Care Home: Orrell Grange

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What the care home does well We observed people being cared for and they were able to receive ongoing attention from staff. We observed people being moved and handled by staff using mobility aids such as wheelchairs and hoists. Generally staff were observed to be competent and supported people well. Staff showed good communication skills when supporting people. We observed that people in the day areas were appropriately dressed and had good standards of personal hygiene. Those spoken with said that staff worked very hard and supported them well. We observed that people were given plenty of drinks over the course of the inspection. There are drinks available at all times in the lounge and these are replenished during he afternoon. We looked at care records for one person. The care records consisted of a plan of care for the person and also supporting documentation such as daily records and reviews. We found the care plan to be well devised and reviewed regularly. It contained clear instructions for staff to follow so that care could be carried out. We spoke to care staff and they were knowledgeable about the daily care of people with catheters, for example, including routine hygiene. The evaluations of the care plan were clear and we were able to see that care had been reviewed and monitored. Staff had also been appropriate in when to refer the person for medical opinion and support such as the GP and specialist nurses. This shows that the home are supporting people with there ongoing health care needs. What the care home could do better: We were concerned that some people were being moved around in wheelchairs without footrests in place. This can put people at risk from injury and we have made a requirement that this must be addressed. We looked at how staff had documented and monitored catheterisation procedures. We were concerned that the notes accompanying clinical procedures were very brief and lacked detail. The need for clear records includes the need to communicate effectively as well as providing a point of reference to influence decisions for further interventions. It is also a legal record of what actually happened. We were also concerned that some clinical nursing procedures such as catheterisation were not written by the nurse carrying out the procedure. We spoke to the manager and staff about current practice around monitoring fluid intake for people who may have a catheter. The care record we reviewed had no monitoring of fluid intake at any time over the stay in the home despite there being indications for this. We would recommend that any person with an indwelling catheter should be monitored carefully for fluid intake and that this should be recorded unless otherwise assessed. We could find no reference to any risk assessments completed regarding the need or otherwise for the indwelling catheter. Again it is good practice to have such an assessment and this is particularly so with people who may lack capacity to give consent because they have dementia for example. Again we would refer the manager to the professional guidance regarding this. Given the comments around the standard of some of the recording and monitoring of people with catheters we would strongly recommend that all of the trained staff are updated with the good practice guidelines from the RCN so that they can reflect on any improvement that may need to be made with regard to the care documentation regarding catheter care and ongoing records, particularly fluid intake records. Random inspection report Care homes for older people Name: Address: Orrell Grange 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michael Perry Date: 2 7 1 0 2 0 0 9 Information about the care home Name of care home: Address: Orrell Grange 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP 01519220391 08707059966 orrellgrange@orrellgrange.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : 1st Care Ltd care home 36 Number of places (if applicable): Under 65 Over 65 6 36 dementia old age, not falling within any other category Conditions of registration: 0 0 One named female out of category service user under pensionable age. The variation applies to the named service user only, should she leave the Home, then the variation will cease to apply. Service users to include up to 36 (OP) and up to 6 DE(E). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Orrell Grange is a purpose built care home designed to provide accommodation and nursing care for thirty-six older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. Care Homes for Older People Page 2 of 11 Brief description of the care home Twenty-six of the bedrooms are single and there are also five double bedrooms. Four of the single rooms have en-suite facilities and all other bedrooms have washbasins. Where there are shared rooms, screens are provided for privacy. Bedrooms are on both the ground and first floor with access available to the first floor via a lift. Downstairs there is a small dining room that people can use. They can also choose to eat in their room or the lounge, as they prefer. On the ground floor there is a large lounge with different seating areas. There are staff available twenty four hours a day to support people with their health and personal care and also to provide some support with leisure activities. It currently costs between 389 and 510 pounds each week to live at Orrell Grange. Care Homes for Older People Page 3 of 11 What we found: We visited unannounced in response to concerns raised by the relative of a person who resided in the home recently. The relative has made a complaint about care issues and this has been responded to by the manager of the home and the responsible individual acting for the provider [owner]. We have made our inspection to look specifically at standards pertaining to the concerns raised to ensure that standards of care are being maintained. The concerns were around the way the person has been cared for with respect to the management of continence and monitoring of fluid intake and output. Specifically the person concerned had an indwelling catheter [tube into the bladder to pass urine] and there were concerns around the management of this. During our visit, which was conducted over four hours we looked at the care records of the person concerned [there are no current residents who have an indwelling catheter], spoke with staff and current residents of the home and one relative, looked at policies and procedures and also staff training and competencies. We made observations of care over an extended period of time in the day areas. We spoke with an external professional who has supported the home in the past. We have used the Royal College of Nursing Guidelines published in 2008 for any reference to good practice guidance in managing catheter care. We observed people being cared for in the day areas. This area was well staffed and people were able to receive ongoing attention from staff. We observed people being moved and handled by staff using mobility aids such as wheelchairs and hoists. Generally staff were observed to be competent and supported people well. For example we saw one person being moved by a hoist but this was uncomfortable for the person. Staff were able to work around this and explained the difficulties and advised us that external professionals were reviewing the person that day [this occurred later on in the afternoon]. Staff showed good communication skills when supporting the person. This shows that staff are aware of changing needs and refer people appropriately when needed for further assessment. We were concerned that some people [three observed] were being moved around in wheelchairs without footrests in place. This can put people at risk from injury and we have made a requirement that this must be addressed. We observed that people in the day areas were appropriately dressed and had good standards of personal hygiene. Those spoken with said that staff worked very hard and supported them well. One person said: I like it here. Staff are good and they get anything you want. A relative commented: Generally the care is good. They can be a bit short of staff at tea time but [my relative] is always clean and well cared for. We observed that people were given plenty of drinks over the course of the inspection. There are drinks available at all times in the lounge and these are replenished during the afternoon. People spoken with said that there are plenty of drinks available. One person who has a history of being prone to urine infections and is therefore in need of plenty of fluids was observed to have a glass of juice in front of them and was also supported to Care Homes for Older People Page 4 of 11 have a cup of tea. We were advised that none of the current people in the home have an indwelling catheter but we were able to look at care records for the person whose relatives were concerned. The care records consisted of a plan of care for the person and also supporting documentation such as daily records and reviews. We found the care plan to be well devised and reviewed regularly. It contained clear instructions for staff to follow so that care could be carried out. It includes good practice such as attention to infection control by using correct procedures when emptying the catheter bag [for example]. It also includes guidance for care staff on what to observed and report to nursing staff such as any signs of infection. We spoke to care staff and they were knowledgeable about the daily care of people with catheters including routine hygiene. The evaluations of the care plan were clear and we were able to see that care had been reviewed and monitored over the period of time the person had been in the home. Staff had also been appropriate in when to refer the person for medical opinion and support. For example when the urine had become infected. Both the GP and the infection control nurse from the local hospital had reviewed the person. This shows that the home are supporting people with there ongoing health care needs. We looked at how staff had documented and monitored catheterisation procedure. [This is where the catheter tube is passed into the bladder via the urethra by a nurse]. The care plan is clear that the catheter must be changed every 3 months and records indicate that this was carried out. We were concerned that the notes accompanying these procedures were very brief and lacked detail however. In all cases there was a brief note to say that the person was recatheterised but no other detail. Good practice guidance around this includes reference to indications used to ensure that the catheter was inserted correctly [ in men - the amount of catheter inserted, obstruction felt, urine drained, no resistance to ballon inflation, no patient reaction or pain related to balloon inflation, free movement of catheter once balloon inflated]. None of these details were present in the care records. On one occasion the nurse who carried out the procedure did not complete the record [another nurse did this]. Again it is good professional practice for nurses to complete their own notes when carrying out any specific nursing procedures and we would recommend that the manager consider and monitor this. The need for clear records includes the need to communicate effectively as well as providing a point of reference to influence decisions for further interventions. It is also a legal record of what actually happened. [ref: RCN guidance]. The care plan is clear about the need to keep the catheter patent by ensuring good fluid intake. We spoke to the manager and staff about current practice around monitoring fluid intake for people who may have a catheter. We were advised that apart from the usual drinks offered there was no monitoring of any extra fluids that may be needed in special circumstances such as those people with catheters. The care record we reviewed had no monitoring of fluid intake at any time over the stay in the home although there are references in the care notes to the staff having to push fluids and staff spoken with said that the persons fluid intake was very variable. We would recommend that any person with an indwelling catheter should be monitored carefully for fluid intake and that this should be recorded unless otherwise assessed. Care Homes for Older People Page 5 of 11 The care notes contained assessments for all kinds of risk including manual handling and smoking for example and there is good evidence that relatives were involved in these assessments and discussions which is good practice. We could find no reference to any risk assessments completed regarding the need or otherwise for the indwelling catheter however. Again it is good practice to have such an assessment and this is particularly so with people who may lack capacity to give consent because they have dementia for example. Again we would refer the manager to the professional guidance regarding this. We spoke to the manager and nursing staff about ongoing updates and training in the home and looked at records of training for staff. Records show that nursing staff have regular updates on care practices generally. For example nursing staff have attended updates regarding flu vaccination, tissue viability, health and safety and infection control. We asked about updates for catheter care and were advised that one nurse attends each year for an update and gives feedback to the rest of the care team. We spoke to two nurses who have been involved in catheterisation procedures and both have not attended for any updates for a number of years however apart from the general feedback. Given the comments around the standard of some of the recording and monitoring of people with catheters we would strongly recommend that all of the trained staff are updated with the good practice guidelines from the RCN so that they can reflect on any improvement that may need to be made with regard to the care documentation regarding catheter care and ongoing records, particularly fluid intake records. We discussed this with the manager who is aware of the guidelines. What the care home does well: We observed people being cared for and they were able to receive ongoing attention from staff. We observed people being moved and handled by staff using mobility aids such as wheelchairs and hoists. Generally staff were observed to be competent and supported people well. Staff showed good communication skills when supporting people. We observed that people in the day areas were appropriately dressed and had good standards of personal hygiene. Those spoken with said that staff worked very hard and supported them well. We observed that people were given plenty of drinks over the course of the inspection. There are drinks available at all times in the lounge and these are replenished during he afternoon. We looked at care records for one person. The care records consisted of a plan of care for the person and also supporting documentation such as daily records and reviews. We found the care plan to be well devised and reviewed regularly. It contained clear instructions for staff to follow so that care could be carried out. We spoke to care staff and they were knowledgeable about the daily care of people with catheters, for example, including routine hygiene. The evaluations of the care plan were clear and we were able to see that care had been reviewed and monitored. Staff had also been appropriate in when to refer the person for medical opinion and support such as the GP and specialist nurses. This shows that the home are supporting people with there ongoing health care needs. Care Homes for Older People Page 6 of 11 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 People moved in wheelchairs 09/11/2009 must have appropriate footrests in place at all times. This ensures the correct use of equipment and reduces the risk of harm to people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Nursing notes for clinical procedures such as catheterisation should be in greater detail and be a clear record of the procedure and all that happened. The notes should be written by the nurse carrying out the procedure. We would recommend that any person with an indwelling catheter should be monitored carefully for fluid intake and that this should be recorded unless otherwise assessed. A risk assessment should be documented for any person undergoing catheterisation or with an indwelling catheter. We would strongly recommend that all of the trained staff are updated with the good practice guidelines from the RCN Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations so that they can reflect on any improvement that may need to be made with regard to the care documentation regarding catheter care and ongoing records, particularly fluid intake records. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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