Care Home: Thelwall Grange Nursing & Residential Home

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What the care home does well Thelwall Grange provides a homelike environment for residents and is generally well equipped to meet their needs. Residents` health and lifestyle needs and choices were respected. Residents said they could choose how they spent their day. The meals provided were of a very good standard and residents said they enjoyed a choice at meal times. Meals were prepared so that resident requiring a diet due to a medical condition could have the same choices as other residents. Thelwall Grange had developed a listening culture as to how the services provided to people that live there can be improved and residents` comments support this. What has improved since the last inspection? What the care home could do better: Make an application to register the manager as the registered manager for Thelwall Grange so that people that live there will be confident it is run in their best interests. Provide call points in all lounges so residents can summon help when needed and maintain their independence and safety. The arrangements for staff working in the building should be revised so residents that are frail and not able to tell staff about their needs are not left in isolation. Provide further investment in training so all care staff have an NVQ level 2 qualification and there is a more skilled workforce. Mandatory training should be undertaken by all new employees a part of their induction programme so residents are in safe hands at all times. A more robust quality assurance system should be in place so mistakes over fire safety monitoring are not repeated. CARE HOMES FOR OLDER PEOPLE Thelwall Grange Nursing & Residential Home Weaste Lane Thelwall Warrington Cheshire WA4 3JJ Lead Inspector Anthony Cliffe Key Unannounced Inspection 08:45 19 and 21st February 2008 th 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 Thelwall Grange Nursing & Residential Home DS0000070031.V352888.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. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thelwall Grange Nursing & Residential Home Address Weaste Lane Thelwall Warrington Cheshire WA4 3JJ 01477 533387 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) www.smallwoodcarehomes.co.uk Smallwood Homes Ltd Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 43 Date of last inspection Brief Description of the Service: Thelwall Grange care home is situated in extensive grounds, in the rural area of Thelwall to the south east of Warrington, approximately 3 miles from the M6/M56 motorway junction. The home provides care for up to 43 older people with personal or nursing care needs. Accommodation is provided in 29 single and 5 double bedrooms. There are 4 lounge/dining rooms and 10 bathrooms. Externally the home provides spacious grounds, which are safe, attractive and accessible to residents. The home is situated in a rural setting and not on a regular bus or train route. The home provides transport. Fees range from £326 to £450. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. This unannounced visit took place on the 19th and 21st February 2008 and lasted twelve hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the manager was asked to complete a questionnaire to provide up to date information about services provided. During the visit various records and the premises were looked at. Twelve people that live at Thelwall Grange were spoken with to find out what they think about the services they receive. Four staff including the manager and an owner was also spoken with and they gave their views about the service. The inspector shared a meal with five residents. What the service does well: What has improved since the last inspection? This was the first inspection of Thelwall Grange as a new service since a change of ownership in October 2007. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 6 Improvements have been made to the management of Thelwall Grange with residents having more choice in their lifestyle choices through recreational activities and being consulted about improvements to the service. Improvements have been made to the menu and variety and choices of meals available. Improvements had been made to the décor of the building, refurbishment of bathing facilities, redecoration of lounges and bedrooms, replacement of corridor, lounge and bedroom carpets and purchase of furniture. Improvements have been made to the standard of housekeeping with the building clean and hygienic and free from odours. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Information is given to and gathered about people who use services so they receive regular support and their needs are not consistently met. EVIDENCE: Thelwall Grange accommodates mainly people from the Warrington area but is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. New information had been produced since the new owners took over in October 2007. The new information included statements on residents rights to privacy, dignity, independence, security, civil rights, choice, fulfilment, quality of care, choice of home, personal and healthcare, lifestyle, concerns, complaints and allegations, environment, staffing and management and administration. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 9 The statement on fulfilment included diversity and that individuals’ religious, ethnic and cultural diversity would be respected. It did not refer to people who were gay or lesbian, transgender or refer to changes in the law about age discrimination. The information contained the details of the new owners and manager. People that use services were provided with an information pack on Thelwall Grange including a brochure and details of the services available. Care records were examined of two residents who had recently moved into Thelwall Grange. The manager had gathered information on the residents’ health and lifestyle needs before they moved in and recorded these. This information was transferred into plans to provide appropriate care to the residents and included information on their diet, personal and healthcare. The plans in place to meet the residents’ needs described where residents were able to care for themselves and when residents needed help from staff. Additional information had been obtained from the local council. A resident that had recently moved into Thelwall Grange said she had visited before deciding to live there and said, “I liked it instantly, I was welcomed and the people were friendly”. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Improved records of care, liaison with health and social care professionals and medicine management is consistent so residents’ health and welfare needs are met. EVIDENCE: The care records of three residents were examined. Each record had information gathered about the persons’ lifestyle and health needs before they moved into Thelwall Grange and additional information from social workers or NHS services involved in their care. From looking at care records, talking with residents and staff, residents’ needs were met. Each resident’s care records had information about their needs. These contained guidance for staff to follow on providing support, help and care to them. Care records recorded some information around residents’ routines and preferences about their care and maintaining their dignity. Care records identified when residents needed help and where they were able to care for themselves. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 11 Records were in place to monitor resident’s mobility, nutrition and skin condition. Records for using bed rail were completed for all residents to see if they needed them or not. A more detailed form was in place to identify the risk of using them. Care records detailed contact with residents’ doctors. A resident was seen by the district nurses to care for pressure ulcers and records for the management of these were in place. The records from Thelwall Grange could have been more detailed in the recording of how the wounds developed but the care records supported that the resident’s health had deteriorated and had been seen by her doctor. When the wounds were noted further pressure relieving equipment was provided and the General Practitioner liaison team contacted for advice on wound care. There was information that residents’ health and mental health was reviewed as necessary and visits from dieticians, chiropodists, continence services and opticians took place. Thelwall Grange had contact with local doctors’ surgeries and residents are supported to keep their own doctor where possible. Medicines were recorded as received and included the date they arrived. Records of medicine administration were completed, including creams, which were recorded. The record sheets had letters to use as a code to show that a dose of medicine has not been given. Staff was using the appropriate codes to record when residents refused or when medicines were not administered. There were no occasions when signatures to record the administration of medicines were not recorded. There were records that residents had been offered and given the opportunity to look after some of their own medicines and their permission sought to do so. Residents were managing their own eye drops and inhalers after staff had ensured they were safe to do so. The quality assurance audit of medicines completed by the manager was looked at for the last two months. Medicine audits for December 2007 and January 2008 by the manager found no concerns and identified that clinical reagents to test urine needed ordering, the homely remedies policy needed to be revised and a new medicine guidance manual was needed was needed. All were completed. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Lifestyle choices have improved so residents have a choice of leisure and social pursuits. EVIDENCE: A variety of large print and audio books were available. A senior carer was responsible for arranging social activities within Thelwall Grange. A monthly activities planner was used to inform residents of forthcoming events. The Activities for February were displayed in all the communal lounges. Activities were being provided for each day. For example on Monday’s a tuck shop and bingo, Tuesdays beauty therapy, Wednesday art, crafts and board games, Thursday entertainment or social event, Friday armchair exercise, Saturday bingo and Sunday a quiz. The programme was not a set one and was flexible dependent upon residents’ choice. Every Wednesday the large lounge was used for a social event with a Valentines party held recently. The home did not employ an activities coordinator but the manager said the owners were planning to employ someone. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 13 The manager said that the current arrangements suited residents, as care staff was more involved in activities. One carer did a three-hour activity on a Friday afternoon incorporating armchair exercise and another carer two and a half hours on Saturday and Sunday afternoons involving activities of residents’ choice. Records of residents’ involvement in activities were kept and records for January and February 2008 recorded activities taking place most days based on the choices available. The owners had also purchased materials for staff to plan activities. The home also borrowed items from the local Primary Care Trust, which had materials to use in the ‘Moving More Often’ exercise programme from the British Heart Foundation being used at Thelwall Grange. A variety of comments were received form residents about the increase in lifestyle choices. A resident said she really enjoyed the social atmosphere and looked forward to the bingo, games and quizzes. She said there was always something going on in the evenings and weekends. She said “we had a party last week and we really enjoyed it” She said she kept to the routines that she had at home. Another resident said, “I’m well cared for and well fed and if I didn’t like anything I would say so. It’s great here I can’t say anything else”. She said she enjoyed watching TV, reading her newspaper and enjoying the view. She said when she preferred her own company she remained in her bedroom but could also sit in the lounge with other residents. She said when she spent time in her bedroom she had a call bell and could summon help. Another resident said, “I have enjoyed the increase in activities, something is happening everyday. I accept that staff are busy but I know I can ask for help when I need it. Staff are always around and they join in the bingo, quizzes and parties. We never had partied before to celebrate Valentines Day. The party we had last week was great. I am asked if I like things, like the menu. The menu is better and we have more choice”. A residents’ committee had been introduced. The first one was held in October 2007 and the second in February 2008. Residents requested tea after lunch and more variety of biscuits. The activities programme was discussed and residents said they were happy with the new activities programme and requested more outings and a regular fish and chip upper. Items discussed were putting shelves in Tatton lounge to accommodate library books. Residents wanted to have bingo twice a week and pay toward this to raise money for prizes and a residents’ fund. Residents wanted more activities to stimulate their memory, regular meals out and condiments available on tables for residents. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 14 Daily menus were displayed in all the communal lounges. There was a staff member responsible for helping residents order meals. Residents were seen ordering a choice of meals from the menu. Meals were prepared so residents that needed a diet due to their medical needs could choose the same as everyone else. The inspector shared a meal with residents. The table was set with cutlery and condiments but residents did not have drinks on the table to serve themselves. Staff served meals to the five resident present. Two of the resident had smaller dinner plates. They said they preferred smaller portions on smaller plates that did not over face them. Staff confirmed with resident the meals they had ordered and they were brought already plated up. Portions were generous in size and resident said portions were always like this. Residents had a soup starter, main meal and choice of sweet. Residents chatted about living at Thelwall Grange. They had all lived there for some time. They said they enjoyed one another’s company and liked to spend the day together. They were aware that the ownership of Thelwall Grange had changed and said it had not had any disruptions on their lives. One resident said she liked the new owners, they talked to her regularly and she liked the brightness of the building. They said that staff came and checked on them regularly but there was no way to call for help in an emergency or summon assistance. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Complaints were dealt with appropriately so residents and relatives would be confident they are taken seriously and acted upon. EVIDENCE: Only one complaint was recorded since the last site visit, which the responsible individual was responding to. A relative had complained about the improvements being made to the building. The manager requested the relative to make a formal complaint. Issues were about the decorating of the building as painters and decorators were redecorating it. A shower on the first was out of use but it was being refurbished. A concern was recorded from a relative about dental services and the manager had responded to this appropriately. Compliments were also recorded. In October 2007 relative’s complimented staff on how well their mother looked and had no worries about her care. In January 2008 the daughter of a resident had it recorded that she did not wish her mother to be moved from Thelwall Grange should her health deteriorate. In February staff received thanks from the family of a deceased resident to thank all staff for the care provided to their mother and said she was cared for ‘in the best place’. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 16 One new staff member that commenced employment was booked to attend the local authority adult protection training on in March 2008. Another staff member was over the recommended two years for adult protection training to be repeated and was also booked for a training update on in March 2008. All other staff had training on adult protection in 2006/2007. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Residents live in a comfortable maintained environment, which is safe, but the use of safety equipment needs to improve so residents’ safety is maintained. EVIDENCE: Thelwall Grange is set in extensive grounds that are well maintained by a gardener. Since the last site visit the building had undergone a major redecoration programme and refurbishment of carpets had been completed. All corridor areas had been repainted in a light cream colour. Tatton, Thelwall and the conservatory Lounges had been redecorated with Arley lounge planned for redecoration ion 2008. Carpets had been replaced in the conservatory corridor, Tatton and Thelwall Lounges and seven bedrooms. Bathrooms and toilets had been redecorated. The shower room on the first floor had been re tiled and new flooring fitted. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 18 Two divan beds and thirteen electric profiling beds had been purchased. Three bedrooms had been provided with new furniture. Housekeeping staff was seen working throughout the duration of the site visit and housekeeping was provided to a very good standard with no odour noted in any areas of the building especially the entrance. In Tatton Lounge there was still only one call point without a lead so residents couldn’t summon help independently. There were no call points in Arley or Thelwall Lounges. A recommendation to add additional call points had been made at the two previous site visits but not acted upon by the previous owners. The new owners gave assurances this will be attended to. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use services experience adequate care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The deployment of staff and training programme needs to be reviewed so residents are protected and in safe hands at all times. EVIDENCE: There were sufficient numbers of registered nurses care assistants, ancillary and catering staff on duty to meet residents’ needs, but the deployment of care staff needs to be considered. Residents sat in Arley and Thelwall Lounge was at times isolated and there were no call points in these lounges for residents to summon assistance. A resident said she had moved to sit in another lounge at her own request to watch TV in the evenings after an altercation with another resident. She said she was now spending all day in Thelwall lounge with another resident that could not hear her and she could not hold a conversation with, and who otherwise slept for long periods. She said staff did not routinely come in and check on her. Two residents sat in Tatton lounge and slept for long periods and there was no interaction from staff seen with them. Eleven care staff was employed. Two of these held and NVQ level 2 and 3 qualification. Four staff had commenced an NVQ level 2 qualification and two staff had registered for an NVQ level 2 qualification. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 20 Two Staff had been employed since the last site visit and appropriate employment practices had been followed. The Smallwood Homes induction training based on Skills for Care induction standards would be used for staff induction for future staff employed. Staff training files was examined. One registered nurse employed in October 2007 had no training recorded on her personnel file. Another care assistant employed had attended induction training for four days in October 2007, fire prevention and health and safety training. There was no training recorded for moving and handling, infection control or food hygiene for the staff member. The manager clarified that the training programme at Thelwall Grange for mandatory training had not been done since October 2007 and all staff other than two new employees were up to date with mandatory training until March 2008 when the programme would recommence. Staff had attended external training courses on end of life care, dementia care, nutrition and malnutrition, first aid and use of chemical products. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Improvements in management and the quality assurance system have been made but further improvements are needed so residents’ safety is protected. EVIDENCE: This was the first site visit to Thewall Grange since a change of ownership took place in October 2007 and it became a new service. A new manager had been appointed. The manager confirmed that she had a Criminal Records Bureau check completed by CSCI and will be applying for registration as manager. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 22 The manager had continued with the development of an auditing system of care plans and medicine administration records. She recorded the errors she was finding and left her findings for the person responsible to address them. The audits of medicines had improved and identified that no errors had been found for the previous two months. The manager said that she felt she had a lot to learn and was very enthusiastic to do the registered manager’s award, as this would give her the specific knowledge about standards and regulations. She felt that since her appointment in October 2007 she had developed a confident management style. She said she had four days a week to complete management and administration. She said her priorities had been to make improvements identified before the change of ownership as well as working with new owners. She had previously been a staff nurse and was now the manager managing the staff team. She said she was confident she had made the transition and her priorities were now to recruit more care staff and registered nurses and develop the staff supervision programme. One of the owner’s was present during the site visit and showed the inspector around the previous owner’s living accommodation and clarified it would be used to provide more facilities for residents for recreation or educational purposes. She said the owners were confident in the manager’s abilities. Residents gave positive feedback on the changes in management of Thelwall Grange. A resident said, “They ask you about things to see if you are happy. I have met the new owners and know the manager. I feel as though I am asked about things and listened to. There’s more activities going on and the building has been decorated. The manager and owners spend time with you and they tell us about things that are going on and what the plans for the future are”. Another resident said, “In the manager we have someone that is kind and caring. If you ask for something to be dome she does it. She doesn’t need to go away and take time to make a decision”. Staff was positive and one said there were a lot of positive changes since the change of ownership. She said the décor was now pleasant and the building did not smell. She said there were more activities available to residents and that residents seemed pleased and happy. She said that staff had been ‘very well supported’ during the changes and that ‘I feel positive about the changes made’. Regulation 26 visits commenced October 2007 when change of ownership was completed. When these take place the owners look at the internal quality assurance completed by the manager and housekeeper. These audits cover medicine administration; care records and health and safety of the kitchen. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 23 The owners’ visits cover discussions with residents, sharing social events, looking at care records to see they are being reviewed and that residents are weighed regularly, identifying improvement and listening to requests. For example the purchase of large print books. In January 2008 the responsible individual identified that the manager needed to check that fire drills were being done as required but this was not fed back to the manager. As part of the visit the owner also check bedrooms for cleanliness and to see if any repairs were needed. The manager’s audits of care plans looks at individual registered nurses as key workers to see that care records are written and reviewed. Medicine audits for December 2007 and January 2008 by the manager found no concerns. Residents’ surveys were sent out to realtives in October 2007. Twelve surveys were sent out and seven residents’ relatives responded. The results of these were displayed in the entrance to Thelwall Grange. The surveys asked questions about the building and housekeeping for which the majority of surveys said was clean and hygienic. Six out of sened surveys said the food was good. Concerns were always dealt with and relatives were consulted about care. Activities was identified as an area for improvement. Staff meeting was held November 2007 and February 2008 and an ancilliary staff meeting in November 2007. The minutes of these were available and recorded that the management team would be looking at staff working practice in the future but were positive about how staff had responed to the change in ownership and in improving recreational activities for residents. Care staff were to receive training on record keeping and would be expected to contribute to residents’ care records. The home was keeping monies for twenty-three residents. Two of these were appointees of the local authority. The balances were checked of three residents and records maintained for debits and credits to the amounts held for them. All balances were correct against the records held. Residents’ purchases were recorded for toiletries, newspapers, activities, tuck-shop and hairdressing. Audits of the health and safety of the building were done by the housekeeper on a monthly basis including testing fire fighting equipment. On examination of these the manager agreed that an oversight in the testing of the fire alarms had recently occurred since the system had been introduced and fire alarms were not tested weekly as required. This had been identified in the monthly audit for January completed by the owners. The fire and rescue authority were contacted and clarified that the owners could be prosecuted for this but as it was an oversight and it would be immediately remedied that no further action would be taken. The fire alarm system had been regularly serviced when faults were found. Staff had received fire training as required. Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 25 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 OP31 Regulation 8(1)(a) Requirement Timescale for action An application to register as the 01/06/08 registered manager for the care home must be made to the Commission for Social Care Inspection so that people that live there will be confident it is run in their best interests. 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 OP22 Good Practice Recommendations Provide call points in all lounges so residents can summon help when needed and maintain their independence and safety. The arrangements for staff working in the building should be revised so residents that are frail and not able to tell staff about their needs are not left in isolation. 2. OP27 Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 26 3. OP28 Provide further investment in training so all care staff have an NVQ level 2 qualification and there is a more skilled workforce. Mandatory training should be undertaken by all new employees a part of their induction programme so residents are in safe hands at all times. A more robust quality assurance system should be in place so mistakes over fire safety monitoring are not repeated. 4. OP30 5. OP33 Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Thelwall Grange Nursing & Residential Home DS0000070031.V352888.R01.S.doc Version 5.2 Page 28 - 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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