Inspection on 08/11/06 for Cartmel Old Grammar

This inspection was carried out on 8th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 24/07/06

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 Ray Mowat Unannounced Inspection 8th November 2006 09:45 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.V316526.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.V316526.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.V316526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) 24th July 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 centre of the village. 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 wellappointed dining room, all of which provide plenty of communal space for the residents to enjoy. Information about the home is made available to new and existing residents. The range of fees charged is from £395 to £495 with additional charges for personal sundry expenses. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place on the 8th November and was completed by an inspector, Ray Mowat and a Regulation manager Penny Wilkinson. During the inspection we spent time talking to residents, staff and visitors to the home. We examined records relating to the care of the residents and the running of the home and spent time with the manager Ms Beverley Clarke. After the last inspection we received 12 relatives comment cards and 2 residents comment cards. We also met with a visiting District Nurse. What the service does well: What has improved since the last inspection? What they could do better: Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 6 The home must make sure all appropriate checks are completed before taking on new staff. The care plan records should be more personalised to reflect the resident’s life history, relationships and interests. The home should review their medication procedures to make sure they are in line with good practice. Food for residents on a soft diet should be well presented and appetising. The home should record their consultation with residents about the quality of the service and publish the outcomes. All staff should receive regular supervision throughout the year that records their concerns, training and personal development needs. 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. The summary of this inspection report can be made available in other formats on request. Cartmel Old Grammar DS0000022582.V316526.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.V316526.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective new residents are provided with suitable information are able to visit the home with family or their representative, prior to moving in, which ensures they are making an informed choice. There was evidence of some assessments being completed making sure the home was able to meet individual needs, however these could be strengthened. EVIDENCE: A selection of residents files were examined during the inspection, which contained signed contracts of terms and conditions. These in addition to the service user guide provide residents with sufficient information about how the home operates. Some residents and relatives I spoke to talked about visiting the home prior to admission and felt they had made their own choice to move into the home. There were social work assessments completed in some cases, however it is felt that the home could strengthen their own needs assessment and care plan to ensure individual needs and preferences are agreed when a person first moves in. This should include information relating to hobbies, social interests and personal relationships, which are important to them. This will give staff a Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 9 better understanding about the residents and their individual needs and preferences. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole the home ensures personal and healthcare needs are met, with good records of healthcare interventions. However care plans could be strengthened to include a personal history and social interests, to give staff a better understanding about individuals. Medication procedures were also in need of review in line with good practice. EVIDENCE: Although all the information was not held on one file, the home maintained a number of records with relevant information enabling staff to monitor and respond to the personal and healthcare needs of residents. The care plans examined although quite basic contained information relating to personal care, moving and handling, food and nutrition, finances and any other areas of concern. A record of all routine and one off healthcare appointments was also maintained, a good example being a reference to actions recommended by a physiotherapist. There was evidence that care plans had been reviewed and agreed and signed by relatives or their representatives. As identified in the previous section it is recommended that a personal or social history is added to the assessment/care plans, which will provide staff with valuable information about Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 11 individuals, such as their life experiences, important relationships and things they value. There was evidence that staff respect resident’s privacy and dignity as they go about their duties. Personal care tasks were carried out discreetly behind closed doors and staff were observed to knock before entering rooms. I witnessed two members of staff helping residents with their meals and both did this with sensitivity. I asked two residents about bathing and personal care and both said they were “happy with the arrangements”. Throughout the visit all the staff were attentative to the needs of residents. The home uses a monitored dosage system to manage the majority of medication administered in the home. When the manager is not there to administer medication, she will dispense it into named pots for each resident, which are securely stored, until the care staff administer them. Although this system is working effectively for the home and there have not been any errors, it is classed as secondary dispensing and is contrary to Royal Pharmaceutical good practice guidelines. This was discussed with the manager who is reviewing the practice and looking at alternative systems in addition to arranging medication training for care staff. Based on my own observations and discussions with residents, staff were respectful to residents in the way they addressed them and offered choices. Residents spoke positively about their relationships with staff with one person describing them as “Very kind and always polite”. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 12 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. 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. Based on our discussions with residents, their relatives and through examining daily records, it was evident the residents are enjoying a good quality of life both in the home and in the local community. EVIDENCE: Based on my discussions with residents, family members and staff and also from examining the home’s records it was evident there were opportunities for people to participate in a range of activities both in the home and in the local community. On the day of our visit the hairdresser was visiting the home, which takes place on a weekly basis. Residents and family members talked about recent outings, which they had enjoyed including a trip to Blackpool for the lights and a meal and a trip to a local pub for a meal. The home had organised a recent firework display and bonfire supper that they had enjoyed. The mobile library service visits the home once a month, which one resident I spoke to particularly enjoyed, with the service providing large print books which they benefited from. One resident described how they had made the floral table decorations in a craft activity and described other activities they had enjoyed. The manager makes a point of acknowledging birthdays one resident said, “we always get a lovely present”. I spoke to one resident who was ordering wine Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 13 by mail order in preparation for Christmas. In addition plans were in place to support residents to go Christmas shopping in the nearby town of Kendal. An activity programme for the Christmas period had also been planned which included a concert by bell ringers, an outing to a pantomime and supporting residents to the candle light service. Religious services are held in the home reflecting the faith of the current group of residents. During this inspection there were frequent visitors to the home some of whom I met. They confirmed that the home provides a “High quality of care” with one person saying the home was “Excellent”. Relatives also talked about the “Personalised care and attention to detail”, which they said made them feel reassured that the staff were knowledgeable about their family member’s needs. We joined a group of residents for lunch, which was served in the dining room. The atmosphere was relaxed with some residents enjoying a glass of wine or sherry with their meal. The meal was freshly prepared and well balanced with special diets and alternatives provided, including a vegetarian option and a diabetic option. One person on a soft diet had their food pureed, unfortunately this was all mixed together, which did not look appetising or enable the person to experience the different flavours of the food. It is recommended that food be pureed individually to enable the person to experience the different flavours and make the meal look more appetising. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures people’s concerns are responded to and has sound procedures in place that safeguard residents and staff. EVIDENCE: The home has a suitable complaint policy and procedure in place to ensure resident’s views are heard and responded to. Residents spoken to were aware of how to complain and who to complain to, saying they would complain to Ms Clarke or the deputy and they seemed confident that they would act to sort things out. However comment cards we received from some relatives suggested they were not aware the policy. There were no recorded complaints since the last inspection. The home also has a suitable policy and procedure relating to the protection of vulnerable adults from abuse. Staff had received training as well as the procedure being discussed as part of the induction to the home. Staff had a reasonable awareness of how to recognise abuse and how to refer suspected incidents. The home had the new Adult Services procedure to guide their practice. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Cartmel Old Grammar prides itself in providing high quality living accommodation that is safe and well maintained. Residents and their relatives complimented the home on its “cleanliness” and “homely atmosphere”. EVIDENCE: Cartmel Old Grammar provides residents with a safe and well-maintained environment that is decorated and furnished to a high standard. All areas of the home were clean and hygienic. Resident’s rooms were personalised with some residents bringing in their own furniture and belongings. As one resident described it “It is a very pleasant and well furnished home in lovely surroundings” another said, “the views are lovely”. Residents were observed to be spending time in their own rooms or in the communal areas of the home. There are well kept gardens and patio areas with seating, which residents said they enjoyed when the weather allowed. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 16 Due to the needs of the residents there was a minimal amount of special aids or adaptations required in the home. The manager completes a building and rooms risk assessment, which includes communal areas of the home. These were recently reviewed with any defects and action taken recorded, signed and dated. A new fire alarm system had been fitted, with the fire officer carrying out an inspection of the home. As a result a new recording system was introduced for all fire safety checks and other relevant records and a new fire risk assessment developed in line with the requirements of new legislation. Residents were appreciative of the facilities within the home. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a consistent and knowledgeable staff team. However the homes recruitment procedures must be strengthened to ensure the safety of residents. EVIDENCE: On the day of the inspection there were the manager, a deputy, two care staff a cleaner and a cook on duty. This seemed to be sufficient staff to allow care to proceed in an unhurried and friendly manner. None of the residents mentioned a lack of care at night and Ms Clarke confirmed that few people required assistance at night. Recruitment practices need to improve as the manager admitted she was not aware of the POVA first system and had started staff when not all the appropriate checks had been completed. The POVA system and the home’s responsibilities within it were explained to the manager. CRB disclosures were in place and two references had been taken. The manager held a copy certificate for all staff who had attended training courses. Recent training included abuse awareness, first aid and food hygiene. Some staff had completed or were working toward their NVQ, however Ms Clarke said she had found it difficult to persuade the more established staff who were near retirement to take up the award. There was evidence Ms Clarke encourages staff to take the award and she said she would consider including it in the terms and conditions of employment for new staff. The home’s training provider was notifying the home, as refresher training was due. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 18 Supervision is currently informal but staff did confirm they regularly discuss their work and any concerns with Ms Clarke or her deputy. There are currently no records of supervision. Induction for new staff is mainly shadowing an experienced member of staff but two staff did say that Ms Clarke had observed them on shift before they worked on their own. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. It was evident the home is run in the best interests of residents and they feel they have the autonomy to lead a life of their choosing. The recording of consultation with residents and their representatives and staff supervision should be strengthened. EVIDENCE: The home’s owner and manager Ms Clarke has many years experience in the management of a care home. She is very committed to providing a high quality service to meet the resident’s individual needs. Based on feedback from residents, their relatives and other professionals the home is maintaining this standard and is being run in the best interests of residents. Based on conversations with residents they confirmed they “plan their own days”. I observed staff sitting with residents and asking their opinions. They said they saw Ms Clarke most days and she was “very kind”. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 20 However it is recommended the home review their current recording systems with a view to formalising their monitoring of service quality on a regular basis by consulting with residents and significant others. Staff feel they are well supported and get clear guidance from the manager, however there is no formal system of supervision that is recorded. It is recommended that all staff receive regular supervision at least six times a year and an annual appraisal with a record maintained and actions agreed. During this inspection we examined food and freezer temperatures and fire safety equipment, which were up to date and accurate. The manager confirmed all COSHH substances were now securely stored. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 22 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. Standard OP29 Regulation 19 Requirement Staff must have the required POVA checks prior to commencement of employment (Timescale of 30.11.06 was not met) Timescale for action 01/01/07 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 OP7 Good Practice Recommendations It is recommended the home develop a more comprehensive care plan based on an assessment of needs that includes a pen picture/social history, hobbies and social interests and personal relationships. It is recommended the home review their medication administration procedures in line with good practice guidelines. It is recommended for people on a soft diet that food be pureed individually to enable the person to experience the different flavours and make the meal look more appetising. It is recommended the home review their current DS0000022582.V316526.R01.S.doc Version 5.2 Page 23 2 3 OP9 OP15 4 OP33 Cartmel Old Grammar 5 OP36 recording systems with a view to formalising their monitoring of service quality on a regular basis. It is recommended that all staff receive regular supervision at least six times a year and an annual appraisal, with a record maintained and actions agreed. Cartmel Old Grammar DS0000022582.V316526.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V316526.R01.S.doc Version 5.2 Page 25 - 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. 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