Inspection on 14/11/06 for Craighaven Residential Home

This inspection was carried out on 14th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Craighaven Residential Home 05/08/08

Craighaven Residential Home 15/08/07

Craighaven Residential Home 02/03/06

Craighaven Residential Home 25/07/05

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

Churchill House Nursing and Residential Home

Field Farm House

Church Terrace Nursing & Residential Home

Fountain Court

The Forbury

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

CARE HOMES FOR OLDER PEOPLE Craighaven Residential Home Craighaven 4 Heath Terrace Leamington Spa Warwickshire CV32 5LY Lead Inspector Sandra Wade Key Unannounced Inspection 14th November 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Craighaven Residential Home DS0000063561.V318805.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. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Craighaven Residential Home Address Craighaven 4 Heath Terrace Leamington Spa Warwickshire CV32 5LY 01926 429209 01926 339686 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) Craighaven Limited Ms Diana Gibbs Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A sluice must be installed no later than 30/11/05. All outstanding requirements made at the unannounced inspection on 09/02/05 are met with agreed timescales. The Manager, Diana Gibb must obtain the Registered Managers Award by December 31st 2006. 2nd March 2006 Date of last inspection Brief Description of the Service: Craighaven provides care and accommodation for 35 older people and has specialist dementia care registration. The home is located in a residential street in the Milverton area of Leamington Spa, approximately 1 mile from the town centre. There are local shops, a post office, pub, hairdressers and churches located within half a mile of the home. Doctors surgeries, dentists, chiropodist etc, are readily available and within easy access of the home. Craighaven provides accommodation on three floors (lower ground, ground and first floor). Each area is accessed by a stair lift and some corridor areas and rooms have steps to access the rooms. There are four lounge areas. The home has a variety of equipment and adaptations including handrails, grab rails, mechanical and electrical hoists, adjustable beds, raised toilet seats and wheelchairs. There is a public telephone available. Service users can arrange to have a telephone installed in their own private room if they wish. The home is set in its own grounds and has an attractive enclosed paved garden area with various tables and chairs. Some of the doors from the main building to access the garden have steps but there is a ramp from one of the doors to allow residents with wheelchairs to access the garden easily. At the time of this inspection fees for the home ranged from £400 – £504. Extra charges are made for Chiropody (£10), hairdressing (£4 - £18), toiletries, newspapers and any activity projects carried out in the home. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Craighaven for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 9.00am and 7.30pm. Two residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (if possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Comments received are included where appropriate within this report. A pre-inspection questionnaire was received from the home on 22 May 2006, some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. What the service does well: The Commission received many comment cards from relatives with positive responses about the home. One comment stated “Craighaven have always cared for my relative with every kindness and I have nothing but praise and gratitude for their hard work”, another stated “wonderful care and lovely staff” and one stated “staff are very caring and friendly”. Staff were observed to be caring and supportive towards residents and residents observed were appropriately and smartly dressed. Various social activities are held in the home which residents enjoy and staff support residents to enable them to participate where needed. A full refurbishment of the home is in the process of being undertaken; those areas completed have much improved the premises for the benefit of the residents. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Service User Guide provided to prospective residents needs to include all of the required information to allow them to make an informed choice whether to stay at the home. Residents also need to receive written confirmation that following their assessment, the home can meet their needs. Care plans and risk assessments need to clearly state how care needs are to be met and care plan records need to clearly identify actions carried out to meet needs identified. Some issues regarding the privacy and dignity of residents and choice need to be reviewed such as sufficient screening in double rooms particularly where commodes are in use, the routine use of pinnies for residents and the limited choices of meals. Some matters relating to the management of infection control and hygiene need to be addressed such as the unpleasant odours identified in bedrooms, easy clean floor surfaces in the sluice and laundry and sufficient hand-washing facilities for staff. Staffing arrangements need to be reviewed to ensure residents receive effective care at all times. This in particular applies to sufficient staff being available to assist residents at mealtimes and ensuring staff do not work double shifts which could contravene the working time directive. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 7 Records need to show that new staff employed receive a suitable induction to the home which demonstrates their competency. In addition, all appropriate recruitment checks need to be carried out before staff work in the home to ensure the safety of the residents. Records relating to the management of residents pocket monies need to be reviewed to ensure they are clear with dated receipts which correspond with records. Health and safety practices need to be reviewed. This includes undertaking risk assessments in regard to the hot water and radiators and carrying out appropriate action to safeguard residents plus ensuring all health and safety checks are up-to-date. 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. Craighaven Residential Home DS0000063561.V318805.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 Craighaven Residential Home DS0000063561.V318805.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): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users receive some information about the home to allow them to make a decision about whether to stay at the home but do not receive written confirmation following their assessment that the home can meet their needs. EVIDENCE: A Service User Guide and brochure for the home are given out to prospective residents. A copy viewed did not contain a copy of the summary inspection report to help resident representatives make an informed decision if their relative should stay in the home. The guide did state a full copy of the report could be obtained from the home. Assessment records of residents were available on care files to confirm assessments are carried out before their admission to identify their needs. Details from these records had been transferred into ‘temporary’ care plans Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 10 which the home use for the first few weeks while they get to know a resident before final care plans are devised. It was not evident from records seen that the home write to residents following their assessment to confirm the home can meet their care needs which is a requirement. Craighaven Residential Home DS0000063561.V318805.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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place for each resident to confirm health, personal and social care needs but it is not always clear that these are being met. EVIDENCE: Throughout the inspection carers were observed to be caring and supportive towards the residents. Comment cards received by the Commission from relatives all confirmed they felt satisfied with the overall care provided. One person wrote “yes very good”. Five comment cards received from residents stated they “always” received the care and support they required. Care files were requested for two residents and were reviewed. Care plans had been written in a person centred approach and provided details about the person in regard to their senses, diet, touch, speech, smell, memory, mobility, oral health, washing and bathing, dressing, maintaining control and culture and fun. They also confirmed if the resident liked to have a cuddle which some residents were seen to enjoy during the inspection. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 12 Generally care plans stated clearly the care needs of residents but did not always state the actions required to address them. One care plan file stated the resident had poor sight and needed her glasses at mealtimes and bedtimes. There was no other information on how her poor sight could be supported such as large print notices, talking clocks or pictures as opposed to printed documents etc. Staff said that the resident could mobilise independently and records stated that the resident could become tired from walking a lot during the day. It was observed on the day of inspection that the resident required assistance to walk from the dining room to the lounge. Staff said that the resident had good days and bad days in terms of mobilising around the home. It was identified that this person had poor speech and was difficult to understand. Staff were able to communicate with the resident but care plan records were not clear on how to effectively communicate with the resident. It was not clear from records how this person’s oral health should be managed. The manager confirmed that the resident chose not wear their dentures. The care plan stated that this resident needed prompting to eat but this resident was observed during lunchtime to need full assistance and was fed by a member of staff. The care plan evaluation sheet completed in August 2006 confirmed the resident needed their meals liquidised and to be fed for all meals. It was advised that the care plan be updated to reflect this so that the support needed by this resident was clear to staff. Risk assessments had been completed and detailed the risks to the resident in terms of nutrition, falls and pressure areas but they did not detail the actions required by staff to manage these risks. Care records stated that the resident had fallen out of bed and staff had taken action to address this by moving the resident’s bed against the wall. The weight chart for this resident showed a slow decline in weight of 1lb a month from July to October, it was not clear this had been acknowledged by staff as there were no specific actions listed in address this weight loss. Daily records had been completed but there was only one entry per day and this was mostly focused on washing, dressing and references to the resident enjoying a meal. Daily records should demonstrate that the care needs identified are being met. A resident spoken to said they were happy in the home. It was evident from information held on the care plan file that this residents family had been involved in planning their care and documents were signed to agree with the Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 13 care plan in place. The file contained a “getting to know you form” to help staff to know the residents likes and dislikes and preferred daily routines. The care plan files clearly identified the residents care needs but did not always identify the staff actions required to address them. Records stated that the resident could get anxious and had a speech impediment but it was not clear how staff should manage these aspects of the residents care. It was noted that this person had fallen several times in the home and had a Parkinson’s disease diagnosis. A body map showing the location of an injury following a fall had been completed so that staff could easily identify the location of the injury and monitor the healing process. The mobility care plan said that sometimes this person could “shuffle” and there were days when the resident was unsteady. It was not clear from care records how these care needs should be managed and the daily records were not clear on how well this person was mobilising on a day to day basis. It was noted from the medication records that this person had been prescribed a medication to take several times a day to help control the Parkinson’s symptoms. A member of staff was observed to administer this to the resident when they were in the lounge. Files viewed contained details of contact with GPs to show health care needs were being followed up. Files also contained information on contacts with the Optician, chiropodist to show specialist support is accessed when required. A review of medication was carried out. The home have a medication trolley and a small medication room to store all medication held in the home. The medication room had limited space and blister packs of tablets were stacked on the floor. The Care Manager said that it was planned to move the medications to a different location so that they could be stored on racks on the wall. The home had suitable storage facilities for controlled drugs and staff were aware of the procedures in administering these. The Medication Administration Records (MARs) had been completed appropriately for Temazepam but the home had chosen not to record the usage of this in the controlled drug register. As a good practice measure this should be done but it is not a requirement. The MAR stated for one resident that they were to take “half Sinemet” and the where the ‘half’ was written on the box this had been crossed off and written over to state 1 Sinemet. The Care Manager said that this had been checked with the GP and it should read 1 Sinemet. Any handwritten entries on the MAR should be signed and dated and records should confirm any changes agreed with the GP so that it is clear the changes have not been made by staff. As the person taking this medication takes it seven times a day and there are only six lines on the MAR, this had resulted in staff squashing signatures in for Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 14 the seventh dose given making the record illegible and unclear whether the resident had received the medication. A medication had not been signed for on one day but it was missing from the blister pack suggesting that it had been given. Dakacort cream in the cabinet had no prescribing label. The care manager said that the label had come off it that morning. A pot of cream in one resident’s room contained a label with a different name on it. The manager did not recognise this person as being a resident in the home and suggested if may have been brought into the home by a member of the resident’s family. Two boxes of eye drops were not dated when opened so that staff could ensure they were destroyed 28 days after opening as required. The care manager said that medications are automatically disposed of when the new ones are delivered. An “O” had been used on the MAR in place of a signature but this had not been defined to show what it meant. A resident was independently using Dermol cream for a rash. It was not evident that a self-administration policy was in place to support the resident using this independently. Residents who self-administer should be assessed by the home to demonstrate they are competent and able to do this effectively. The Care Manager said that she had been checking the cream to ensure the resident had been using it and she felt confident the resident could use it independently. Loratadine tablets were checked, 30 were received, 18 were signed for as given and 13 were remaining. This adds up to 31 suggesting a tablet has been signed for that had not been given. Aspirin in the trolley for one resident had a worn label, the number received had not been recorded on the MAR so that staff could audit the amount received and given as being correct. The Care Manager felt a member of the resident’s family may have brought this into the home. A thermometer was available in the drugs fridge displaying the minimum and maximum temperatures although only one temperature was being recorded. Both temperatures should be recorded to demonstrate medications are being stored at safe levels consistently. In regard to the privacy and dignity of residents. It was observed that in one of the dining rooms all residents were wearing pinnies. It is accepted that on occasions this can help to residents to eat independently and in these cases an Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 15 assessment should be completed to demonstrate this. Many of the residents in this dining room appeared to eat without any difficulty and using pinnies all residents could be seen as compromising their dignity. During the tour of the home it was found that most of the bedroom doors were locked preventing residents from independently returning to their rooms. The manager said that this practice was already in place when she came to the home and it had been done at relatives request due to items going missing from residents rooms. If residents are known to wander into other resident’s rooms and take items, assessments should be completed showing how this is to be managed to prevent this. Locking doors restricts the freedom of residents as well as their choice and private time. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users enjoy the social activities provided but have limited opportunities to exercise their choice to maintain their independence and wellbeing. EVIDENCE: Activities are provided in the home and one of the carers organises these each week. Carers help to provide organised activities as planned. The manager said they aim to provide activities in the home each afternoon, seven days a week. Relatives are invited to join in some of the activities including the cream teas and sherry and mince pie evenings. The person who organises activities said that she organised giant snakes and ladders, skittles, hoop la, card games, colouring scenes, music, sing-along, Friday film day, musicals with pop corn and outings to Whittle Court which provides sheltered housing. The carer said it was planned to organise Christmas card making and they always made Wednesday and Saturday a pub night with games of darts for the residents. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 17 The carer confirmed that Tea dances are held in the home on a monthly basis and they move all the furniture in one of the lounges and ask families if they would like to be involved. It was observed during the tour of the home that they have an old-fashioned dolls house fully furnished. The manager said that they regularly take residents to this part of the home to view the dolls house and hold reminiscence sessions. In the entrance hall to the home there is a “walk in programme” displayed on the wall which basically is a map of the home showing where residents and visitors can walk to view items of interest such as the dolls house. Care plans confirmed residents interests. One resident spoken to confirmed they liked skittles and ball games which was reflected in their care plan file. Another care plan viewed stated that the resident liked music and “loves tea dances”. During the late afternoon residents were observed in one of the lounges dancing to music with staff. Residents were smiling and clearly enjoying this. One resident came out of the lounge where the dancing was taking place and went into the quiet lounge. They said that dancing was “not their thing” and not what they were used to and they preferred to sit in the quiet lounge. This person said that the staff used this lounge as a staff room but they didn’t mind the residents also using it. Staff said that it was used as a quiet lounge for residents but they also used a small area of it as there was nowhere else in the building that staff could use as an office or meeting point. It was observed during the inspection that staff handover to the next shift also took place in this lounge. While the dancing was taking place in one lounge, residents in the lounge next door were doing a large piece jigsaw puzzle with staff. It was not evident that the home keeps records of activities that residents participate in to demonstrate that all residents are accessing these and there is something of interest being provided for everybody. Five comment cards were received by the Commission from families who had completed these on behalf of the residents. Three of these confirmed that activities are arranged by the home that residents can “always” take part in. One said “usually” and one said “never” as the resident was “too frail and confused”. At lunchtime meals were prepared in the main kitchen and taken to the lounges a few at a time on a small open trolley. Each resident was provided with a meal and no choices of the main meal were offered. The meal was mashed potato, stew, dumplings, sprouts and mixed vegetables followed by rhubarb and custard. Menus did not show that choices are being made available; the manager acknowledged this was an area that needed to be improved. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 18 One resident spoken to said they liked fish and chips and this was their favourite meal. On viewing their care plan this information was confirmed. One resident said that the food in the home was “awful” and they were used to “good home cooking”. This resident said that they rarely had joints of meat and they were suffering health problems as a result. The resident also said that they did not have green vegetables and the vegetables that were provided were always soft. At lunchtime this resident ate most of their meal which included sprouts. A member of staff asked the resident if they enjoyed the sprouts and the resident said they had not been given any. They refused the desert so was offered yoghurt which they accepted. One resident was observed to push her plate away and say “that’s rubbish” and another resident replied “it’s how it’s cooked dear”. Comment cards received by the Commission in regards to the food showed that three out of five residents “always” like the food and two “usually” do. Two relatives have added comments to those ticked “always” to state “I can only assume my relative does, since being at Craighaven she has gained weight”. “The food smells at the home are good, never really present at mealtimes but we have received no complaints”. One of the dining rooms was observed during lunchtime. There was one carer to watch over and assist 10 residents. One of these needed one to one attention to be fed. The carer was at times standing up to feed this resident then at others sitting down, she was constantly distracted by the other residents while trying to feed the resident. This resulted in it taking an hour to feed the resident as they were having spoonfuls in between the member of staff attending to other residents. This would not have been a positive experience for the resident and the meal was not warmed up throughout this time meaning the resident would have been eating cold food. The member of staff was asked if she was always working on her own in the dining room and she confirmed that she was as staff were needed in the other dining rooms to assist other residents. One person was struggling with a knife and folk and the member of staff got up to change them for a spoon. Two residents had an argument and the member of staff got up to calm them down. One resident got up from their chair to leave, the member of staff again got up to encourage them to sit down. One resident would not eat her meal and this was hindered by the fact they would not let go of their doll. This person was encouraged by the member of staff to give them the doll but the resident would not let go despite her attempts and several attempts by other staff. This person did not eat their main meal but did eat their pudding still holding the doll. One resident was clearly hungry as they finished their meal very quickly and were looking for more. The resident next to her had left some of their meal Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 19 and this resident started to eat this. The residents whose plate it was snapped at the resident saying it was her plate. It was noted that staff delivering the meals did not ask residents if they wanted any more food. At teatime residents had their tea in the main lounge areas on small tables as opposed to sitting in the dining room. They had white and brown bread with slices of ham and beetroot. The kitchen was viewed and it was noted that the home are using Whole UHT milk and there was no fresh milk available to allow residents the choice to have this. Staff suggested that this was due to problems with storing fresh milk. Some of the dried food had been sealed with cling film ties as opposed to sealed containers. The carer working in the kitchen transferred these dried food to sealed containers straight away. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 20 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. Procedures are in place to manage any complaints or allegations of abuse effectively to ensure the protection of residents. EVIDENCE: The Commission has not received any formal complaints about this home but a concern was raised by a relative in regard to the management of their relative following a fall. This person was asked to raise their concerns with the manager of the home so that a full investigation could be undertaken. The manager advised that this person had chosen not to contact her. No complaints had been documented in the home’s complaints register and the manager confirmed there had been no allegations of abuse. Comment cards received from 13 relatives confirmed that ten people were aware of the complaints procedure, two were not and one did not answer. All relatives who responded said that they had not needed to make a complaint. It was evident from training records that most staff have attended training on the identification and prevention of abuse. Staff spoken to said they would report any abuse to the manager and complete the relevant paperwork stating what had happened. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 21 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, 25, 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 subject to ongoing refurbishment to provide a safe, pleasant and well-maintained environment for the residents. EVIDENCE: This home is subject to ongoing refurbishment and due to the number of areas identified to be redecorated it is likely this will be ongoing for some time. Areas completed to date include a new kitchen, 12 bedrooms, hall stairs and landing at the front of the building, new chairs in the lounges and a redecorated dining room including newly covered chairs. Areas viewed had been pleasantly decorated and completed to a good standard. Not all areas of the home had signs to assist residents in locating the different areas in the home. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 22 Access around the home is via a variety of staircases which have stair chairs, there is no shaft lift to support wheelchairs. A hairdressing sink is available in one of the toilets by lounge 3 which is used to provide a hairdressing service to the home. Bedrooms viewed contained personal items to make them homely and most were clean and tidy. Some of the rooms had patio doors with steps leading to the outside patio area as opposed to ramps which would be easier to manage for those with mobility difficulties. A large ramp was available to access the patio area from the main building. Two of the bedrooms viewed had an unpleasant odour. Twin rooms viewed had portable screens as opposed to full screening such as a curtain which could provide more privacy when residents are using commodes or receiving personal care. One of the twin rooms had a commode but no portable screen at all. One of the rooms seen had a hard surface red floor and some rooms had mop buckets in the ensuites. Some of the ensuites did not have storage areas for toiletries. The manager said the home was short on storage space and she acknowledged that there are still many areas of the home requiring decorating. Some of the rooms did not have towels and the manager said that staff remove these and replace them once they have been laundered. This means that if the resident should return to their room they would not have towels available to them. The manager said there were sufficient supplies of towels in the home to replace these at the same time the others were removed. During the tour of the home it was found that several radiators did not have covers to protect residents from the hot surfaces. Hot water temperatures tested in several rooms were hot and above the recommended 43°C which could present a scald risk to residents. The sluicing facility in the home is situated on the first-floor and is not easily assessable from all areas of the home particularly if transporting commode pots for cleaning. The walls in this area have been plaster boarded but had not been sealed to allow for effective cleaning. Half of the floor in this room was carpeted which also would not allow for effective cleaning of any spills etc. There was a handwash sink with liquid soap for staff to wash their hands but no gloves or aprons to support good infection control practice. Large fans were stored in the sluice room which is considered as a “dirty” area, and not suitable for storage. The manager advised later in the inspection that the fans had been removed. Records had been completed to show areas cleaned in the kitchen and the kitchen was clean and tidy with the exception of the microwave which was food splattered. Some of the records had not been dated to confirm how often Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 23 equipment and areas were being cleaned. Fridge temperatures had been recorded daily to show food was being stored safely. The laundry contained one washing machine and two tumble driers to cater for the washing of 35 residents. The person who does the laundry said that if there is a problem with any of the machines, the contractors come out the same day to complete repairs. The laundry is situated in the basement of the home and is transported into the laundry in white bins. It is then sorted into 6 black bins which are labelled towels, underwear, kylies, bedding, day clothes and jumpers. The laundress has a uniform specifically for working in the laundry and there is a sluice sink available in the laundry to use for heavily soiled clothes. The washing machine also has a sluice cycle. There was no dedicated hand wash sink for the laundress to wash her hands and there were bars of dirty cracked soap available as opposed to liquid soap to wash hands. The floor in the laundry was painted but large areas were chipped preventing the floor from being sufficiently sealed to effectively clean it. The floor looked dirty in areas and the laundry area generally was cluttered. The laundress said that the manager was planning some changes to the laundry to improve this. The laundress said that she works for four hours a day in the laundry and confirmed that the night care staff also do bedding and towels to help. This would take carers away from the resident areas and reduce support available to residents during the night. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 24 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing is sufficient but arrangements are not always effective to ensure resident’s needs are met at all times. Staff training is being provided on an ongoing basis but the recruitment practices of the home are not sufficient to ensure the protection of residents. EVIDENCE: The manager advised that they aim to provide six care staff between 8am and 1pm, five carers between 1pm and 9pm to care for 35 residents. In addition the Deputy Manager is also available and the Manager of the home works in a supernumerary capacity. During the night there are two care staff available plus two additional care staff who sleep in should they be required. There is a cook available in the home seven days a week from 8am to 1pm and a kitchen assistant who works for seven days a week from 1 – 5pm. The manager advised that there are staff who provide housekeeping duties such as laundry and cleaning for 60 hours per week over a six day period. The day when there is no cleaner on duty, care staff complete any cleaning required. On the day of inspection the cleaner was off sick and carers were doing any immediate cleaning tasks required. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 25 Duty rotas show that on some days there are seven care staff including the Deputy Manager but on other days there are 6 staff including the Deputy Manager during the morning up to 1pm. During the inspection it was observed that staff were always busy but at lunchtime it was particularly busy due to the support needed by residents. Comment cards received by the Commission from relatives confirm they feel there are sufficient staff on duty in the home and all comment cards from residents, some of which were completed with support, state they feel staff are available when they need them. The manager confirmed there are 27 carers working in the home and ten had completed a National Vocational Qualification (NVQ) II in Care to help them provide effective care to the residents. The care standard states that 50 of care staff should achieve this to ensure there are sufficient numbers of suitably qualified staff to meet the needs of the residents. The manager said that five staff were currently undertaking the training which would bring the home up to the required standard. Induction training is completed based on the TOPSS principles and the Care Manager signs to confirm each part of the induction completed. Staff competencies and understanding of the areas covered were not demonstrated through records available. The staff file for one carer was viewed and this did not show the dates each unit of the induction had been completed. The manager said that there is an ongoing programme of statutory training for staff such as moving and handling, food hygiene and fire safety. In addition other training appropriate to the work they carry out is also provided such as dementia care. Two staff records were reviewed to confirm recruitment practices carried out. Both of these contained completed application forms but one of these had gaps in employment. The manager said that this was due to the member of staff being at college. Both staff had not commenced a formal induction to the home to ensure they had been deemed safe and competent to manage the residents. The manager said that training was planned to commence soon. One file contained one written reference as opposed to two which is a requirement. The manager said that a verbal reference had been obtained but not recorded. Both staff had been employed to work at the home before the receipt of a Protection of Vulnerable Adults (POVA) check or Criminal Record Bureau (CRB) check which is poor practice as this could compromise the protection of the residents. The manager stated that she had been experiencing problems Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 26 with receiving the checks in good time when the home needed to employ more staff. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 27 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is suitably experienced to run the home and is able to discharge her duties fully. Some actions are required to address the management of money and health and safety matters to ensure residents can be fully protected. EVIDENCE: The manager has many years experience of working in a management capacity within a care environment and commenced the position of manager at Craighaven in June 2005. The manager said that she is currently undertaking the Registered Managers Award qualification and confirmed this would be completed by December 2006. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 28 The manager advised that she had forwarded questionnaires to all relatives in July 2006 to assess their views on the care and services provided at the home. The results of these had not been collated and published so that residents and relatives could see the outcome of these. At a glance most of the responses to questions asked were positive. The manager said that it was planned to start a Relative Support Group in February 2007 to allow relatives to be more involved in the home. Comment cards received by the Commission from relatives were positive in their responses. One comment stated “Craighaven have always cared for my relative with every kindness and I have nothing but praise and gratitude for their hard work”, another stated “wonderful care and lovely staff” and one stated “staff are very caring and friendly”. A review of resident’s pocket money was carried out. Records in place were not fully clear in regard to what residents had spent their money on. One record showed that £4.00 had been spent but did not say what for; the manager said this would have been for hairdressing. One record only listed the person’s first name and did not state what they had purchased. Individual receipts were not available for all transactions. One chiropody receipt was dated 17.6.06 but it was not evident residents had received chiropody on this date making it difficult to audit records. Health and safety records were reviewed to confirm checks carried out. Gas safety had been checked and a certificate issued on 21 August 2006 to confirm this was acceptable. The pre-inspection questionnaire for the home showed a 5 year electrical wiring test was completed in September 2003. Records showed that a fire lecture was next due on 16 November 2006. A fire risk assessment for the home had been completed and the manager had identified that smoke detectors were not available in some rooms. A letter was seen showing that the manager had made contact with the fire service about this. The manager advised it was planned that the fire service visit the home to undertake a full risk assessment so that any matters requiring attention could be identified and addressed. Hot taps within the home do not have temperature controls to ensure the water can be kept at a safe level to prevent scalding. Water temperature records showed these were last tested in June 2006. Water temperatures should be close to 43°C and as a good practice measure should be tested monthly to ensure hot water is being maintained at a safe level. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 29 The manager said it was planned to employ a maintenance person for the home who could undertake health and safety checks as required. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 30 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 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 31 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 5 (1)(d) Requirement The Registered Person must ensure a service user guide is available with all of the required information. The Registered Person must confirm in writing that following the assessment of a resident, the home can meet their needs. The Registered Person must ensure that care plans clearly state staff actions required to meet care needs and confirm that these are carried out. Risk Assessments must be completed to show actions required to manage the risks identified. 4. OP9 13,17 The registered person shall make 31/12/06 arrangements for the recording, handling, safe keeping and safe administration of medicines received into the care home. Issues as detailed in the body of this report must be addressed. Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 32 Timescale for action 31/01/07 2. OP4 14(1)(d) 31/01/07 3. OP7 12,13 31/01/07 This includes ensuring all medications are clearly labeled to ensure they are only used for the person they are prescribed for. 5. OP10 12(4) The Registered Person is to review the practices in the home which compromise a resident’s privacy and dignity. The Registered Person shall so far as is practicable ascertain the wishes and feelings of residents in regard to care and services they receive. The registered person is to show that the home is being conducted in a way that maximizes service users personal autonomy and choice. The Registered Person must be able to demonstrate that wholesome and nutritious food is being provided consistently which is varied (eg a menu showing choices made available for each meal). The Registered Person must ensure the premises are suitable to the needs of the service users and that suitable adaptations are made to the premises to support this. (eg signage, ramps, handrails). The Registered Person must ensure the home is safe for residents and any risks to their health and safety are managed. This in particular applies to hot water and hot radiators. (eg radiator covers and thermostatic mixing valves). The Registered Person must DS0000063561.V318805.R01.S.doc 31/03/07 6. OP14 12 (2)(3) 28/01/07 7. OP15 16, 14 28/02/07 8. OP19 23 31/03/07 9. OP25 13 31/03/07 10. OP26 16 28/02/07 Version 5.2 Page 33 Craighaven Residential Home ensure there are effective systems and procedures in place for managing infection control and hygiene within the home. Issues as identified in the body of this report are to be addressed. 11. OP27 18 The Registered Person must ensure that staffing arrangements are sufficient to support the needs of the residents. This in particular applies to mealtimes and the prevention of staff working double shifts such as a day shift followed by a night shift which can contravene the Working Time Directive. Duty rotas must show “sleep in” staff. 12. OP29 17, 19, Sch 2 The manager must ensure that recruitment procedures are robust and that staff files contain evidence of all information as specified in Schedule 2 of the Care Homes Regulations 2001. References and Criminal Records Bureau disclosures must be obtained for all staff appointments prior to commencement of employment. (Outstanding from 30/08/05) 13. OP30 18 The Registered Person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home. New staff must receive effective training appropriate to the work they are to perform and which demonstrates their competency. 31/01/07 31/01/07 31/01/07 Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 34 14. OP35 20 The Registered Person is to review the management of resident monies to ensure there are clear records of all transactions and clear receipts are available to confirm these. The Registered Person must ensure all health and safety checks are up-to-date and address matters as detailed in the body of this report. 31/01/07 15. OP38 23,13 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations It is advised that records are kept of residents who participate in social activities to show that all residents are benefiting from these. It is advised that the use of pictoral aids or photographs are considered in aiding communication and menu choices. It is advised that an up-to-date refurbishment plan is devised showing all remaining works to be done in the home demonstrating that the issues raised in this report will be addressed. It is advised that once the manager has completed the report on the outcomes of the quality satisfaction surveys, this is made available to service users and their representatives. 2. 3. OP15 OP19 4. OP33 Craighaven Residential Home DS0000063561.V318805.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. 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