Inspection on 14/09/06 for Carranmore

This inspection was carried out on 14th September 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

Carranmore 14/10/08

Carranmore 19/12/05

Carranmore 14/07/05

Carranmore 19/01/05

Carranmore 05/08/04

Carranmore 23/02/04

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

CARE HOME ADULTS 18-65 Carranmore 218 Warwick Road Carlisle Cumbria CA1 1LH Lead Inspector Liz Kelley Unannounced Inspection 14 September 2006 13:00 th Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carranmore DS0000022570.V303749.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carranmore Address 218 Warwick Road Carlisle Cumbria CA1 1LH 01228 514180 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) carrranmore@croftland.plus.com The Croftlands Trust Mr Peter Cork Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (6) Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of MD (Mental disorder excluding learning disability) under the age of 65 years of age. up to 6 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age) Date of last inspection 19th December 2005 Brief Description of the Service: Carranmore is run by The Croftlands Trust, a non-profit making organisation, which runs a number of residential and community based services in the county for people with mental health problems. Carranmore accommodates up to 6 people who have, or who have had, difficulties in maintaining aspects of their mental health. The property is located on a busy road close to the centre of Carlisle, with good bus links and close to a wealth of local shops and facilities. The home is a large terraced, three-storey older property, which has been modernised and converted for its present use. On the ground floor there are two lounges, kitchen-dining room, office, utility room and toilet. One lounge is designated as the smoking area. On the first and second floors there are 6 bedrooms, and two bathrooms. At the rear is a small parking area and patio garden. All service users have individual bedrooms, each with a wash hand-basin. All referrals are made, and funded via the Integrated Health and Social Services Team. The current scale for charging is £373.69. A Handbook is available for prospective residents, which includes a summary of the latest Commission for Social Care Inspection report. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection looked at all the main standards and took place over a one month period. This included a visit to the home and surveys were sent to service users, relatives and health and social services professionals. The visit to the home was carried out over an afternoon when the majority of service users were at home. Time was spent with service users individually and collectively. Staff were interviewed and observed carrying out their duties. Documents examined included care plans, daily notes, safety and maintenance records. What the service does well: What has improved since the last inspection? What they could do better: Although some recommendations were made this should not detract from the overall good quality of care offered to residents at Carranmore. Staff would benefit from up-to-date training on Adult Protection and the procedures for referring incidents to social services. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 6 The home needs to ensure that resident’s families are familiar with the complaints procedure. 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. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has robust and well-established procedures in place to introduce new residents and this results in a high number of successful placements. EVIDENCE: The home has suitable procedures in place to introduce new service users and ensures that each person has a full assessment prior to living at the home. This ensures that they only take people whose needs they can meet, and the individual has the opportunity to vet the home and make an informed choice of where to live. Files contain relevant paperwork, including social work assessments and reports from health care professionals prior to a person choosing to stay at the home. Admissions are not made to the home until full needs assessment has been undertaken. The manager also carries out an assessment which includes visits to see the person in their own home. A new service users file was examined in more detail and this demonstrated that an initial referral was made via the Integrated Care Team, a referring assessment was in place along with an up-to-date risk assessment. Evidence via daily notes and speaking to service users established that he had been given choice and plenty of opportunities to visit and this allowed him to make an informed decision. These measures ensure that admissions to the home only take place if the service is confident staff have the skills and ability and qualifications to meet Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 9 the assessed needs of the prospective resident. This results in placements to the home being appropriate and successful. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff work hard to encourage residents to take control and make informed choices which is carefully monitored through a well-developed system of care planning. EVIDENCE: Individual care plans were well organised and laid out in a format that clearly identified needs and how they were to be met. These were supported by additional information such as profiles and pen pictures to aid greater understanding and knowledge of the individual. Files also included details of a persons mental health disorder and any restrictions imposed via the Mental Health Act or Power of Attorney Orders. Risk assessments included details of restrictions imposed on residents for example limiting cigarettes and alcohol, and these had been agreed by the resident, appropriate relatives and at review meetings with mental health professionals. Part of this process was to make residents aware of any potential risks and to discuss these so the individuals could make an informed choice. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 11 The home has a daily residents meeting each morning to discuss and agree the plans for the day, for example who’s turn it was to cook tea, and to agree chores and cleaning tasks for the day. This meeting is also used by residents to voice any issues and concerns that they wished to discuss with staff and other residents. Residents said they found this very helpful in planning their day and resolving any problems. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All the above Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal development and making informed decisions is a key feature for individuals and the staff team are skilled at enabling residents to make these choices. EVIDENCE: The majority of residents attended day services for people with mental health problems. However a significant number chose to direct their own free time and access the community independently to go to the shops, town centre, library and local parks. The home has recently focused on a number of organised day trips out and residents said these had been enjoyable. Residents were supported to maintain and develop relationships with the community and were in contact with relevant professionals, such as community psychiatric nurses, to assist in developing their social skills. Residents were observed interacting in a positive manner with staff and other residents. There was lively conversation and an interest in the welfare of others in the home. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 13 Family contact is indicated in each persons individual plan and staff were knowlegble about the extent of this contact. Staff were also supportive of the family and relationship dynamics for each person. Where, appropriate family were encouraged to visit and arrangements are made to allow privacy on visits. The home had developed a good balance between risk-taking and a duty of care, and much of the dialogue with residents is around rights, choices and developing positive coping strategies. Menus are planned with service users on a weekly basis and a communal evening meal is encouraged, usually prepared by service users. Although there is a weekly shop for the house where service users choose to take part, individual shopping is also encouraged to develop independence and daily living skills. Staff are given training on the importance of healthy diets and the role this plays in promoting good mental health for service users. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care issues are well managed and residents are supported to make informed decisions. EVIDENCE: Staff have a good understanding of the support needs of residents. The staff team work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain their mental health. Staff recently provided continuity of care for service users in hospital, and carried out a nursing role under the direction of District nurse on return home. Service users said they were particularly appreciative of this role and the level of support given by staff to give them the confidence to make the right decision. The home keeps comprehensive records and systems to monitor service-users health care needs. Each service-user is registered with a GP of their choice. The Home and service-users make effective use of the Primary Health Care Team and more specialist services when required. Details of other healthcare professionals visits and advice were recorded on individual care plans and staff demonstrated a good working knowledge support services available to residents. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 15 Policies and procedures for medicines handling were inspected and are appropriate for the setting. Emphasis was placed on maintaining independence through self-medication and this was supported by staff. Some residents currently control their own medication, and risk assessments had been undertaken to support this safely. Service users had access to locked facilities for the safe storage of medicines, and residents agreed to staff periodically checking compliance. All staff have recently taken a Managing and Safe Handling of Medications through a local College, to Level 2 as recommended by CSCI guidance, and Level 1 for new staff as part of Induction. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory measures in place to safeguard the well-being of residents. EVIDENCE: Carranmore has a clear complaints procedure, which is given to new residents when they move in to the home. The atmosphere in the home is open and friendly and residents stated that they can raise any complaints and appropriate action will be taken to resolve their concerns. Residents were observed freely expressing opinions on the home to staff. Residents said that they would feel able to speak to any of the staff and approach the manager with any issues they had, and often used the daily morning meeting to do this. A recent survey carried out by the home revealed that a number of families were unfamiliar with the homes complaints procedure. Although this was mostly, they said, due to the fact they had never had occasion to use it. The policies and procedures regarding protection of people who use the service are satisfactory but need to be reviewed and updated in line with regulations and other external guidance. The Home has induction training that covers basic adult protection issues and the various forms of adult abuse. However, the manager, who is the key person in managing allegations, had not received upto-date training on local adult protection guidance. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a well kept and safely maintained home that is centrally located for local amenities. EVIDENCE: The home has been completely refurbished to high standards and residents were very pleased to be back home after the flood. Every room in the house has been refurbished and opportunities have been taken to improve areas, for example the lay out of the kitchen. The downstairs office has recently been temporarily used as a resident’s bedroom while they recovered from an operation. The advice of an occupational therapist was gained to make the best use of the house in promoting the independence of residents. Residents spoke of preferring this house to the temporary one and particularly enjoyed being back in a central location. Residents also said that they appreciated having non-smoking areas, and the choice of sitting rooms. Satisfactory reports had been received from both the Fire Officer and the Environmental Health officer. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff recruitment, training and staffing practices of the home are well developed which ensures that residents’ well-being is promoted, by staff that have the qualities, aptitudes and skills to work in social care. EVIDENCE: Carranmore has a stable workforce with a good mix of skills, experience, age, and gender, which reflects the profile of the residents. All staff are clear regarding their role and what is expected of them. Residents comment cards stated that staff working with them know what they are meant to do, and that they are able to meet their needs. This leads to good levels of confidence and satisfaction from residents, relatives and professionals with the care that is delivered. The Home followed the recruitment procedure of The Croftlands Trust. Staff files are now held in the home, contained all the relevant documentation and were clearly sectioned and well-organised. This had recently been carried out for a second time, as a lot of paperwork had been lost in the flood. The selection procedure included obtaining two written references, a formal interview and an informal interview involving service users, wherever possible. All staff had CRB disclosure checks and applications were subject to equal opportunities monitoring. Upon appointment staff were issued with a Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 19 handbook, which includes job descriptions and terms and conditions. Appointments are subject to a six-month probationary period. The Croftlands Trust has a code of conduct and all members of staff have a statement of terms and conditions. A new member of staff interviewed confirmed these practices. These are all good practices and ensure that service users are supported by a carefully selected and vetted staff team. The home has a framework for supervisions and appraisals, and these have been carried out to good standards; staff reported that these are helpful and they feel well supported by the manager and the organisation. Staff training continues to have a high profile in the home and staff are keen to gain new knowledge and skills that will assist them in supporting service users. For example all staff have recently completed a Safe Handling of Medication training course. The majority of staff now have a qualification in care, either NVQ 2/3 and the manager has the Registered managers award and NVQ 4 in care. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run with comprehensive systems to ensure the well-being and safety of those that live and work at Carranmore. EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. Staff and residents spoken to confirmed that they felt that the atmosphere in the home was relaxed and supportive. A newly introduced Quality Assurance system ensures that residents’ views are listened to and acted upon. From information gained from residents, staff and Community Psychiatric nurses and from documentary evidence the manager was judged to be competent and effective in managing the Home. The Home has a comprehensive set of policy documents and procedures to guide and instruct staff on good practice. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 21 The provider, The Croftland Trust, appoints an operations manager to carry out Quality Assurance checks (regulation 26). These are sent into the Commission for Social Care Inspection on a monthly basis. From these reports areas for improvement are highlighted and the actions were checked at inspection. These were judged to work well in monitoring and improving the service for those living at the Home. Advice is taken from the local environmental health and fire officers regarding maintaining a safe environment. The records examined on the day of the inspection were well-ordered, relevant, appropriate and up-to-date to assist in the smooth running of the Home and in meeting the needs of the residents. Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Carranmore DS0000022570.V303749.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. 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