Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Caldwell Grange Donnithorne Avenue Nuneaton Warwickshire CV11 4QJ The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Beadsworth
Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home
Name of care home: Address: Caldwell Grange Donnithorne Avenue Nuneaton Warwickshire CV11 4QJ 02476383779 02476384798 jackywest@warwickshire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Warwickshire County Council, Social Services Department Name of registered manager (if applicable) Mrs Jacqueline Karen West Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Caldwell Grange is owned and managed by Warwickshire County Council. The home provides care and accommodation for 35 older people with a wide range of needs. The home is situated in a quiet cul-de-sac on a large housing estate in Attleborough, Nuneaton, with many of the service users coming from the immediate local area. There are local shops, a post office, pub, hairdressers and churches located within half a mile of the home. Caldwell Grange provides accommodation on two floors. All the sitting areas are on the ground floor, where there is a large dining room, incorporating a bar, and four lounge areas including a conservatory. The self-contained day care accommodation is available to residents outside day care hours. The home is set in its own grounds with a well maintained and accessible garden area. There is car parking space available for a number of vehicles. At the time of the inspection visit the fees Care Homes for Older People
Page 4 of 33 care home 35 Over 65 35 0 Brief description of the care home charged were within the local authority range. Additional fees are charged for newspapers, toiletries, chiropody, hairdressing and individual outings or holidays. Care Homes for Older People Page 5 of 33 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included an visit to Caldwell grange. As part of the inspection process the registered manager of the home completed an Annual Quality Assurance Review (AQAA), which 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 the service. Ten surveys were sent to residents and four were completed and returned to us. Seven residents/visitors also completed and returned surveys relevant to them. Information contained within the AQAA, in surveys, from previous reports and any other information received received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience Care Homes for Older People
Page 6 of 33 of living in the care home by meeting or observing them, talking to their families or friends, where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Other records examined during the inspection included, care files, staff recruitment, training, residents social activities, staff duty rotas, health and safety records and medical records and systems. The inspection process also consisted of looking at policies and procedures where appropriate and relevant, discussions with the manager, staff, three visitors and residents. The inspection took place between 11am and 9pm. What the care home does well: The home provides sufficient information about the home to prospective residents to assist them in making a choice about their care. The Statement of Purpose and Service User Guide that contain this information were available for inspection and had been distributed to residents. Pre-admission assessments had taken place in sufficient detail to enable the staff to ascertain if they could meet the persons needs or not before a decision was made regarding the admission. The home informs the prospective resident in writing of the outcome of the assessment and encourage the person to visit the home before a trial stay at the home. A welcome checklist is kept for all people newly admitted and completed by staff to ensure that the person feels welcome. This includes whether they want other services such as hairdressing or newspapers and if they wished to have a key to their room. All residents have an attached worker from the care staff team who, along with a senior member of staff, gathers further information about the person in order to establish their specific needs. This information, along with any information gleaned from family and friends where necessary, is used to draw up the care plan that instructs staff on the care that is required. The AQAA tells us that the care plan is driven by the resident in order to ensure that it is person centred and delivered in the way that person chooses. Surveys completed by residents and their relatives or visitors told us that they think residents receive the care and support they need and positive comments were made such as, The staff at the care home ... are very caring and look after their residents with respect and love. Necessary risk assessments and screening regarding areas of care are in place in order to minimise the risk in these areas of care. On going health care needs are met with evidence of health care professionals, such as the optician, chiropodist, district nurse, continence adviser and Community Psychiatric Nurse being involved with the residents care. Residents answered Always or Usually to the question in the surveys, Do you receive the medical support you need? The manager told us that they had focused on medication in the past year. The home has safe and efficient medication system and practice that safeguards the health and welfare of the people living and staying at the home. Observations made, the completed surveys and discussion with residents showed us that residents are treated in a respectful manner with one resident saying, Oh yes. They are very polite. They wouldnt come into my room without knocking first. Care Homes for Older People Page 8 of 33 The home provides stimulating and varied activities for the residents. These included the familiar activities of board games, bingo and jigsaws but also more innovative occupation such as water colour classes, craft classes, interesting trips out, two organised holidays a year and gardening. Residents surveys said that there are Always or Usually arranged by the home that they can take part in. One relative commented that there were activities on offer that kept residents happy and alert. Special occasions were also celebrated. Visitors said that they were always made welcome and were always offered a hot or cold drink. Residents said that they enjoyed the meals provided. Menus looked at showed us that the meals were varied and nutritious and that there was an ample choice offered at each mealtime. People said that they enjoyed the meals and that the food is, good quality. Complaints and concerns were listened to, investigated and appropriate action taken. There were appropriate Policies, procedures and practices in place to safeguard residents from abuse. Caldwell Grange offers comfortable, clean, well maintained, well decorated and safe surrounding for the people using the service. One resident said of the home, I love it. Everything is lovely. One resident was benefiting from a specialist chair that enabled them to sit out of bed, which improved their quality of life. Infection control was well maintained with staff having attended relevant training, appropriate hand washing facilities and protective clothing provided to prevent cross infection. There are sufficient staff available to meet the needs of the people using the service. Residents and their visitors made very positive comments about the staff. Training has a high profile and its importance recognised. More than 50 of the care staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and all staff have undertaken mandatory training related to health and safety issues. There are robust recruitment procedures and practices to safeguard residents from the employment of unsuitable people at the home. Staff files looked at all included the required information to evidence this. The manager is registered with us and has the appropriate qualifications and experience for the post. She showed an enthusiastic commitment to the home, leadership and to meeting the care standards. There are systems in place to monitor and audit the quality of the services provided at Care Homes for Older People Page 9 of 33 the home in order that the home acts in the best interests of the people using them. There are appropriate records of transactions and cash balance against thee records, for any money held on behalf of the residents. This indicated that their financial interests were safeguarded. A random check of records of maintenance and health and safety checks showed that they were up to date. In house fire safety checks were also up to date. These records and observations made, indicated that the home was a safe place to live and work. What has improved since the last inspection? What they could do better: Daily records were brief and would benefit from being in more detail about the days events for that person. There was a shortage of storage space and a bathroom, not currently in use for bathing, was being used for the storage of hoists and other equipment. Care Homes for Older People Page 10 of 33 The medication policy being revised by the Local Authority should be implemented as soon as possible. It should include a homely remedy policy and procedure tht enables staff to treat minor ailments safely. There should be evidence to show that handwritten medication charts had been checked by a second member of staff, and the instructions had been verified, for their accuracy. A step ladder in the pantry was in need of cleaning in order to maintain hygienic conditions. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 33 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: The surveys returned to us by service users and by relatives/visitors all said that they had been given sufficient information about the home. All residents said in the surveys that they had received a contract. These were not inspected further on this occasion. The AQAA told us that the homes Statement of Purpose and Service User Guide reflected the types of service that was provided at Caldwell Grange and that these documents had been updated in the last year. They were available for inspection and had been distributed to prospective and existing residents. The AQAA and discussion with the manager showed that the social work team makes
Care Homes for Older People Page 13 of 33 Evidence: all referrals to the home and that they carry out a full assessment of need. A visit is then made by the senior staff at the home to assess if the home was able to meet the persons needs or not. Three sets of care files were looked as part of the case tracking process. Each included the social workers needs assessment and a pre-admission assessment that had been carried out prior to the person moving into the home by senior staff. Each assessment identified the care required, covering all areas of need, thereby providing sufficient information to make a decision about whether the home could meet that persons needs or not. The prospective resident was then sent a letter to inform them of the outcome of the assessment. A visit to the home was encouraged by the senior staff prior to any trial stay at the home, although records and discussion showed that residents had often been a day care user or had previously stayed at the home for respite or assessment visits. The care files also had a welcome checklist that included the initial welcome, what other services were required, for example, hairdressing, newspapers, if the person wished to have a key to their room - with any reason for refusal noted. This checklist assisted the person to settle into the home, and to have needs and wishes met. Care files looked at included evidence of annual reviews that had been led by the allocated social worker, six monthly placement reviews held by the senior staff of the home and monthly reviews of the care plans. Care Homes for Older People Page 14 of 33 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are detailed and up to date care plans and risk assessments in place to provide staff with the information they need. Residents have access to health care professionals and are cared for in a respectful manner. There is a safe medication system in place that safeguards residents health and welfare. Evidence: All residents have an attached worker from the staff team on admission. This member of staff spends time over the first few days, along with a senior member of staff, gathering information from the newly admitted person in order to be able to establish the specific needs of that person and how their care will be provided. If necessary relatives and other carers are also asked to provide information. This information is used to draw up care plans that instruct staff on the care that is required by individuals. The AQAA tells us that the service given to the residents is driven by them and discussion with the manager confirmed this. Three care files were looked at as part of the case tracking process and each included
Care Homes for Older People Page 15 of 33 Evidence: care plans that gave detailed information to care staff about the care the person required and the way they wished to spend their day. These had been drawn up in a person centred way and had been signed by the resident further showing that they had been involved with them and were in agreement. Observations and discussion indicated that the plans were up to date. They had been reviewed monthly and updated as necessary, thereby enabling needs to be met. All four of the surveys returned by residents answered Always or Usually to the question, Do you always receive the care and support you need? and the majority of the relatives answered Always to the question, Do you think that the care home meets the needs of your relative/friend?. All comments made in these surveys were positive and included, The people at the care home that my (relative) is a resident of are very caring and look after their residents with respect and love. The care given to my (relative) with their illness has been exemplary. Completed assessments for nutritional screening, risk assessments for the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area), falls and a manual handling were in place. These would help to minimise risk for the person in these areas of care. Preventative measures such as pressure relieving mattresses and cushions were being used for residents at risk of developing pressure sores. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist, continence adviser and Community Psychiatric Nurse being identified in the care files looked at. Visits from health care professionals were recorded separately and were easy to track and cross reference to changes in care needs. Residents spoken to confirmed that they could see the doctor if they wished and that they had visits from the chiropodist, optician, district nurses and other health care professionals when necessary. Daily records had been maintained and briefly related to the care plans. However those looked at gave little information and would have benefited from more detail. Activity records had been maintained and one record looked at included a trip to shops and to lunch in Nuneaton, a trip to the Motorcycle Museum, Bingo games, reminiscence sessions, doing jigsaws and a trip to the Garden Centre. Mental health records showed changes in mental health and behaviour patterns, care plans related to how to manage these changes thereby enabling staff to be directed in
Care Homes for Older People Page 16 of 33 Evidence: the residents care and to support their mental health needs. All residents answered Always or Usually to the question in our surveys, Do you receive the medical support you need? In the AQAA and in discussion the manager told us that there had been a focus of attention on medication during the year and in order to improve and maintain a good standard only senior staff now administer medication. These staff have completed an accredited Distance Learning Training programme, as well as the training programme given by the homes pharmacist that all care staff undertake. The medication system was inspected. Although a medication policy is in place this continues to be in the process of being revised by the organisation. The manager advised that this was on the verge of being implemented in all the Local Authority homes. It should be available as soon as possible and should include a policy and procedure for homely remedies so that staff are able to treat minor ailments with over te counter medication in a safe and timely manner. The current procedure relied on residents visitors providing this medication. The ability to monitor this medication and the intereaction with prescribed medication is limited. The medication is provided by the pharmacist in multi dose system (MDS) blister packs, although some tablets are unable to be packaged in this way and are dispensed in original bottles or packets. The Medication Administration Record Sheets (MARS) were looked at and were in good order with no unexplained gaps and appropriate codes used to explain the reasons if medication was not given. However handwritten MARS had not been countersigned to show that a second member of staff had checked them for accuracy. These should also show that the instructions had been checked and where they had come from. This would ensure that the correct medication was being given and safeguard the health and welfare of the resident. What had been given and at what time was clearly recorded, for example if the dose was for one or two tablets it was clearly recorded which of these had been given. A protocol for as required medication was in good detail and included an explanation for use and the duration of time between doses. This meant that staff had clear directions about when and why they should offer this medication. The MARS folder also included specific information about how each individual preferred to take their medicines, such as likes to take tablets off a spoon, likes a full glass of water, ensuring that medication is also administered in a person centred way. Care Homes for Older People Page 17 of 33 Evidence: The receipt of medication, and any carried forward from the previous cycle, was recorded on the MARS and any disposal of medication was recorded in a separate designated book. This assisted the accurate auditing of medication. An audit of medication not in the blister packs was carried out by us and all those that were checked indicated that they had been administered correctly and as prescribed. Storage of medication was also in good order with air conditioning having been fitted since the last visit in the room where medication was stored to ensure that the correct temperature of less than 25 degrees centigrade was maintained. The temperature of the medication fridge was checked and records maintained showing that medication requiring refrigeration were also stored at recommended temperatures, thereby maintaining the stability of the medication. The home sees the ideal outcome would be for residents to self medicate, although there was only a small number who had been assessed to be able to do so. A relevant policy was in place and appropriate risk assessments were included in care files. All residents had a lockable space in their bedroom to store medication when required. Observations of care staff and residents together showed that residents are cared for in a respectful manner ensuring that their dignity and self-esteem are maintained. Terms of preferred address were on the residents care plan and heard to be used by staff. Residents spoken with confirmed that this was usual and when asked if staff were respectful, the following comments were made. Oh yes. They are very polite. They wouldnt come into my room without knocking first. Couldnt ask more from the staff. Care Homes for Older People Page 18 of 33 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were occupied and stimulated by varied and interesting activities. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Menus included residents wishes and preferences and the varied and nutritious meals were enjoyed by them. Evidence: A designated activities organiser worked weekdays to provide activities based on individual residents preferences and hobbies and other planned or unplanned activities were provided by care staff. An activity programme was displayed to inform residents of forthcoming events that included board games, dominoes, gardening, jigsaws and outings. People living at the home maintain raised flowerbeds at the front of the home and the manager advised that there were plans to provide a patio with further raised flowerbeds for them. All the residents replied Always to the question in the survey, Are there activities arranged by the home that you can take part in?. One relative said in a survey that the home provided activities that residents enjoyed such as, sing alongs, water colouring and making Christmas cards. Others commented that excellent activities
Care Homes for Older People Page 19 of 33 Evidence: are on offer that keep the residents happy and alert and residents spoken with said that there was plenty to do. There was lively interaction seen between residents and between staff and residents. Water colouring classes had taken place with residents over three months and their work was displayed in the home. Residents were suitably proud of their achievements and said that they had enjoyed the course. They were now doing a craft course for the following three months and had made Christmas cards and Christmas baubles. There are two holidays planned for residents every year in appropriate accommodation and all residents have the opportunity to go. Five residents are taken on each occasion and the number of staff required to support them accompanies them. Photos were available of a recent long weekend holiday that that had been enjoyed by five residents. Special occasions were celebrated and the AQAA told us that suitable meals were planned and provided for these occasions. A residents birthday was being celebrated with birthday cake and everyone singing Happy Birthday at the teatime of our visit. Visitors in both the surveys and those spoken with answered positively about being made welcome at the home, and about staff being, very friendly and approachable. One relative said that the staff always asked how they were and always offered a hot or cold drink when they visited, making them feel welcomed. Menus were displayed in the reception area and meals were varied and offered two main choices in both courses at lunch and at teatime, with a third option of sausage and fries and fresh fruit or yoghurt always being available if preferred to the other choices. A cooked breakfast was available each weekday. Discussion with the manager and residents told us that residents had been involved in drawing up these menus at their monthly residents meetings and in the surveys the home had circulated that had focused on mealtimes. This meant that the meals provided would include the wishes and preferences of the people living at the home. The home has one large dining room that caters for all people living and staying at the home and those using the day centre. This large communal area was a bright and comfortable dining space. A bar adjacent to it provided comfortable seating for social occasions and had facilities for alcoholic and hot beverages. Residents who needed it to assist their independence were using specialist cutlery. Care staff were available to offer assistance and did so in a sensitive manner. Care Homes for Older People Page 20 of 33 Evidence: The home was trying out dining chairs with wheels that had a braking system, to make moving chairs to and from the tables easier and reducing the risk of injury to the resident and the member of staff. All residents said in the surveys that they Always or Usually liked the meals at the home. Comments in the surveys and from people spoken with included, All food is good quality. Meals are wonderful. The food is lovely Visitors/relatives agreed with these comments. The kitchen was clean and well managed, a record of fridge, freezer and high risk cooked food temperatures were held and maintained. A cleaning schedule was in place and used to make sure all areas of the kitchen were regularly cleaned and well organised and food was stored appropriately and safely. There was a good variety of good quality dry foods stored in the pantry and snacks such as crisps, crackers chocolate biscuits and chocolate bars. Care Homes for Older People Page 21 of 33 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies, procedures and practices to safeguard people living and staying there. Evidence: The complaints procedure was displayed in the reception area to inform residents, other service users and visitors how to make a complaint. There was evidence that concerns were listened to and that people could be confident that they action would be taken. The manager said that she had recently undertaken a Complaints Training course in order to assist her further in handling complaints appropriately. A complaints log looked at was adequately maintained, and showed the investigations and outcomes of concerns raised and any action needed. A suggestion box in the reception area also enabled people to raise concerns, anonymously if they wished, and further showed that the home was willing to listen to concerns. The AQAA told us that this box was checked daily. The large majority of visitors/relatives answered Yes when asked in our surveys if they knew how to complain and all said Always or Usually when asked if the home had responded appropriately if they or the person they visited had raised any
Care Homes for Older People Page 22 of 33 Evidence: concerns. There were also comments that indicated they had never needed to complain, with one person saying that this was because they (the staff) are so understanding and kind. Staff were aware of safeguarding and had attended training that would assist them in identifying abuse and what to do if they suspected or witnessed abuse. The AQAA told us that the safeguarding policy had been reviewed in 2008. A recent safeguarding incident was suitably addressed. All recruitment practices safeguard residents from the employment of unsuitable people and all financial records of monies held on behalf of people living at the home indicated that their financial interests were safeguarded. Care Homes for Older People Page 23 of 33 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers comfortable and pleasant surroundings that are clean, safe, free of offensive odour, generally in good decorative order and well maintained. Evidence: Caldwell Grange offered comfortable, clean, well maintained and safe surroundings for the people living and staying there and is located in a quiet cul-de-sac. The decor, furniture and fittings were mainly domestic in appearance giving a more homely feel. The gardens are also well maintained. Residents were encouraged to assist in the maintenance if they wish to do so. There is adequate parking space at the front of the home. When asked if they liked the home one resident said, I love it. Everything is lovely. Comments in the residents and visitor/relatives surveys also showed that people found the home clean and comfortable. There is ample communal space with the lounges and the dining room being on the ground floor. There are further sitting areas in the large and attractive reception area
Care Homes for Older People Page 24 of 33 Evidence: and the conservatory that is situated off one of the lounges and overlooks open fields. Environmental improvement was identified in the AQAA and noted at the time of the visit. These included redecoration of seven bedrooms and the lounge and conservatory and new floor covering provided in these areas and added to the comfort of communal and private living space for the residents. There was no evidence of the flood damage experienced the previous year. There was a shortage of storage space for equipment in the home. A bathroom was being used to store hoists and other equipment. The manager said that this bathroom was not currently used and was awaiting conversion to a walk in shower. To prevent confusion the bathroom sign should be removed. Bedrooms of the people case tracked were looked at and all had been personalised to suit the occupant and had ensuite facilities. They were clean, comfortable and with coordinating soft furnishing. One of the rooms had a special armchair, provided by the home that enabled the person to safely and comfortably sit out of bed either in the bedroom or lounge, greatly improving their quality of life. A bedroom viewed had a tracking hoist system in place in order to safely transfer the occupant of the room, who was unable to weight bear, safely from and to their bed. There were adequate assisted toilet and bathing facilities with automatic disinfectant cleaning equipment for the baths. They were clean and hygienic and apart from a shower room on the ground floor provided appropriate hand washing facilities to maintain infection control. The decor was domestic in appearance making the areas more homely. Gardens were attractive, easily accessible to residents and well maintained. All other areas of the home were accessible to residents by means of a passenger lift. Laundry facilities were inspected and found to be well organised, clean and hygienic. Practices seen maintained infection control. Disposable towels and soap dispensers were provided in all communal areas where staff and residents would be expected to wash their hands thereby maintaining infection control. Protective clothing in the form of disposable aprons and gloves were readily available when required to prevent cross infection. All cleaning cloths were colour coded so that they were used in a way that prevented cross infection between, for instance, kitchen and bathrooms. However a stepladder in the pantry was in need
Care Homes for Older People Page 25 of 33 Evidence: of cleaning in order to maintain hygenic conditions. Care Homes for Older People Page 26 of 33 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff available to meet the needs of residents. Robust recruitment procedures and practices protect residents from the employment of unsuitable people. The importance of training is recognised. Evidence: Discussion with the manager and observations made showed that the usual number of care staff on duty were five care staff in the morning, four in the afternoon and evening and two during the night. The care staff were supported by ancillary staff of housekeepers, cooks and laundry assistants. Rotas were available that showed the actual hours worked by staff and showed the capacity in which each employee worked, and these confirmed the information given by the manager. Observations made during the visit indicated that there were sufficient staff to meet the needs of the people using the service. There were many positive comments about staff in the surveys returned to us. Some of these were as follows. They are always cheerful when helping them residents). I am very pleased with all the staff that care for my (relative) The staff are loving and caring. (The manager) and her staff work very hard to keep the home running well, that is also kitchen,
Care Homes for Older People Page 27 of 33 Evidence: cleaning and laundry staff. I cant praise them enough. All in all they are a wonderful team. In the surveys they completed for us visitors/relatives said that staff Always or Usually had the right skills and experience to look after people properly. The AQAA told us, and records showed, that all new staff undertake the Local Authoritys induction training (known as Common and Foundation) to give them the knowledge and skills to start their employment. Training has a high profile in the Local Authority and staff at Caldwell Grange had undertaken mandatory training in moving and handling (the safe transferring of residents from one place to another), fire safety, first aid, infection control, safeguarding of adults and medication. This training gives staff the knowledge and skills they need to carry out their work competently and safely. More than the fifty per cent of care staff had achieved the National Vocational Qualification Level 2 in Care, with five more care staff currently undertaking the training. This qualification shows that they have been assessed as being competent care staff. The files of three of the most recently appointed staff were looked at. All of them included the appropriate Criminal Records Bureau and Protection of Vulnerable Adults First checks, two verified written references from a suitable source and a completed medical check. The AQAA and records also showed that a robust recruitment procedure is followed in order to safeguard residents from the appointment of unsuitable people. Care Homes for Older People Page 28 of 33 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate qualifications and experience manages the home and provides good leadership. Services are audited and monitored to ensure that the home operates in the best interests of those using it. Health and safety practices protect those living and working at the home. Evidence: The manager had been at the home for two and a half years. She had achieved the Registered Managers Award, and NVQ Level 4 in Care and in Management. She is supported by an assistant manager, four care officers and a part time administrative assistant. She also manages two other non-registerable Local Authority services away from the home. In the AQAA, in discussion and in observations made she showed an awareness of the homes strengths and a commitment to make improvements where they could be made. Records and discussion showed us that the manager continues to undertake training to update her knowledge and skills. Care Homes for Older People Page 29 of 33 Evidence: The AQAA had been completed in good detail by the manager and gave us all the information we had asked for. In the surveys, and when spoken with, relatives and residents made positive comments about the manager. Evidence indicated that the home benefited from her leadership. The home uses the Local Authoritys Quality Assurances Programme that audits and monitors all areas of the service and a representative of the Local Authority oversees this. Surveys had been given to residents for feedback on the service, which on the most recent occasion focused on mealtimes as previously discussed. A representative of the Local Authority makes unannounced visits to the home and makes a report on their findings for us and for the manager. These systems indicate that the home is monitoring the service in order to enable growth and improvement. The manager told us in discussion and in the AQAA that monthly reviews and residents meetings were also occasions when feedback about the service was given. There were appropriate records of transactions, and cash that balanced against these records, for any money held on behalf of residents. these showed that the residents financial interests were safeguarded. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. There were no concerns about health and safety seen in the areas of the home viewed, apart from the door of a linen cupboard adjacent to the laundry that had been wedged open by items stored there. This could have created a risk in the case of a fire in a high-risk area but the manager informed us the following day that this had been addressed. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Daily records should be in sufficient detail to inform others of the events that have taken place in the day of the person. The medication policy being revised by managers in the Local Authority should be implemented as soon as possible. This should include a homely remedy policy and procedure that enables minor ailments to be treated safely. Handwritten medication record sheets should show that they have been checked by a second member of staff and the origin of the instructions for their use. Consideration should be given to providing adequate storage space for hoist and other equipment. the ladder stored in the pantry should be thoroughly cleaned in order to maintain hygenic conditions. 2 9 3 9 4 5 22 26 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 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. 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!
