Care Home: The Grove and The Courtyard

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What the care home does well Two care files were looked at for people living in The Courtyard. The purpose of looking at these care files was to check if people are now involved with their care records and that there is evidence of this. Also to check the involvement of other health care professionals and to ensure that there was information to show who was responsible for certain aspects of health care delivery. The first file had nineteen care plans in place, five of which had been signed by the person. A number of these records had recently been updated. The unit manager confirmed that these would be fully discussed with the person concerned and evidence would be available in respect of this. There is evidence of reviews for which the person is fully involved in. In the second file, there were nineteen care plans of which sixteen had been signed by the person. This person has a depot injection for their mental health needs. There is clear information that this is administered by a health professional within the visiting professionals records and also that they attend Lothian Road for this. In this respect it is clearly the role of a CPN outside of the home responsible for this health delivery. There is however no care plan in place detailing that this person has a depot injection and what there needs are around this and why they are prescribed it. This would be helpful to staff to have this knowledge and understanding. Two care plans were looked at for people living on The Grove and Lodge suite. The care plan viewed on the Grove suite was for someone admitted in March 2010 and this was not fully completed and had not yet been signed by the individual or their representative. There was however, clear evidence showing the input from other professionals and there were fifteen care plans in place stating how the individuals care needs should be met. The care plan on the Lodge suite had been reviewed by a nurse on the 27/04/2010, there were fifteen care plans in place which included evidence of input from other professionals including a dietitian. We looked at behaviour recording records to check that a care plan was in place where someone had behaviour which could be challenging. This information was included within care plans. The medication system were looked at in relation to fridge items, dating of items once opened and self administration of medicines. Currently in The Courtyard there are no fridge items. In terms of self medication some people do administer their own creams. The staff record on the reverse side of the MAR sheet the date in which the creams and lotions are given to the person and this is checked by two people. One person was visited in their room and their tube of cream was looked at, however so far the person has not had to use it so it remains unopened. Three people`s MAR sheets were looked at and there were double signatures in place where needed and no gaps.Another person who self medicates was visited and they showed us the locked facility in which they keep their medication. They were fully aware of all of the medication and were well in control of them. The medication balanced to what should have been there. In the Cleveland Suite three people`s MAR sheets were looked at. Where there were handwritten items, these had been double signed and there were no gaps and medication balanced. Fridge temperature were being recorded am and pm. On the Grove and Lodge suite we looked at medication records for two people. MAR sheets contain a photo to identify the individual, the date medication is received and this is signed by a staff member. In the main any handwritten entries were double signed by staff. We looked at menus and gained feedback from people regarding the food. We were going to observe the practice at mealtime but as the majority of people were out that day instead we have used the information and observations made by the area manager which have been included in their Regulation 26 visits to the service. One person who lives in The Courtyard said, "food is alright, have a choice, lunch today sandwiches (due to an outing), no idea what is for the evening meal Make own tea on a Tuesday. Meals that come out of the main kitchen, enough variety, portion size alright, get fruit sometimes. Make drinks when I want". Another person who lives in the Courtyard said, "No complaints about the food, I am pleased with it, get enough to eat and always asked if you want more, have a choice and alternatives available. Do have salads available, can make a snack, quality of food is ok for me". A third person from The Courtyard said, "I don`t like cooked dinners every day, tends to be meat, veg and potatoes, much the same, If you don`t want it then it tends to be a sandwich. Quantity of food is ok, if others ask for more there is more. Sometimes fresh fruit". A Staff member on the Courtyard said, "food could be better, need more choice, need to think about portion size and quality of cooking. There is choice but it`s the same in a way, need more salads, need to request them, alternatives are available. Some concern about the delivery of service as sometimes food items out of stock. Do have theme nights such as American Nights, Curry nights and for birthdays" We looked at the activities provided by the home, one person on The Courtyard said, "Spend day by joining in with activities, pool, dominoes, cards, TV sometimes. Listen to the radio. Depends on what is going on, will also spend time in room". A Staff member said, "I think people have a really good quality of life, went to Edinburgh last year, this year going to Crows Nest near Filey". The manager confirmed that activities generally had improved at the home, activities on The Grove and Lodge suite included cake making, outings, music and celebrations. The majority of people living at the home had gone out on a sponsored walk on the day of the visit. Staff and relatives had accompanied them. Staff training records were looked at anda copy of the training matrix and NVQ information was made available. The training matrix shows that training has taken place and that in the main it is up to date with fire safety, fire drills, food hygiene, moving and handling, COSHH, Health and Safety, POVA. A number of staff have received training in nutrition. We also discussed with the manager about the competencies of the qualified staff as they are not all RMN`s. There is the need to ensure that staff without a dementia care qualification undertake addition What the care home could do better: In terms of self administration of medication, the care plans need to be more specific to the individual. For example, one of the interventions state "frequency of checking, daily, weekly x 2 monthly", it is not clear which this is without having to search through the evaluation of care. In another person`s file it states, "Staff will check daily until competent a member of staff said they are now checking weekly. The audit information is also not clear around the frequency of audits and what is meant by audit, as there should be some information to ensure ongoing competency and safety. Again with the self medication, the form used is not headed and contains very limited information this needs to be expanded upon. In one of these records the person had not signed it, in another they had, one member of staff had signed the record but there was no designation and no evidence of being checked by a unit manager/senior manager. People did have letters in place from the GP confirming that the individuals are competent to undertake selfmedication but the service themselves need to have robust systems in place. Whilst care plans are in place detailing the medication to be self administered, in one person`s it did not include sudocrem. Of the three records of medication looked at on the The Grove and Lodge suite, two had medication that was out of stock, there was evidence that these items had been ordered from the GP and we were told that they were waiting for the pharmacy to deliver them. On the residential unit one persons hand written medication records were not double signed. We also found a bottle of eye drops with a twenty eight day shelf life which was dated on opening on the 14/05/2010, this was out of date. One person in the Lodge was seen with medication left on the table in front of them, medication needs to be administered safely to ensure that it is taken by the intended recipient. A Relative was spoken to whose mum had been living at the home on the EMI nursing unit for seven weeks. She said that her mum was not very good at feeding herself and she wished the staff would wash her hands and face after her meal. She said she has fed this back but that it had not improved. She also said that she was surprised one day when one lady emptied her pastie and beans on to her place mat and she was left to eat it off the mat by a member of staff who said "If you want to, you can eat it like that ". As issues around dignity, especially during mealtimes were raised in the previous inspection, further training and support may be required for staff as this practice does not support people`s dignity. An area in which more training is needed is infection control. Additional dementia care training is still required for some staff. Staff would benefit with further training in regard to recording and managing difficult or challenging behaviour. Although standards of recording generally have improved, a number of responses were `told that behaviour is inappropriate` . As the people accommodated have dementia it is unlikely that they will understand their behaviour, so the onus is on staff and the way in which they manage this. When people on the Courtyard and Cleveland suites were asked what could be improved upon, they said that more money to do things such as going to the pictures and swimming. Residents pay for themselves but staff have to be paid for from the resident fund which means that this money has to be raised. Random inspection report Care homes for older people Name: Address: The Grove and The Courtyard 341 Marton Road Marton Middlesbrough TS4 2PH two star good service 15/12/2008 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: Tanya Newton Date: 1 5 0 6 2 0 1 0 Information about the care home Name of care home: Address: The Grove and The Courtyard 341 Marton Road Marton Middlesbrough TS4 2PH 01642819111 01642819103 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Beverley Denise Grimes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bramble Care Homes Ltd care home 55 Number of places (if applicable): Under 65 Over 65 0 0 15 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 19 26 0 The maximum number of service users who can be accommodated is: 55 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 category: Older Person Code OP 15, Mental Disorder Code MD 26, Dementia Code DE 19 - maximum number of places 55 Date of last inspection 2 5 0 8 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home The Grove and The Courtyard is a purpose built care home providing care for three different client groups, within four separate units. The Grove Suite incorporates a 15 bedded unit for older people. The Lodge provides 14 nursing beds for people with dementia. The Cleveland Suite provides 14 beds and The Courtyard 12 beds for younger adults with a mental disorder of a neurological cause. All rooms have ensuite facilities which include toilet and wash-hand basin and some rooms include a shower. The home is located centrally in Middlesbrough; it is on a busy main road, close to public transport, shops, public houses and churches. The weekly fees for The Grove and The Courtyard are: £420 for residential care and EMI nursing care up to £550 for private clients. Specialist residential fees are £541. Please contact the manager for more information about fees and what they include. Care Homes for Older People Page 3 of 11 What we found: We carried out an unannounced random inspection of the service on the 15th June 2010. A random inspection allows us to focus on specific areas and in this case allowed us to follow up progress in relation to the requirements and recommendations made in the previous inspection from 01/12/2010. What the care home does well: Two care files were looked at for people living in The Courtyard. The purpose of looking at these care files was to check if people are now involved with their care records and that there is evidence of this. Also to check the involvement of other health care professionals and to ensure that there was information to show who was responsible for certain aspects of health care delivery. The first file had nineteen care plans in place, five of which had been signed by the person. A number of these records had recently been updated. The unit manager confirmed that these would be fully discussed with the person concerned and evidence would be available in respect of this. There is evidence of reviews for which the person is fully involved in. In the second file, there were nineteen care plans of which sixteen had been signed by the person. This person has a depot injection for their mental health needs. There is clear information that this is administered by a health professional within the visiting professionals records and also that they attend Lothian Road for this. In this respect it is clearly the role of a CPN outside of the home responsible for this health delivery. There is however no care plan in place detailing that this person has a depot injection and what there needs are around this and why they are prescribed it. This would be helpful to staff to have this knowledge and understanding. Two care plans were looked at for people living on The Grove and Lodge suite. The care plan viewed on the Grove suite was for someone admitted in March 2010 and this was not fully completed and had not yet been signed by the individual or their representative. There was however, clear evidence showing the input from other professionals and there were fifteen care plans in place stating how the individuals care needs should be met. The care plan on the Lodge suite had been reviewed by a nurse on the 27/04/2010, there were fifteen care plans in place which included evidence of input from other professionals including a dietitian. We looked at behaviour recording records to check that a care plan was in place where someone had behaviour which could be challenging. This information was included within care plans. The medication system were looked at in relation to fridge items, dating of items once opened and self administration of medicines. Currently in The Courtyard there are no fridge items. In terms of self medication some people do administer their own creams. The staff record on the reverse side of the MAR sheet the date in which the creams and lotions are given to the person and this is checked by two people. One person was visited in their room and their tube of cream was looked at, however so far the person has not had to use it so it remains unopened. Three peoples MAR sheets were looked at and there were double signatures in place where needed and no gaps. Care Homes for Older People Page 4 of 11 Another person who self medicates was visited and they showed us the locked facility in which they keep their medication. They were fully aware of all of the medication and were well in control of them. The medication balanced to what should have been there. In the Cleveland Suite three peoples MAR sheets were looked at. Where there were handwritten items, these had been double signed and there were no gaps and medication balanced. Fridge temperature were being recorded am and pm. On the Grove and Lodge suite we looked at medication records for two people. MAR sheets contain a photo to identify the individual, the date medication is received and this is signed by a staff member. In the main any handwritten entries were double signed by staff. We looked at menus and gained feedback from people regarding the food. We were going to observe the practice at mealtime but as the majority of people were out that day instead we have used the information and observations made by the area manager which have been included in their Regulation 26 visits to the service. One person who lives in The Courtyard said, food is alright, have a choice, lunch today sandwiches (due to an outing), no idea what is for the evening meal Make own tea on a Tuesday. Meals that come out of the main kitchen, enough variety, portion size alright, get fruit sometimes. Make drinks when I want. Another person who lives in the Courtyard said, No complaints about the food, I am pleased with it, get enough to eat and always asked if you want more, have a choice and alternatives available. Do have salads available, can make a snack, quality of food is ok for me. A third person from The Courtyard said, I dont like cooked dinners every day, tends to be meat, veg and potatoes, much the same, If you dont want it then it tends to be a sandwich. Quantity of food is ok, if others ask for more there is more. Sometimes fresh fruit. A Staff member on the Courtyard said, food could be better, need more choice, need to think about portion size and quality of cooking. There is choice but its the same in a way, need more salads, need to request them, alternatives are available. Some concern about the delivery of service as sometimes food items out of stock. Do have theme nights such as American Nights, Curry nights and for birthdays We looked at the activities provided by the home, one person on The Courtyard said, Spend day by joining in with activities, pool, dominoes, cards, TV sometimes. Listen to the radio. Depends on what is going on, will also spend time in room. A Staff member said, I think people have a really good quality of life, went to Edinburgh last year, this year going to Crows Nest near Filey. The manager confirmed that activities generally had improved at the home, activities on The Grove and Lodge suite included cake making, outings, music and celebrations. The majority of people living at the home had gone out on a sponsored walk on the day of the visit. Staff and relatives had accompanied them. Staff training records were looked at and Care Homes for Older People Page 5 of 11 a copy of the training matrix and NVQ information was made available. The training matrix shows that training has taken place and that in the main it is up to date with fire safety, fire drills, food hygiene, moving and handling, COSHH, Health and Safety, POVA. A number of staff have received training in nutrition. We also discussed with the manager about the competencies of the qualified staff as they are not all RMNs. There is the need to ensure that staff without a dementia care qualification undertake additional training to give them the competencies and skill to lead and manage the dementia care unit. NVQ information was made available. Of the forty three staff involved in care delivery, only eight are not qualified, however of the eight, one is on maternity leave, two are bank staff and two have just commenced employment. We spoke to people living on The Courtyard. They said, It is great, like it here, the staff are so helpful, supportive, meet different people, mix with people from the different units, have made friends. Another person said, Its ok here now, staff are brilliant, help you do anything you want. Personal allowance records were looked at for six people living at the home. All amounts balanced, signatures were in place and a money slip system is also in place which the person signs as does a staff member. Of what is good about the service, one member of staff said that the staff are wonderful, care is second to none, excellent. They talked positively about the relationships that had been developed and about the personal development of people living in the service and their increased motivation. We looked at records to monitor quality at the home. The area manager carries out regular visits to the service under Regulation 26. These reports confirm that requirements and recommendations made in the previous inspection report have been addressed. Audits have been carried out on care plans and on medication. The manager carries out accident analysis and this also includes any action to be taken as a result. What they could do better: In terms of self administration of medication, the care plans need to be more specific to the individual. For example, one of the interventions state frequency of checking, daily, weekly x 2 monthly, it is not clear which this is without having to search through the evaluation of care. In another persons file it states, Staff will check daily until competent a member of staff said they are now checking weekly. The audit information is also not clear around the frequency of audits and what is meant by audit, as there should be some information to ensure ongoing competency and safety. Again with the self medication, the form used is not headed and contains very limited information this needs to be expanded upon. In one of these records the person had not signed it, in another they had, one member of staff had signed the record but there was no designation and no evidence of being checked by a unit manager/senior manager. People did have letters in place from the GP confirming that the individuals are competent to undertake self Care Homes for Older People Page 6 of 11 medication but the service themselves need to have robust systems in place. Whilst care plans are in place detailing the medication to be self administered, in one persons it did not include sudocrem. Of the three records of medication looked at on the The Grove and Lodge suite, two had medication that was out of stock, there was evidence that these items had been ordered from the GP and we were told that they were waiting for the pharmacy to deliver them. On the residential unit one persons hand written medication records were not double signed. We also found a bottle of eye drops with a twenty eight day shelf life which was dated on opening on the 14/05/2010, this was out of date. One person in the Lodge was seen with medication left on the table in front of them, medication needs to be administered safely to ensure that it is taken by the intended recipient. A Relative was spoken to whose mum had been living at the home on the EMI nursing unit for seven weeks. She said that her mum was not very good at feeding herself and she wished the staff would wash her hands and face after her meal. She said she has fed this back but that it had not improved. She also said that she was surprised one day when one lady emptied her pastie and beans on to her place mat and she was left to eat it off the mat by a member of staff who said If you want to, you can eat it like that . As issues around dignity, especially during mealtimes were raised in the previous inspection, further training and support may be required for staff as this practice does not support peoples dignity. An area in which more training is needed is infection control. Additional dementia care training is still required for some staff. Staff would benefit with further training in regard to recording and managing difficult or challenging behaviour. Although standards of recording generally have improved, a number of responses were told that behaviour is inappropriate . As the people accommodated have dementia it is unlikely that they will understand their behaviour, so the onus is on staff and the way in which they manage this. When people on the Courtyard and Cleveland suites were asked what could be improved upon, they said that more money to do things such as going to the pictures and swimming. Residents pay for themselves but staff have to be paid for from the resident fund which means that this money has to be raised. 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 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 9 Documentation regarding the self administration of medicines should be improved and should contain specific detail about the level of support required and the frequency and content of any audits. Handwritten entries and changes to MAR charts must be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. Medication which has a shelf life should be monitored to ensure that it is disposed of when out of date. Medication should be given directly to the individual and not left in front of them. The manager should continue to monitor practice during mealtimes to ensure that people are treated with dignity and respect. The way in which staff respond to difficult or challenging behaviour should also be monitored to ensure that peoples dignity is maintained. 2 9 3 10 4 15 The manager should monitor the implementation of the Page 9 of 11 Care Homes for Older 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 homes action plan in relation to the use of menus both written and pictorial. 5 27 The ongoing training should continue for all staff and include dementia and infection control. Further training around dignity during mealtimes should be provided. 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. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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