Inspection on 15/08/07 for Craighaven Residential Home

This inspection was carried out on 15th August 2007.

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 14/11/06

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 Unannounced Inspection 15th August 2007 08:45a 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.V342336.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.V342336.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 vacant post Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Craighaven Residential Home DS0000063561.V342336.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 home may accommodate one named service user over the age of 60 years. 14th November 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 is no shaft lift available in this home to accommodate wheelchairs to access the upstairs 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 £399 - £530 per week. Extra charges are made for Chiropody (£10), hairdressing (£4 - £18), some toiletries, newspapers and any activity projects carried out in the home. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place from 8.45am to 7.05pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Upon the receipt of this a number of questionnaires were sent out to service user families to ask their views about the home. Seven questionnaires were returned and information contained within these plus the AQAA are detailed within this report where appropriate. Two people who were staying at the home were ‘case tracked’. This involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide, staff duty rotas, social activity records, kitchen records, accident records, financial records, health and safety records and medication records. Since the last inspection the manager has left the home and the provider was therefore present to support the inspection process throughout the day. A tour of the home was undertaken and the inspector spent time speaking with residents, visitors and staff within the home. What the service does well: All residents are assessed prior to their admission to the home so that the home knows whether they can meet the needs of the resident. The staff are friendly, caring, approachable and have a good rapport with the residents. A comment card from a relative stated, “the staff at Craighaven do a wonderful job in sometimes difficult circumstances they are always friendly and helpful and should be commended for doing a good job”. Another stated “The care home always makes us feel welcome when we visit X and we know we can visit anytime of the day or night. X is always very clean and never smells of urine. X is well cared for and all X needs are met. There are always Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 6 plenty of staff around and all of them seem well informed of each persons needs. We are very happy with our choice of care home for X”. Visitors to the home are made to feel welcome and those spoken to were complimentary of the home and the staff. Residents are provided with appetising meals, which they enjoy. Many of the residents enjoy social activities provided by the home and staff are dedicated in assisting residents to join in and enjoy themselves where possible. A relative comment card stated, “the staff seem to have infinite patience and fabulous sense of humour. They try hard to change the environment with decorations for Valentines Day, St Georges Day etc. They have a range of activities to stimulate the residents”. What has improved since the last inspection? What they could do better: Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 7 Care plans continue to need further work. Records need to clearly state all care needs of the residents and detail the staff actions required and carried out to meet these needs. Failure to do this can result in an oversight in care. Risk assessments require further review to ensure all risks to residents are fully identified with sufficient action plans to manage the risks. This includes appropriate action to manage the risk of a resident locking themselves in their room and forgetting how to get out and how residents who cannot reach or remember how to use a call bell are to be managed. The home must be able to demonstrate that where specialist interventions are identified as required such as advice or treatment from the District Nurse, this is followed up accordingly to ensure the care needs of the resident are addressed and recorded. Some further attention is needed for the effective management of medications. Records need to clearly show prescribing instructions are being followed. Medication Administration Records (MARs) must consistently show that medications prescribed have been given. Staffing arrangements in the home should be reviewed to ensure care staff are not being taken away from caring duties to do ancillary tasks which both compromises effective infection control procedures as well as reduces the amount of time carers have with residents. A review of care staff working double shifts also needs to be undertaken as staff can become less effective in working with residents and this also can compromise the Working Time Directive. Duty rotas need to clearly illustrate how staff are utilised in the home by defining any codes used to show care staff undertaking other duties. Night staff need to be clearly indicated. This is so the amount of hours dedicated to care and services can be accurately defined and deemed sufficient for the care of the residents. The home need to consider equality and diversity issues linked to the care of the residents. This includes providing menus and the Service User Guide in alternative formats such as large print or pictures so they are more accessible to people who are to use the service. Staff training records need to be developed so that ‘at a glance’ it is possible to see which staff have done all of the required training and which staff, if any, still need to complete this. Records should also show any training linked to the care of the residents such as dementia care, diabetes etc. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 8 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.V342336.R01.S.doc Version 5.2 Page 9 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.V342336.R01.S.doc Version 5.2 Page 10 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): Standards 1,3 and 4 assessed. Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. 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. Residents are assessed prior to their admission to ensure their needs are identified and the home know they can meet these needs but copies of the records are not routinely held on the care plan files so that staff can access these when planning and reviewing the care of service users. It was however Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 11 evident that information obtained at the assessment stage had been transferred into care plan records. 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. The provider agreed to address this matter. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9 10 and 11 assessed. Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Throughout the inspection carers were observed to be caring and supportive towards the residents. Of the seven comment cards received by the Commission from relatives, five responded that the home “always” meets the needs of their relative, one relative did not respond and one stated that the home “usually” met the needs of the service user. A service user spoken to during the inspection said that they liked it at the home and staff were “good” they were unable to explain further details about their care due to difficulties in remembering. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 13 A relative comment card received by us stated “X is always very clean and never smells of urine. X is well cared for and all X needs are met. There are always plenty of staff around and all of them seem well informed of each persons needs. We are very happy with our choice of care home for X. Care files were requested for two residents and were reviewed. Care plans provided details about the person in regard to their senses such as diet, touch, and smell and also included details of the person’s speech, memory, mobility, oral health, washing, bathing and dressing. They also confirmed if the resident liked to have a cuddle. One of the two care plans viewed contained a “getting to know you form” which listed the names of relatives of the service user, where the person grew up and hobbies etc so that staff could use this information to support the service users care. Care plans did not consistently detail medical needs and how staff should manage them. One person was noted to suffer from TIAs (mini strokes) but there was no action plan in place for staff to monitor these or to state what actions they should take if they should observe the resident to have had a TIA. The care plan stated that the resident was not able to use a call bell to summon help but there was no risk assessment in place to show how this risk should be managed to ensure the resident received suitable care to monitor their condition. Care plan notes made reference to a resident having the district nurse to change a dressing on their leg but it was not clear what for. A hospital admission record showed that this person had suffered a wound to their leg in June; there was no care plan in place for the management of this. Care plan records repeatedly stated that care plans had been reviewed and there was “no change” and yet it was clear from reading daily records and other records on file that changes had occurred. One person for example developed a rash – there was no care plan devised to manage this but medication records revealed that the GP had prescribed a cream for it. Care plan records were insufficient to show how physical and verbal aggression should be managed to ensure a consistent approach by staff in managing this. Daily records for one resident stated that they “screamed a lot” when staff had assisted them with personal care and the resident was “very angry” and had caused damage to their room. There was also reference to the resident “hitting” staff but there was no care plan in place showing how staff should manage this aggression. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 14 Where residents were indicated to have mood swings, care plans were not sufficient in detailing staff actions to monitor these to identify triggers or to detail how these should be managed for each resident. One care plan stated “tearful and anxious needs lots of reassurance” but did not state in what way this reassurance should be given to help the resident. One care plan referred to a resident having “muddled” speech but stated staff could communicate through facial and body expression. It was not clear that other methods of communication such as pictoral aids had been tried or used to communication with the resident. Files did contain information on contacts with the Optician and chiropodist to show this specialist support is being accessed when required. A care plan for a resident who had passed away was requested to establish how this person’s care was managed in their final days. The death certificate received by us did not record of the cause of death although the home had been in receipt of the death certificate. A daily record entry stated that the resident had developed a pressure sore and the District nurse was to be contacted the following day. There was no record of the district nurse being contacted or visiting and no care plan had been devised to manage the pressure sore. It was evident that due to the deterioration of the resident they were spending long periods in bed and were not eating well. Records showed that the resident was of a low weight before they became ill and lost additional weight due to their illness. Records in place indicated that the food intake of the resident had only been monitored several days before the resident died as opposed to prior to the person becoming ill when they were of a low weight. A nutritional risk assessment had been completed but it was not clear what actions were required to be carried out as a result of this. Food intake records showed minimal food intake suggesting the person was receiving insufficient nutrition. Staff said the GP had said the resident could only take fluids due to swallowing difficulties – this agreement was not clear from records in place. This matter was discussed with the provider with a view to suitable food and fluid intake charts being implemented when there are signs that a resident’s health is deteriorating or they are of a low weight due to insufficient nutritional intake from food and fluids. The provider took immediate action to obtain a more comprehensive nutritional risk assessment, which would ensure staff took suitable actions to review the food and fluid intake of residents to maintain their health. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 15 It was also not evident that the GP had been contacted following a fall, which resulted in injuries to the resident. The risk assessment for falls had not been reviewed since March 2007. The provider established through discussions with staff that a relative had requested cot sides but these had not been provided. The provider agreed to implement a better system to allow visitors and relatives to record any requests to ensure these would be followed up. A review of medication was carried out and overall these were managed effectively. Since the last inspection extra space has been allocated for the storage of medications to prevent some of them being stored on the floor. The home have a medication trolley, a small medication room and a cupboard to store all medication held in the home. Appropriate secure storage facilities are available for controlled drugs and staff were aware of the procedures in administering these. The controlled drug register had been completed appropriately to show medications given but the Medication Administration Record (MAR) had not been completed. As a good practice measure the MAR chart should also indicate controlled drugs given. For one resident, the prescribing part of MAR said a cream was to be applied three times a day but staff had only written in two times for it to be given so it would only have been applied twice. The member of staff assisting the inspector changed the records to ensure this would be used as prescribed. Some medications had lines through them with no explanation why. A member of staff said this was because the GP had stopped the medication. Any handwritten entries on the MARs should be dated and signed and indicate agreements with GPs. A bottle of paracetamol was being used as a homely remedy so that if a resident needed pain relief, a tablet could be given. Although tablets given from this bottle had been given to one resident and recorded on the back of the MAR, there was no individual record for the paracetamol so that it was clear how many tablets there were to start with and how many were being used each day so that staff could audit they were being used appropriately. It was noted that the amount of medications being received each week were not always accurately reflected on the MAR. This applied to Lactulose and Diprobase cream. The home needs to ensure MARs accurately reflect what is received each week. MARs had not been routinely signed when “Forticreame” and “Fortisips” were being given so that it was clear the resident had received these. In regard to the privacy and dignity of residents. 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. Staff explained that this was Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 16 done because some residents wander into other resident’s rooms and move or take things out. The layout of the home prevents staff being able to monitor residents all of the time. 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. Generally the privacy and dignity of residents is maintained but some attention is required to monitor residents using toilets and bathrooms to ensure doors remain closed to retain their dignity. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 17 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): Standards 12,13,14 and 15 assessed. Quality in this outcome area is good. Service users have access to social activities and are able to exercise some choices regarding their care. Service users enjoy the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Social activities are provided and there is an Activity Co-ordinator in post who works 20hrs per week. At the time of inspection the Activity Co-ordinator was off sick and this had affected the amount of activities being provided. In the entrance hall to the home there is a “walk in programme” displayed on the wall which is a map of the home showing where residents and visitors can walk to view items of interest such as the old fashioned dolls house. The dolls house is fully furnished and is situated in one of the corridors in the home. Staff reported at the last inspection that this is used for reminiscence sessions. The provider said that activities provided in the home included bingo, tea dances, films, sing-alongs, exercises, board games, music, newspapers, visiting entertainers and activities of daily living such as dusting and helping with laundry tasks. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 18 There is no activity schedule in place within the home to evidence the range and frequency of activities provided and the annual quality assurance (AQAA) document provided by the home does not give any detailed information on the types of activities provided. There are systems in place to record activities that residents take part in and the provider stated some of the residents had recently visited Whittle Court to play skittles. Some residents appeared contented to sit in the lounge and listen to music or interact with staff as they came into the lounge. Others were seen wandering around the home frequently suggesting they were in need of something to occupy or stimulate them. Some residents attempted to play a game of magnetic darts with staff but staff had to spend a lot of time trying to explain to residents how this worked. It was suggested that a further review of the range of activities, which would then include a wider range of residents. A relative comment card received by us stated “there are lots of activities that X can join in if X wants to” the relative stated that the resident had said “time passes very quickly”. Another relative stated when referring to staff “as far as I can tell they put their efforts into the aspects of care that make the most difference to residents such as the activities, keeping the home looking pleasant and stimulating” The provider stated that weekly religious services are held in the home and residents are supported according to their wishes to attend. Specific information on service user choices is detailed within their care plans such as whether they like the light on at night, what evening drink they prefer and special dietary requests. During the inspection visitors were made welcome to the home and one confirmed that entertainers do come into the home for residents and the meals “always looked nice”. There is no permanent cook employed at this time, and allocated carers were sharing this role. The provider said that attempts had been made to employ a cook but he had not been successful in recruiting to-date. On the day of inspection the main meal choices were bacon, sausage and liver with onions in gravy with potatoes and vegetables, the desert was peach and pear crumble or yoghurt. The meals looked appetising and residents appeared to enjoy their meals. The atmosphere in the dining rooms was calm and organised and much improved from the last inspection. It was established that those residents who get agitated around other people at lunchtime had been Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 19 seated in the lounge areas with their own tables to help minimise their agitation and allow them to eat their meals without disruption. Staff fed those residents needing their assistance before the main lunchtime of 1pm so that they could dedicate sufficient time to do this sensitively. Choices of meals available were listed on menus on the wall near the dining area. Picture format menus were not available which could help people with dementia to better identify with the meals being provided. The kitchen was viewed and found to be clean and tidy. Fridge temperatures were operating at appropriate levels for the safe storage of food and food in the fridge had been labelled and dated. It was observed that the home continues to use UHT milk as opposed to fresh milk. The provider said that it is planned that this is reviewed so that residents can have fresh milk. Craighaven Residential Home DS0000063561.V342336.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): Standards 16 and 18 assessed. Quality in this outcome area is adequate. Procedures are in place to manage any complaints or allegations of abuse but these are not always managed effectively to ensure the protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is in place and this is detailed in the Service User Guide. The procedure does not give the actual names and addresses of the person to contact or detail the investigation process to help those people who do not visit the home regularly to know who to contact. Despite this, six out of seven comment cards received by us from relatives confirmed they know how to make a complaint. The complaints book contained details of one complaint regarding the treatment of a resident following a fall and it was evident the home were involved in investigating issues relating to this. Since the last inspection, we have received concerns regarding the care of two residents in the home, which suggested there was reluctance by the home to take on board comments made and to act upon these. It was not evident that the home routinely record things people are not happy about or comments, suggestions and compliments from residents and visitors. The provider gave a commitment to look at improving systems within the home to record these to demonstrate the home take comments received seriously. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 21 The provider said that most staff had completed training on the protection of vulnerable adults. This was confirmed at the previous inspection to the home and staff were aware of how to report abuse should they observe this. It was of concern that during the inspection a resident was found shouting, “help me” from inside their room. Their door was locked and could not be accessed by the inspector and a member of staff had to be called for. The staff member advised that the resident must have locked the door from the inside and advised other residents had also done this. It was established that the resident would not remember how to use a call bell to seek staff assistance. This matter was discussed with the provider with a view to prompt action being taken to review the locking systems on bedroom doors. Concerns were raised that due to the dementia diagnosis of residents they would not necessarily remember how to unlock the doors meaning they would be locked inside their rooms. The provider agreed to address this. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 22 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): Standards 19, 25 and 26 assessed. Quality in this outcome area is adequate. The home is subject to ongoing refurbishment to provide a safe, pleasant and well-maintained environment for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home is subject to ongoing refurbishment and this is due to continue for some time. Areas viewed had been pleasantly decorated and completed to a good standard. There are four lounge areas and those viewed looked homely with old-time pictures on walls. Since the last inspection actions have been taken to install radiator covers and thermostatic mixing valves to hot taps to control the temperatures and some of the furnishings have been replaced. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 23 Access around the home is via a variety of staircases, which have stair chairs; there is no shaft lift to support wheelchairs. Corridors are not very wide to effectively support residents confined to the use of wheelchairs. The home has an attractive enclosed paved garden area with various tables and chairs for residents to use in finer weather. Since the last inspection handrails have been fitted to the outside steps from bedrooms so assist residents when accessing the garden. There is also a ramp that is available for those residents who use wheelchairs. All bedrooms in home are kept locked, staff confirmed this is being done because there are a lot of residents that wander into other residents’ rooms and take things. This prevents residents being able to freely return to their rooms and having to rely on staff to unlock doors for them. This matter requires continuing review to ensure resident choices and independence is not reduced. A hairdressing sink is available in one of the toilets by lounge 3 that 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 that would be easier to manage for those with mobility difficulties. A large ramp was available to access the patio area from the main building. In one room the blind was missing from the window and there was no towel rail. The provider said that the service user had pulled the blind down and plans were in place for this to be put back up. This room had a call bell switch as opposed to a lead that the resident could access when in bed. The provider stated that those rooms with a switch could not have leads fitted to them but the resident in the room in question was not able to use the call bell. The home will need to ensure appropriate risk assessments are in place for those residents who are unable to access the call bell when in their rooms. One room had a hard floor as opposed to carpet and was in need of painting due to stains on the ceiling and woodwork. The room looked stark in comparison with other rooms in the home. The provider said this was one of the rooms due for refurbishment. In the corridor area near to the dolls house, the plaster was exposed and there appeared to be water damage to the ceiling and wall. This is in need of decorating. Some bathrooms had raised toilet seats to assist residents and liquid soap and paper towels were available to aid good hygiene practices. In one bathroom Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 24 there were toiletries on the bath and sink suggesting these could be used communally. All toiletries should be named and kept in resident’s rooms to ensure they only use them; this promotes good infection control practices. There was also a hoist stored in this bathroom and a large storage box making the bathroom cluttered and less homely. Appropriate storage facilities need to be available for equipment used in the home. A shower room viewed had no paper towels for residents to dry their hands and also contained toiletries, which were not labelled. During the tour of the home it was noted that there were baskets of laundry around various areas in the home including corridors and resting on a stair chair. A member of staff said that they use the sheets and towels in the baskets to make the beds and replace the towels once service users are up. It was explained that the night carers do the laundry and leave it in baskets for day staff to use. The laundry was viewed and was well organised for managing a dirty to clean flow of washing. Gloves and aprons were available and since the last inspection a hand wash sink has been fitted although there was no liquid soap or paper towels for staff to wash and dry their hands. There remains one washing machine to cater for all laundry needs of the home and the provider said this was something they were going to review. The home does have a sluicing facility for cleaning commode pots etc but this is situated on the first-floor and is not easily assessable from all areas of the home. Since the last inspection action has been taken to plaster the walls and paint these and a new sluice machine has been purchased. New flooring had been fitted but liquid soap was not available for staff to wash their hands. Inappropriate items stored in sluice at the previous inspection had been removed. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 25 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): Standards 27,28,29 and 30 assessed. Quality in this outcome area is adequate. Some attention to staffing arrangements in the home is required to ensure care and services provided to residents are effective at all times. Staff training is provided but records need to demonstrate this consistently to show staff are competent to carry out their roles safely and effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection to the home the manager advised that they aimed to provide six care staff between 8am and 1pm, five carers between 1pm and 9pm to care for 35 residents. During the night she stated there is two care staff available plus two additional care staff who sleep in should they be required. In addition to this the Deputy Manager was available and the Manager was working in a supernumerary capacity. Since the last inspection the manager has left and one of the owners has been working in the management role. He confirmed that there has been no change to the staffing numbers for the home. Duty rotas showed that sometimes the staffing arrangements planned for the home are being met and at other times they are not. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 26 It was identified that there is no dedicated cook working in the home and two carers were covering this role. It was evident that caring staff were also carrying out laundry duties prior to the member of laundry staff coming on duty at 11am. Care staff said that once they have got residents up they make the bed, clean the sink, refresh the towels and then make the residents breakfast in the dining room. When care staff are required to undertake non caring duties, this inevitably will reduce the amount of time they can spend with the residents. It is also poor infection control practice for carers to be complete both “clean” and “dirty” tasks when dealing with residents. Staff confirmed that the domestic staff hoover and clean the rooms but if cleaning staff are not available they are expected to pick up any immediate cleaning required. The laundry person confirmed that she does as many loads of washing that the one machine will allow when she is working in the laundry. A relative comment card received by us stated “obviously there are constraints because it is a business and illness amongst several staff members at the same time poses problems occasionally but there are no examples where I would/could identify significant problems. The provider explained that it was planned to trial a new system of working whereby cleaners would follow on from carers so that they could carry out any cleaning tasks including changing the bedding to prevent carers having to do this. This would allow the carer time to spend with residents. It is not clear from duty rotas what codes written on them mean such as “c”, and “k”. The provider explained that “c” meant the carer was working in the kitchen in the morning and “k” meant the carer was working in the kitchen in the afternoon. Where codes are written on the rotas these need to be defined so that the number of care hours allocated to other duties are clear and it can also be confirmed there are sufficient laundry and kitchen hours being provided. Rotas also need to make it clear which staff are completing night duty. It was observed during the inspection that staff were friendly and had a good rapport with the residents. They were supportive and caring and there were many positive comments made about staff working in the home from relatives. One relative comment card received by us stated that the person “wishes to thank all staff at Craighaven for doing such a fabulous job to make X feel welcome at the home since X joined you”. Another comment card stated “Craighaven has very caring staff…... “I feel satisfied at the care X receives. Any care home could do with more staff so Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 27 each person has a one to one care. But this is the real world and we know that is not going to happen”. Another comment cards states “whenever I visit X, X thanks me for finding a place at Craighaven”, “X always says how happy they are to be there, how friendly everyone is”. The provider advised there are 29 carers working at the home, 26 of these are female and three are male. Of these there are ten staff who have achieved a National Vocational Qualification (NVQ) II in Care and there are two staff who have nurse qualifications. There are a number of staff that are currently undertaking this qualification. 50 of staff will then be qualified to this standard. This training helps staff to provide more effective care to the residents. Certificates held in the home confirmed that many staff have undertaken training on an ongoing basis and some had completed training in dementia awareness. A schedule of training sessions completed and planned for staff was viewed. This showed that training sessions had been held on equality and diversity, manual handling, caring for people who are dying, infectious diseases, health and safety and the physical and mental effects of aging. Further training included, protection from abuse, management of drugs, first aid and infection control. It was not fully clear that all staff had completed necessary training within the required timescales and the provider agreed to address this. Detailed induction training for new staff is completed but it was not evident this is linked to the “Skills for Care Common Induction Standards” as required. This training requires staff competencies to be assessed in a number of areas over a number of weeks so that staff are deemed suitably trained and competent to work safely with service users. Two staff records were reviewed to confirm recruitment practices are carried out. Both of these contained completed application forms although one person’s employment history was not clear on their form. One person did not have two written references as required but both had Protection of Vulnerable Adult (POVA) checks carried out prior to them working in the home. As information relating to the criminal record bureau applications was not on file it was not clear that the POVA checks were for the people stated on the files. The provider agreed to address this. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 28 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): Standards 31,33,35 and 38 assessed. Quality in this outcome area is adequate. There is currently no registered manager working in the home and some actions are required to implement quality monitoring to demonstrate the home is being run in the best interests of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection there was no registered manager in post and her role was being covered by one of the owners of the home. The deputy manager was on holiday. The owner was open and transparent throughout the inspection process and demonstrated a commitment to make improvements where needed. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 29 Yearly quality questionnaires are usually used to obtain the views of relatives on the care of residents in the home. The provider stated that the questionnaires had not been sent out this year but these will be done. The home will need to do a report of the outcomes of these and detail any resulting actions. Copies of these should then be made available to relatives and other interested parties. Relatives are invited to social functions held at the home and also attend a garden party held at the home in September. The provider advised that a meeting was held with relatives in April/May to consult them on matters relating to the management of the home. The Annual Quality Assurance Assessment document forwarded by the manager of the home states that a relative support group has been established that meets quarterly. The provider also stated that families visit the home frequently and have a good relationship with staff. Relatives are able to raise any immediate concerns with staff so that these can be resolved. Comment cards received by us from relatives were positive in their responses. One person stated “although X cannot telephone herself, we ring daily and if X is awake they will give her the phone to speak to us. Another person stated “the staff at Craighaven do a wonderful job in sometimes difficult circumstances they are always friendly and helpful and should be commended for doing a good job”. Another relative said in response to what the home does well; “providing a sense of security especially to those finding difficulty in coping with outside world”. We received a telephone call from a person who wished to know how they could compliment the home on the good care and services provided to their late relative. The person stated they were “extremely pleased with the care their late relative received at the home”. Staff meetings are held so that there is an opportunity to provide their views on issues relating to the management of the home and notes of these meetings are kept to show what has been discussed. Systems are in place to manage the personal allowances of residents and records are in place to confirm transactions undertaken which were mostly for chiropody and hairdressing. Although receipts are being obtained these were not organised so that each resident had their individual receipts for their expenditure. Each resident needs to have individual receipts for each transaction carried out so that all transactions undertaken can be clearly evidenced. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 30 A review of health and safety checks was done to ensure residents live in a safe environment. Hot water temperature records showed that these were operating at safe levels. The Landlords Gas Safety Certificate was dated 21.8.06, the owner explained that it was planned to have new boilers but the dates for these to be fitted had slipped and it was now unlikely to happen this year. The gas safety check will therefore need to be done imminently. Records confirmed that hoists were serviced in June 2007 and the fire alarm tests in August 2007. Electrical portable appliances had been tested but records were not dated to confirm when this took place. The provider said these had been done in August 2007. The Annual Quality Assurance Assessment completed by the manager shows that the five-year electrical wiring check was last done in September 2003 and the stair lifts checked in June 2007. Risk assessments in relation to the locks on the residents’ bedroom doors and residents being unable to access or recall how to use call bells should be undertaken. Suitable actions identified to manage these risks. Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 31 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 Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 32 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 33 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 OP7 Regulation 12,13 Requirement Care plans must 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 and safeguard residents. (Outstanding, timescale of 31/01/07 not met) 2. OP8 12(1)(a) Records demonstrating that specialist interventions are followed up where appropriate must be available. This includes access to district nurse support to maintain the health of the resident. Medications must be managed appropriately and records must demonstrate consistently that service users have received medication as prescribed to maintain their health. • Craighaven Residential Home Timescale for action 30/09/07 30/09/07 3. OP9 13(2) 30/09/07 This includes ensuring Version 5.2 Page 34 DS0000063561.V342336.R01.S.doc creams are administered as prescribed. • Any handwritten entries are clearly dated, signed and reflect GP agreements as appropriate. Records confirm medications prescribed are being given. This in particular applies to “Forticreme” and “Fortisip” food supplements. Where homely remedies are used such as paracetamol, clear running records are maintained. This is so that it is clear how many are available at any one time and how many are being given out and to whom. 20/09/07 • • 4. OP18 13(6) Systems must be in place to prevent service users from being placed at risk of abuse. A review of locking mechanisms on residents’ rooms is to be undertaken to ensure residents are not placed at risk of locking themselves in their rooms without remembering how to get out which could be harmful to their health and wellbeing. 5. OP27 18 Staffing arrangements must be sufficient to support the needs of the home. A review of staff working double shifts such as a day shift followed by a night shift is to be undertaken as this contravenes the Working Time Directive and 31/10/07 Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 35 can result in staff being less effective when caring for residents due to fatigue. Outstanding, timescale of 31/01/07 not met. 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 OP1 Good Practice Recommendations The Service User Guide should be available with all of the required information so that prospective residents and their representatives can make an informed choice to stay at the home. (Outstanding from previous inspection). Residents should be informed in writing, following assessment that the home can meet their needs. (Outstanding from previous inspection). Controlled drugs administered should be entered onto the MAR chart in addition to the CD register so staff are fully clear these have been given. A further review of the provision of activities should be undertaken to ensure there are regular, varied and appropriate activities taking place which meet the social care needs of all residents in the home. The use of pictoral aids or photographs should be considered in aiding communication and menu choices. An up-to-date refurbishment plan should be devised showing all remaining works to be done in the home including any issues as identified in this report. Liquid soap and paper towels should be available in communal bathrooms, sluice and laundry areas to maintain good hygiene. 2. OP4 3. OP9 4. OP12 5. 6. OP14 OP19 7. OP26 Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 36 A review of care staff undertaking “dirty” tasks such as cleaning and laundry should be undertaken to ensure any risks associated with poor infection control management are addressed. Infection control procedures for the home should be reviewed and appropriate practices implemented to reduce the risk of infection. 8. OP27 Duty rotas must show sleep in staff and should clearly define codings used to show where carers are doing noncaring tasks. Duty rotas should clearly state those staff that are doing night duty. 9. OP29 New staff should not be allowed to work in the home until all recruitment checks including the receipt of two written references have been undertaken. Evidence of criminal record bureau (CRB) applications should be maintained on file so POVA checks can be cross-referenced to original applications. It is advised that a training schedule is developed showing staff names and dates of training completed to demonstrate all staff have received sufficient training to support their role in the home. This includes induction training linked to the Skills for Care Common Induction standards. Prompt action should be taken to pursue the registration of a manager for the home. Any changes in management arrangements should be confirmed in writing as appropriate. Quality monitoring should take place on at least an annual basis. Any resulting outcomes from surveys should be detailed in a report with any appropriate actions and made available to service user representatives or interested parties. In regard to the management of resident monies, there needs to be clear receipts for each resident confirming transactions carried out. This is to confirm that resident’s personal allowances are being managed appropriately by the home. 10. OP30 11. OP31 12. OP33 13. OP35 Craighaven Residential Home DS0000063561.V342336.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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