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Inspection on 27/07/05 for Craghall Residential Home

Also see our care home review for Craghall Residential Home for more information

This inspection was carried out on 27th July 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Good information is available to residents and relatives on the services and facilities offered by the home. Residents described being very well looked after and said staff are polite, nice and very kind towards them. Plans are recorded that shows how residents care needs are to be met. Residents understand how to make a complaint. They said they feel safe and protected living at the home. The building is very well maintained, clean and comfortable.

What has improved since the last inspection?

Some of the improvements required from the last inspection had been addressed. These included fire instructions for staff and updating information on the home. The majority of the recommended improvements were also followed up.

What the care home could do better:

All new residents should have their care needs fully assessed before moving into the home. The needs of residents with dementia will be better met by being cared for in a separate area by designated staff. Care plans for mental health and behaviour are also needed. More staff require training in caring for people with dementia. The home`s systems for recording medication continue to need improvement, and not enough staff have had medication training. Information on advocacy services is not available.There was not consistent care staffing to meet the needs for the number and dependency levels of residents. New staff were not being properly recruited. Staff were not being provided with regular supervision. Improvements are still needed to some aspects of fire safety.

CARE HOMES FOR OLDER PEOPLE Craghall Residential Home Matthew Bank Newcastle upon Tyne NE2 3RD Lead Inspector Elaine Malloy Unannounced 27 July 2005 10:45 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 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. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Craghall Residential Home Address Matthew Bank Newcastle upon Tyne NE2 3RD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 284 6077 N/A N/A Welburn Care Homes Limited Vacant CRH 38 Category(ies) of DE(E) Dementia - Over 65 - 6 registration, with number OP Old Age - 32 of places Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 6.1.05 Brief Description of the Service: Craghall is a care home that provides personal care to 32 older people and 6 older people with dementia. The home is located in South Gosforth and has extensive well kept grounds and car parking space. The property was converted to a care home. A major refurbishment and extension was completed in November 2004. This included installation of a passenger lift, stair lift and ramped areas to aid access. There are 34 single and 2 double bedrooms, 30 of which have ensuite facilities. Four bathrooms and a shower room are provided. There is access by public transport. Local amenities and shops are available in Gosforth and Jesmond. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 5½ hours. Management, staff and residents were spoken to. Each area that the home was asked to improve at the last inspection was examined. Parts of the building and a range of records were also inspected. What the service does well: What has improved since the last inspection? What they could do better: All new residents should have their care needs fully assessed before moving into the home. The needs of residents with dementia will be better met by being cared for in a separate area by designated staff. Care plans for mental health and behaviour are also needed. More staff require training in caring for people with dementia. The home’s systems for recording medication continue to need improvement, and not enough staff have had medication training. Information on advocacy services is not available. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 6 There was not consistent care staffing to meet the needs for the number and dependency levels of residents. New staff were not being properly recruited. Staff were not being provided with regular supervision. Improvements are still needed to some aspects of fire safety. 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. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 4. Up to date information on the home’s services and facilities is available. Full assessment of care needs before admission was not being completed for privately funded residents. Residents were positive about the care provided. The home could not demonstrate that the care needs of residents with dementia were being fully met. EVIDENCE: At the last inspection a Requirement was made for copies of the revised Statement of Purpose and Service User Guide, reflecting changes to the home’s registration, must be provided to the CSCI. This had been actioned. A range of information, including a ‘welcome pack’ is also provided in each resident’s bedroom. The care records of the last two residents admitted to the home were examined. Both residents were privately funded, and had not therefore received assessment from Social Services. Minimal pre-admission assessment of care needs was evident for both residents. There were also no details of medical history for one resident. The assessment must cover all areas of need as set out under Standard 3.3, and be fully completed. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 9 Arrangements to meet the care needs of residents in the Older People with Dementia category of care were discussed. These residents were not being cared for in a separate communal area of the home by designated staff, as previously agreed. The Manager and 7 staff only have completed training in caring for people with dementia. Further care staff need to undertake this training. One resident spoken described to the Inspector how the behaviour of residents with confusion affected her. Care plans addressing mental health needs and behaviour were not always in place. Residents spoken with provided many positive comments about living in the home. They said they were very happy here and that nothing is a bother to the staff. They said they were very well looked after and staff are polite, nice and very kind towards them. One lady described how she had viewed other care homes before deciding upon moving in. She said she had seen an advertisement about the home and it had been recommended to her. Some residents were aware of the information kept in their bedrooms. One lady said that the care provided was exactly as the company’s slogan ‘care without compromise’. Residents said their health needs were attended to. Choice of meals was confirmed and residents said the food is lovely, and they often have treats. Residents were well aware of the range of activities and on offer and relayed their enjoyment of social events that had been held. One lady had misplaced her copy of the activities programme and requested staff give her another copy. The accommodation was described as being very clean, tidy and comfortable. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9. Plans are recorded that demonstrate how residents care needs are to be met. However plans addressing mental health needs were not always in place. Residents are not fully protected by the home’s systems for recording medication. There is also insufficient staff with medication training. EVIDENCE: A sample of care records was examined. Care plans covered a range of health, personal, and social care needs. Mental health needs were not however suitably addressed in care plans. An example of this was a resident for whom behaviour charts were being completed, but no behaviour care plan was devised. At the last inspection a Requirement was made for a range of improvements to medication recording and training. Relevant records were examined to check if these had been actioned. There continued to be a number of unexplained gaps to signatures within medication records. Maximum dosage within 24 hours for ‘as required’ medication was now specified. Recording of Controlled Drugs was not to a satisfactory standard. Some gaps were evident to two staff signatures. The Inspector checked one resident’s controlled medication via the register and found a number of discrepancies including incorrect stock balances. The manager and 4 senior staff had undertaken medication training. One of the Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 11 senior staff was leaving employment in the near future. The main concern was that the senior from night duty with training works one night weekly. Arrangements must therefore be made for staff trained to give medication on the other 6 night shifts, until further staff have completed medication training. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14. Information on advocacy services is not available. EVIDENCE: A Recommendation was made at the last inspection for information on advocacy services to be made available to residents and their relatives/representatives. This had not been actioned. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 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 standard(s) 16 and 18. Residents understand the process for making complaints. The home has procedures for protection of vulnerable adults, and residents feel safe. EVIDENCE: A Recommendation was made at the last inspection to document outcomes to complaints. This had been actioned. Three complaints were recorded in the period since the last inspection. Each was dealt with appropriately. Residents spoken with were able to describe how they could make a complaint. Some residents were aware of having a copy of the complaints procedure. There are policies and procedures for the protection of vulnerable adults, including prevention of abuse and whistle blowing (informing on bad practice). There have been no allegations of abuse since the last inspection. Residents said they felt safe and protected living at the home. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 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 standard(s) 19 and 24. The environment is very well maintained, clean and comfortable. Bedrooms are personalised and properly furnished and equipped. EVIDENCE: The Inspector conducted a short tour of parts of the building. All areas seen were clean. Bedrooms were nicely personalised with resident’s possessions. A number of residents said they liked their comfortable rooms. At the last inspection a Requirement was made for closure mechanisms to bedrooms doors to be adjusted to ensure they close fully, and fit a door guard to bedroom 4. A Recommendation was also made to provide small tables and chairs in bedrooms where space permits. All had been actioned. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. There is not consistent care staffing to meet the needs for the number and dependency levels of residents. The home does not follow a robust process when recruiting new staff. Staff were not being provided with all the training they require to be competent in their work. EVIDENCE: At the time of the inspection there was 36 residents, 31 category Older People and 6 category Older People with Dementia. Minimum care staffing levels are 5 carers across the waking day and 3 carers at night. Examination of the rotas indicated regular shortfall of one carer, particularly for evening shifts. This was discussed with a senior manager from the company. Advice was given that cover for absence must be organised and amended rotas submitted to the CSCI. There are sufficient weekly domestic/laundry and catering hours. A Recommendation was made at the last inspection to review the extent of the Acting Manager’s supernumerary hours. Ms Barbrook was now in receipt of 16 supernumerary hours weekly. At the last inspection a Requirement was made for references for new staff to be obtained from appropriate sources. The personnel files for two recently recruited staff were examined. It was evident that references had not been requested from previous care home employment for both staff. Application forms and interview assessments are completed. One interview record did not demonstrate that a 3-year gap in employment history had been explored. Proof of identification is kept on file. Arrangements are in place for staff to be employed subject to Criminal Records Bureau checks. These were inspected. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 16 There was no documentary evidence that a trace had been discussed with an applicant. As previously stated, additional staff require training in caring for older people with dementia, and medication training. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38. Staff are not provided with regular individual supervision. There was not compliance with some aspects of fire safety. EVIDENCE: At the last inspection a Requirement was made for senior staff responsible for providing individual supervision to complete relevant training, and to devise a schedule for staff supervision. This had not been actioned. The Acting Manager and Senior No. 3 are taking responsibility for provision of supervision. They had not undertaken training to date, however both were booked to undertake a course the following month. There was no forward planned schedule, though the majority of staff had received supervision in recent months. The standard for care staff to be provided with individual supervision 6 times annually was not currently being met. At the last inspection Requirements were made for staff to be provided with fire instructions at the correct intervals, fire alarms to be tested weekly, and monthly checks of emergency lighting and fire equipment. Records showed Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 18 that staff now receive in house instructions more frequently than required. Fire alarms were not consistently tested on a weekly basis. There was a gap between May and June 2005, and the last recorded test was 8th July 2005. There were also gaps to the records of checks of emergency lighting and fire equipment from October 2004 to April 2005. These were however now being conducted and recorded monthly. A Recommendation was made at the last inspection for accident analysis to be carried out. This had commenced, though advice was given that the analysis should be used to identify any patterns regarding times, locations etc. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION 3 x x x x 3 x x STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 2 Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 20 YES 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 3 Regulation 14(1) Requirement (a) Needs assessment must be fully completed for all prospective new residents (b) The needs assessment must cover all areas as specified under Standard 3.3. Arrangements must be made to ensure suitable supervision and care of residents with dementia, including designated staffing. Care plans must be devised that address dementia/mental health/behaviour. (Outstanding Requirement) (a) There must be no unexplained gaps to signatures within medication administration records (b) An audit must be completed of Controlled Drugs and entries to the CD Register to rectify errors, including stock balances (c) Two staff signatures must be recorded for all entries to the Controlled Drug Register (d) Arrangements must be made for all staff who administer medication to undertake medication training. All care staff must be provided with training in caring for people Timescale for action Immediate action 2. 4 12 Immediate action. 27.8.05 Immediate action Staff training to be completed by 27.9.05 3. 4. 7 9 15 13(2) & 18(1)(c) 5. 4 & 30 18(1)(c) 27.10.05 Page 21 Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 with dementia. 6. 27 18(1)(a) Care staffing levels of 5 carers across the waking day and 3 carers at night must be consistently maintained. Immediate action and rotas to be submitted to the CSCI on a weekly basis until further notice. Immediate action 27.8.05 7. 29 19 Schedule 2 18(2) 8. 36 9. 38 23(4) (Outstanding Requirement) References for new staff must be obtained from appropriate sources. (Outstanding Requirement) A schedule for staff supervision must be devised that meets the standard of six supervisions annually. (Outstanding Requirement) (a) Fire alarms must be tested on a weekly basis (b) Monthly checks and tests of emergency lighting and fire equipment must be conducted and recorded Immediate action 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. 2. Refer to Standard 14 29 Good Practice Recommendations (Outstanding Recommendation) Information on advocacy services should be made available to service users and their relatives/friends. (a) Gaps to employment history should be explored when recruiting new staff (b) Documentary evidence should be maintained of discussion and decision-making as a result of any traces on Criminal Records Bureau checks. Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Northumbria House Manor Walks Cramlington, Northumberland NE23 6UR 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 Craghall Residential Home B53 B03 S39863 Craghall V234794 270705 Stage 4.doc Version 1.30 Page 23 - 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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