CARE HOMES FOR OLDER PEOPLE
Craighaven Residential Home Craighaven 4 Heath Terrace Leamington Spa Warwickshire CV32 5LY Lead Inspector
Sheila Briddick Unannounced Inspection 2nd March 2006 09:30 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.V285649.R01.S.doc Version 5.1 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.V285649.R01.S.doc Version 5.1 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.V285649.R01.S.doc Version 5.1 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 Managers Award by December 31st 2006 25th July 2005 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 two floors, and 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 if they choose, make arrangements to have their own telephone installed in their own private room. The home is set in its own grounds and benefits from a safe garden area which is attractive well maintained and accessible. There is a variety of garden furniture. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two visits. The first visit was between the hours of 10 a.m. and 4 p.m. second visit was between 11 a.m. and 1:30 p.m. the manager and staff working in the home co-operated fully with the inspection. The inspection process involved a tour of the home, examining records and care plans, observation of care practices along with discussions with residents, staff, relatives and visiting professionals. Current residents were unable to express their opinions on the service. This inspection visit focused on the requirements made at the previous inspection and the standards relating to those areas. What the service does well: What has improved since the last inspection?
Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 6 The new owners and manager continue to make improvements within the environment. At the time of the inspection visit the kitchen was being refurbished fully and a dining area was undergoing re-decoration, which included new flooring and a kitchen unit. As resident bedrooms become available these are being completely refurbished. A visiting relative confirmed that prior the family member coming to live in the home they had been involved in choosing wallpaper and flooring for the bedroom the family member would be using. The manager has provided the Commission with a timed action plan for the continuing refurbishment of the home. The new care plan format and review procedure is steadily being introduced into the care home. Care plans that have been completed in the new format, which set out in detail a resident’s, health, personal and social care needs. The timescale for the requirement for all care plans to be in place has been amended. Medication management is now much improved and safe for residents. Suitable cupboards for the storage of medicine has been provided and there is a designated key holder on duty at each shift. Records relating to medicine are being well maintained and kept up to date. It was demonstrated that the menu provision in the home has been reviewed and this included consideration to giving alternative choices of meals to residents. The manager said that this proved not to be beneficial to the majority of residents, however it was felt that resident’s likes and dislikes are well known by the staff team and documented. The vulnerable adult procedure for the home has been reviewed and staff have accessed training to ensure their knowledge of their role and responsibility within this. What they could do better:
The Manager must ensure that all assessment, including risk assessment, and care planning into the new format is completed to ensure that staff are able to know what to do for each resident and that this is reviewed monthly or as needs change. The menu provision for residents must be kept under review so the service can continue to demonstrate they meet the needs of all residents. Proper employment checks are necessary to ensure that applicants are suitable to work with residents. The registered provider must visit the home on a monthly basis and provide the Commission with a copy of each report visit.
Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 7 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. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 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.V285649.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 There has been some progress in care planning to ensure that the arrangements for health, personal and social care needs of each resident is identified and planned for. Some shortfalls still have the potential to place residents at risk. Systems for the management and administration of medicine has improved and is ensuring that residents receive their medicine as prescribed. EVIDENCE: Individual care plans are available for each resident and are based on a person centred model. Four care plans were viewed including one in the new care plan format. The manager said that approximately a third of resident’s care plans are now in the reviewed care plan format. The new care plan system is to a good standard and clearly identifies the health, personal and social care needs of the resident and focus on the dementia care needs of the individual with clear guidelines for staff to follow. Details of resident’s care needs in the new format include taste, touch, smell, recalling events, recognising people and orientation. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 11 Staff spoken with demonstrated a good understanding of the individual needs of the people living in the home. Care plans viewed showed that pressure sore assessments, manual handling assessments, risk of falls assessments and nutrition assessment had taken place but not reviewed on a monthly basis. Daily entries in care records identified changing care needs including, nutrition, pressure sore care and risk of falls. Staff spoken with were aware of these changing needs and meeting them appropriately however the changed needs were not reflected in the risk assessment or care plan. A district nurse was visiting at the time of the inspection and gave positive feedback regarding the care given to residents in the home and said that ‘care overall was good’, however, it was felt there were some inconsistencies in care practice although this was not putting people at risk. Clear written guidelines for staff to follow in care planning would promote consistency in care practice and therefore ensure resident’s health and well-being is maintained according to their identified needs. Visiting relatives said that they were happy with the care provided and their mother was well looked after. During the visit time was spent in the lounge observing care delivery and the interactions between residents and staff. Residents were all smartly dressed and appeared well cared for. There was appropriate and positive interaction between residents and staff who were seen to be kind and caring. One resident was not well and staying in their room. The room was clean, free from odours and the resident’s bed linen and nightwear was clean and fresh. A record was being maintained of the resident’ fluid intake. A family member of the resident was met on the second visit to the home and expressed their satisfaction with the care the relative was receiving. Systems for the management and administration of medicines in the home was observed and showed that there has been significant improvement since the last inspection visit to include: • • • • Appropriate and secure storing facilities for all medication. Clear and consistent recording practice on all medicine administration record sheets. Medication records for medicine prescribed, as required included a written record of the reason for the administration. A designated person has responsibility for the medicine cabinet keys at each shift. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Meals are nutritious and well-balanced, mealtimes are a social occasion and the staff team understands individual preferences. Choice and variety however, is not offered on a daily basis to everyone. EVIDENCE: The kitchen was being refurbished at the time of this visit and considering the upheaval in kitchen routine the lunchtime meal provided was wholesome, nutritious and looked appetising. A requirement was made at the last inspection for the home to review the menus and ensure that alternative choices of meal were available to meet resident’s needs and this was discussed with the manager. It was explained that provision of two meal choices a day had been tried with residents and it was found that for some residents offering a choice was confusing for them. The outcome of the review was that the four-week rolling menu would be changed regularly and a choice of meal would always be given to people when it was known that the meal of the day would not be that persons choice. A daily record of the food provision is being maintained and seen to have some variety in it for individuals. Staff spoken with said that they were aware of each residence likes and dislikes. Residents were not able to give their views on the food provision however all residents asked if they had enjoyed their meal said
Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 13 they had. Discussion took place with the manager about keeping the current arrangement under regular review to ensure this was meeting resident’s needs and choice. An inspector from the environmental health was visiting at the time of this visit and was satisfied with the refurbishment and improvement that was being made to the kitchen facilities. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff are being supported to develop a knowledge and understanding of adult protection issues to ensure the provision of a safe environment to protect residents from harm. EVIDENCE: A requirement was made at the last inspection for a review of the vulnerable adults procedure and the training of staff to ensure they had updated information in the protection of vulnerable adults and only this aspect of the standard was assessed on this occasion. The training record was examined and showed that all staff working in the home had training in January 2006 relating to the Protection of Vulnerable Adults, (POVA). Examination of accident and incident reports suggest that staff have a good knowledge of incidents that affect the health and well-being of people and the risk assessment process. Incidents and accidents are reported, as required, to the Commission for Social Care Inspection and the manager complies with any requests made by the Commission for further investigation if identified as being necessary. There have been no reported allegations of abuse in the home since the last visit. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 There is a planned programme for refurbishment of this care home which, when completed, will provide a comfortable and safe environment for those living there and visiting. EVIDENCE: A requirement was made at the last inspection visit for the Commission to be provided with a timed action plan for the refurbishment of the home. This has now been forwarded and action was taking place at the time of this visit as identified in the plan. The kitchen was being refurbished at the time of the visit and this included new flooring, new kitchen units, new wall coverings and kitchen equipment. On the second visit to the home alterations were taking place also in one of the dining rooms to provide a separate dining area from the lounge. This change will be beneficial for people sitting in the lounge, as they will not be disturbed by people continually walking across the lounge to access the dining room.
Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 16 Bedrooms are being refurbished as they become available and relatives spoken with confirmed that as part of their family member coming to live in the home they were involved in the refurbishment planning of the bedroom. A bathroom and a shower facility have been completely refurbished to provide a warm, pleasant and safe facility for residents. The home now has a sluicing facility and this is situated on the first-floor with the property. This was a condition of registration that has now been met and can be removed. Further refurbishment identified and planned for includes: • Removing the old linen cupboard in the home and making a separate area for medicine cabinets. • Redecoration outside of the service and decoration to the hallway and some living areas. It is noted that the staff team were working extremely well whilst the building work in the kitchen and dining area was happening and resident’s care needs continued appropriately and safely. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The recruitment and selection process for new staff coming to work in this home is generally good however current Criminal Records Bureau clearance is not always sought when previously employed staff are coming to work in the home again and this shortfall does not ensure the protection of the people living in the home. EVIDENCE: The manager has taken steps to ensure that all staff records contained evidence of the information specified in the Care Home Regulations, Schedule 2. Examination of the records showed that instances when care staff, who previously worked in the home are re-employed, a request for up-to-date Criminal Record Bureau check (CRB) is not taking place. The records of three recently appointed staff members indicated that information necessary to ensure the protection of residence was not in place. This included a copy of a birth certificate, a copy of the passport of an overseas worker and up-to-date CRB checks had not been requested for two staff who had worked previously in the home. Two references had been sought prior to recruitment and files contained application forms, interview reports, training information and contracts of employment Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The manager of this home is supported well by the registered provider, who visits regularly, however written reports on the conduct of the care home by the registered provider are not maintained. EVIDENCE: The manager said that they are supported well by the registered provider who is visiting regularly. Staff spoken with said that the registered provider and owners of the service are very interested in the care provision and ensuring the environment is warm and welcoming. One of the owners of the service was supervising the refurbishment that was taking place and was seen to have a good rapport with residents and the staff team. The registered provider however is not visiting the home on a monthly basis to interview residents, or their family members, interview staff working at the
Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 19 home, inspect the premises, its record of events and records of any complaints and preparing a written report on the visit. Advise regarding the Provider Visit report format was forwarded to the manager. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X X Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 21 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 15 Requirement The manager must ensure that all care plans and risk assessments are current and set out in detail each service users health, personal and social care needs. Care plans should be reviewed monthly or as needs change. (Timescale of 30/10/05 not met) The manager must ensure that the option to provide residents with a choice of menu at mealtimes be kept under review, at least six monthly, and documented. 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. (Timescale of 30/08/05 not met) The registered provider, or one
DS0000063561.V285649.R01.S.doc Timescale for action 30/04/06 2. OP15 16 14 01/09/06 3. OP29 17, 19, Sch 2 30/04/06 4 OP33 26 30/04/06
Page 22 Craighaven Residential Home Version 5.1 of the partners for the care home, must make a visit to the home in accordance with Regulation 26 Of the Care Home Regulations and provide a written report as specified in Regulations 26.4(a) (b) (c) and 26.5. 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 OP15 Good Practice Recommendations The inspector recommends the use of photographic menus to assist residents to identify their choice of meal. Craighaven Residential Home DS0000063561.V285649.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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