Inspection on 07/02/08 for Cranmer

This is the latest available inspection report for this service, carried out on 7th February 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cranmer 08/11/05

Cranmer 05/07/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 28/10/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Cranmer Cranmer 237 Coleman Street Whitmore Reans Wolverhampton West Midlands WV6 0RG Lead Inspector Deborah Sharman Unannounced Inspection 7th February 2008 09:15 Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 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 Cranmer DS0000029983.V349498.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 and Care Homes for Adults 18 – 65*. 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. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranmer Address 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) Cranmer 237 Coleman Street Whitmore Reans Wolverhampton West Midlands WV6 0RG 01902 747945 01902 712610 londonroad@tiscali.co.uk Milbury Care Services Ltd Miss Michelle Louise Grant Care Home 8 Category(ies) of Learning disability (8), Old age, not falling registration, with number within any other category (8) of places Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum number of residents - 8 persons category MH/E Any Mix Date of last inspection 5th September 2006 Brief Description of the Service: Cranmer, 137 Coleman Street, is a care home providing accommodation and personal care to eight adults with learning disabilities. The ‘mixed category’ status of this home reflects the age range of the service users. This now requires review. It is one of a group of homes owned by Voyage, formerly known as Milbury Community Services Ltd. The home is located in the Whitmore Reans area of Wolverhampton. It is close to local amenities and on a main bus route into the city. Staff at the home also supports six local tenants and there is a high degree of contact and cooperation between the resident and tenant groups. All bedrooms are single occupancy and are individually decorated to a high standard. The lounge and dining areas are comfortable, homely and well furnished. Further information is available about the home in the form of a service user guide. This requires review, as it does not reflect an up to date weekly fee. Further information about the weekly fee should be sought from Cranmer, or its provider Organisation, Voyage. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. One Inspector carried out this unannounced key inspection between 9.15am and 5.30pm. As the inspection was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess at least all the National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. We sent surveys to independent health professionals who have contact with the home, relatives and to people who live at the home. We received completed surveys back from one independent person and from all seven residents living at the home. None were received back from relatives. The provider also carries out spot checks monthly and submits the reports of these to us. The information received in conjunction with information held about the recent history of the home, helped us to formulate a focus and plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. We looked in detail at the care provided to one service user and we sampled aspects of others’ care. We talked to three staff (one in detail) and the assistant manager. We were also able to talk to the registered manager who was available throughout the day to support the inspection process. Most residents were out during the day, but we were able to observe staff interaction with residents at lunchtime and we were able to ask a resident about her experiences of living at Cranmer. We sampled a variety of other documentation related to the management of the care home such as training, recruitment, maintenance of the premises, accidents and complaints. We were also able to tour the premises. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A few issues were identified that require attention. Brochures available to support service users’ decision making before moving in to Cranmer are out of date. Discussion with the manager and assessment of the homes written purpose along with their categories of registration indicate the need to fully review the homes objectives and intentions. We are conducting a national review of Conditions of Registration and this will prompt improvement. However, the provider needs to determine the purpose of the home, ensuring this is clearly outlined in its documentation and that it complies with its legal registration. Administration of medication is generally managed well. An improvement in some systems however will further promote accountability. For example, where short courses of medication are prescribed mid medication cycle, it is Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 7 important that they are checked in as robustly as other medications and that the amount of medication received is checked and recorded into the premises. Also where medication is prescribed as ‘as required’, it is important that this is defined for the staff by a medical practitioner and included in written protocols. This will ensure that medication is consistently administered as intended. Furthermore any changes in medical direction must be accounted for in records and on medication administration records. Documentation in respect of recruitment has been removed from site and is now retained at head office. This meant that not all records, or evidence of pre employment checks were available for inspection as they should be. Furthermore although police checks had been carried out for an active volunteer, full checks had not been pursued contrary to the Organisations policy. The home is managed well on a day-to-day basis. Regulation 26 reports have been provided to us and were used for the purpose of this inspection. The Manager expressed concern about inaccuracies in regulation 26 reports, which are spot checks, carried out by the provider. Similarly, although it is not affecting outcomes for service users and the manager feels well supported, she is not receiving formal supervision with sufficient regularity. 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. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. Quality in this outcome area is adequate. Written information available to applicants before moving in needs review to ensure they can be provided with updated information. Steps are taken to gather information about applicants before offering them a place. More attention must be paid to the timeliness of this to ensure that full and robust information about applicants is known in advance of admissions to the home. This judgement has been made using available evidence including a visit to this service. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 10 EVIDENCE: Written documentation to aid decision-making prior to moving in needs to be reviewed and updated. The Manager said that the Statement of Purpose was reviewed about 4 years ago, as without being dated this was difficult to determine. There are some contradictions between the categories of service users currently accommodated, the homes written intention in the Statement of Purpose and the registration categories. This is further complicated by environmental restrictions, which will determine who the home can and cannot accommodate. For example the Statement of Purpose says the home intends to accommodate people with learning disabilities who have a physical disability. The home is registered to accommodate older people with learning disabilities. However the premises and lack of facilities would compromise this. In the annual return to us, the manager recognised ‘changes in service users needs due to the ageing process’ as being a barrier over the last 12 months. This needs to be reviewed with us as a priority and then accurately reflected in pre admission documentation. The Service User Guide does not reflect the homes current weekly fee. Two new people have moved in since the last key inspection and there is currently a vacancy. Assessment of admission processes shows that the Manager is careful to obtain information from the placing authority prior to offering a place. The person whose care was looked at in detail had been offered a place based on visits and third party information prior to the manager having carried out her own assessment. This was carried out well but on the day the person was admitted to the home. The Manager is aware that it is good practice to assess in advance of offering a place and explained that, this occasion was the exception. However, there is good evidence that the person settled in very well and very quickly and is benefiting from her placement at Cranmer. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 7, 14, 33. Quality in this outcome area is good. Service users can be assured that their personal and health care needs are known and are responded to comprehensively with attention to personal preference, independence, privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 12 Care plans are positive, clear and address peoples strengths and abilities as well as their support needs. Staff find them helpful and are familiar with them. There are systems in place to ensure that care and plans are regularly reviewed by staff and by placing authorities. There was good evidence that care is provided in accordance with the agreed written plan of care. Risk assessments are carried out in consultation where possible, with the person to whom they relate and are based on best interest principles with regard for capacity. Discussion with staff showed they have an excellent understanding of how to minimise risk whilst promoting independence. Discussion with staff, residents and perusal of residents meeting minutes provided reassurance that the service is run in the best interest of service users and that they can influence the running of the service. The home could provide good evidence of how direct requests made by service users had been facilitated in relation to both leisure activities, menus, holidays and maintenance of the building. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 14 12, 13, 15, 16, 17. 10, 12, 13, 15 Quality in this outcome are is excellent. Quality is excellent. People who use the service continue to make choices about their life style and are supported to develop their life skills. Social, cultural and recreational activities meet individual’s expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home are supported to take part in their preferred activities. There are a range of group and individual activities provided that have been requested by service users. For example, one person was in the process of planning to attend a football match that weekend. Individual requests for Christmas had been carried out and trips had taken place to the pantomime and Cadburys World. Residents told us that they are in the process of planning their summer holidays and meeting minutes showed diverse individual holiday requests. Residents who want to attend the local church and are supported by the congregation. Staff are satisfied that staffing levels support a regular and varied activity programme. The manager has accurately reflected the situation to us in her annual return which says ‘as a result of listening to people we have increased choice and frequency of activities and increased staffing levels on specific days to allow for support during activities / outings’. Residents and staff confirmed regular contact with family and friends and a volunteer visits the home regularly to befriend service users, who value this. Service users enjoy their meals and are consulted about what they eat. We observed service users eating different lunches based on their individual and unusual preferences. Assessments show the service user whose care was looked at in detail needing her food cut up for her for dental reasons. Other documentation indicates there may be a risk of choking, hence the need for staff to cut meals up into bite size pieces. Discussion with the manager and staff indicated that the initial assessment is not being adhered to as they have found her able to manage cutting her own meals with little assistance. The risks however are not clear, have not been reviewed and there was some uncertainty and contradiction that must be resolved. The Manager agreed to reassess the risk and ensure that the care plan describes the support required. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 15 Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. 8, 9,10. Quality in this outcome area is good. Service users can be assured that their personal and health care needs are known and are responded to comprehensively with attention to personal preference, privacy and dignity. Some minor improvements to medication management systems have been identified as required to better assure the provision of medication to service users in accordance with prescribing direction. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 17 Discussion with a staff member showed an excellent understanding of how privacy, dignity and independence is maintained when providing personal care for a key client. A service user confirmed being satisfied with how staff assist her. The staff member who confirmed that male staff do not assist female service users with personal care said: ‘I never rush him. He loves his shower. I ask if he wants a shower and he gets his stuff. He’s got his own toiletries. He gets undressed himself like in his care plan. I stand outside with the door closed while he gets undressed. I do the water. He gets in the shower by himself. I stay in the room while he showers and I do his back. He sits on a chair and makes sure a mat is under his feet. I only dry his back. I then leave him to dry him self. I help him into his dressing gown. He can brush his own teeth.’ Staff understand service users health needs well and could describe how they help to maintain and improve health. The GP visited a service user on the day of inspection and earlier in the day the community nurse had also visited. Records of health care are very well maintained and demonstrate how changing health needs have been responded to and followed up in a timely way. Records show too that service users weights are monitored and routine health screening is provided such as chiropody, breast screening, ear syringing etc. This attention has ensured that a service user referred to hospital by an optician at a routine appointment has been diagnosed with a condition that will now be medically monitored and treated. This is a credit to the staff at the home. We discussed with the manager the need to now ensure that appropriate care plans are put in place to guide staff following this recent diagnosis. Staff confirmed that they don’t give out medication if they are not trained. Four staff are currently in this position and this is recognised in the homes annual return. We observed a senior staff member administering medication in a structured and systematic way. Her actions were witnessed and checked by the Manager. Medication stocks are appropriate and records indicate that service users are receiving their medication. Medications are checked and recorded in upon delivery. The Manager must now ensure that any short courses of medication obtained mid medication cycle are managed in the same way upon receipt. This will better account for the management of medication and will enable the home to evidence that medication is being administered as prescribed to promote service users health. For example records indicated that a service user had received 21 antibiotics when the course finished. By not recording the number of tablets prescribed / received it is not possible to demonstrate that he received the full course. Similarly, medication records showed a medicine to be prescribed as ‘when required’. Records showed that the resident was being given the medicine several times per day on an ongoing basis. Discussion with staff and the manager indicated that they were following a change in prescribing direction but this could not be accounted for Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 18 and requires review. The Manager agreed the need to develop guidance protocols for medications prescribed ‘as required’. These must be based upon medical advice and will help staff to administer medication consistently in accordance with the intention of the medical practitioner. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. 16-18, 35 Quality in this outcome area is good. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints about the home since 2004. Staff are proactively reminding service users regularly about how to make a complaint and are prompting them in residents meetings to voice any concerns they may have. Alternative and accessible systems are in place to enable those to complain who may not wish to do so in a meeting. It is positive too to see that information about how to complain has been sent recently to relatives. There have been no allegations or incidents of concern. There is an atmosphere of mutual respect and there have been no incidents between service users and no staff disciplinary action arising from concern about care Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 20 or protection of service users. All staff have received training about adult abuse and discussion with staff indicated a well developed understanding of what abuse is and their role in preventing and reporting it. The Manager has policies and procedures available to her to guide her in the event of their being a concern and from discussion also was able to show that she is aware of her role and responsibilities. Staff are satisfied that current systems protect service users monies and possessions. Inspection confirmed this. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. 19, 26. Quality in this outcome are is good. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 22 EVIDENCE: As discussed earlier in this report, the homes purpose requires review. The Statement of Purpose says they will accommodate adults with learning disabilities who have physical disabilities. They are registered to accommodate older people who have learning disabilities, although currently only two of their seven residents are older people. The Manager is concerned about their ability to admit older people or people with physical disabilities into the home as she feels they are not equipped to meet any mobility or physical needs. For example there is only one ground floor room, no bathing aids and adaptations and no hoists or passenger lift. She feels space is restricted limiting the possibility of using manual hoists. She explained how, there was concern at the time about how the home could meet the deteriorating physical needs of a service user who has since passed away. She said there was some discussion at the time of the need to find alternative accommodation. The environment however is meeting the needs of current residents and where there are some compromises risk assessments are supporting individuals e.g. staff need to support one resident up and down stairs. This is preventing full independence but staff support is limiting the barriers as far as possible. A tour of the premises showed it to be clean, homely and domestic in style. It is maintained safely and was free of obvious hazards. Soap and paper towels were available to support staff hand washing at all appropriate points and staff described in detail steps they take to promote good infection control. We visited the bedroom of the service user whose care was assessed in detail. The bedroom was personalised, comfortable and safe. Décor is the main area requiring improvement. This is particularly in the main communal lounge areas, where especially at corners, wallpaper is dirty and damaged. The Manager is aware of the need to improve the décor. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. 27, 28, 29, 30. Quality in this outcome area is good. Staff are motivated, well trained, supported and competent. Staff are provided in sufficient numbers to promote the smooth running of the service, ensuring that service users health, safety and welfare is maximised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 24 It is commendable how newly recruited staff, who are new to care have been supported to settle into and fulfil their role. Staff described being well supported on a day-to-day basis, records show them to receive supervision and training regularly and discussion with them and residents assures us that staff are competent. Everybody we spoke to were satisfied with staffing levels. This along with a well-structured rota and written shift planning system ensures that the needs of residents (and tenants) are met without compromise. Detailed and clear records of regular staff meetings show us that meetings are used to aid communication between the staff group and that managers provide direction and leadership in pursuit of maintaining and improving standards. Service users are the focus of these meetings. The only weakness in the staffing standards is recruitment, or more specifically evidencing recruitment given the decision to remove documentation from the care home to head office. By regulation all such records must be available for inspection. Omissions in documentation were followed up by telephone with head office who verbally confirmed their presence. This is not sufficient. Head office could not confirm that satisfactory steps had been taken for the appointment of an active volunteer. Risk had been minimised as Criminal Record Bureau and POVA checks had been carried out in advance, but other steps to ensure compliance with policy had not been adhered to e.g. there was no application form, no references, no self disclosure of criminal convictions, no confirmation of identity and no evidence of induction or how the limits of the volunteer role had been made clear. The volunteer was recruited before the current manager was in post and she, along with head office understood the omissions and resolved on the day of inspection to address this. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 26 37, 39, 42. 31, 33, 35, 38. Quality in this outcome area is good. The management and administration of the home is based on openness and respect. The service is operating in the best interests of service users and as far as practicable risks are identified and minimised to ensure service users health, safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager has been appointed since the last key inspection and has in this time applied to us and has been successfully registered as Manager of the service. She is not fully qualified and although registered to start the required course, informed us that a shortage of assessors is holding progress up. She feels well supported on a day-to-day basis but is not receiving the required amount of formal supervision. She said her manager is always available to her and provides support during Regulation 26 visits, but has not had formal supervision since October 2006. Since she has acted as manager in August 2006 she has not received an appraisal of her performance. A staff member told us ‘I think this is a really, really good home and if I thought otherwise I would tell them’. ‘Its nice and clean. Everyone is nice to each other. Service users and staff are nice. The atmosphere is good. A happy atmosphere and the care is excellent’. Of the manager, s/he said ‘great, excellent. The help is there’. Other staff supported this view. In a survey completed by an independent person we were told; ‘I’ve had 17 years experience of working in places such as this and by far this is the nicest place and I don’t feel it could be any better. This home is outstanding for the level of care given and the staff are the most caring there are about’. Staff receive safety training and most aspects of safety management that we sampled were in good order e.g. COSHH assessments and management, general risk assessments in respect of the environment including fire risk, cold food storage management, hot food temperature safety management, water temperature management, fire drills, fire equipment, gas and portable electric appliances. The only omission in service records is a 5-year electrical wiring certificate to assure the safety of structural wiring. The Manager said that she would follow this up. Both the Fire Officer and Environmental Health Officer have visited the premises in 2007, the latter the manager explained, concluded Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 27 that the risk of legionella from the water supply is low. The Manager is satisfied that her request for repairs are dealt with quickly and efficiently. We were able to see how the service assesses its own performance. The manager completed the annual return (AQAA) to a high standard and this positively supported the inspection planning process. Regulation 26 checks are systematic and measure the manager’s compliance with tasks set. The Manager expressed concern about the accuracy of some recorded outcomes. Additionally, in 2007 satisfaction surveys were sent by the home to both relatives and service users. Responses were received from 4 relatives who all expressed general satisfaction. Service users also jointly expressed high levels of satisfaction. Results were quantified and demonstrate an 80 satisfaction level. We discussed the need to use the data obtained within an action plan to enable ongoing improvement and development in accordance with service users feedback. We also discussed options for obtaining feedback from service users who are less able to vocalize their feedback. These developments would help the home achieve excellence. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 1 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 3 39 3 40 X 41 X 42 3 43 3 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 4 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cranmer Score 4 4 2 X DS0000029983.V349498.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? 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 YA34 Regulation 19 Requirement The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person all documentation required by regulation. This applies to any person including volunteers who may in the course of his duties have regular contact with service users. This will ensure the greater protection of service users. New requirement arising from this inspection Timescale for action 12/02/08 2 YA34 17(2) The Registered person must ensure that records required by regulation are kept up to date and are at all times available for inspection in the care home. This will ensure the service complies with regulation and that it can evidence how it is complying with regulation. New requirement arising from this 12/02/08 Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 30 inspection 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 YA1 Good Practice Recommendations The Statement of Purpose and Service User Guides should be reviewed to ensure that the stated intention complies with the homes current purpose, environmental limitations and registration. New recommendation arising from this inspection. 2 YA2 Steps should be taken to ensure that the service carries out assessments of need before admission and before offering a place to service users. New recommendation arising from this inspection. 3 YA17 Support required by service users whilst eating should be clarified and any risks assessed and reduced. This will ensure that staff are aware of support required and will ensure service users needs are met and risks to health, safety and welfare reduced. New recomendation arising from this inspection. 4 YA20 Steps should be taken to better account for receipt of short courses of medication received mid medication cycle. This will help to evidence that service users are receiving their medication as prescribed. Steps should also be taken to provide written direction based on medical advice for medications prescribed ‘as required’ to ensure service users receive medication consistently as prescribed. Steps should also be taken to account for changes to prescribing direction to evidence that service users are receiving their medication as prescribed. New recommendation arising from this inspection. 5 YA36 Steps should be taken to provide the manager with regular, recorded, formal supervision six times per year as a minimum. DS0000029983.V349498.R01.S.doc Version 5.2 Page 31 Cranmer New recommendation arising from this inspection. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Cranmer DS0000029983.V349498.R01.S.doc Version 5.2 Page 33 - 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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