professional and caring” manner in which staff provided care to people living in the home. Since the last key inspection staffing levels had been increased during the day and evening. All seven staff who returned questionnaires felt that there were enough staff on duty. One remarked that there were enough staff to enable “quality time” with people living in the home with additional support if palliative care was required. Evidence from the “Daily Life and Social Activities” section of this report supports this view. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 22 Staffing appeared to be well organised. Examination of the staff rotas showed that three carers were on duty during the day and evening supplemented by a cook, cleaning staff and a general assistant. We spoke with the senior carer who had responsibility for organising shifts. She told us that the home was organised into “zones” for which the carers on duty had responsibility on a rotating basis. At night there is one staff awake in the building who is supported by extra support staff. A further member of staff on “sleep in” duty is on call in a nearby cottage. At the last key inspection we required the Registered Provider to review this arrangement in respect of any risks it presents. The Responsible Individual has done this and has concluded that it is satisfactory on the basis of low fall and accident rates. Staff records were examined. One staff member recruited since the last inspection had commenced employment on 15th August 2007. A “POVA First” Check had been completed on 7th November and a criminal records check had been completed on 15th November 2007. The file for this staff member contained no confirmation of identity or written references. The Registered Manager stated that one of these had been taken verbally, though there was no record of this. The other reference had been applied for. A staff information pro forma had been partially completed. Copies of contracts were seen on some files. The contacts of foreign workers were differently worded form those of UK nationals. This had led to some confusion over holiday entitlements and was in not in keeping with the organisation’s stated commitment to equal opportunities. Staff who returned questionnaires commented positively about the available training. For example, one staff member stated “Since I have started at Ogwell Grange I have done a NVQ and become a senior. I have done numerous courses eg. Manual Handling, Health and Safety, Incontinence, First Aid, Medication Course, Pova awareness, Infection control. Fire safety, Dementia course.” Each file contained details of the training received by staff members. Induction training had been provided to new workers but not to national standards this was discussed with the Registered Manager and we have provided information to a worker in another of the company’s homes to which she has access. On the first day of our visit an independent trainer was present who was providing training to staff in fire safety and dementia. Staff files confirmed that that they had received training in topics relevant to their roles such as the correct fitting of incontinence products, moving and handling, the safe handling of medicines and the safeguarding of vulnerable adults from abuse. It was noted that the home’s cleaner had not received training in infection control. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 23 Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ogwell Grange is generally well managed for the benefit of the people who live there. Record keeping needs improvement to meet the requirements of regulation. EVIDENCE: Questionnaires returned to us by residents and their families and other visitors to the home continued to convey high level of regard and respect for the Registered Manager and the way the home is managed. For example, “Sylvia Kay is so caring, my mum was admitted to hospital twice in November and she accompanied her on both occasions”, and Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 25 “In general I consider that Ogwell Grange provides a very good service in a lovely environment. Having looked at many care homes in a 20 mile radius, Ogwell stood out as a special place” Staff were similarly positive “Our manager is very approachable, listens and has good understanding and awareness of all that is going on in her home. I have no problems with asking our manager for assistance and guidance in any situation that arises” A system was in place to review the quality of the service provided. This included seeking the views of people living in the home. these had been summarised and an action plan produced. We discussed quality assurance issues with the registered Manager during our visit and ways in which it might be broadened to encompass other areas of the home’s management. Since the last key inspection there have been evident improvements in accordance with our requirements and recommendations though some remain outstanding Notes were seen of regular meetings of the Registered Manager with her staff and with the Responsible Individual. Staff files showed that staff were receiving formal supervision though in some instances this was irregular. Nonetheless the feedback received from staff indicated that they felt well supported. The Registered Manager stated that neither the management nor staff of the home had any involvement in residents’ finances other than small amounts of cash held in trust. A sample of records concerning these cash amounts was examined. The records were supported by receipts. Record keeping in the home was generally sufficient but it has been noted that staff files lacked some records required by regulation. However the home is now reporting incidents affecting peoples’ welfare to the Commission as required by regulation. Issues regarding the health and safety of staff and people living in the home were examined. As previously stated in this report, fire safety measures in the home have improved since the last inspection. The Registered Manager stated that a fire evacuation plan was in place to meet the requirements of the fire authority. Fire training was taking place during the visit. Infection control practice has also improved, particularly in respect of the labelling and distribution of skin creams. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 26 The requirements of an Environmental Health report early in 2007 had all been met except the replacement of kitchen units. Records showed that recent checks and servicing of equipment and services had taken place such as personal electrical appliances, oil fired heating, and the home’s shaft lift. There was no evidence of testing for legionella infection. A daily maintenance log was seen which identified all the issues outstanding and completed. Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 27 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 3 Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement Timescale for action 01/02/08 2 OP9 13(2) 3 OP29 19(1) 4 OP37 17 The Registered Person must ensure that there is a clear recorded account of all medicines prescribed for use by people living in the home. The Registered Person must 01/02/08 ensure that there is a supply of all prescribed medicines available for administration according to the prescription. The Registered Person must 01/02/08 operate a thorough and robust recruitment procedure based on equal opportunities and ensuring the protection of people who use the service. Evidence of this will be via a clear audit trail of information kept on individual staff files. (Previous timescale of 01/06/07 not met) The Registered Person must 01/02/08 ensure that all records and documents specified in Schedules 3 and 4 are kept in a care home; that they are kept up to date and in good order. (Previous timescale of 01/06/07 not met) DS0000032352.V352634.R01.S.doc Version 5.2 Ogwell Grange Care Home Page 29 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 OP4 Good Practice Recommendations The Registered Provider should write to prospective residents confirming that they can be accommodated at the home and that their pre-assessed needs can be met at the home. Care plans should be reorganised so that information can be easily accessed. Records in the plans should be signed and dated to ensure that records are current and their author is identifiable. Notes made in the daily records should be specific so that a clear picture of peoples’ needs and how the home has responded top these can be established. For example, entries such as “all care given” should be replaced by more specific information The Registered Person should ensure that staff are clear about how to alert independent agencies of abuse or suspected abuse. The Registered Person Should ensure that induction training conforms to national training standards. Cleaning staff should receive training in the control of infection. The Registered Person should arrange for tests to be conducted concerning the risk of legionella infection in the water supply 2 OP7 3 OP7 4 5 6 7 OP18 OP30 OP30 OP38 Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Ogwell Grange Care Home DS0000032352.V352634.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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