CARE HOMES FOR OLDER PEOPLE
Cartmel Grange Care Home Cartmel Grange Care Home Allithwaite Road Grange over Sands Cumbria LA11 7EL Lead Inspector
Marian Whittam Unannounced Inspection 1st August 2006 09:00 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 Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cartmel Grange Care Home Address Cartmel Grange Care Home Allithwaite Road Grange over Sands Cumbria LA11 7EL 015395 32028 015395 35438 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) Brancaster Care Homes Ltd Ms Valerie Kendall Care Home 61 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (61), Physical disability (2) Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 61 service users to include: up to 61 service users in the category of OP (Older people not falling within any other category) 2 named service users in the category of PD (Adults with physical disabilities) up to 23 service users in the category DE(E) (Dementia over 65 years of age) up to 5 service users in the category DE (Dementia under 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 16th March 2006 2. Date of last inspection Brief Description of the Service: Cartmel Grange Nursing Home is a care home with nursing, registered to offer nursing care for up to 61 residents including those with dementia. It is a large Victorian building extended and adapted to its current use and retaining many of its period features. It is on the on the edge of town of Grange-Over-Sands, overlooking the surrounding countryside and with extensive views across Morecambe Bay. The home is set in large gardens within walking distance of the town and local amenities, including the local railway station. The Home is on three floors, Bay View on the ground floor, Arnside on the first floor accommodating residents with dementia and Ingleborough View on the second floor. All floors have a separate lounge and one large main communal dining room on the ground floor. There is a passenger lift to allow residents access to all three floors. Brancaster Care Homes Limited owns and runs the home. Information is available to prospective residents in the Statement of purpose and service users guide; this is available and displayed in the home and the service user guide/welcome pack is in all bedrooms. A copy of the last inspection report is on display. The fees charged by the home range from £396.00 to £500.00 per week as at the date of the inspection. An additional charge is made for personal toiletries, newspapers, magazines, also hairdressing and chiropody services and any personal travel expenses, according to information provided during the inspection. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection visit took place on 1st August 2006. Pre inspection information on residents, fees, staffing and services provided requested in advance of inspection by CSCI was not returned before the visit but provided on the day of the inspection. No resident surveys were returned before the inspection. Therefore before the site visit information was gathered on the service from records of previous visits, notifications, regulatory activities and complaints, concerns and allegations received. The morning was spent looking around the home talking with residents in the lounges and in their own bedrooms. The manager was spoken with at length also care and supervisory staff, the cook, activities coordinator and observing activities on the units and work practices, and looking at care plans. Ten residents were happy to talk about their experiences of living in the home and three relatives. An inspection of medication handling and records was carried during this visit. The afternoon was spent examining policies and procedures, menus, systems for recording complaints and quality assurance, activities programmes, financial, personnel and training records as well as other records required by regulation. What the service does well:
The management team and owners of the home present a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and quality of life of residents living in the home. The home has clear planning systems in place and planning and budgeting is done to make sure changes and improvements are seen through in the short and long term. Care planning is subject to audit and improvements have been made to provide clear and easy to use plans that reflect changing need. There is a clear emphasis on continuing to develop ways to include residents and families in how the home is run and supporting residents to achieve what is important to them. The home works hard at and is creative in providing leisure and recreational opportunities for residents. The activities coordinator organises and provides a varied activities programme based on individual preferences and capabilities. These are designed to appeal to different groups of residents and on an individual basis with one to one support where that is wanted. Staff are motivated to work to a good standard, well supported and supervised. Training and staff development is given a high priority. Consequently staff morale and enthusiasm is high benefiting those who live and work there. The health care needs of the residents are being met through
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 6 good working relationships with the local doctors and specialist nursing services. The home monitors aspects of its services through audit and review to try to make sure it is delivering the services it says it provides and seeks to include residents and families in this. The environment is homely, clean and comfortable and is being improved and developed with resident needs in mind. The refurbishments within the home and repairs to it are to a good standard to improve facilities for residents. Resident’s liked the changes and improvements to the home and residents and relatives spoke positively on how the home has improved under new management. Residents spoken to liked the staff team and spoke well of them and said they felt that staff “are kind” and “polite”. Staff are aware of the needs of residents and work well with relevant health care professionals to maintain an appropriate service for residents. Care plans are detailed and have an emphasis on the individual resident and their choices and preferences and are clear and up to date. The home supports staff to train and develop and reflect on their practice. The staff on duty at the inspection responded positively to the inspection process. The manager responds promptly to any areas that can be improved and works well with the CSCI and seeks advice appropriately. What has improved since the last inspection?
The home continues to improve resident bedrooms and communal areas through redecoration and refurbishment. Bathing facilities continue to be improved for residents and upgraded in a planned programme of work. Improvements in the kitchen environment and the provision of new equipment and crockery have improved facilities for resident’s meals along with the recruitment of two dedicated dining room assistants to help residents. Large scale improvements have been done, and are still in progress, to make sure that heating control is available in all resident’s bedrooms and that water temperatures are maintained at a safe temperature. A sluicing disinfector has been ordered awaiting fitting, initially on the ground floor. This should improve overall infection control measures that should be extended when each floor has such a facility as plans indicate. Externally work goes on to improve the use of the grounds to meet residents needs especially to make them better for residents with dementia. The exterior is being repainted to provide a more attractive place to live for residents. The home has improved the privacy in two bedrooms that previously had a shared access. These two rooms now have separate access that and still meet National Minimum standards on room sizes and allows wheelchair access. For the two residents involved this has significantly improved their privacy. The home has a named nurse system incorporating a key worker and associate key worker to provide consistent lines of communication for residents and
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 7 relatives. The use of white boards in resident’s rooms for messages and important dates has added to improving lines of communication. The activities coordinator is continuing to improve, develop and deliver a programme of recreational and leisure activities suited to residents preferences and abilities. The provision of meaningful activities and opportunities in this area of social life continues to improve for residents. Particular attention is being given to improving recreational activities for the residents with dementia. The home has provided digital upgrading to televisions to make sure that resident’s use of their televisions will not be disrupted when the change to digital TV comes into operation. The provision of a large plasma screen television for residents during the World Cup has improved resident’s access to this kind of entertainment and is useful for the video club. There is improved information available for residents and families in the homes service user guide and welcome pack and on advocacy and support services, with regular input from Age Concern. Management systems and continuity of care has been significantly influenced and improved by having a permanent and experienced manager. Improvements have been made in the quality of risk assessments and policies and procedures and monitoring of services. The home has made substantial improvements over the last year across all outcome areas to provide a good standard of service. 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. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and facilities is clear and easily available before and following admission so residents have useful information and are able to make an informed choice. A detailed assessment and care planning system is in place to provide staff with the information they need to satisfactorily meet resident’s needs when they come to live in the home. EVIDENCE: Clear and comprehensive information is readily available about the home for prospective residents and their families in the statement of purpose and service users guide so they know what the home can provide. An information/welcome pack for residents is provided for all residents and kept in their rooms. New residents spoken with said they have found this useful, one said it was “very good” and it was in large print. The home also has a monthly in house newsletter that gives residents useful information on what goes on in the home.
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 10 All residents have an individual plan of care and individual needs had been assessed in detail before and following admission and their individual care plans developed from this. The home manager or senior staff do an individual assessment of needs to ensure that the home can meet them before residents came to live there. Social services management plans have been obtained where appropriate. Care plans and records indicate that relevant care agencies and professionals are involved in providing information and making assessments of the needs to be met. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning records and assessments provide staff with the information they need to meet resident’s healthcare personal and social care needs. The systems for the administration of medicines are monitored and are improving to meet resident’s medication needs. EVIDENCE: All residents have a clear and easily followed individual plan of care, based on assessments and setting out their health, personal and social care needs. Changes identified at review are incorporated into care plans and needs assessments and the plans are resident focused. Doctors from the local surgeries do a weekly visit to the home to monitor and see residents. There is a named nurse and key worker system in operation that helps communication. Each bedroom has a white board for communication and reminders between the resident’s key worker and residents families and friends. There is evidence of timely referral to health care services and working with other agencies, including the tissue viability nurse for residents with wounds, and the actions taken following their involvement. Monitoring of health and psychological care and needs are in place and up to date and actions recorded.
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 12 Medication procedures and records have improved and are subject to regular detailed audit by senior staff and intended to include the areas identified as unsatisfactory at the last medication inspection. However, some aspects of handling did not reflect this. Handwritten medication administration record charts (MAR) were found that had not been signed, checked and dated to help ensure they are correct before administration. Eye preparations did not always identify which eye is to be treated. Some MARs had numerous entries for medications no longer in use that needed removing to avoid confusion and error. The reasons why these errors had not been picked up during the audit were quickly investigated and identified by the manager during the course of the inspection and put right. Actions to prevent them being missed again by senior staff at audit were implemented before the end of the visit. One resident was having medication crushed to help them take it. Crushing of this medication is advised against. Nursing staff explained this was following doctor’s instructions. In such cases it is recommended that the prescribing doctor’s instructions and rationale be documented in the care plan and discussions with the pharmacy for advice should be undertaken and recorded in the care plan. Otherwise the home has, using its audit system, made significant improvements in medicines handling. Residents spoken with said their privacy was respected and felt their dignity upheld during care. Residents confirmed they were asked about their care and for some less able to communicate their opinions and preferences there was evidence of family involvement. Residents confirmed they saw their doctors in their own rooms. During the day staff were observed chatting and interacting with residents and their approach was friendly and informal. One resident said that staff always explained about their care, such as when they were going to use the hoist. The home is using the ‘Liverpool Care Pathway’ for care homes for terminally ill residents, setting goals in their care and giving a clear pathway for assessment and management of pain and situations arising at the end of life. Attention is also given to meeting spiritual needs. Clear indications are there for when to contact the GP and palliative care team. The home does involve the community Macmillan nurse in such care. Training records indicate that training in palliative care is booked to take place, externally, in September. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A varied programme of organised activities and outings is in place and clearly advertised and take into account residents individual preferences, choices, capabilities and cultural and religious expectations. Dietary needs are well catered for with a varied choice of nutritious food on the menu including special dietary needs. EVIDENCE: The home has an activities coordinator in post and they have developed a programme of musical and social events as well as individual and group activities in consultation with residents. Particular attention is being paid to extending activities for residents with dementia and information on such activities has been obtained from the Alzheimer’s Society. Activities are provided at different times of the day and during the visit residents were having musical entertainment and also manicures for female residents. The home runs a film club and book club for residents, quizzes. For those less able there is reading out loud as part of this. Activities are planned with residents and the monthly newsletter ‘The Porthole’, also gives information on activities and what is going on in the home, with staff
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 14 changes, improvements and planned changes as well as asking for residents ideas. There are trips out locally to places that residents chose, the day before the visit it was to visit a garden centre, on the day following the visit a Summer Party is to be held and a trip is planned to visit Morecambe shortly. There have also been trips out to the theatre. Several residents said how much they had enjoyed the events. One resident said that staff help them to the lounge in their wheelchair and then into a comfortable chair to take part, that there was “good company” and “plenty to do if you want to”. Links are in place with a local church to provide a monthly Christian religious service and Holy Communion for those that want it. Some residents are visited by their own priests, as they want. The care plans have information on leisure preferences and interests and detailed life stories are being developed with residents and with help from families. The activities coordinator showed clear records of the activities residents chose and what they enjoyed or what did not work so well for them. The home has a 16-seat bus for residents, equipped for wheelchairs for travel to events and trips out. Information on advocacy is displayed and the service made available to residents and useful contact information. The home has plans underway to considerably extend the advocacy services within the home working with Age Concern. The home has a 3-week menu that offers choice and variety including a vegetarian option. Lunch in the dining room was observed and was relaxed and sociable. Staff sat with residents and assisted them if needed. The home has 2 dining room assistants who do regular drinks rounds in the home, prepare the tables and assist residents if they need this. The home has a ‘hot cupboard ‘ to transport food to residents who wish to eat in their rooms. The kitchen is clean, with records maintained and has been improved and new equipment in place. Residents spoken with all said the quality and choice of food was good. One resident said that the food was good and staff are “very obliging” and will “get you whatever you want”. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 15 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, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system that is readily available in the home and clear and comprehensive adult protection procedures in place supported by staff training to promote residents welfare. Residents felt confident that the manager and staff would listen to them and act to deal with their concerns. EVIDENCE: The home has received 1 complaint since the last inspection. One concern was passed to the home by CSCI to respond. The home has a clear complaints procedure and logs complaints for investigation and the procedure is readily available to residents. The complaints procedure is displayed on the home’s notice board and in the service user guide provided in each resident’s room and that is larger print. Residents spoken with say they are confident that the staff and owners would listen to them and deal with any complaints they made. One resident said that they had no complaints but would speak with the manager if they had, who “popped in every day”. Information on advocacy and support services is provided for residents in the home and the service is obtained on request. The home has developed links with Age Concern to provide advocacy advice for residents and families in the home on a regular basis. Staff training records show that training on abuse and adult protection has been given to staff and the Cumbria multi agency guidance is available in the
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 16 home. The home has clear policies and procedures in place for adult protection; identifying and reporting abuse, POVA procedures and whistle blowing. Staff spoken with confirm that training is given and are aware of what to do should abuse be suspected and expressed confidence in the manager to support them in raising any issues about care. Systems and policies are in place to safeguard residents financial interests and the home invoices some bills and keeps receipts individually for any monies kept. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 17 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): 19, 20, 21,22 23, 24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Extensive redecoration, improvement of facilities and refurbishment of the home has taken place and is ongoing to provide a uniformly good standard of accommodation within the home that is safe, clean and homely for residents. EVIDENCE: Since the last inspection the home has been continuing with its planned programme of refurbishment and repair. General maintenance is continuing along side the environmental upgrading. The second floor accommodation has been refurbished to provide a high standard of accommodation for residents. This good standard of refurbishment and improvement has been continued in the first floor communal rooms, bedrooms and bathrooms. Residents spoken with said they were pleased with the changes and improvements to their rooms and the home generally. Progress has been good
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 18 and the improvements are of a high standard with attention to detail to improve resident’s environmental quality of life. There is sufficient communal space for the residents with a refurbished and redecorated lounge on each floor and a large redecorated dining room on the ground floor. The main lounge has been redecorated and re carpeted to a high standard and used for a range of group and individual activities and a large plasma television installed. Improvements to the kitchen facilities and equipment have been done. Improvements are planned to the staff room and to provide a dedicated staff training room. The grounds are continuing to be improved and made tidy and residents have seating out there and wheelchair access. Work has begun on re painting the exterior wall and windows. Equipment and adaptations to help residents get around the home are provided and call bells are accessible in areas used by residents. Some residents have gates at their bedroom door on Arnside unit to deter other residents from coming into their rooms uninvited. This individual choice is made in consultation with residents and relatives and discussion clearly documented in the care plans including consultation with the fire officer. Heating in all bedrooms cannot be temperature controlled by residents. However the homes development plans and budgeting indicate this work will take place in September 2006 as major work is being undertaken on the heating systems. Sluice facilities are available in the home and for laundry however there are no sluicing disinfectors to provide good infection control given that nursing care is provided. The home is addressing this and documents indicate that a sluicing disinfector is on order. Initially this is to be on the ground floor with all floors being fitted as part of the homes longer term development planning. Residents spoken with said they were pleased with the improvements made to the home and liked their rooms, one said “its like living in a hotel”. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 19 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, 28, 29 and 30 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 staffed to meet residents’ needs with staff that are trained and supported in their role to care for residents. Satisfactory procedures are in place for recruiting staff to protect people living in the home EVIDENCE: Staff have training files and an ongoing training programme is in operation and budgeted for. Training is well planned and supported by the management team and staff. One day each month is designated as a training day for which all staff are paid. The rotas and observation of staffing during the visit show that the staffing levels are good on each of the floors and that there is an appropriate skill mix of staff on duty. There is a Registered Nurse on duty on each floor both day and night. NVQ level 2 training is well established, with 86 of care staff having obtained this qualification. Nursing and care staff spoken with say they are well supported to undertake training and professional development and that staff morale is good. Staff spoken with said that there are plenty of opportunities for training and development and for registered nurses to update their practice. Robust recruitment procedures and practices are being observed and all necessary checks to safeguard residents are being taken prior to staff starting work there. Registered nurses personal identification numbers are checked on recruitment and periodically thereafter.
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 20 There are good numbers of ancillary staff to maintain a clean and safe environment and support residents. Residents spoke well of the staff team and expressed confidence in the manager and staff. One resident said their carer was “wonderful.” Another who had lived in the home some time said they there had been “real improvements in the home”. A new resident said, “ I feel I will be content here”. One resident said of their carers “ I could not be better looked after” and another that “ the staff are marvellous, very helpful, they all try to help, sometimes they try too much to please.” Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a clear development plan and vision for the home and is well supported by senior staff in providing clear leadership and planning in the home that is communicated to residents, relatives and staff. Quality assurance and financial systems are in place to seek resident’s views and safeguard resident’s interests. EVIDENCE: The registered manager is well qualified and experienced in the care of older people and with the conditions and diseases associated with old age. There is a good supportive working relationship with the provider. There are regular staff meetings and staff say that the manager is approachable and supportive. Staff spoken with also confirmed they had regular supervision with their team leaders. There are also regular residents meetings and families are encouraged to be involved if residents want this. The manager has a very clear sense of
Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 22 direction for the home and includes staff to promote an open and transparent management process. Staff say how valuable the support and motivation demonstrated by the manager has been in sustaining improvements in the home and raising staff morale. One said the manager “ has brought so much to the home”. Quality assurance systems are in place to monitor services and consult with residents. There is evidence of a clear long term development plan for the home and the services offered to residents. Surveys are in use within the home and a system of internal audit and review of policies and procedures to promote a consistent service for residents. The manager demonstrates a commitment to supporting residents in what is important to them within their abilities and expectations and is innovative in trying to develop this. There are systems in place to safeguard and uphold resident’s financial interests. The home does not handle any resident’s finances, only small amounts of personal spending money with appropriate records. Residents are supported to control their own finances where possible, other wise families, legal representatives and social services support residents. Age Concern has also been involved in assisting individuals. The standard of record keeping is good, accidents and incidents are recorded and an analysis is undertaken to identify trends and risks to residents and action taken to reduce any risk. The home has a thorough system of risk assessment for health and safety and recently reviewed fire risk assessments. Records and servicing contracts indicate that the home has systems in operation to promote resident health and safety. There is evidence that appropriate testing and cleaning being carried out to reduce the risk of Legionella and water temperature testing to reduce the risk of scalds to residents. Records showed that servicing and maintenance of equipment is being done. Staff have been given appropriate training for safe working practices including 6 monthly fire training however in line with regional fire service guidance the home must make sure that night staff are given this 3 monthly. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 23 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 4 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 3 2 Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 23 (4) (d) Requirement Night staff must have fire training at 3 monthly intervals. Timescale for action 31/08/06 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. Refer to Standard OP9 Good Practice Recommendations Where medication is being given in a manner that may affect its action clear medical instructions should be recorded and pharmacy advice obtained and recorded. Cartmel Grange Care Home DS0000064543.V297851.R01.S.doc Version 5.2 Page 25 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
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