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 16th March 2006 10:30 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.V283531.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 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 Vacant Care Home 60 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 (60), Physical disability (2) Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 60 service users to include: up to 60 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. 9th August 2005 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 60 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 has a lounge on each of its 3 floors, 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. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 16th March 2006. There were 56 residents in the home on the day of the inspection The inspection focussed on how well the home was meeting the needs of the people living there and on the improvements to the environment since the last inspection. This was assessed by speaking to residents, care staff, nursing staff, the cook, the activities coordinator and the manager and by observing activity in the home. Medication records, staff records, policies and procedures and training records were checked. The inspectors looked around all parts of the home and examined a sample of the records, which the home is required to hold under Regulation. What the service does well:
The management team and owners have a clear vision of what they are trying to achieve in improving 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. There is a clear emphasis on trying to develop ways to include residents and families in how the home is run and the services and facilities developed to meet their needs and preferences. Staff are well supported and supervised and training and staff development is being 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 good working relationships with the local doctors and specialist nursing services. The home now checks 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, 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. Residents commented positively on these changes and how the home has improved under new management. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Despite having a good overall standard of care planning and assessment there were a small number of residents who had not had a recent monthly review of care and some life histories had not been completed. For one EMI resident an initial psychological assessment had not been completed. To make sure that the general good standard of care planning is maintained for all residents these areas of assessment and review must be improved. There is an occupied bedroom where access is through another residents room, making one room a thoroughfare and essentially shared. There must be
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 7 consultation with the resident and/or their representative/advocate and evidence of a positive choice having been made regarding the arrangement. There is no evidence of ongoing monitoring of it to promote resident’s choice and maintain individual privacy. Privacy would also be improved by making sure that when residents are having aspects of care attended to it is always done in private. Staff were observed weighing and checking blood pressures in the communal lounge with visitors and other residents looking on. This must improve and staff must make sure they respect resident’s privacy and confidentiality when doing these measurements. Some bedroom doors are without locks suited to resident’s capabilities and providing this facility would be good practice to promote privacy. The home has policies and procedures for infection control and sluice facilities for waste. However there is no sluicing disinfector for the disinfection of pots, bedpans and urinals for residents receiving nursing care. Given the differing complexity and conditions and physically frail nursing residents a sluicing disinfector would promote the prevention of infection, toxic conditions and the spread of any infection in the home. Cleaning substances were found to be stored in an unlocked room and cupboard and these must always be kept safely at all times when being stored to protect residents from potential risk. 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.V283531.R01.S.doc Version 5.1 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.V283531.R01.S.doc Version 5.1 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 and 4 Information about the home is available before admission so residents are able to make an informed choice. A new and more detailed assessment and care planning system has been put place to provide staff with the information they need to satisfactorily meet resident’s needs. EVIDENCE: Clear and recently updated information is 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 has been developed for all residents in their rooms. 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
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 10 be met. This was evident for two residents where the community psychiatric nurse was attending to support and advise on specific problems. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 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 and 10 Overall the care planning records 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 satisfactory to meet resident’s medication needs. EVIDENCE: All residents have an 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. However a mental health assessment, and life history was missing for one resident with EMI needs. For two residents seen their care plans had not been reviewed the previous month. There is evidence of timely referral to health care services and working with other agencies and the actions taken following their involvement. Medication procedures and records are satisfactory and subject to audit by senior staff. Residents spoken with said their privacy was respected and felt their dignity upheld during care. They confirmed they saw their doctors in their own rooms. One resident said her carer was “wonderful”, another resident said staff were “cheerful” and helped “without being grumpy”.
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 12 During the day staff were observed chatting and interacting with residents and their approach was friendly and informal. However, staff were observed using a weighing scale chair to measure residents weight in one of the communal lounges and checking blood pressures. Other residents and visitors were present and activities were going on. Such measurements must be attended to in a way that maintains individual privacy and ensures confidentiality about the information obtained. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 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 and 14 A varied programme of organised activities and outings is in place taking into account residents individual preferences, choices, capabilities and cultural and religious expectations. EVIDENCE: A new activities coordinator is in post and the home now has a 16 seat bus for residents use. The coordinator was developing a new programme of musical and social events as well as individual and group activities. Particular attention is being paid to extending activities for residents with dementia. Information on this has been obtained from the Alzheimer’s Society on this. Activities are provided at different times of the day and during the visit residents were singing songs they had chosen to musical accompaniment. Residents spoke of visiting musical events in Grange and a recent visit to a Pilipino Cultural Festival in a nearby town. Staff and residents commented on this giving them an insight into that country and culture as some of their carers are from that country. Several residents said how much they had enjoyed the events. Links are being made with local churches to give access to different religious needs and so offer a variety of religious services and support. Some residents are visited by their own clergy, as they want, at present.
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 14 Information on advocacy is displayed and the service made available to residents. This had been done for one resident to represent their interests. The home has plans in place to considerably extend the advocacy services within the home. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 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): 18 The home has clear and comprehensive adult protection procedures in place and staff training to promote residents welfare. Residents said they felt confident that the manager would listen to them and act quickly on any concerns. EVIDENCE: Information on advocacy is provided for residents in the home and the service is obtained on request. Staff training records show they have been given have recent training on abuse and adult protection and the Cumbria multi agency guidance is available. The home has clear and comprehensive policies and procedures in place for adult protection; identifying and reporting abuse and whistle blowing. Staff are aware of what to do and expressed confidence in the manager to support them. 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.V283531.R01.S.doc Version 5.1 Page 16 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 Extensive redecoration and refurbishment of the home has taken place and is continuing as planned to provide a uniformly good environment within the home that is safe 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 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 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 dining room on the ground floor.
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 17 The main lounge has been redecorated and re carpeted to a high standard. Improvements to the kitchen facilities and equipment are in progress. The grounds are being improved and made tidy and residents have seating out there and wheelchair access. Equipment and adaptations are provided to help residents get around the home and call bells are accessible in areas used by residents. Some areas of the home still need some upgrading to achieve the same good standard for residents. • Heating in all bedrooms cannot be temperature controlled by residents. However the homes development plans and budgeting indicate this work will take place in the warmer summer months as major work is being undertaken to provide thermostatic controls in bedrooms. • Bathing facilities on the ground floor still needed upgrading to the same good standard as the others in the home. • Some bedroom doors do not have locks on, suited to their capabilities, for use by them if they wish. The home should provide this to promote privacy and choice. The homes maintenance and renovation schedule showed that the planned improvements to address these outstanding matters are proceeding on schedule to achieve this. One resident was in a bedroom where access was through another bedroom in use. There was no evidence of a positive choice or consultation with the residents and/or their representatives on having made a positive choice to do this. Although the two occupants were not physically sharing the same room the home must make sure that the arrangement is acceptable to them both, maintaining privacy and reflecting their choice and/or consult with their representatives/advocates to support an informed choice. 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. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 18 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 and 30 The home is adequately 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 training files and the training programme in operation show that training is budgeted for and is well planned and supported by the management team and staff. The rotas showed that the staffing levels are adequate and that there was an appropriate skill mix of staff on duty. NVQ and an ongoing training and practice updates are provided and continuing to develop in the home. One day a month is allocated for training including dementia training, adult protection and POVA and infection control along with mandatory training. Some staff with particular areas of interest participate in teaching and training, one area being wound care. Records and comments from nursing staff indicate that they are undertaking training for their professional development one area being post registration training in dementia care. Staff spoken with said that there were opportunities for training and development and for registered nurses to update their practice. Staff spoken with felt that they were well supported in training and development and staff morale is good. Robust recruitment procedures and practices are being observed and all necessary checks to safeguard residents are being taken prior to staff starting
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 19 work there. Registered nurses personal identification numbers are checked on recruitment and periodically thereafter. Residents spoke well of the staff team and expressed confidence in the manager and senior staff. One resident said their carer was “wonderful.” Another who had lived in the home some time said they thought the staff took good care of them, moved them as they wanted and that there had been “real improvements in the home”. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 20 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 and 36 The manager is well supported by senior staff in providing clear leadership and planning in the home and this is communicated to residents and staff. Quality assurance and financial systems are in place to seek resident’s views and safeguard resident’s interests. EVIDENCE: The manager is in the process of registering with the CSCI. 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. Staff also told the inspectors how good they found the new manager and that she was “inspiring” and provided “good professional leadership”. Quality assurance systems are in place and recorded evidence of a clear development plan for the home and services offered to residents. There are regular residents meeting including invitation to the families. Surveys are in
Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 21 use and a system of internal audit and review of policies and procedures to promote a consistent service for residents. The ground floor room where cleaning fluids are stored was not locked and the cupboard containing the substances was also open. This poses a potential risk to residents. The manager and domestic staff attended to this during the visit. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 22 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 3 3 3 2 3 2 2 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X X Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14 (2) Requirement All assessments of care and social needs must be completed and then reviewed to reflect any changed needs. Staff must maintain resident’s personal privacy and confidentiality during all aspects of care. Residents in rooms with common access must be consulted and the arrangement monitored to promote their positive choice. Sluicing disinfectors must be provided for infection control in nursing care. All hazardous substances and items must be securely stored when not in use. Timescale for action 14/04/06 2. OP10 18 (1) 14/04/06 3. OP23 12 (2) (4) (a) 13 (3) 16 (2) (j) 13 (4) 14/04/06 4. 5. OP26 OP38 30/06/06 10/08/05 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 Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 Page 24 1. 2. OP21 OP24 The ground floor bathrooms should be improved to the same good standard as the others in the home. Doors to resident’s private accommodation should be fitted with locks suited to their capabilities to promote privacy and choice. Cartmel Grange Care Home DS0000064543.V283531.R01.S.doc Version 5.1 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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