Care Home: Romford Grange Nursing Home

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What the care home does well All the requirements made at the last key inspection have been met. The nutritional needs of the residents are well considered and food and mealtimes are seen as being important for all people living in the home. Comments from residents included: "If I don`t like anything they ask me what I would like" "The food is really nice, there is always a choice and I often have a cooked breakfast." There was a good response from surveys and generally all commented very positively about the quality of care being provided in the home. Comments included: "Staff are very friendly and always ready to help, including management". "I am now mostly bed bound. However, if there is an event going on e.g. entertainment, they spend time in my room to ensure that I am part of what is going on". "A very happy and homely home. Staff extremely caring and friendly" Good staff interaction was observed with all of the residents and this resulted in a high level of motivation for people living in the home. All staff are very aware that Romford Grange is the home of the residents and try hard to make this as pleasant as possible. What has improved since the last inspection? Staff are receiving supervision in groups, 1:1 and through care practice observations, and a written record is being maintained. Some of the lounge chairs have been replaced, and the bathroom floors have been replaced with improved flooring. A new bath was being installed on the day of the visit. Cleaning schedules have been improved and we found the home to be clean and tidy with no offensive odours, even at the early start of the visit. CARE HOMES FOR OLDER PEOPLE Romford Grange Nursing Home 144 Collier Row Lane Romford Essex RM5 3DU Lead Inspector Ms Gwen Lording Unannounced Inspection 25th September 2008 08:15 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 Romford Grange Nursing Home DS0000015601.V372363.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. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Romford Grange Nursing Home Address 144 Collier Row Lane Romford Essex RM5 3DU 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) 01708 755 185 01708 754 454 romfordgrange@schealthcare.co.uk Southern Cross Care Homes Limited Maureen O`Connor Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Romford Grange Nursing Home DS0000015601.V372363.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 with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 41 14th November 2007 Date of last inspection Brief Description of the Service: Romford Grange is a purpose built care home providing nursing and personal care for 41 older people. The home is operated by Southern Cross Limited who operate a number of similar homes. It is situated in a residential area of Romford within walking distance of local shops, and on several bus routes into Romford town centre. There are bedrooms on the ground and upper floor, and a passenger lift that is wheelchair accessible. One of the bedrooms on the upper floor has been converted into a sensory room. There is a large, open plan, lounge and dining area on the ground floor, plus a smaller, similar purpose room, which is also used for meetings. The bedrooms are all single, but do not have ensuite toilets. There are bathrooms and toilets on both floors. A small patio area off the main lounge contains raised planted beds, and outdoor seating. On the day of the inspection the range of fees for the home was between £545:00 and £848:00 per week. A copy of the Statement of Purpose and Service User Guide is made available to both the residents and their family. A copy of both these documents and the most recent inspection report are available at the main reception. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This was an unannounced inspection which started at 08:15am and took place over five hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The deputy manager was available throughout the visit and the organisations Operations Manager was present during the feedback at the end of the inspection. This was a key inspection in the inspection programme for 2008/2009. Discussions took place with the deputy manager; kitchen, laundry and domestic staff; and the home’s administrator. We spoke to a number of residents and relatives; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. At the time of the inspection occupancy levels were low and there were 21 residents being accommodated in the home. A tour of the premises, including laundry and main kitchen was undertaken. The files of several residents were case tracked, together with the examination of other staff and home records. This included medication administration, staff training and staff recruitment procedures and files, maintenance records and complaints. Information was taken from an Annual Quality Assurance Assessment (AQAA); which was completed by the manager and returned to us prior to the inspection. This is a self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 26 monitoring reports and Regulation 37, notification of events. Surveys were sent out prior to the inspection for completion by staff and residents. An incident has recently occurred in the home that is currently being investigated under the London Borough of Havering safeguarding procedures and has not yet been concluded at the time of this inspection. The registered providers are working co-operatively and openly with regard to these safeguarding concerns. The London Borough of Havering informed us that they temporarily suspended the commissioning of placements to the home, however this suspension has now been lifted. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 6 During the inspection we asked several people living in the home how they wished to be referred to in the report. The majority expressed a wish to be referred to as ‘resident’. This is reflected accordingly in the report. We would like to thank the staff and residents for their input during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 7 The registered persons must ensure that all parts of the home are maintained in a good state of decoration and repair. Priority must be given to the boiler room door, the rubbish skip and the corridor doors and doorframes, to which this timescale is given. This will add to the quality of the living environment. The registered persons must ensure that the side access door is always shut to ensure the safety of the residents, staff and the building. It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently and highlighted on the front sheet of the residents file and on the MAR chart. The GP’s do not regularly or routinely undertake reviews of records or medication. It is strongly recommended that residents GP’s be contacted in order to undertake medication reviews. 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. Romford Grange Nursing Home DS0000015601.V372363.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 Romford Grange Nursing Home DS0000015601.V372363.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): Standards 3, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Comprehensive pre-admission assessments are undertaken for all residents. This means that staff have the detailed information to enable them to determine whether or not the home can meet a prospective residents needs. The home does not offer intermediate care. EVIDENCE: We looked at the files of 7 residents, 1 of whom had recently been admitted to the home. All files showed evidence of the home having undertaken a comprehensive pre-admission assessment from which a care plan had been compiled with input from the resident where possible, family members where appropriate, and health and social care professionals. Prospective residents and their families have the opportunity to visit the home prior to admission, Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 10 talk to staff and access the home’s facilities. We spoke to one resident who told us “I came with my family to look at the home and they even gave us lunch.” Romford Grange Nursing Home DS0000015601.V372363.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): Standards 7, 8, 9,10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health, social support and personal care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to medication EVIDENCE: We looked at the files of 7 residents and each of the residents had a comprehensive care plan which covered areas such as communication, night care and sleep, continence care, moving & handling, oral care, end of life wishes and mobility. Where a resident had a specific need such as catheter care, wound care or diabetes then the necessary care plan was also in place. Generally the care plans were very detailed and gave a real sense of the Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 12 individual resident. We saw evidence that care plans are reviewed on a monthly basis, and that where necessary a specific care plan had been updated in accordance with the review. During the visit we saw that 4 residents had pressure area wounds and all had been seen by the tissue viability nurse. We also noted that 2 of these residents acquired their pressure area wounds whilst in hospital, and 1 whilst at home. Daily records were comprehensive around health and personal care needs, and were generally reflective of all of the care plans and the outcomes. For example 1 record showed “M was able to wash herself to-day with minimal assistance, which was an improvement.” Some care plans did indicate whether a person had capacity to make an informed decision in certain areas, for example in 1 file it stated that “E does not have capacity to make own decisions around end of life wishes.” However, this was not generally the case and not with regard to the question around resuscitation. This area of the care plan was often signed by a relative with no indication as to the resident’s capacity, or not, to make an informed decision. This was discussed with the deputy manager and the operational manager during the inspection. We also left a copy of the Commission’s guidance on the Mental Capacity Act 2005 with the deputy manager. Many of the residents at Romford Grange have very high care needs due to complex medical problems, and training has been undertaken to ensure that trained staff can meet these complex needs. Training has included nasogastric feeding, wound care, swallowing difficulties, nutritional awareness and end of life care. Residents were observed to be clean and well dressed, and there were no offensive odours anywhere in the home. We saw evidence of good risk assessments being put into place, and these included reduction of falls, the use of bed rails, wheelchairs, hoists and special reclining chairs. We would also recommend that the provider look at the use of assistive technology which could include mattress alarms, chair cushion alarms and other such aids which could alert staff to a resident experiencing difficulties in his/her bedroom, but being unable to use the emergency alarm system to summon assistance. We spoke to 1 resident who likes to sit in her bedroom and she told us “I am never lonely as the staff are always popping in to make sure that I am okay, and always ask if I would like a cup of tea.” We saw evidence that residents’ are being weighed on a regular basis, generally monthly but more frequently if necessary. Also that referrals were being made to dieticians or nutritionists when necessary. All residents also had visits to or from the optician, dentist, chiropodist and GP. Visits to and from other health or social care professionals were also arranged as necessary. As previously stated some care plans contained details around end of life wishes, but this is still an area which needs further development. However, we Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 13 are confident that residents and their families receive, and will receive, care in accordance with their wishes in a caring and sensitive manner. It was evident that the religious, cultural and individual needs of the residents were being identified and met by the service, and in discussions with staff they were very aware of equality and diversity issues. From observations and discussions with staff we were able to evidence that the privacy and dignity of residents was respected. Staff were heard to call residents by a preferred name, some residents were referred to as Mr/Mrs or Ms X, and others by a first name. There are policies and procedures for the handling and recording of medication. An audit was undertaken of the management of medicines in the home, and a random sample of Medication Administration Records (MAR) charts were examined. Discussions with staff and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to their medication. The organisation undertakes regular audits on medication, and there has been a recent audit from the company, together with one undertaken by the pharmacist. The pharmacist did identify that the GP’s do not regularly/ routinely review records or medication. We did discuss this with the deputy manager and the operational manager during the inspection and recommended that the GPs be contacted in order to undertake medication reviews. Where a resident had an allergic reaction to either medication or food this was recorded on the MAR chart and in the care plan. However, it is strongly recommended that where such an allergy has been identified, it is recorded more prominently and highlighted on the front sheet of the residents file and on the MAR chart. Romford Grange Nursing Home DS0000015601.V372363.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 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The lifestyle within the home matches the expectations and preferences of residents with regard to their social, cultural, religious and recreational interests and needs. The attitude and practice of the service and that of the staff, promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. The nutritional needs of residents are well considered so that food and mealtimes are seen as being important for all residents. EVIDENCE: There is a weekly programme of activities for all of the residents and these include outings from the home, garden parties, external entertainers visiting the home and group activities such as games, bingo and quizzes. The organisation is looking at the provision of transport which could be shared amongst other homes within the group who are located in the general area. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 15 The provision of such transport would be beneficial to all of the residents in enabling them to more fully participate in the wider community. The home does employ an activities co-ordinator but other staff spoken to told us “we all help with activities, even if it is just sitting and talking to our residents.” On Sundays residents and relatives can enjoy snacks and drinks from the trolley service. Residents can participate in religious services held at the home on Sundays, and would also be enabled to visit a place of worship if this was their wish. Residents’ birthdays are celebrated within the home, as are other festivals and special occasions. The home held a summer fete recently and one recording seen in the daily records was “with much encouragement E got up and came into the lounge for the day and N won a cuddly toy for her.” We were able to observe that the routines of daily living were very flexible to suit the preferences and capacities of residents. It was apparent that residents can choose when to get up and when to go to bed, as on our arrival at the home at approximately 08.15 am some residents were still asleep in their bedrooms, whilst others were up and dressed. We were told that one resident prefers to get up later in the morning and staff are ready to assist him at this time. We observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives. All staff are very aware that Romford Grange is the home of the residents and try to make this as pleasant as possible. The care plan of another resident stated: “likes to sit by the french doors as she enjoys the fresh air”. The home has weekly visits by a hairdresser and it was evident that she has a good understanding of the needs of the residents and is viewed as a member of the home’s staff team. We arrived at the home during breakfast, and some residents were in the dining room but others had breakfast in their rooms. Tables were nicely laid with cloths, napkins, cutlery and flowers. One resident told us that “the food is really nice, there is always a choice and I often have a cooked breakfast. “Another resident told us “If I don’t like what is on the menu you can ask for something else – which I sometimes do”. Mealtimes are staggered so that residents who require assistance with eating can be given the necessary time by staff. We were able to observe breakfast and part of the lunchtime meal being served. Both meals were well presented and residents who required assistance were being given this in a positive, sensitive and encouraging manner. Visiting times are flexible and relatives/ friends are encouraged to visit. We observed visitors being offered tea/ coffee, and visitors spoken to confirmed that refreshments are routinely offered whenever they visit. One resident Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 16 usually visits her home once a week but had not been able to do so more recently due to the ill health of a family member. On the day of the visit we were told that family members would be joining her at Romford Grange for lunch. A resident told us: “There have been occasions when I have been unwell and my family have stayed. The staff proved outstanding, giving comfort, meals and tea to my family”. A visit was made to the kitchen and we were able to discuss the storage and preparation of food, and menus with the cook. There is a daily menu and a record is maintained of what each individual chooses to eat. A cooked breakfast is available each day and on the day of the visit eight residents had chosen one variety or other from this option. Residents can also chose to have cooked eggs every morning, for example boiled, fried, scrambled. Fresh fruit is provided daily and is available on request. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake or diminished appetites. On the day of the inspection we were told that menus are currently being reviewed, particularly the options available at suppertime. Romford Grange Nursing Home DS0000015601.V372363.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 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The organisation and staff team make very effort to sort out any problems or concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to, taken seriously and acted upon. All staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaint or concerns made to them. We looked at the complaints log and found that all complaints are taken seriously and are dealt with in accordance with the home’s policy and procedure. Since April, 2008 two complaints had been received. In discussions with some of the residents they told us that they knew how to complain, who to and that they would complain if they had need to. One resident told us “I have been here for 3 years and have nothing but praise for the staff who are excellent. They really care and take time to come in and talk to me as I do not Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 18 like leaving my room very often.” Another resident told us: “Staff are always willing to listen and are very obliging”. All staff have undertaken training in safeguarding vulnerable adults and this is included in the induction training for all newly recruited staff. This was evidenced on staff files and training schedules. There is a policy on whistle blowing and challenging bad practice at work. Staff told us that they had received training in safeguarding vulnerable people, and a member of staff told us “if I saw a member of staff ill-treating a resident in any way, I would immediately report them to the senior person on duty”. A resident told us “I feel safe here.” A copy of the complaints policy and procedure was prominently displayed in the reception area of the home, together with comprehensive information on safeguarding vulnerable adults with various contact numbers. This also included the use of an advocate if necessary, and this could be accessed through Age Concern. As previously detailed in the summary of this report an incident has recently occurred that is currently being investigated under the London Borough of Havering safeguarding procedures, and has not yet been concluded at the time of this inspection. The registered providers work co-operatively and openly with regard to safeguarding adult concerns. Romford Grange Nursing Home DS0000015601.V372363.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, 24, 25 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs and particular lifestyle of the people who live there. Overall the home is welcoming, clean and tidy. The ongoing redecoration programme and improvements as highlighted in the AQAA will add to the quality of the living environment. EVIDENCE: We did a tour of the premises, at the start of the visit and all areas were visited later during the day. The inspection commenced at 08:15am and on arrival we found the home to be clean, tidy and there were no offensive odours. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 20 However, it was very evident that although some areas had been redecorated there were still many areas of the home that require redecoration especially with regard to worn, chipped paintwork on many of the doors and door frames. There is a programme of redecoration and refurbishment which is ongoing. Some of the lounge chairs have been replaced, and the bathroom floors have been replaced with improved flooring. Due to the low levels of occupancy there are currently no residents being accommodated in first floor bedrooms. The home is using this as an opportunity to carry out re-decoration on this floor. Part of the garden area has been repaved, and is generally well maintained. However, the boiler room doors need replacing, a skip of rubbish is waiting to be removed from the sideway and a side door requires attention. This side door was left open, even though it does have a keypad lock. For the security of the residents, staff and building, it is essential that this door be always shut after use because it is open to the unsupervised sideway of the home, and would give easy access to intruders. Residents could also leave the home unobserved by staff if the door were left open. Some bedrooms were seen by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms seen were very personalised, well maintained and reflective of the occupant’s culture, religious and personal interests. There was evidence of aids and equipment at various points around the home which are capable of meeting the needs of all residents. Lounge/dining areas were also well furnished and decorated and there are plans to review the seating and dining areas in the main lounge/ dining room, in consultation with residents, to make it appear less ‘institutionalised’. Currently one of the lifts is out of action as the maintenance company is waiting for a replacement part. The other lift is in good working order. None of the bedrooms have en suite facilities. However, the AQAA informed us that plans have been submitted for several bedrooms on the first floor to have en suite facilities and separate shower room. We visited the laundry and this was found to be clean, with soiled articles being stored appropriately pending washing. The laundry is situated outside the main building but there is a covered access and suitable equipment for transportation of soiled/ clean linen and personal clothing. Personal protective clothing and equipment were available and in use. Hand washing facilities and alcohol hand sanitisers are prominently sited and staff were observed to be practising an adequate standard of hand hygiene and control of infection. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 21 Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staff rotas were inspected and the staffing levels and skill mix of qualified nurses and care staff, appeared appropriate to meet the assessed nursing and personal care needs of the residents. Currently there is 1 RGN plus 3 care workers both during the day and during the night. Sometimes this is supplemented by the deputy manager who also does care shifts. Staff were being effectively deployed to ensure that residents choosing, or needing to remain in their bedrooms were being cared for appropriately. Effective team working was observed throughout the inspection. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 23 We saw evidence that staff are receiving supervision in groups, 1:1 and through care practice observations, and this was supported through records seen, discussions with some staff members and the deputy manager. Staff training is given a high profile within the service and current training has included safeguarding vulnerable adults, dementia awareness, Mental Capacity Act 2005, health & safety, infection control, nasal-gastric feeding, food hygiene, end of life care, nutrition, wound care, infection control, oral hygiene and use of bed rails. All staff working in the home have recently received refresher training in moving and handling which incorporated a written test paper. The AQAA stated that 75 of the care staff are trained to National Vocational Qualification (NVQ) level 2 or above. There is a consistent team of staff with very little turnover, and this does mean that residents at Romford Grange do get consistent care from staff that they know well. Southern Cross Limited, as an organisation employs a workforce from diverse cultures and backgrounds. In discussions with some staff they were able to demonstrate a good understanding of the importance of appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. The organisation is able to demonstrate that they operate a proactive recruitment and selection process in accordance with the requirements of legislation, equal opportunities and anti discriminatory practice. The personnel files of three staff were examined. All elements of recruitment were accurately recorded and all required documentation is obtained prior to the commencement of employment. Romford Grange Nursing Home DS0000015601.V372363.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 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager is an experienced and well-qualified person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken by the responsible person to monitor and report on the quality of service being provided in the home. EVIDENCE: The registered manager is currently on sick leave. However, in her absence the home continues to be managed in the residents best interests by the experienced deputy manager. She is being well supported by the organisation and arrangements are in place for her to liaise with registered managers on a Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 25 daily basis from other homes in the organisation. On the day of the inspection one of these managers was able to offer the deputy manager the required level of support and assistance. The home employs a full time maintenance person. We looked at maintenance records for gas, electric, water, lift maintenance, hoist and other equipment maintenance, water temperature checks, fire alarm and the emergency alarm testing and all were found to be in good order and up to date. Accident/ incident records were also examined. In addition to the completed accident form there is a pro-forma Accident/ Falls Observation Record which is completed following all accidents/ falls. Staff record hourly and then two hourly observation checks as required. We were able to evidence completed copies of these records on residents files we case tracked during the inspection. There had been a visit by the London Fire & Emergency Planning Authority in August 2008, and the home was compliant with the Regulatory Reform (Fire Safety) Order 2005. A visit by the local environmental health food safety officer in October 2007 had identified some problem areas but the requirements/recommendations made had all been complied with at the time of our inspection on the 25th September 2008. Regulation 37 notification, required under the Care Homes Regulations 2001 are being sent to the Commission when necessary, and the unannounced visits and reports required under Regulation 26 of the Care Homes Regulations 2001 were also evidenced during the inspection. We saw evidence of the regular supervision of staff, and this was confirmed in discussions with some staff members. Currently the manager does not act as an appointed agent for any resident. Residents financial affairs are managed by the individual resident, or their relatives/ representatives. There is a computerised financial system which is managed by the home’s administrator. Through discussion and records inspected, there was evidence to show that residents financial interests are safeguarded. Secure facilities are provided for the safekeeping of any valuables held on behalf of residents. The AQAA clearly identifies the plans for improvement and further development of the service over the next year. Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 23 Requirement The registered persons must ensure that all parts of the home are maintained in a good state of decoration and repair. Priority must be given to the boiler room door, the rubbish skip and the corridor doors and doorframes, to which this timescale is given. This will add to the quality of the living environment. The registered persons must ensure that the side access door is always shut to ensure the safety of the residents, staff and the building. Timescale for action 31/12/08 2. OP19 OP38 13 (4) 25/09/08 Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently and highlighted on the front sheet of the residents file and on the MAR chart. It is strongly recommended that residents GPs be contacted in order to undertake medication reviews. 2. OP9 Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Romford Grange Nursing Home DS0000015601.V372363.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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