Care Home: Uphill Grange

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What the care home does well Staff we spoken with and from surveys indicated that morale in the home was good. The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive and caring manner. Residents were calm relaxed and looked well cared for. The manager ensures that there are sufficient numbers of staff to meet the residents’ needs. Aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. Some positive comments on the survey forms received included: “I am happy here” and “Good caring staff” Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Comments from staff surveys included, “Staff training is up to date, there is good activities for residents and choice of food”. What has improved since the last inspection? Employing a suitably qualified person to manage to the home and establish stability in management of the home for the benefit of residents. The employment of two activity co-ordinators. Updating the Service user guide and Statement of purpose to give clear information to prospective residents. End of life planning and person-centeredness to enhance the quality of care of residents. Recruiting an activity organiser to help identify resident’s expectations and preferences and to satisfy their social, cultural and recreational interests. Appraisal and supervision process is in place. What the care home could do better: Ensuring residents have access to dental services on a regular basis to maintain or improve their dental health. Ensuring interview notes for new staff are more comprehensive and include standard questioning for which responses could be recorded and scored for comparative purposes. Key inspection report CARE HOMES FOR OLDER PEOPLE Uphill Grange Uphill Road South Weston Super Mare North Somerset BS23 4TX Lead Inspector Andrew Pollard Key Unannounced Inspection 09:00 3 September 2009 rd DS0000020290.V376803.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uphill Grange Address Uphill Road South Weston Super Mare North Somerset BS23 4TX 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) 01934 635422 01934 419384 uphill.grange@fshc.co.uk Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Ms Green, pending completion of a fitness assessment. Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 26 persons aged 50 years and over requiring nursing care May accommodate up to 18 persons aged 65 years and over requiring personal care Manager must be a RN on parts 1 or 12 of the NMC register. Staffing Notice dated 03/12/2001 applies Ms Stevenson successfully completes Level 4 NVQ in Care and Management by 30th September 2006. 18th June 2008 Date of last inspection Brief Description of the Service: Uphill Grange is registered to provide personal care and or nursing care for 44 residents. The home is a converted older property in the small village of Uphill, on the outskirts of Weston Super Mare. Accommodation is provided in single and two double rooms. The majority of these have en suite facilities. A large dining room, with a small lounge area, is situated on the lower ground floor and a lounge and dining room on the ground floor, which overlook the large garden and surrounding countryside. Two small passenger lifts ensure level access throughout the home. Fees range from £546 to £650. Acegold limited, a wholly owned subsidiary of Four Seasons Health Care, owns Uphill Grange. Uphill Grange DS0000020290.V376803.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 Two stars. This means that the people who use the service experience good quality outcomes. There have been a number of improvements in quality of care in the home for residents since the last visit in 2008. These are described in the sections below. This visit was unannounced and took place in one day. Before the visit survey forms had been sent for staff, health professionals and residents and their relatives to complete, a small number were returned. The information gathered was used to help us form judgments about the quality of the service provided. No complaints were made and in general the outcomes were positive and are reflected in the body of the report. Information has also been gathered from the Annual Quality Assessment Audit, the last report and notifications sent from the home to the Commission. The home continues to be managed by a new manager Ms Green who has a clear grasp of her role and responsibilities and is driving forward improvements in the home. What the service does well: Staff we spoken with and from surveys indicated that morale in the home was good. The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive and caring manner. Residents were calm relaxed and looked well cared for. The manager ensures that there are sufficient numbers of staff to meet the residents’ needs. Aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. Some positive comments on the survey forms received included: “I am happy here” and “Good caring staff” Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 6 Comments from staff surveys included, “Staff training is up to date, there is good activities for residents and choice of food”. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 7 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Uphill Grange DS0000020290.V376803.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 Uphill Grange DS0000020290.V376803.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective clients and their families are given relevant information in written or verbal form about the home. Contracts and terms and conditions of services are provided to all clients. The assessment procedure is clearly written and a thorough assessment of prospective residents needs is carried out so that they can be confident that their needs will be met in a manner to suit the individual. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 10 EVIDENCE: A clearly written Statement of Terms and Conditions is available to each resident as part of an information pack including statement of purpose and service user guide. These document are informative and clearly presented. Both documents and the homes brochure have been reviewed and updated. We discussed the fact that they could include more detail about the range of people they wish to care for and the admission criteria, particularly related to young disabled people and people for respite care. There should be more clarity about the level of charges made for such things as transport and dentistry. Respite care is offered in two rooms on a rota basis. No intermediate care is provided. The surveys returned stated that people had received adequate information to help them decide if Uphill Grange was somewhere they would like to live. They also confirmed that they had received terms and conditions and a contract on admission to the home. The home has an admission procedure and pre-admission assessments including activities of daily living, health needs and personal history. Some residents are privately funded but the majority of residents are admitted through Social services or via the PCT who provide assessment care plan documentation prior to admission. The manager visits and assesses prospective residents. The assessment tool used for this is comprehensive. The procedure takes into account the dependency rating and takes account of the existing residents group the staffing numbers and skill mix. Visits to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. All residents have Waterlow, handling, nutritional, falls and continence assessments. There have been some new admissions since the last inspection. There was a full assessment of their needs and then a considered decision made about whether the home could meet their needs. All of the residents are older people and are of white UK ethnic origin. There are some younger people admitted for respite care. Individual assessments ensure that any specific needs i.e. spiritual/cultural are identified and included in the care support plans. Uphill Grange DS0000020290.V376803.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans detail residents care needs and are well written and give clear directions to staff. The staff provide appropriate personal and nursing care to maintains residents’ health, well-being and dignity. Proper arrangements are in place for residents to access primary healthcare services apart from dentistry. The staff properly store, administer and record medication on behalf of residents Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 12 EVIDENCE: A new comprehensive case file format is in use. Several residents files were looked at, including assessments, care plans personal history profiles and risk assessments. The records showed consistency and they were detailed and up to date. Regular evaluation of resident’s care plans was taking place. Where possible residents/relatives are engaged in the process and sign care plans and consents. Risk assessments were in place with detailed information to ensure safe procedures including, manual handling, and the correct use of bed rails and how to reduce the risk of falls. Nutritional assessments are completed for each person and weights recorded monthly. Information about people who are having difficulty in eating or who will need a special diet is written in their care plan. The new care plan format has been introduced with more emphasis on developing a person centred approach to care and involve family more comprehensively in the care planning process where appropriate. In conjunction with the work being done by the activities staff each residents likes and dislikes will be at the centre of the service to provided more focus on the holistic and social model of care. Care plans supports people’s health and social needs including, psychological, emotional, and cultural needs putting the residents wishes first. Rarely have residents seen a dentist in the last six months and it is not routine to record that this is offered to or arranged for residents. People were asked to elect if they wished to see a dentist but the letter was unclear about the charging for this and charging for transport. It is accepted that there can be difficulties in securing NHS dentistry at times. However during the inspection the manager has identified an NHS dentist prepared to visit the home so this aspect of care provision should improve. In addition the manager will re-write the related letter. A wound care plans was in place for one person and was accompanied by wound assessments of the size and condition of the wound and recorded any improvement or deterioration in the wound. Formal end of life Care Plans are being established in the home whereby residents are encouraged to think ahead about the care they would like to receive if their health deteriorates. There are documents relating to “Not for resuscitation” directions, which had been signed, by relatives and the GP following a Mental capacity assessment Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 13 Each resident was referred to a GP on admission to the home and an initial first visit was then set up. All residents are registered with a local surgery and a GP makes fortnightly visits or as required. Policies and arrangements are in place for the storage administration, disposal and recording of drugs. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were up to date and in order. The storage and recording of controlled drugs was in order. For residents who wish to self-medicate there are appropriate procedures are to support this Uphill Grange DS0000020290.V376803.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social and recreational activities is arranged that seek to enhance the quality of life for the residents and meets individual preferences and expectations. Residents are able to maintain close contact with families and friends. Residents families are informed of issues related to their relatives and to take part in activities running in the home. Mealtimes are sociable and pleasant time with food that residents enjoy and they are supported to eat their food if need be. EVIDENCE: An activity co-ordinator and Activity assistant have been recruited providing forty hours per week. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 15 The aims of the service are ambitious and will enhance the quality of life for the residents. In conjunction with the residents the activities coordinator develops a monthly timetable of activities and forthcoming events. A copy of this is placed in communal areas throughout the home, to ensure that all residents and visitors are aware of the planned activities. People are assessed on an individual basis at admission to enable the staff to plan suitable activities relevant to their cognitive function and preferences. The activities coordinator completes personal history profiles of the residents. The information obtained included details of the residents’ work history, hobbies or interests and younger and adult memories. The profiles enable staff to recognise the person as an individual and improve personalised care. It also creates topics of conversation, encouraging life review and reminiscence, which will have meaning to the individual. The activities coordinator provides a varied programme of activities for the residents and one to one work where appropriate. She is knowledgeable of the residents’ needs and wishes. The coordinator is responsible for documenting a record of any activities the residents have taken part in. Various entertainers visit the home and it is intended to review this and identify a wider variety of entertainments and reduce repetition. Resident’s benefit from services run by the local church including Holy Communion regularly. There are no residents with particular cultural or religious needs. At present there are no residents with specific cultural needs. The menus are four week rotational with seasonal variation. Residents are asked for their choices the day before and there is choice for each meal. Staff were seen to be assisting some residents on a one to one basis in a dignified manner. The cook is given information about people special needs in regards to their diet. Meals can be adapted to meet the needs of the people in the home. Residents spoken with and survey outcomes stated that residents enjoyed their meals. Residents’ surveys expressed that “The food is always very good” and “we have plenty of choice”. The most recent Environmental Health report found all to be in good order and gave a four star rating. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are robust policies in place to protect residents, investigate complaints or manage allegations of abuse. There are good arrangements in place for staff training in these matters so residents can feel safe and their concerns dealt with. EVIDENCE: A copy of the complaints procedure is on display and included in the Service User Guide provided to people on admission. The complaints policy and procedure is clear and contains the required information. No formal complaints have been received by the home since the last inspection. There have been no complaints received by the Commission since the last inspection. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 17 Minor concerns or grumbles have been recorded in a log including the outcomes and were quickly resolved. Resident and relative surveys indicated people knew how to complain and indicated that they knew whom to talk if they were not happy. Comments included, “I’ve never had cause to complain “. A number of “thank you” and complimentary letters were seen. The home has written procedures for adult protection, whistle blowing and management of aggression. The Local Authority ‘No Secrets’ document is available. Abuse and adult protection information is included in the induction workbook for all staff. The Local Authority (LA) provides staff training in the protection of vulnerable adults. There have been no allegations of abuse. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of furnishing and décor is good to the benefit of residents. The home provides a safe and well-maintained environment for the residents. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the resident’s needs. The standard of cleanliness is good. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 19 EVIDENCE: There are assisted baths and showers in the home including a parker bath. Most rooms have en-suite bathrooms. The tap heads of the hot water outlets are removed unless the resident wishes to and is able to use the bath safely and then a mixing valve (to reduce the risk of scalding) is installed and the tap head replaced. Safety valves have been installed to all hot water taps in the communal baths, showers throughout the home. The maintenance man regularly tests and records hot water outlet temperatures. The residents sitting in the communal areas appeared relaxed. Suitable dining room seating and table facilities are provided so that residents can enjoy their meal times comfortably and in a congenial setting. The home was clean, warm, well lit and free from unpleasant odours. There is ongoing redecoration of rooms and carpets have been replaced. Resident’s rooms were well furnished and had been personalised. Resident areas are fitted with appropriate aids such as grab rails, suitably equipped bathrooms and there are fixed and mobile hoists. All rooms have a nurse call system with audible alarm facility. A range of pressure relieving equipment is in use and kept in stock. Two small passenger lifts ensure level access throughout the home. Survey outcomes said the home was always clean and fresh. People spoken with liked their rooms and felt they had all they needed. Sluice areas included a washer disinfector. The laundry has sufficient washing machines and tumble dryers. There are infection control, policies and procedures in place. Staff have attended training in Health and Safety and Control of Substances Hazardous to Health. The clinical waste is correctly disposed of to prevent the spread of infections. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment procedures are robust. The home is well staffed with appropriately trained and experienced staff for the number of residents. Training for care staff and Registered Nurses training arrangements are in place. EVIDENCE: At the time of the visit there were 16 people living in the home and two respite care residents. There are 3 care staff and 1 Registered Nurse (RN) are on duty all day. At night there are 2 carers and 1 RN, both are waking. The manager stated that the dependency levels and resident numbers are reviewed to ensure appropriate skill mix and staff numbers are in place. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 21 The manager role is supernumerary Monday to Friday and the deputy manager has twelve hours supernumerary each week. There are good staffing arrangements for admin, housekeeping, laundry, catering and maintenance. There are two activity co-ordinators working a total of 40 hours per week. Overall the staffing levels have been increased and combined with stable management has resulted in improving standards throughout the home. The organisation has an equal opportunities policy. The recruitment records seen were satisfactory and met the requirements of the Regulations. Completed application forms, two written references, a statement of health and fitness to work, proof of identity and the persons qualifications are on file. However interview notes were very scant and appeared to have no standard questioning for which responses could be recorded and scored. The home has acquired CRB disclosure of the persons suitability to work with vulnerable people. In future a formal log created by the counter signatory will records all the relevant details so the disclosure can be destroyed. NMC qualification confirmations are checked for all RN’s annually. The home uses a comprehensive induction booklet, which is given to new staff to work through when they start. The induction programme is comprehensive and based on the Skills for Care standards. After completion of the common foundation training care staff enrol on a National Vocational Qualification (NVQ) programme to at least level 2. It was accepted that less than 50 of care staff have achieved at least level 2 National Vocational Qualification (NVQ), however this target will soon be achieved. A training matrix has been developed to show that all mandatory training including fire safety, food hygiene, first aid, infection control, load handling and adult protection was undertaken and course dates had been organised for staff. A new company training project is in place and the LA and UWE have put in place a year long clinical training programme that the manager intends to offer to the RN’s. We discussed the need to enhance the clinical updating for RN’s at a professional level in areas relevant to caring for older people. It was recommended that RN learning needs be fully assessed at appraisal and individual nurses equipped to have some expertise in various areas of clinical practise. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 22 Residents’ surveys stated that, “the staff work hard to please everyone” Visitors’ comments included, “The whole team are of a caring nature” and “Staff are friendly, approachable and respectful”. Residents and relative surveys agreed that staff were available when they needed them and listened and acted upon what the residents had to say. Staff were observed to be treating people with respect and care. There was a warm cheerful atmosphere in the home. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run taking into account the views and wishes of the relatives and residents and as they are able. There are good arrangements in place to maintain and service the equipment and facilities in the home. The Home protects the health and safety of residents and staff. The staff supervision and appraisal arrangements are good. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 24 EVIDENCE: Ms Green the manager has been in post for a number of months and is in the process of applying for a fitness assessment to be carried out by the Commission. Ms Green is an experienced nurse and manager and has a clear grasp of her role and responsibilities. The regional manager visits the home regularly and is responsible for monitoring the home and carrying out monthly Regulation 26 visits copies of which are available to the Commission. There is a full time deputy manager in post. Staff appraisal and supervision takes place on a one to one basis. There is delegation of supervisions to other RN’s. A Process is in place to conduct annual appraisals for all staff by the manager. The procedure for safekeeping of resident’s money was examined. Each person has a ledger sheet, which accounts for all transactions and receipts for purchases are kept, however money is pooled in a float rather than each person having their own cash available. A recent company audit has taken place of all the home financial dealings and no problems have been identified to date. The maintenance man is a trained fire Marshall. The fire alarm system is checked weekly and the maintenance checks of the fire fighting equipment and alarms are done regularly. Staff are updated with fire safety training regularly. The manager has made arrangements for staff to be trained in moving and handling. The home has appropriate load handling and pressure relieving equipment and that staff have attended updates on handling residents. The home employs two maintenance men who also keep up the grounds. Records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, gas and electrical services, water, wheelchairs, hoists and lifts. Communal baths and showers have thermostatic mixer valves. The en-suite baths are disabled so that no hot water can be run. The monitoring of hot water outlet temperatures takes place to ensure comfortably hot but safe water, which in future will include showers. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 25 Staff have carried out residents risk assessments and made appropriate provision to protect residents from injury. Padded bed rails are used to reduce the risk of falls where there is an assessed need and consent are in place. There are restricted openings on windows. There are radiator covers in areas of identified risk. Accidents were properly recorded and reviewed as required. A form is in use to record follow up comments or concluding statement about each incident. A discussion took place about accidents and the need to inform the Commission through the Reg 37’s forms in that the manager has freedom to use judgement about what was serious enough to warrant notifications. All residents have risk assessments including tools for assessing falls and falls prevention. The atmosphere in the home was positive and calm. Staff were noted interacting with residents in a caring and friendly manner. Visitors and residents spoken with had confidence in the manager and staff and felt safe and well cared for. Some comments from surveys included; “There is good team work”, “I’m happy here”, “Good caring staff” and “ I have no complaints”. Uphill Grange DS0000020290.V376803.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 3 3 3 X 3 x 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 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 3 Uphill Grange DS0000020290.V376803.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. Standard Regulation Requirement Timescale for action 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. 2. Refer to Standard OP8 OP29 Good Practice Recommendations The registered provider should ensure residents have access to dental services on a regular basis. The registered provider should ensure that staff interview notes be more comprehensive and include standard questioning for which responses could be recorded and scored and compared with other candidates. Uphill Grange DS0000020290.V376803.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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