Inspection on 19/03/09 for Craven Nursing Home

This is the latest available inspection report for this service, carried out on 19th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Craven Nursing Home 29/12/05

Craven Nursing Home 22/06/05

Craven Nursing Home 30/11/04

Similar services:

Abbey The

Snydale Care Home

Whiteley House

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Craven Nursing Home Keighley Road Skipton North Yorkshire BD23 2TA Lead Inspector Anne Prankitt Key Unannounced Inspection 19th March 2009 09:45 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 Craven Nursing Home DS0000061132.V374670.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. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Craven Nursing Home Address Keighley Road Skipton North Yorkshire BD23 2TA 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) 01756 700994 01756 790925 thecravenskipton@aol.com Craven Nursing Home Ltd Mrs Felicity Coleman Care Home 68 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (28), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (1), Old age, not falling within any other category (38), Physical disability (2) Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users in the category (DE) to be aged 60 years and over. Service users in the category (PD) must be aged 55 years and over and require nursing care. To provide personal care and accommodation for up to 6 service users from the age of 60 years and over. 6th February 2007 Date of last inspection Brief Description of the Service: The Craven Nursing Home is situated in a semi rural setting on the outskirts of the market town of Skipton. The home is registered to provide nursing care for up to sixty eight older people, some of whom may have a mental disorder, or dementia. The home is separated into three separate units. One of these units cares specifically for people with dementia. The home overlooks the Skipton to Keighley road and at the rear, the Leeds / Liverpool Canal flows close by. There are two vertical lifts providing level access to the first floor. The registered manager told us on 19 March 2009 that the current weekly fees range from £600 to £630. People pay extra for chiropody and hairdressing. We were told that the home has a Statement of Purpose and service users’ guide which, along with the inspection report, is available upon request. Craven Nursing Home DS0000061132.V374670.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. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Completed surveys from ten people who use the service, four health professionals who are involved in people’s care, and three staff. A site visit to the home carried out by one inspector over approximately eight hours on 19 March 2009. • • During the site visit, several people who live there, some staff, relatives, and the registered manager were spoke with. Three people’s care plans were looked at in detail, as well as someone’s pre admission assessment, two staff recruitment files, training records, and some information about health and safety. Care practices were observed where appropriate. Some time was also spent watching the general activity on each of the three units, to get an idea about what it is like to live at the Craven Nursing Home. The registered manager and her deputy were available all day, and were provided with feedback at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People get good care from staff who understand their needs. There are good links forged with outside professionals who give advice and support to the home where this is needed. People made comments like ‘I do receive good care’, ‘I am happy with the help I receive’, ‘When I do need care staff are always there for me’ and ‘The team that look after me are very nice’. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 6 People are offered a range of group and individual activities, depending upon their needs and circumstances, which they can choose to join in as they wish. The activities person writes about these in a personal way, so it is clear to see that people’s wishes and wellbeing have been considered. People can have their visitors whenever they wish. This helps to maintain social links with friends and family who are important to them. Staff have no doubt that if they thought anyone living at the home was not being treated properly, or had concerns that needed addressing, they would report these to the registered manager, and would make sure that something was done about it. The environment is kept clean, warm and comfortable for people. People can bring in their own belongings to make their bedroom feel more familiar and homely. The premises are kept maintained so the home is a safe place for people to live in. People’s right to privacy is respected by the care staff. One said they were ‘fascinated’ that staff always knock before entering their bedroom. Care staff are encouraged to complete nationally recognised training so they understand what good care is. And nursing staff also get training to keep them up to date with their practice, and to be proficient in caring for the people that The Craven offers care to. What has improved since the last inspection? What they could do better: As well as having discussion with those professionals who have played a part in people’s care, written information could always be collected from them before people move in, to make sure that any decision made about whether the persons needs can be met, is based on all available information about their current needs. People could be given a copy of their service users’ guide as well as their family, which is currently the case. Having this in their possession would allow them to refresh their memory about the home once they have moved in. For instance, what it provides, and how they can complain. People’s care plans contain a lot of good information about their nursing and personal care needs. Ways in which their emotional and social needs are to be met could be recorded in more detail. Certain risk assessments could always Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 7 be completed to check that the action taken by staff to keep people safe from unnecessary risk is consistently measured. Some areas of people’s medication could be checked and recorded more efficiently, so it can be clear that people are getting the medication as prescribed by their doctor, and so it does not run out. People could be asked their views about the home, not just their relatives. This would give the registered manager a clearer idea about how they would like their home to be run. For instance, to the menu, activities, and whether staff are available when people need them. With regards to staffing, the registered manager could look again at the way staff are deployed, based on the current dependency levels of the home, to check that there are no changes needed. Although staff know they cannot keep secrets should they suspect that someone at the home has been abused, they need to know who they can go to if they need to report anything of concern, and do not feel they can tell the management of the home. Plans to seek advice about making the dementia unit more interesting for those who live there, and easier for them to recognise key areas of the home more easily, could be pursued. These plans may assist people in maintaining their independence better, and make the environment more interesting. Newly recruited staff could have more thorough checks done to be sure that they are suitable workers. This includes making sure that references from their previous employer are obtained, to see why they have left. And making sure that a Criminal Records Bureau check is completed for each staff member coming to work at the home, so up to date information about any criminal record, or whether they have been barred from providing care, can be obtained. Care staff meetings could be held, and formal supervision sessions with individual staff increased in number, to encourage two way communication, and opportunities for staff as a group to identify and pass on their views and experiences about day to day issues. This would help the registered manager when improving the quality of the home for people, and in identifying where training may be needed for individual staff. 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. Craven Nursing Home DS0000061132.V374670.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 Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using this service experience good quality outcomes in this area. People are assessed before they arrive. However, ensuring that information from other professionals is always collected before the admission takes place would help to confirm the decision about whether the placement is definitely suitable for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager or deputy visits anyone who is referred to the home in their current placement, before they are admitted. This allows them to get a good idea about what the person’s needs are before they decide whether the home can meet them. This involves collecting assessments from other professionals who have been involved in the person’s care, such as their care manager or hospital staff. Generally, these professionals give this information before the assessment is completed. On occasions, the written information does not arrive until after the admission has taken place. It is good practice for the home to get this information as part of the decision making process, because it helps to provide Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 10 a better overall picture of the person’s needs. The registered manager said she always tries to make sure that this happens, and an example was seen where this had occurred for one person who was awaiting an assessment before coming in. We agreed with the registered manager and staff spoken with that the written assessment completed by the home could be more detailed. The document used comprises of tick box answers. This has already been recognised by staff, who are going to devise a better form. This will mean that staff have more written information about the person so they can read about them, and have better detail to refer to so the person gets the right care as soon as they arrive. Staff also need to make sure that they date these assessments, so they have more relevance should they need to be referred to in the future. Four of the ten people who returned their surveys said that they did not get enough information about their admission, and only three knew they had a contract. Some thought that both matters would have been sorted out between the home and their family. People should be consulted, wherever possible, in this process, so they remain involved in decisions about their care, when they are well enough to do so. However, one person spoken with said that they trusted their family, who, they said, made a ‘good choice’ of home on their behalf. Another said that the registered manager had visited them before they arrived, and that they had not been disappointed with the care during their stay. We were told that people or their families get a copy of the brochure so they can see what the home looks like, and what it provides. The registered manager said it is normally the person’s family who are given a copy of the service users’ guide, and to whom the contract is given, rather than the person moving into the home. People could be asked if they would like this information so they can refer to it when they need to. The home does not provide intermediate care. Therefore standard six is not applicable. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using this service experience good quality outcomes in this area. People get the right care from a group of staff who understand their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Everyone has a care plan, which is developed from their initial assessment. The plans gave lots of information about the person’s personal and health care needs, and were reviewed and updated regularly by the staff. Staff are developing ‘pen pictures’ to explain what interested people in the past, to help make their social life at the home more meaningful. The activities co-ordinator makes regular entries to show how this has been achieved. These entries were good, and individual to the person concerned. This information, if transferred over to the social care plans, would reflect better the support people get to help meet these needs and wishes. It was agreed that further information could be written down about how people’s emotional needs could be met. For instance, it would help staff to understand what triggered periods of anxiety, and how they could help Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 12 alleviate this. However, someone commented that they are very well supported, and that staff are always there to listen. Where people are identified as being at risk, assessments are completed, followed by a care plan, to see how this may be reduced, so that staff work in a safe, consistent way. For example, people have assessments done to check how they should be moved safely, and to see whether they are at risk from skin damage. Nutritional assessments are completed if, as part of an ongoing assessment of their weight, there are identified fluctuations, which need further attention. Equipment has been provided to help reduce risk. For example, special beds and mattresses, and moving and handling equipment, to help staff move people safely. Staff were observed using this equipment confidently. This helps to alleviate any anxieties for people needing assistance. Staff need to make sure they always complete an assessment to check the risk to individuals from falls, especially where they have been identified as being at high risk. This helps to identify triggers where further professional input may be needed to help reduce that risk. People’s families sign to give consent to the use of bed rails, and the equipment is checked regularly to make sure it is safe for use. However, before a decision is made to use them, a full assessment must be completed to make sure that this is the best course of action for the person concerned. This assessment must be reviewed regularly. Many of the people admitted to the home are very dependent when they arrive, and have multiple care needs. From discussion with the registered manager, and from the records looked at, it could be seen that the staff keep in contact with other professionals to keep their care right. This includes end of life care. The majority of the trained nurses have attended training so they know how to provide this, and they work closely with other professionals in order that people are supported during this stage of their life. One person said that the registered manager and staff gave them excellent support, and that they had every confidence that they would receive the right attention, so they felt safe. Three health professionals who returned their surveys answered ‘always’ or ‘usually’, when asked general questions about how well people’s needs were met, and whether staff had the right training to understand these overall needs. Comments were made like ‘Facilities have improved over the last year or two. Good palliative care’, ‘Standard of care is always high with a high level of common sense used in patient management’, and ‘Staff try hard to address patients’ needs. Excellent matron’. Staff on the day spoke to people with respect. They provided their care in private. One person said they were ‘fascinated’ because staff always knock on their door before entering. They said they had asked staff why they do this, and were told it was because it was their room, and their home. However, staff had posted information in public places about people, including details about Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 13 what sort of diet they should receive, information about bathing times and nail care, and information about fluids. This means that visitors, and other people living at the home, could see information about people which they may not wish them to know about. The registered manager is arranging for this to be kept in a more private area, as she thought was already the case, so that information about people’s care is kept confidential. The ten people surveyed said they ‘always’ or ‘usually’ get the care they need. Nine of these people said that staff always listen and act on what they say. People made comments like ‘I do receive good care’, ‘I am happy with the help I receive’, ‘When I do need care staff are always there for me’ and ‘The team that look after me are very nice’. Although some people said that they sometimes have to wait for this care when staff are busy. On the day, people made comments like ‘I’m very content. I’m sure this must be the best home’, ‘The staff are very respectful, very caring’, and ‘I am happy with the care – the girls are nice’. A relative said that they could ‘only commend Felicity (the registered manager) and the staff’. Another said that they were very happy with the home, and since their relative moved there, it had ‘taken a lot off’ their mind. People and their families are not always involved in the review of their care. It would be good practice to ask if they would like to be, where able, so that they can be included in any ongoing decisions made about the care they get. Trained nurses look after people’s medication. There are separate facilities for safe storage on each of the three units of the home. When people want to look after their own medication, staff complete an assessment to check that it is safe for them to do so. This was missing in one file. The deputy manager said she would make sure that this was completed straight away. However, another person had, after discussion with staff, decided to hand over this responsibility as part of their risk assessment. This shows that staff had checked that this person remained safe and able to look after their medication, and provided support when a decision was made that they were no longer able to do so. The medication records were mainly up to date. However, because stock balances had not been maintained, in two cases the medication remaining in stock did not tally with what the records said there should be left. One person did not receive their prescribed pain relief on one occasion because the stock had run out. This should be checked as part of a regular audit, and staff should be aware when medication needs to be reordered, especially when this does not fall in line with the normal monthly cycle of reordering and delivery. Where a person had been prescribed a variable dose of medication, staff had not been consistent in recording how much they had been given. This makes it more difficult for the doctor to see how much has been needed, and how effective the treatment has been, when they review the person’s care. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using this service experience good quality outcomes in this area. People can maintain social links with people who are important to them, and can make decisions in their daily lives. But by learning more about people’s views about the activities and the menu, the home would be in a better position to decide whether what is on offer matches with their collective needs and wishes. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are two activities persons employed over six days. They provide both group and individual activities for people. Care staff say that they also like to try and spend time with people socially. On the day of the site visit, they had time to sit and chat with people. This helps them to get to know each other better. Staff said that sometimes though they are more rushed, and they have to concentrate on their care duties. The registered manager said that the most recent quality assurance survey conducted by the home provided feedback that some relatives did not know what activities were happening there. She has therefore displayed information in the public areas to show them what is being provided for the people who live there. Whilst this is good practice, and the views of their relatives are important, people themselves are not given surveys. Without their collective Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 15 feedback it is more difficult for the registered manager to assess whether people themselves are satisfied with the activities on offer. Indeed, those spoken with during this site visit said they enjoyed the activities. And their surveys agreed that there are ‘always’ or ‘usually’ activities for them to join. They said things like ‘They are frequent and interesting’, ‘There are always activities but it is my choice not to join in’, ‘Always there for when lonely and no visitors’. Some of these activities take place in people’s rooms. For instance, chats, reading and nail painting. Other activities are provided for groups of people. These included forthcoming events such as card making, musical sing along and poetry reading. On the day, one person was knitting. Others were doing craft work. One of these said ‘I only came to watch, and look, I’m joining in now!’ There is also a monthly communion service which people can attend if they wish. This is held in the ‘general’ unit. However, we were assured that the activities organiser also asks people living on the dementia unit if they would like to attend the service, to help meet their spiritual needs. Staff said there is a routine, which they try to keep flexible so that people can make choices each day, such as when to get up, and when to go to bed. They try to ask what people would like to wear, and what they would like to do with their day. People can have their visitors whenever they wish, in the privacy of their own room if they want to. This helps to maintain links with family and friends who are important to them. The comments people made about the meals were not consistent. Two people who returned their surveys said they always like the meals. One of these said ‘Fabulous’. Six people said they usually do. Their comments included ‘Sometimes not very interesting’, I would like more choice’, ‘I always enjoy my breakfast and my teas but I’m sometimes not hungry for lunch’. ‘Would like more choice, not asked what want. Do realise we have to go with the majority’. People get offered drinks between meals. One said they were offered tea ‘on tap’. There is no advertised choice at mealtimes. The cooks explained that people can ask for something else to be prepared for them if they would like something different from the menu, and the registered manager said there is always an alternative available. However, people were not clear that this was the case. And one staff member thought that the alternative to the main meal at lunchtime would be sandwiches. This is not an equitable alternative. Neither was it clear to everyone that there was a choice at tea time. One said that the tea comprised of sandwiches and soup every day. They said that this was a bit ‘boring’. A staff member said that the ‘hot alternative’ was made Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 16 available less and less, and agreed that it was ‘soup and sandwiches every day’. Another person however said that they were served a lovely range of food, including fresh fruit, every tea time. It would be better if everyone were offered a choice at mealtimes, rather than having to ask, as some may not wish to do so. As staff do not keep a copy of what has actually been provided at the mealtime, it would not be possible for the registered manager to check this. They need to do so. Surveying people to find out their views about the meals would allow everyone who is able, to comment, and to pass on suggestions about how they may like their menu changed. The management have agreed to do this. Doing this is good practice, and will help to make sure that people’s views are considered when making changes to the menu, and how choice is offered. The cooks said that staff were good at letting them know about people’s dietary needs. This makes sure that they receive the meals they need to maintain their nutritional health. They said that there is always a good supply of fresh meat, vegetables and fruit to help them achieve this. One professional had commented that the person’s increase in weight was down to good nutrition. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using this service experience good quality outcomes in this area. People can complain, and these complaints will be taken seriously. Further training will make sure staff know exactly to whom they can pass on concerns about safeguarding people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Seven out of ten people who returned their surveys said they know who to speak to if they are not happy. Two said they usually know, and one was not sure. Eight people said they know how to complain, and two do not. One person on the day said ‘Felicity (the registered manager) is very kind. I would go to her with any complaints’. Another said they were sure that if they had any concerns ‘Felicity would sort things out’. The complaints procedure is displayed at the home. It is also included in the service users’ guide, but it is normally people’s family who get a copy of this when the person is admitted. It would be good practice for people to receive this guide also. However, one person spoken with said that the registered manager was very careful to explain their right to complain when they moved in. They were made to feel confident that their complaints would be taken very seriously, and acted on by her. There has been one formal complaint made about the home in the last year. This resulted in a random unannounced visit to the home by the Commission for Social Care Inspection in August 2008 to look at each of the issues raised. The outcome of the visit was that staff must get regular supervision. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 18 Anonymous concerns were also raised about staffing levels at the home. The registered manager responded to the commission’s request for information and provided evidence to show how she was meeting the staffing levels set by the company. She informed us at this visit that she has increased the number of nurses on duty at night as a result of this. The home has an abuse policy, which supports the role of social services, who lead in investigations into allegations of abuse. Staff were very clear that they would report to the manager any suspicions of abuse that they may have. They also said they would make sure that these were dealt with by her. However, they were not clear about the role of the local authority, who they can contact should they want or need to report their concerns outside of the home. None of the staff said they have had training in abuse awareness, although the registered manager said this is part of the National Vocational Qualification programme. She has agreed to make sure that they are given a training update. This will make sure that there are no delays in the right action being taken to protect people from abuse should this ever happen. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using this service experience good quality outcomes in this area. People live in a clean, warm and comfortable environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The environment is clean, warm and comfortable. Nine out of ten people who returned their survey said this was always the case. The tenth, who answered ‘usually’, added ‘Pretty good’. It is a large building. However, because it has been divided into three units, it feels more homely. Accommodation and bedrooms are provided over two floors. There are two passenger lifts providing easy access to each of the floors. Some work has been completed to the kitchen since the last key inspection, and the recent routine visit from the Environmental Health Officer commented upon the ‘excellent controls in place’. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 20 Many people have their own room, which they are encouraged to personalise, so it feels more homely. Some have lovely views of the canal, which runs behind the back of the home. People said they like watching the activity and views, and wildlife, especially in the summer months. The registered manager and her staff on the dementia unit are thinking about how they can make it easier for people to identify their rooms, and to develop the environment to help those who may get more easily disorientated. This will help to support people’s independence, and will make the unit a more interesting place to live. They should seek further advice from the relevant specialists to see how they could best achieve this. The laundry facilities are suitable. There was protective clothing for staff, and equipment so that soiled linen can be transported and washed separately to reduce the risk from cross infection. People’s clothes looked well cared for. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 21 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 using this service experience adequate quality outcomes in this area. People agree that they get good care, but may have to wait for it when they ask for it. Staff get training so they understand what good care is, but the recruitment procedure could be improved so people can be assured that every step is taken to protect them from unsuitable workers. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People said they get good care from staff who understand their needs. However, some said they sometimes have to wait for this care if staff are busy with others. Whilst four people who returned their surveys said staff were always available, five said this was usually the case, and one said sometimes. They made comments like ‘There may be a delay if they are busy’, ‘Do expect to have a wait if staff are busy’, ‘Staff are available unless busy with other residents’. On the day, people’s comments varied. One said ‘Staff know they must come straight away if I buzz’. Another said they were satisfied with everything about the home, but ‘The only thing is the staff are sometimes short’. Staff agreed that they are often very busy, but they make sure that people’s care needs are met. They were certain that they achieved this, although one commented that sometimes they were ‘rushed off our feet’. Although one agreed that if they asked for more staff, these would be provided where the registered manager was able, they said there was ‘not always the time’ to Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 22 provide the choice and flexibility that they would like for people, and that it sometimes felt that there were not enough staff. One staff member said there were certain times of the day they found more difficult. For instance, they said at teatime, there were more people who needed help with their meal than were staff available. They were anxious that people were not rushed, and saw this as an area where improvements could be made. And a health professional commented that the service could improve by ‘providing more staff per patient’. As the dependency of the people moving to the home is increasing over time, this is an area that the registered manager must keep under constant review. As part of this review, she could survey people, and ask staff their views, so she can have a good idea where adjustments could be made based on their collective comments. Staff who returned their surveys said that they get training to update their skills. The majority of nursing staff have completed training about palliative care, which helps them to understand people’s needs, and how their care can be planned for, during the final stages of their life. Many of the care staff have achieved, or are working towards a National Vocational Qualification at Level 2 or 3. In support of this, we were told the home has achieved an ‘Investors in People’ accreditation which shows their commitment to staff training. This helps to make sure that people are looked after by a well qualified work force, who know what good care is. Two staff files belonging to recent recruits were looked at. The first had undergone the necessary police checks, and a check had been made to make sure they were not barred from providing care, before they were allowed to work with people living at the home. The second had not had a police check completed by the home. Instead, one had been accepted that their previous employer had carried out. New recruits must have a Criminal Records Bureau check completed by the service they are applying to work with. The registered manager had been given different information in the past, and thought that this check was transferable between jobs. She agreed to organise another check the following day, and said that this will not happen again now she is aware. In addition, the registered manager must make sure that, wherever possible, a reference is obtained from the person’s previous employer, to check the reasons why they are leaving, and that they have not been barred from providing care. This had not been done in one case. Both new staff had completed an induction, which the registered manager said she has now improved in line with Skills for Care minimum standards. This will help staff to each have a good grounding about what is expected of them when they care for people, or work at the home. Craven Nursing Home DS0000061132.V374670.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 and 38 People using this service experience good quality outcomes in this area. The manager is well qualified, organised and receptive to individuals. A more formal agenda to discover where improvements could be made, based on people’s views and staff experience, would make sure that the way the home runs day to day, stems from a formal action plan based on the collective comments and wishes of the people who live there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager has many years experience in a variety of settings, including the care of older people. She holds a management qualification. She updates her skills through training opportunities as they arise, and keeps in touch with outside health professionals with whom she has developed good links. In addition, she is in the process of completing a certificate in education. Staff made comments like ‘The management is very good. They are always asking if everything is OK’, ‘Felicity is good – she is always heavily involved’. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 24 However, one staff member thought that there was little direct communication between the management and staff. They said they sometimes felt ‘isolated’. Another said that communication ‘doesn’t always work well, despite the registered manager’s door being always open for staff.’ A third said that although the registered manager does ‘sit and listen’, the communication was sometimes ‘poor’. They said this was partly because there was no supervision or meetings for them. Although staff see the registered manager around the home, and know she is there if needed, some would like a more formal structure in place to improve communication. Although the registered manager said they do provide annual appraisal, staff said they do not have regular formal supervision. This should be introduced, because it gives the opportunity to identify individual support and training needs based on their performance. The people who live at the home said that they know the registered manager, and see her often. She surveys their families annually to request their views about the home, and the care. This information is used when measuring the quality of the service people get. People themselves however are not surveyed, nor are the professionals who support them. They should be, because the views of people living at the service may be different to their relatives, and are very important when deciding how the home should be run. Information provided showed that the home is kept maintained. And staff have undertaken, or are going to receive, training over the next three months so that they are up to date with compulsory refresher training in fire safety, moving and handling, infection control and food hygiene, so that the current gaps are filled. This will help staff to work in a safe and consistent way. However, comments were made that the wheelchairs were not kept maintained. One staff member said that they often took some out of circulation so they could be sure that those in use were safe. The registered manager disputed this, and said that three new chairs have just been provided. However, she agreed that, the following day, the maintenance person would check all wheelchairs in the building to make sure they are safe and fit for use. Some formal way of making sure this happens on a regular basis, and the check recorded, must be devised. The home does not handle people’s money. However, we were told that should people have a wish to manage their own, they would be supported to do so if this help was required. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X 3 Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 13 Requirement People must have a completed assessment with regards to the risk from: • • • Falls The use of bed rails Self medication Timescale for action 30/04/09 2 OP27 18 This will make sure that the right action is taken to minimise any risk to their health and welfare. The availability of staff at different times of the day must be reviewed, so that improvements can be made where people identify regular shortfalls and delays in receiving care. 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 27 1 OP3 The written assessment completed by other professionals should always be obtained before a decision is made to admit a person, so they can be assured that all available information has been looked at about their needs before deciding that they can be met by the home. So that they remain informed about what the home provides, people, as well as their families, should be given the service users’ guide, and should be asked whether they wish to be informed about their contractual arrangements. People and/or their families should be invited to be involved in the review of their care, so they can be involved in decisions about how their needs will be met. A regular audit of the medication should include checks of stock balance, to make sure that the records staff keep tally with the medication that remains in stock. The number of tablets given to people where the dose is variable should be recorded. This allows their doctor when reviewing the medication to see how much has been given, and how effective it has been. Staff should keep a better check on stock levels so that medication prescribed for people does not run out. This allows the treatment prescribed by their doctor to continue as planned. So that information about people remains confidential, details about their care needs should not be displayed in public areas. People should be informed that there is an alternative to the menu so they are able to choose in advance what they want to eat, and enjoy more variety. Staff should keep a record of the menu that has been provided for people, so that the registered manager, or anyone else with the authority to do so, can check that it is sufficiently varied and satisfactory. All staff should be provided with a training update on abuse, to include the role of the local authority. This will mean that staff who have not undergone National Vocational Qualification training are also included in an update about what to do, and who they can go to, should they ever have any concerns about the people in their care. The advice of the appropriate professionals should be sought regarding good practice for improvements to the dementia unit environment. This may help people who find DS0000061132.V374670.R01.S.doc Version 5.2 Page 28 2 3 OP7 OP9 3 4 OP10 OP15 5 OP18 6 OP19 Craven Nursing Home 7 OP29 8 OP32 9 OP33 10 OP36 it difficult to find their way around the facilities of the unit, to retain some independence, and ownership and identification of the room belonging to them. In the case of new recruits, a reference should always be obtained from their current employer to establish why they are leaving, and whether they have been barred from providing care. More planned, formal ways in which to communicate with staff should be introduced. For instance, through regular staff meetings. This would give everyone the opportunity to discuss views and topics which may have relevance to the way the home is run, in the best interests of the people who live there. People who live at the service, and the professionals who support them, should be surveyed as part of the quality assurance programme. These views once collated should be fed back to people, and published, with an action plan to show what is being done in response to their views. Staff should receive regular formal supervision to discuss their career development needs, aspects of care practice, and the philosophy of care at the home. Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Craven Nursing Home DS0000061132.V374670.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!