CARE HOMES FOR OLDER PEOPLE
Cartmel Old Grammar Cartmel Grange-over-Sands Cumbria LA11 7SG Lead Inspector
Mrs Margaret Drury Unannounced Inspection 11th January 2006 10:00 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 Old Grammar DS0000022582.V271308.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 Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cartmel Old Grammar Address Cartmel Grange-over-Sands Cumbria LA11 7SG 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) 015395 36868 Ms Beverley Anne Clarke Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 19 service users to include: up to 19 service users in the category of OP (Older People) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 15th July 2005 Date of last inspection Brief Description of the Service: Cartmel Old Grammar offers accommodation for up to 19 older people needing social and personal care. The home is owned and managed on a day-to-day basis by Ms Beverley Clarke. Cartmel Old Grammar is situated just outside the village of Cartmel, overlooking the racecourse and within walking distance of the Priory and the shops. It is a large two-storey building that has been refurbished and extended for its present use as a care home. There are large well-kept gardens providing outside sitting areas, with car parking facilities at the front of the building. Accommodation is on two floors, with the upper being accessed by a passenger lift. There is a bright airy entrance hall, a lounge and a well-appointed dining room, all of which provide plenty of communal space for the residents to enjoy. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home that took place over one morning. It was the second inspection of the year and those standards not assessed on this occasion were inspected and met during the previous visit in July 2005. This visit also took into account the findings of an inspection conducted by the pharmacy inspector that was completed on 15/09/05 and the requirements that were made at that time. During the visit time was spent talking with the manager, staff and residents. Documentation to do with the running of the home and the care of the residents was examined and parts of the home were looked at. The tour of the building included the rooms that had been completely refurbished after the fire that took place last year. What the service does well: What has improved since the last inspection?
Two of the three bedrooms that were damaged in last year’s fire have been completely refurbished, with the third only requiring the finishing touches. The recording of the medication has improved in line with some of the requirements made during the pharmacy inspection. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4&5 Residents and/or family members benefit from the opportunity to visit the home to assess its suitability to care for the prospective residents. EVIDENCE: All prospective residents and/or their families are invited to the home to look around and meet the staff and other people living there. This gives them the opportunity to see whether or not the home is suitable to meet all the assessed needs and to view the facilities on offer. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 & 11 The healthcare needs of the residents are understood and reasonably well maintained, together as the medication records. EVIDENCE: The recording of medication and the medication records has improved since the last inspection and on the advice of the pharmacy inspector. Two of the requirements made by the pharmacist have now been met but attention should be given to securing the medicine trolley to the wall in the office. Medication should be administered directly from the container supplied by the chemist and staff should receive appropriate external training in safe handling of medicines. Requirements were made in respect of these three points. The policy for dealing with the death of a resident is available for staff to read and residents understand their wishes will be adhered to. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 10 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): 14 There is a sociable atmosphere in the home and residents are happy with the daily routines and the fact they can please themselves. EVIDENCE: The inspector was able to speak with several residents and one family member during the visit and received many positive comments about life in the home. All the residents agreed that they “could do what they wanted to” and “ go out into the village” if they were able. Some residents were sitting in the lounge with the family dogs and others were in their rooms or sitting in a small sitting area on the upper floor. The home’s hairdresser was there on the day of the inspector and she was very complementary about the care she observed. The registered provider said she does not feel the need for residents’ meetings but would have one if she felt it was necessary. She told the inspector that she speaks with the residents on an individual basis every day. Many of the residents are able to make their wishes known but care should be taken to ensure the staff are aware of the wishes of any who may find direct communication difficult. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 11 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): 17 Residents benefit from the availability of an advocacy service should this ever be required and from the opportunity to vote in the local/national elections. EVIDENCE: Discussions with the manager evidenced that the residents have always had family members or a solicitor to assist them with their personal and/or financial affairs. She was, however, familiar with an advocacy service and would make the information available to anybody who wanted to use the service. Six of the residents wanted to vote in the last elections and arrangements were made for them to do so via the postal system. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 12 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): 22, 23 & 24 This home offers very comfortable and warm accommodation with all areas extremely well maintained. This contributes to a good quality of life for the residents. EVIDENCE: The home is extremely well maintained with a high standard of fixtures and fittings. All bedrooms have full en-suite facilities and the three rooms damaged by last year’s fire are now almost totally refurbished. There is just one that needs the finishing touches to complete the work. The bedrooms were well furnished and made personal to the residents with, pictures, photographs and ornaments. Although there are some specialist aids such as bath hoists and rails on corridors, the home does not have the use of a hoist to assist with the movement of residents. The proprietor does not see the necessity for such an aid at the moment but with the growing dependence of the residents the purchase of a hoist should be a future consideration.
Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 13 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): 28 & 29 The staff have a good understanding of residents’ support needs, as evidenced by their rapport with those living in the home. However, residents would benefit even further from a good staff training and development programme. EVIDENCE: There was, generally, a warm atmosphere in the home and the residents spoke highly of the care and support they received from the staff. There is, however, a lack of external training for the staff who only receive limited mandatory training from outside sources. The registered provider feels she has enough experience to deliver any training courses she thinks are necessary. All staff are recruited following a through recruitment process. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 14 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): 34, 37 & 38 Residents benefit from good policies and procedures in place to ensure their safety. They are however put at risk from the incorrect storage of cleaning materials and lack of footrests on wheelchairs. EVIDENCE: The registered provider works with her accountant to ensure the financial viability of the home. The home has a full set of policies and procedures prepared by a professional consultancy company. Updates are sent to the home on a regular basis to ensure they are kept up to date. Staff are given the opportunity to read the policies but there is no evidence to show this ever happens. It would be good practice for the staff to sign each time they read one of the policies. The inspector noticed that cleaning products were kept in residents’ bathrooms and that the store cupboard for the cleaning materials was not, nor could be,
Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 15 locked. It was requested that in future, all cleaning products be kept in secure facilities and a requirement was made in respect of this. Because of the growing dependence of some residents, staff now have to use wheelchairs to transfer people from the lounge to the dining room. The inspector observed one resident being moved in a wheelchair with no footrests in place. This meant that her feet dragged along the floor, which was both dangerous and potentially harmful for the resident. A requirement was made that all wheelchairs must have the footrests in place all the time. Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 x X X X 3 3 3 X x STAFFING Standard No Score 27 X 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X X 2 2 Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 17 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. Standard 1 2 OP9 OP9 Regulation 13 13 Requirement The medicine trolley must be secured to the wall when not in use. Medicines must be administered directly from the container in which they are supplied, to the service, and not potted up in advance. The cupboard in which the supply of cleaning materials are stored should be kept locked at all times Residents should not be transported in wheelchairs that have no footrests attached. Timescale for action 31/03/06 31/03/06 3 OP38 13 31/03/06 4 OP38 13 28/02/06 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 OP37 Good Practice Recommendations It is recommended that a record be kept documenting that members of staff have read and understood the policies that are in place to assist with the running of the home.
DS0000022582.V271308.R01.S.doc Version 5.1 Page 18 Cartmel Old Grammar 2 OP36 It is recommended that staff are supervised every 2 months Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 19 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. Extracts may not be used or reproduced without the express permission of CSCI Cartmel Old Grammar DS0000022582.V271308.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
