Inspection on 13/03/06 for Cairndhu Rest Home Ltd

This inspection was carried out on 13th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Cairndhu Rest Home Ltd 18/06/09

Cairndhu Rest Home Ltd 18/07/08

Cairndhu Rest Home Ltd 18/07/07

Cairndhu Rest Home Ltd 06/07/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cairndhu 6 Warren Road Blundellsands Liverpool Merseyside L23 6UB Lead Inspector Ms Lorraine Farrar Unannounced Inspection 10:45 13 March 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 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. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cairndhu Address 6 Warren Road Blundellsands Liverpool Merseyside L23 6UB 0151 924 8427 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) Cairndhu Rest Home Ltd Ms Veronica Parker Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service is registered to accommodate up to 17 service users in the category of OP. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 19th August 2005 Brief Description of the Service: Cairndhu is registered to provide personal care without nursing for seventeen older people. There are staff in the home 24 hours a day to assist residents and meals and laundry facilities are provided. The house is semi-detached in a residential area of Blundellsands, it fits in well with local houses and does not stand out as a care home. It is very well located for accessing local facilities including shops, cafes, pubs, Crosby Beach and public transport. Cairndu is operated and managed by Veronica Parker who has worked in the home for many years. She is assisted by a deputy manager and a staff team who are experienced carers and well known to the people living there. Accommodation within the home is provided over three floors. Private accommodation is available in either single or double bedrooms, with a lift providing access to the upper floors. Shared accommodation is all downstairs and consists of a sitting room to the front of the house and a large dining room with lounge to the back of the house. The home has a large front garden and rear gardens with seating areas. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by two inspectors, Lorraine Farrar and Joanne Revie. Information for the inspection was gathered in a number of ways, this included discussion with residents, relatives, the manager and deputy manager, reading documents and files in the home and a partial tour of the building, including all bathrooms and lounge / dining areas. Following this inspection an arranged follow up visit was made to the home on 29/3/06 by Lorraine Farrar. Information from that visit is included within this report, however scores and judgements in the report relate to findings on the day of the unannounced inspection. What the service does well: What has improved since the last inspection? The home have begun work on improving how they organise and record information. Clear assessment information and life histories are in place for most residents. Health and safety records, checks and certificates are mostly up to date with the home clear about the dates these are due to be renewed. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The home do not always obtain or carry out an assessment of a residents needs before they move in to ensure the home can provide the support the person requires. EVIDENCE: One care plan looked at contained a copy of the local authorities assessment of the persons needs and others contained assessments carried out by the home. However a new resident admitted for a trail period 3 weeks ago did not have any form of assessment in place. It is important that the home obtains and carries out assessments before a person moves in, so that they can make sure the home can meet that persons needs. Cairndu does not provide an intermediate care service. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 Staff have access to a detailed history for each resident but do not have access to detailed instructions on the care required. Medications are not always managed safely. Staff treat residents with respect. EVIDENCE: The deputy manager confirmed that new care plans had been developed since the last inspection. Three care plans were looked at, these were found to contain comprehensive assessment information and details such as past life experiences were well documented and nicely written. However the resident’s needs were mixed in with this information and no clear plan of action as to how they were to be addressed was in place. Not all health assessments were up to date and the plans had not been reviewed regularly. The new plans have space for the resident to sign to show that they understand and agree with the care that is offered. However this had not been used and was left blank. At the follow up visit to the home on 29/03/06 the home had begun the process of discussing their care plans with residents and all but 2 plans had been signed. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 10 A daily communication record was viewed which staff use to record daily changes in residents needs. Some of the entries were not dated and other were not signed or used the member of staff’s first name only. This record is a useful document and helps to make sure all staff are aware of residents current or changing needs. However the manager needs to ensure all records are completed accurately so that there is a clear audit trail. The manager confirmed when asked that a resident who was admitted 13 days ago had no care plan in place. When asked the deputy manager confirmed that no policy was in place detailing when care plans would be implemented for new residents. It is important that care plans are in place and reviewed for all residents so that staff are aware of their needs and how they can provide support to meet these. Medication storage systems and records were viewed and a discussion was held with the manager. It was noted that a bottle of oxygen was being stored in the lounge, the manager confirmed that residents who wish to smoke also use this room. Smoking around oxygen can cause it to ignite and places residents at risk of harm. On a follow up visit to the home on 29/3/06 the manager had taken action to address this. Oxygen is now used in the resident’s bedroom only and there are clear warning signs in place. Medications are stored in a glass-fronted cupboard, which is fitted to the wall. Due to the glass front the cabinet is not very secure and the home should consider replacing it with a metal cabinet. The service uses the Boots system for medications. Medication administration records were viewed. Many of these had missing signatures so it was difficult to determine whether residents were receiving medication as prescribed. One medication administration record had been ripped in half. The two halves were being used by two different residents. The Manager explained that this was carried out, as the home had no blank sheets to use for new medications prescribed. This practice leaves no clear audit trail for ensuring medications are being managed and given out as prescribed. During the follow up visit to the home the manager had obtained blank medication sheets to make sure this did not occur again. A handwritten medication policy was viewed giving guidelines on administration and receipt of medication Discussions were held with four residents. All confirmed that staff were respectful towards them and that they felt staff protected their privacy when giving personal care. Staff were seen to knock on doors before entering and were heard to speak respectfully to residents. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15 Residents are encouraged to become part of the local community and receive visitors when they choose. Residents are supported to make choices, which affect their lives and are provided with a nutritious home cooked diet. EVIDENCE: Discussions were held with four residents and the visitor’s book was viewed. All confirmed that they could receive visitors whenever they chose and that their visitors were always made to feel welcome and the visitor’s book showed that people come and go at various times during the day. A relative said, “its that kind of home, you are always welcome”, and explained that visitors can just call in, there is a homely atmosphere and described the staff team as “brilliant”. The manager stated that one resident is being supported to attend a local church independently. Two other resident’s confirmed that they are free to come and go as they please. Residents confirmed that they are able to choose when they go to bed, when they would like to get up and what food they would like to eat. One resident who requires assistance to dress confirmed that although help is needed she always chooses what to wear. A care plan was viewed which gave a very good Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 12 overview of the person’s life but didn’t include personal preferences such as likes and dislikes. All confirmed that they receive their post unopened and are registered to vote. The lunchtime meal was viewed. This was carried out in a relaxed manner. Tables were set with cloths and condiments and the meal appeared appetising and nutritious. The deputy manager stated that weekly menus are available but that they were being reprinted and menus were not on display for this reason. Staff are recording most days what meal was offered in a diary, the home needs to make sure that a record of all meals and alternatives offered is kept. This will provide a way to ensure residents are offered a variety of nutritious meals that met their needs. All residents spoke with stated that the standard of food offered was very good, with one resident explaining, “the foods lovely, I have no complaints”. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Residents and their relatives have access to copies of the home complaints policy and the home has copies of the local authorities policy for adult protection available. EVIDENCE: Residents and their relatives have access to the homes complaints procedure, with copies available in all bedrooms. The home do not maintain a record or book for recording any complaints made along with the outcome and the manager explained that the home have not received any complaints regarding their service. The home must set up a system for recording any complaints received and their outcome so that these can be easily audited. The home had a copy of the local authorities new policy and procedure for the protection of vulnerable adults. However staff had not received any training in this area, which could place residents at risk in the event that an incident or allegation occurred. At the follow up visit to the home on 29/03/06 the manager had made arrangements for all staff to receive this training on 18th May 2006. The home does not act as appointee for any residents benefits and does not hold money for residents. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 Bathrooms are not utilised as well as they could be. EVIDENCE: All bathrooms were viewed and a discussion was held with the deputy manager. The home has three bathrooms. Each contains a toilet and a separate toilet is available on the middle floor of the home. All bathrooms appeared clean and contained soap and towels. The ground floor bathroom was being used by the hairdresser, which meant residents who were sitting in the lounge/dining room were restricted to using upstairs bathrooms. The deputy manager explained that the hairdresser was very obliging and that residents on the ground floor of the home used commodes on that day. This was discussed with the manager, as most residents use the downstairs areas during the day this practice may be inconvenient for them. The manager should review this practice and consider using a different bathroom where there is less impact on residents’ daily lives. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Residents are satisfied that there are sufficient staff working in the home to meet their needs. Recruitment checks are undertaken to ensure staff are suitable however induction training could be developed further to improve this. Staff have had training in the past but this needs updating. EVIDENCE: Residents and relatives spoken with stated that there are enough staff working in the home to meet residents needs. However no record or rota of names, times and dates staff worked was maintained. This was discussed with the manager who explained that all staff work the same shifts each week. However it is important that a record is kept of planned staff cover and any alterations made to this to cover staff absence. On a follow up visit to the home on 29/3/06 the home had provided planned rotas and the manager stated she would ensure these were maintained. Three staff files were viewed. All had CRB checks and contained two references, proof of ID and an application form. Some contained evidence of induction training but this focused on emergency situations within the home. Each staff file contained a variety of certificates many of these were for basic training such as manual handling, first aid etc, but were outdated with dates for 2002 and 2003. Some staff had undertaken training in the safe handling of medications in March 2005 and Fire training in May 2005. No training plan was Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 16 available to effectively record the training staff need to undertake to meet residents needs safely and ensure this is in date. The home must make sure that all staff have up to date training in basis care areas, this includes, manual handling, adult protection, health and safety, fire and food hygiene. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The home is managed by an experienced manager. There is no formal system in place for the home to monitor and improve the quality of the service they offer. Some improvements have been made to ensure the safety of the building however some health and safety checks are not carried out as frequently as required. EVIDENCE: The registered manager, Mrs Veronica Parker has many years experience within the field of care for older people and has worked at the home for some time, she also holds a management qualification. There is no formal system in place within the home for auditing the quality of the service offered. The manager explained that in the past the home have sent out questionnaires however these have not been used within the past year. She also explained that residents meetings are held but these are on an Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 18 ad hoc basis and no minutes were available. During the inspection residents were given time to talk in private with the inspectors and express their views. The home should introduce a system for monitoring the quality of the service that they offer and planning future improvements. The home does not manage any residents monies for them, the manager explained that this is their policy, residents either manager their own money or are supported by their relatives to do so. The home had satisfactory records and certificates in place for the fire system, emergency lights, gas, small electric appliances and mains electrics. Records of call outs to the lift were available however there was not record of the last test carried out, the manager explained that this was due and stated she would make arrangements. The fire book recorded that staff last received instruction and fire drills in January 06. However the fire alarm and lights were last tested on 09/01/06. The home must make sure that the fire alarm is tested weekly and emergency lights monthly to ensure they are working correctly. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 19 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X 2 X X X X X STAFFING Standard No Score 27 2 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X N/a X X 3 Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15(1) Requirement Where an assessment identifies a need for support the home must provide written guidelines in their care plan. This is a requirement from the last inspection The home must provide a format in each care plan for ensuring the plan is reviewed on a monthly basis. This is a requirement from the last inspection The home must ensure they maintain an accurate record of all food served. This is a requirement from the last inspection The manager must provide a care plan for each service user that contains all the information required by this Schedule. This is a requirement from the last inspection. The manager must ensure that all staff receive formal supervision at least six times a year. This is a requirement from the last inspection. DS0000065360.V289539.R01.S.doc Timescale for action 07/06/06 2 OP7 15(2)(b) 10/05/06 3 OP15 17(2) 19/04/06 4 OP7 15 schedule 3 10/05/06 5 OP36 18(2) 07/06/06 Cairndhu Version 5.1 Page 21 6 OP38 13(4)(c ) 7 OP7 15(1)(2) 8 OP7 17(3)(a) 9 OP9 12(1)(a) 10 11 12 13 14 OP21 OP30 OP30 OP27 OP3 12(2)(i) 18(1)(c) 18(1)(c) 18(1)(c) 14(1) 15 16 OP38 OP38 13(4)(c) 23(4)(v) 17 OP16 17(2) The home must carry out a documented risk assessment regarding practice of leaving the front door open. Action must be taken to minimise any identified risks. This is a requirement of the last inspection The manager must ensure that care plans are produced for new residents within a set timescale. This information must be developed into a clear policy The manager must ensure that staff understand the importance of keeping clear daily records and how to write these. The home must ensure that staff are made aware that oxygen is highly inflammable and must never be stored near residents who wish to smoke. The home must ensure that residents have access to toilets on each floor at all times. The home must arrange for all applicable staff to undertake basic food hygiene training The home must arrange for all applicable staff to undertake training in moving and handling The home must arrange for all applicable staff to undertake fire training. The home must ensure no resident is admitted without a full assessment of their needs being undertaken. The home must arrange for the lift to be serviced. The home must ensure emergency lights and the fire alarm system are tested at regular intervals. The home must introduce a system for recording any complaints received. DS0000065360.V289539.R01.S.doc 10/05/06 10/05/06 19/04/06 19/04/06 19/04/06 24/05/06 24/05/06 07/06/06 19/04/06 19/04/06 19/04/06 10/05/06 Cairndhu Version 5.1 Page 22 18 OP33 24 The home must introduce a system for quality assuring the service they provide. 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 Refer to Standard OP26 OP30 OP9 OP9 OP29 Good Practice Recommendations The home should have a supply of water soluble bags The home should produce a training record for all staff which details the training they have undertaken, dates training requires renewing and training planned. The manager should consider replacing the glass doors on the medication cupboard with something more secure. The manager should ensure all staff do not leave gaps in signatures on the medication administration records The manager should familiarise herself with current good practise for induction training. Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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 Cairndhu DS0000065360.V289539.R01.S.doc Version 5.1 Page 24 - 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!