CARE HOMES FOR OLDER PEOPLE
Craigarran Care Home Margaret Terrace Deaf Hill Trimdon Station Co Durham TS29 6PG Lead Inspector
Miss Rachel Dean Unannounced Inspection 8th March 2007 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 Craigarran Care Home DS0000062500.V330923.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. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Craigarran Care Home Address Margaret Terrace Deaf Hill Trimdon Station Co Durham TS29 6PG 01429 880550 01429 882100 No e-mail address 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) Mr Matt Matharu Mrs Jean Kennedy Brenda Hall Care Home 35 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (35), Physical disability (5) of places Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Craigarran is a care home that provides personal care and nursing care for older people and people with dementia. The home is owned by a business partnership, consisting of Mr Matharu and Mrs Kennedy, who became the registered providers on 26th January 2005. The home consists of a purpose built modern building and an older building, which is currently being renovated to provide more accommodation. At the time of this inspection the building work was not finished and the home consisted of a single storey building, built in a rectangle and enclosing an inner garden. All bedrooms are used as single bedrooms with en suite toilets and washbasins. Communal lounge facilities, bathrooms and toilets are situated through out the building. One main dining room is provided and lunch is served in two sittings in order to accommodate all of the residents. At the time of this inspection the homes fees ranged from £364.50 to £565.07 per week, depending on the level of care people needed. This does not include hairdressing, personal papers and magazines and personal toiletries. Up to date information about fees should be sought from the manager. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 8th March 2007. It was completed by two inspectors and took place over one day. Three people living in the home completed surveys and four people were spoken to about life at Craigarran. Two people visiting the home were also spoken to and five staff members were interviewed during the inspection. Discussions were also held with the manager of Craigarran, throughout the inspection. During the inspection one of the inspectors looked around the home and a number of records and policies and procedures were inspected. What the service does well:
The home assesses the needs of people before they move in to the home, to make sure that Craigarran can meet their needs. Everyone living at Craigarran has a record and plan of their care needs and people receive the personal, health and nursing care that they need. People felt that staff treated them well and with respect. Comments made by people living in and visiting the home included, ‘I like living here and always get seen to whenever I buzz for help’, ‘staff are polite, but like to have a bit of a joke’ and ‘staff are always very cheerful’. Service users find that they can mostly have the lifestyle and social life that they choose, while living in the home. Comments made by people living in the home included, ‘I get involved in the activities’ and ‘I don’t like activities, like to stay in my room, occasionally I’ll go if I feel in the mood’. People are able to make choices about their daily routines in the home and comments made by people living in the home included, ‘I get a bath or shower when I ask, usually two or three times a week’, ‘I go to bed after supper, that is when I want to go’, ‘I can have my breakfast in my room’ and ‘I can get up and go to bed when I want’. Visitors are made to feel welcome and can visit the home at times that are convenient for them. A balanced diet is provided by the home and comments made about the food at Craigarran included, ‘the foods not too bad, staff usually ask what I want, if I don’t want the main meal I can have something else’ and ‘foods sometimes a bit boring, not much choice…they will get me something else if I don’t want the main meal’ and ‘foods alright for me, sometimes get choice, I’ve been sickly the last few days and they’ve given me what I’ve asked for’. People living in the home felt confident that any concerns they had would be handled quickly and appropriately by the manager and staff.
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 6 Sufficient numbers of care and nursing staff are provided in the home to meet the needs of the people living there. Comments made by people living at Craigarran about staffing included, ‘I think there’s enough staff, they come quite quickly when I buzz’, ‘Always plenty of staff around, they come straight away as soon as I need them’ and ‘sometimes staffing is a bit short when people off ill, one the whole pretty well staffed’. The home has an experienced manager who has a good relationship with people living in the home, their visitors and the staff. Comments made by people living or visiting the home included, ‘Brenda (the manager) comes in most days and asks if the meals are okay, things like that’, and ‘manager’s lovely, you can approach her and she would sort things out straight away’. There are quality assurance systems in place, which include the people living in the home and safe systems are in place to help people living in the home manage small amounts of personal money. What has improved since the last inspection? What they could do better:
The home provides a wide range of different care specialisms and there is currently the potential for conflict between the different needs of the people accommodated at Craigarran. The home needs to think very carefully about the types of care it provides and how these can be managed in the best interests of all service users. This should include reviewing the home’s Statement of Purpose and Service User’s Guide, so that people have clear information about home and what it will be like to live there. The home doesn’t currently have clear and fair terms and conditions or contracts for the people who live there. These are important so that people have clear information about their fees, rights and responsibilities when living in the home. Some care plans need to be kept more up to date, so that the information contained in them reflects and provides accurate information about their care needs. Some aspects of the homes medication procedures and the way some medication is stored and recorded could also be improved.
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 7 The home’s training records could be improved and some staff would benefit from receiving up date training or specific training in areas like dementia care. This is important so that staff are kept up to date and have the skills they need to look after the people living at Craigarran. The manager does not currently have sufficient time dedicated to her management role, due to carrying out nursing duties in the home. It is also apparent that the registered provider is not currently undertaking and recording the formal monitoring visits that are required. These issues need to be addressed to make sure that the manager and staff in the home have the resources and support they need. Although most aspects of the home’s maintenance and health and safety arrangements are up to date, some important things like the home’s fire risk assessment and electrical installations certificate need to be updated. 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. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home assesses the needs of people before they move in to the home, to make sure that Craigarran can meet their needs. The home doesn’t currently have clear and fair terms and conditions or contracts for the people who live there. The home provides a wide range of different care specialisms. There are sometimes conflicts between the different needs of the people accommodated at Craigarran. The home needs to think very carefully about the types of care it provides and how these will be managed in the best interests of all service users. Craigarran does not provide intermediate care. EVIDENCE:
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 10 The home has in place appropriate systems for assessing people before they come to live in the home. This includes gathering information from other professionals and undertaking assessments to make sure that Craigarran can meet the person’s needs. The home’s manager has developed a statement of terms and conditions that give people information about their rights and responsibilities while living in the home. However, this doesn’t currently provide clear enough information about people’s fees, including the different people that might contribute (for example, the Local Authority, Primary Care Trust, the individual resident or a third party top up). The Office of Fair Trading has recently produced a report on ‘Fair Terms for Care’ which sets out what should be included in a fair contract or terms and conditions. The provider must review the current documentation and practice around contracts and terms and conditions for residents and must ensure that a fair and clear system is in place. Craigarran currently provides a lot of different types of care, with no separation between the different groups. This means that people with dementia, including some people with very challenging behaviour, share the same facilities, communal space and staff as people with very complex nursing needs. This could potentially impact negatively on the people living in the home and could put people at risk (for example, infection control where people wander into the rooms of others, people interfering with others who can not easily move away, very poorly people being disturbed by others with disturbed sleep patterns or those who shout out and make a lot of noise). The Home needs to clarify what types of care it can provide and think carefully about how it will develop the service to meet the very different and individual needs of these people. This may involve considering the development of separate units or other ways in which the home can provide the appropriate safeguards and specialist care that the people it accommodates needs. The home’s Statement of Purpose and Service User’s Guide must also be reviewed to make sure that people have access to very clear information about the types of care the home provides and how they are provided. This is very important so that people know what to expect when they decide to come to live at Craigarran. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Everyone living at Craigarran has a record and plan of their care needs, although some of these were more up to date and accurate than others. People receive the health and nursing care that they need. Medication is handled safely at the home, although some areas could be improved to increase the safeguards that are in place. People living in the home feel that staff treat them with respect and help maintain their privacy. EVIDENCE: Each person living at Craigarran has in place a care plan and record of the care they receive. A selection of these care plans were inspected and some were found to be detailed and up to date. However, others were not up to date and
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 12 the information in them didn’t always reflect the current care needs of the person. Care plans should be regularly reviewed and should always contain up to date information, so that staff are fully aware of the persons needs. The records showed that people received the nursing and medical care that they needed. Three people who live in the home completed surveys about life in the home. All three said that they always received the care and support they needed, that staff listen and act on what people say and that they always receive the medical support they need. The home has in place policies and procedures covering the storage and administration of medication at Craigarran. Overall, medication was found to be managed safely at the home. However, some areas for improvement were identified. The home’s medication procedures need to be reviewed to make sure they are up to date and reflect the home’s practice and legal responsibilities. For example, they don’t currently cover the disposal of drugs accurately or have enough detail about what action should be taken in the event of a drug administration error. The treatment room felt very warm on the day of the inspection. The temperature of the room should be monitored regularly and if necessary action should be taken to cool the room, to make sure that drugs are always stored within safe temperature parameters. Some aspects of recording need to be improved. For example, staff should always record the reason that medication has not been given on the back of the medication administration record and should always sign for dressings and gels. The home would also benefit from a larger controlled drugs cupboard, to prevent medication being damaged during storage. Comments made by people living in and visiting the home included, ‘I like living here and always get seen to whenever I buzz for help’, ‘staff are polite, but like to have a bit of a joke’ and ‘staff are always very cheerful’. During the inspection staff were observed to be polite and treat people nicely. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Service users find that they can mostly have the lifestyle and social life that they choose, while living in the home. Visitors are made to feel welcome and can visit the home at times that are convenient for them and their friend or relative. People are able to make choices about their daily routines in the home. A balanced diet is provided by the home, although the choices specified in the home’s written menus aren’t currently being provided. EVIDENCE: The home employs an activities coordinator for four days each week, to organise and provide social events in the home. Two of the three people who returned surveys said that there were always activities arranged by the home that they could take part in. The other person said that there were sometimes
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 14 activities arranged by the home that they could take part in. Comments made by people living in the home included, ‘I get involved in the activities’ and ‘I don’t like activities, like to stay in my room, occasionally I’ll go if I feel in the mood’. At the time of this inspection the activities coordinator had been off work for some time. Discussions with staff and people living in the home showed that, although care staff tried to do activities in the absence of the coordinator, their main priority was care tasks and that activities sometimes suffered as a result. The home has a relaxed visiting policy, with people being able to visit their friends and relatives when they want to. Visitors spoken to during the inspection said they were made to feel welcome and could come and go as they pleased. People spoken to during the inspection felt that routines in the home were reasonably flexible and that staff tried to help people do what they wanted. Comments made by people living in the home included, ‘I get a bath or shower when I ask, usually two or three times a week’, ‘I go to bed after supper, that is when I want to go’, ‘I can have my breakfast in my room’ and ‘I can get up and go to bed when I want’. The care staff who were spoken to showed a good understanding of the importance of encouraging independence and choice. Comments made about the food at Craigarran included, ‘the foods not too bad, staff usually ask what I want, if I don’t want the main meal I can have something else’ and ‘foods sometimes a bit boring, not much choice…they will get me something else if I don’t want the main meal’ and ‘foods alright for me, sometimes get choice, I’ve been sickly the last few days and they’ve given me what I’ve asked for’. Two of the three people who returned surveys said that they always like the meals at the home. The other person said that they usually like the meals at the home. The home has recently taken on a new cook, who is reviewing the homes current written menus and trying out new ideas. As a result of this the current written menus don’t really show what meals are being provided. Lunchtime meals currently consist of one main meal, with alternatives (like omelettes) being offered if people don’t want the main choice. The new kitchen staff plan to complete focus on food training in the near future and need to update their food hygiene training. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. People living in the home feel confident that their complaints and concerns will be listened to and acted upon. Allegations and suspicions of abuse are reported and handled appropriately by the manager and staff in the home. EVIDENCE: The home has in place policies and procedures covering complaints and the protection of vulnerable adults from abuse. The staff who were spoken to during this inspection were aware of how to report any concerns they had to management and felt that management would handle any concerns properly. A complaints book and records of investigations were available and showed that complaints and allegations were handled appropriately. The home’s policies and procedures covering the protection of vulnerable adults from abuse would benefit from being reviewed. They don’t currently include any information about how to refer staff for inclusion on the Protection of Vulnerable Adults list (a list of people considered unsuitable to work with vulnerable people) and a page was missing out of the formal policy and procedure file.
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is undergoing a programme of refurbishment and redecoration, although some parts of the home, it’s furnishings and equipment still need to be renewed. The home is generally kept clean, tidy and provides a hygienic place for people to live. EVIDENCE: During the inspection one of the inspectors looked around the building with the manager. The home is currently undergoing refurbishment, with quite a lot of work still to complete. However, it was clear to see that the provider is investing in the home and improving the standard of accommodation provided
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 17 at Craigarran. The areas of the home that had been re-decorated looked fresh and homely, but there are still areas of the home that need attention, and equipment and furniture that should be replaced. For example, the old weigh scales, a number of old commodes, some bathrooms and the toilets in reception (which need refurbishing and are currently kept locked and not freely accessible to the people living in the home). One bedroom smelled quite strongly of urine, but discussions with the manager showed that alternative types of floor coverings were being considered to make it easier to keep the room clean and free from unpleasant smells. All three people who completed a survey form said that the home was always fresh and clean. Other comments made by people who lived at or visited the home included, ‘X likes her room, can’t you see how individual it is?’, ‘my room does what I want it to, got telly, some of my own things, little odds and ends’ and ‘I’ve been offered a change of room, but like this one’. The home has domestic staff on duty every day to do the cleaning and laundry. Care staff were aware of the importance of infection control and confirmed that they were provided with the personal protective equipment they needed. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of care and nursing staff are provided in the home to meet the needs of the people living there. Staff are provided with a wide range of training to enable them to do their jobs well. However, training records could be improved and some staff would benefit from up date training or specific training in areas like dementia care. Staff are generally recruited in a safe way, with the required checks being completed before new staff start work. EVIDENCE: Comments made by people living at Craigarran about staffing included, ‘I think there’s enough staff, they come quite quickly when I buzz’, ‘Always plenty of staff around, they come straight away as soon as I need them’ and ‘sometimes staffing is a bit short when people off ill, on the whole pretty well staffed’. Staff rotas showed that sufficient care staff and nursing staff are on duty. Discussions with staff confirmed that staffing levels are maintained at appropriate levels.
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 19 Staff spoken to during this inspection thought that the home provided a good range and level of training. They described having a wide range of training that was relevant to their jobs. The manager is a manual handling trainer, who has just up dated her own training and is about to start up dating her staff. Some staff have completed a distance learning course in dementia care, although all staff would benefit from this due to the needs of the people they care for. Some staff would also benefit from updating their first aid training, to make sure that a suitably qualified first aider is always available in the home. The training records maintained by the home could be improved, as there isn’t currently an easily accessible and clear record of the training all staff have completed and when updates are due. Thirteen out of seventeen care staff employed by the home have achieved an NVQ level 2 or above in care. During this inspection the staff records of four staff were inspected. This included three recently recruited staff. These records showed that staff usually went through a thorough recruitment process, to make sure they were suitable to work with vulnerable people. However, one member of staff had started work after having a PoVA First check, while waiting for their full Criminal Records Bureau disclosure to be returned. The Department of Health has issued guidance on the supervision arrangements that must be put in place in these circumstances, but there was no record of these having being put in place. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager who has a good relationship with people living in the home, their visitors and the staff. However, the manager can not currently allocate sufficient time to her management role, due to carrying out nursing duties in the home. There are quality assurance systems in place, which include the people living in the home. However, the registered provider is not currently undertaking and recording the monitoring visits that are required. Safe systems and storage are in place to help people living in the home manage small amounts of personal money. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 21 Care staff are well supported by the manager and nursing staff. However, staff, including the manager, don’t currently receive formal supervision as often as they should. Although most aspects of the home’s maintenance and health and safety arrangements are up to date, some important things like the home’s fire risk assessment and electrical installations certificate need to be updated. EVIDENCE: The manager of the home has a lot of experience managing care and nursing services, is a registered nurse and is registered with CSCI as manager of Craigarran. Comments made by people living in the home or visiting included, ‘I don’t see a great deal of the manager, but she is very good’, ‘Brenda (the manager) comes in most days and asks if the meals are okay, things like that’, and ‘manager’s lovely, you can approach her and she would sort things out straight away’. Staff also spoke highly of the manager, saying that they felt well supported and part of a good staff team. However, the manager has not yet undertaken the Registered Managers Award (RMA), which is a qualification that care home managers are expected to achieve. There is also an issue with the amount of time the manager currently spends covering nursing duties within the home. She currently splits her time, spending approximately half her hours on managerial tasks and half on nursing cover in the home. This is not ideal and the provider should consider how more management time can be provided. The registered providers are not currently completing the visits and reports that are required by Regulation 26 of the Care Homes Regulations. The last Regulation 26 report available in the home was from May 2005. There is also a lack of formal supervision for the registered manager, with no recent records of formal supervision being available. The home carries out surveys to get feedback from the people living there and people felt happy to bring things to the attention of staff and the manager if there was something they weren’t happy with. People felt that the manager would help sort out anything that they brought to her attention. The home has in place systems for helping service users store and access small amounts of personal money while they live in the home. Each person has a record of their personal transactions, which includes the signatures of two staff and receipts. A random selection of three of these records were checked. Two were found to be accurate, while one record was found to be five pence out. When people are countersigning records they must check that the information they are signing to confirm is correct. Care staff who were spoken to during this inspection felt that they were well supported by the manager and nursing staff. They described how they had
Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 22 detailed handovers before starting each shift and how they could approach the manager if they had any problems. However, staff also confirmed that formal one-to-one staff supervisions do not take place very often and the inspection of supervision and appraisal records confirmed this. Staff should receive formal one-to-one supervision on a regular basis, ideally at least six times a year. Inspection of the home’s maintenance records showed that the majority of regular maintenance work was up to date. This included the servicing of the home’s fire equipment, manual handling equipment and portable appliance testing. The home’s maintenance man completes regular checks of the homes fire alarms and equipment. However, it was noted that these tests do not get completed when the maintenance man is on holiday or of sick, sometimes resulting in long gaps between checks. Arrangements must be made to make sure that the necessary safety checks get completed on a regular basis and in line with the homes policies and procedures. It was concerning that the home’s electrical installations certificate expired in January 2006 and has not yet been renewed. It was also noted that the home’s fire risk assessments had not been up dated or reviewed since 2005. This must be updated, reviewed and the review must take into account recent changes to fire safety legislation. The home should seek guidance from the Fire Authority about this. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 23 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 2 2 3 2 X N/A 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 1 Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4(1), 5(1) &6 Requirement The home’s Statement of Purpose and Service User’s Guide must be reviewed to make sure that people have access to very clear information about the different types of care the home provides and how these are provided and managed. The provider must review the current documentation and practice around contracts and terms and conditions for residents and must ensure that a fair and clear system is in place The home needs to clarify what types of care it can provide and think carefully about how it will develop the service to meet the very different and individual needs of these people. Information about this should be provided to CSCI. Care plans should be reviewed regularly and kept up to date. The home’s medication policies
DS0000062500.V330923.R01.S.doc Timescale for action 30/06/07 2. OP2 5(3), (4), 5A & 5B 30/06/07 3. OP4 12(1), (4) 30/06/07 4. 5. OP7 OP9 15(2)(b) 13(2) 30/06/07 30/06/07
Page 25 Craigarran Care Home Version 5.2 and procedures need to be reviewed and up dated, particularly the areas covering the disposal of medication and the action to take in the event of a medication error. 6. OP29 19(9), (10) & (11) Where staff start work after a PoVA First check, but before their fully CRB is received, the supervision arrangements specified in the Regulations and the Department of Health Guidance must be followed. All staff should receive training on dementia and caring for people with dementia, due to the specialist dementia care service the home is registered to provide. The registered provider is required to undertake monthly unannounced visits to the home. Records of these visits should be maintained at the home and should be made available to CSCI on request. This requirement remains outstanding from the previous inspection – the original timescale of 01/03/06 has not been met. An up to date electrical installations certificate must be obtained. The home’s fire risk assessment must be reviewed and updated to be compatible with the recent changes in fire safety legislation. 30/06/07 7. OP30 18(1)(a) 31/12/07 8. OP33 26 30/04/07 9. OP38 23(2)(b) 30/04/07 10. OP38 23(4) & (4A) 30/04/07 Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 26 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 OP9 Good Practice Recommendations It is recommended that the temperature in the treatment room be monitored and any necessary action should be taken to ensure that medication is stored within safe temperature parameters. It is recommended that more space is provided for the storage of controlled drugs, so that they can be stored safely and without being damaged. Staff should be reminded to record the reasons why drugs have not been administered and to record the use of prescribed dressings and gels. 2. OP12 It is recommended that arrangements are made to cover the activity coordinators working hours and role when she is off work. The home’s policies and procedures should be developed and reviewed to include information on how to refer staff for inclusion on the Protection of Vulnerable Adults list. All staff should receive training on dementia and caring for people with dementia, due to the specialist dementia care service the home is registered to provide. Training in first aid should be provided to make sure that there is always an appropriately trained first aider on duty in the home. Training records in the home should be improved, to provide easily accessible information about the training staff have completed and when up date training is due. 5. OP31 The registered manager is expected to achieve a relevant management qualification (the Registered Managers Award or equivalent). The registered manager should have sufficient supernumerary hours to realistically fulfil her management
DS0000062500.V330923.R01.S.doc Version 5.2 Page 27 3. OP18 4. OP30 6. OP31 Craigarran Care Home duties within the home. 7. OP36 Care staff should receive formal supervision at least six times a year. The home’s manager should receive appropriate supervision. 8. OP38 Arrangements should be made to ensure that regular maintenance checks continue to be completed, even if the maintenance man is not at work for any reason. Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Craigarran Care Home DS0000062500.V330923.R01.S.doc Version 5.2 Page 29 - 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!
