Inspection on 24/07/06 for Cartmel Old Grammar

This inspection was carried out on 24th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cartmel Old Grammar 20/11/07

Cartmel Old Grammar 08/11/06

Cartmel Old Grammar 11/01/06

Cartmel Old Grammar 15/07/05

Cartmel Old Grammar 25/01/05

Cartmel Old Grammar 20/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cartmel Old Grammar Cartmel Grange-over-Sands Cumbria LA11 7SG Lead Inspector Colette Hibbert Unannounced Inspection 24th July 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 Old Grammar DS0000022582.V296704.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 Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 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.V296704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for amaximum 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. 11th January 2006 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.V296704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home took place over the course of two days as the manager and deputy manager were not available at the first visit. Before visiting the home pre-inspection questionnaires had been sent out to the service for the provider, residents and relatives to provide information about the service, this will not be included within the context of this report, as they had not been returned to the Commission for Social Care Inspection Unit. On the two visits time was spent talking with residents, staff, manager and visitors, looking around the buildings and looking at care plans, records and documentation required for registration. What the service does well: What has improved since the last inspection? What they could do better: Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 6 The home must look to improving the pre-admission assessment and the manager or senior staff member must make a full assessment of residents prior to admission. This information should then be documented within the care plans for each resident. Care plans need to contain a full evaluation of all the residents care needs including social, emotional and psychological care needs as well as medical and personal care. This will enable the staff to provide appropriate care to the residents. The system used for storage, administration and documentation of medication must be improved and safe practices must be used to keep the residents from harm. A social activities programme must be included within the daily routine of the home, and more involvement into the wider community would benefit the residents. Residents must be given the opportunity to be included in the planning of their day and allowed to make suggestions to improve the service they receive Staff training must be included within the home, at present it is very limited, the home must seek to incorporate a training plan to include external providers to deliver planned training relevant to the residents needs. The home must seek to include the residents opinion on the service it is providing so enabling them to improve the residents quality of life and the day to day routine should not be dependant on the staff available. All staff must have appropriate employment checks prior to commencing work within the home to ensure the safety of the residents. Staff must receive one to one supervision at least six times a year with an annual appraisal to provide guidance and support and to enable them to identify training needs and improve the service they provide Policies and Procedure within the home must be available for the staff to read and they must sign to indicate that they have read and understood them. Cleaning fluid must be securely stored to prevent the residents from harm. 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.V296704.R01.S.doc Version 5.2 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.V296704.R01.S.doc Version 5.2 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): 2,3,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are admitted to the home prior to assessment, which may lead to the home not being able to meet the resident’s health care and social needs. Residents are given the opportunity to visit the home prior to admission. EVIDENCE: The manager prior to admission informally assessed some residents, but this was not formally documented within the care plan. The manager stated that she received information from GP, hospitals and social workers and this formed the assessment by the home. Residents are given a statement of purpose, service user guide and a contract on admission to provide the relevant information about the services provided by the home. Some residents said that they had looked around the home prior to admission and felt that they could make an informed choice from this. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 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): 7,8,9, and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all residents had a care plan in place putting them at risk of their health, personal and social needs not being met. Medication practices are poor putting the residents at risk from receiving inappropriate medication. Residents’ dignity and privacy was maintained. EVIDENCE: Not all residents within the home had a comprehensive care plan in place. Care plans that were in place contained minimal information about the individual holistic needs. There was good documentation on the practical medical needs but no mention of the residents’ social or physiological care needs Medication practices remain poor with staff still secondary dispensing the medications. Staff had not been given adequate training to perform this task. This puts the residents at risk from receiving incorrect medication. The medication trolley has not been secured to the wall when not in use. Documentation for controlled medication that had been dispensed to residents did not have the signature of two staff. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 10 Staff appeared to be aware of the need to maintain residents privacy and dignity and care needs were carried out discreetly. All the residents had a bath on the same day and an extra member of staff worked to cope with this task, one resident said ‘it would be nice to have a shower instead of a bath sometimes’ and another said ‘it would be nice to have a bath more often but the home did not have the staff to cater for this’. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 11 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 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The programme for social, and recreational interests and needs are very limited. Residents maintain contact with families and friends, but are not fully able to make choices and control of their daily routine. Residents have some choice in the diet they eat. EVIDENCE: The home has a social programme for two days of the week when the residents can listen to music or take part in an exercise morning. Staff said that they did not find the residents wanted to take part in activities and that they did not show an interest in any outing being organised. Several residents spoken with said that they would like an occasional bus trip or outing. Two residents said they walked into the village for a coffee at least once a week and they enjoyed that. Residents did say that they maintained contact with family and friends and one visitor spoken with said that they were made very welcome when they visited saying ‘the staff are very friendly’ One resident said that they found it difficult as the staff refused to address them by their full name, just using their Christian name as it was ‘to much of a mouth full to give everyone their full name’ Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 12 All the residents are served breakfast within their own bedroom but other meals are served in the dinning room. Residents and staff spoken with explained there was not really a choice at dinnertime but they were asked what they would prefer for the evening meal. The cook makes home made cakes and pudding which several residents made reference to. There was plenty of stock within the kitchen including fresh fruit and vegetables. Residents on a soft diet were served a bowl containing a brown thick mash, which did not look tempting, or appetising, the home must look at ways to improve the presentation of these meals. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 13 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were confident that complaints would be listed to and acted upon and there were clear policies and procedures in place. Staff are aware of the action to take to promote residents’ safety and wellbeing. EVIDENCE: The home has clear complaint procedures in place, residents spoken with said that they would either speak to the care staff or their social worker if they had any problems. They felt that any concerns would be dealt with in an appropriate manner Staff spoken with confirmed they were aware of the action to take to protect the residents in their care. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 14 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): 19,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home offers very comfortable and warm accommodation with all areas extremely well maintained. This contributes to a homely environment 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. The rooms vary in size but are all within the regulation requirement size. The residents are able to personalise the rooms with pictures and ornaments. Residents spoken with said that they liked their rooms and were able to add pieces of their own furniture, pictures and ornaments. Many of the rooms had pleasant views over the racecourse, which the residents said was ‘an added bonus’. The home was very homely, clean, pleasant and tidy. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 15 Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. The home does not support or encourage the development of a competent staff team and training is very limited, putting the residents at risk from receiving inappropriate care. The staff recruitment procedure does not offer protection to the residents within this home. EVIDENCE: During the morning of the visit there were two care staff a cleaner and the cook on duty. The staff were seen to care for the residents in a friendly calm manner, call bells were answered without delay. At night there is only one carer on duty and a sleeping member of staff on the premises for emergencies. Some residents said that they felt at night they had to wait for attention due to lack of staff or because the carer had domestic work to undertake as well as care. The home does not have adequate recruitment procedures in place to keep the residents safe as references, Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks are not carried out prior to employment of staff. Staff training files indicates that appropriate training is not being provided other than Moving and Handling and Fire Safety. One member of staff said that all other training is done ‘in house, on the job, by working with other staff’ This Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 17 lack of training is putting the residents at risk of not receiving up to date current and appropriate training to met the residents changing care needs. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 18 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): 31,33,35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The day – to - day running of the home is based upon staff availability and not the residents’ best interests, affecting the quality of life of the residents within the home. Health and safety practices do not promote a safe environment for the residents. EVIDENCE: The owner manages the home. The daily routine within the home is lead by the staff and number of staff available. The residents do not have any input into planning their own day and they do not have the opportunity to give their opinion on the service they are receiving, as they do not have residents meetings or a yearly audit. Residents finances are recorded and receipts kept within the care plan. Residents spoken with said that they were ‘given bills on a regular basis for Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 19 any money they owed the home for things like hairdresser, so they could stay up to date with their finances’ This is seen as good practice. Staff spoken with said that they did not receive supervision and the manager confirmed this, this was a recommendation at the last inspection and is repeated as a requirement. The storage of cleaning fluids must be improved, the door to the store cupboard must be fitted with a lock, and cleaning liquids must not be stored within the residents’ bathrooms to secure the safety of the residents. This was a requirement made at the last inspection and has been repeated. Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 20 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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 2 2 Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 2 Standard OP3 OP7 Regulation 14 15 Requirement Timescale for action 30/11/06 3 4 OP8 OP9 12 13 All new residents must have health care needs assessed prior to admission All residents must have 30/09/06 individual care plan to enable staff to deliver individuals care needs Health care needs of individual 30/09/06 residents must be met The medicine trolley must be 30/11/06 secured to the wall when not in use.(Timescale extended from 31/03/06) All control drugs must have two signatures recorded when dispensed Medicines must be administered directly from the container in which they are supplied, to the service, and not potted up in advance.(Timescale extended from 31/03/06) More social activities must be offered to the residents Residents must be able to make choices and have input into DS0000022582.V296704.R01.S.doc 5 6 OP9 OP9 13 13 30/11/06 30/11/06 7 8 OP12 OP14 12 12 30/11/06 30/11/06 Cartmel Old Grammar Version 5.2 Page 22 9 10 11 OP29 OP30 OP33 19 18 18 12 13 OP36 OP37 18 17 14 OP38 13 planning their day Staff must have the required POVA and CRB checks prior to commencement of employment Staff must receive training appropriate to the residents health care needs The home must be run in the best interests of the residents and not depend on staff availability. Staff must have supervision every two months Records must 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. The cupboard in which the supply of cleaning materials are stored should be kept locked at all times(Timescale extended from 31/03/06) 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cartmel Old Grammar DS0000022582.V296704.R01.S.doc Version 5.2 Page 23 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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