Inspection on 05/08/08 for Craighaven Residential Home

This inspection was carried out on 5th August 2008.

CSCI found this care home to be providing an Adequate service.

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 15/08/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Craighaven Residential Home Craighaven 4 Heath Terrace Leamington Spa Warwickshire CV32 5LY Lead Inspector Sandra Wade Unannounced Inspection 5th August 2008 8:00 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.V369396.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.V369396.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 Elizabeth Joy Heritage Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Craighaven Residential Home DS0000063561.V369396.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. 15th August 2007 Date of last inspection Brief Description of the Service: Craighaven provides care and accommodation for 35 older people and has 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). There are 25 single rooms and five double rooms and all have ensuite facilities. 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. There are three main lounge areas and a new sensory room. 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. Residents 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 were not published in the Service User Guide. The provider was available in the home and confirmed these could be published within this report. Fees ranged from £418 (social services rate) up to £590 (private rate) per week. Extra charges are made for Chiropody, hairdressing, some toiletries and any activity projects carried out in the home. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 home’s 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 between 8.00am and 7.00pm. Three people who were staying at the home were ‘case tracked’. The case tracking process 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, staff duty rotas, kitchen records, accident records, complaint records, financial records, maintenance records and medication records. Because people with dementia are not always able to tell us about their experiences, a period of time was spent one of the lounges to observe residents. Both breakfast and lunchtimes were also observed. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: All residents are assessed prior to them living at the home so that their needs can be identified and a decision can be made on whether these can be met. The staff are friendly, caring, approachable and have a good rapport with the residents. A letter received from a relative stated: “from the moment you walk through the front door at Craighaven its as if you are joining an extended family with such a lovely atmosphere. Every member of staff is truly devoted to their job and very caring”. A comment card from a relative stated: “I had a very difficult time making the decision to move X to Craighaven, X was very agitated in the Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 6 beginning. Every member of staff were professional and understanding. I was especially grateful to the time spent one to one with me”. Residents receive choices of meals which are appetising and which they enjoy. Relatives are happy with the care and services being provided and are also made to feel welcome at the home. One relative commented:“whenever X has required medical intervention, it has been arranged quickly and efficiently” and “every time I have raised a concern over anything including X’s physical health, the correct, appropriate action has been taken. I have always then been quickly informed of what the action was and what the outcome was”. The home is comfortable and homely and residents enjoy the freedom of being able to access different lounges including a new sensory room. Staff try to ensure that a social activity is provided every day so that residents get the social stimulation they need. Half of the care staff have achieved a National Vocational Qualification (NVQ) in care so that they can more effectively care for the residents. Staff feel they are well supported by the manager and it was observed that staff work well as a team to support residents. What has improved since the last inspection? Records now show any specialist interventions such as district nurse or chiropody input needed to maintain the health of the residents. A refurbishment plan for the home has been devised showing each month the work that is to be done to the home to improve the environment for the residents. Work done since the last inspection includes: two of the lounges being redecorated with new carpets and curtains, new carpets in the hallways, new boilers and thermostats so that residents can control the temperature in their rooms and a new call bell system throughout the home. Liquid soap and paper towels are now available in communal bathrooms and the laundry areas to enable staff to maintain good hygiene. Duty rotas now show sleep in staff and staff on night duty so it is clear who is providing this cover to support residents during the night. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 7 The providers have recruited a new manager for the home who has also registered with us to ensure the home is effectively managed. The home has implemented quality monitoring by sending out satisfaction surveys to relatives to complete with the residents to obtain their views about the home. The results of these were positive with 100 of responses returned stating they felt the home met the resident’s needs. Health and safety checks are now up-to-date to ensure the home is safe for residents. The complaints procedure for the home has been reviewed and now contains clearer information on how to make a complaint including details of how to make contact with the owners if required. New sit on weighing scales have been purchased so that the weights of residents can be more effectively monitored before this impacts on their health. All staff have been issued with new uniforms so that residents and visitors to the home can more easily identify them. What they could do better: Care plan records 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 falls, poor nutrition and skin damage. Action is required to ensure the effective and safe management of medications. Records need to clearly show prescribing instructions are being followed. Door locks on residents rooms need to be reviewed to ensure residents cannot accidentally lock themselves in which could cause them distress. Staff need to ensure they adopt safe practices when moving and handling residents to prevent any possible injuries. Screening needs to be available in double rooms as well as locks to toilet doors in communal areas to maintain the privacy and dignity of residents. The policies and procedures in regard to abuse need to be updated to ensure the protection of residents is managed effectively. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 8 The washing processes of resident’s underclothes need to be more effective so that residents do not have to wear stained underclothes. Staffing arrangements for the home need to be reviewed to ensure staff have sufficient breaks between shifts so this does not impact on their effectiveness when working with the residents. Duty rotas need to contain all of the information about staff including those on annual leave and sick leave so that staffing arrangements can be effectively audited and organised. All recruitment checks should be undertaken before new staff commence at the home to ensure staff are deemed safe and appropriate to work with the residents. 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.V369396.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.V369396.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 were assessed. Quality in this outcome area is good. Prospective residents receive some information about the home to allow them to make a decision about whether to stay. The needs of residents are assessed prior to them living at the home to ensure these can be met. 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. This was noted to be in small print which could be difficult for some people to read. The copy viewed also did not contain a summary of the inspection report as required to help resident representatives make an informed decision if their relative should stay in the home. The guide did state a copy of the report could be requested from the home. Residents are assessed prior to their admission to identify their needs and to ensure the staff and management know they can meet these needs. Copies of Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 11 the records are kept at the home and information obtained at the assessment stage had been transferred into care plan records as appropriate. Since the last inspection action has been taken to ensure letters are written to residents following their assessment to confirm the home can meet their needs, which is good practice. Craighaven Residential Home DS0000063561.V369396.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 and 10 were assessed. Quality in this outcome area is adequate. Residents feel well cared for and care plans are in place for each resident but these are not sufficiently detailed to ensure care needs are met. It is not clear that residents always get their medication as prescribed to maintain their health effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection staff were friendly, caring and supportive towards residents. Staff always acknowledged residents when they walked passed them and were attentive to their needs when in the lounge areas. Comment cards received from five residents showed that they all felt they get the care and support they need and that staff “always” listen and act on what they say. A relative had written to us to express how happy they were with the care their relative had received in the home. They stated “from the moment you walk through the front door at Craighaven its as if you are joining an extended Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 13 family with such a lovely atmosphere. Every member of staff is truly devoted to their job and very caring”. Another relative commented: “whenever X has required medical intervention, it has been arranged quickly and efficiently” and “every time I have raised a concern over anything including X’s physical health, the correct, appropriate action has been taken. I have always then been quickly informed of what the action was and what the outcome was”. A review of the care and records for three residents was undertaken. Care plans contained details about the person in regard to their senses such as diet, touch, and smell and as well as details about their speech, memory, mobility, oral health, washing, bathing and dressing. They also confirmed if the resident liked to have a cuddle. Care plans relating to specific health care needs such as problems with the skin, incontinence, poor nutrition or mobility were not sufficiently detailed to get a clear picture as to how these should or were being managed. It was clear in some cases that the care was being given but records just did not reflect this. One person had a care plan for mobility which said they used a wheelchair and needed the help of two carers to assist them around the home. There was insufficient information about what this person could and could not do for themselves or how exactly staff should “assist” the resident. Two staff were noted to lift (carry) this resident from the wheelchair to the chair in front of them. Lifting the resident in this way is not considered safe either for the resident or staff. The manager advised that staff should not have lifted the resident in this way and stated the resident was able to weight bare. This demonstrates the need to be clear about how staff should move and handle residents as well as detail what equipment should be used when assisting them from wheelchair to chair or bed to commode etc. A care plan stated that the weight of a resident was 36.9 (5 stone 8lb) but it was not clear when this weight had been taken. There was no instruction on this part of the care plan stating that this persons weight should be monitored. The manager was asked about this and was able to provide a folder with the weights of all residents. It was evident from viewing this that appropriate action had been taken to weigh this resident weekly as opposed to monthly and that their current weight was 36.6kg but tended to fluctuate between 36 and 37kg. Although not clearly identified in the care plan records, action was being taken to monitor the food intake of this resident. Records were available in the kitchen to show that the daily food intake of this resident. The manager said that food supplements had been recommended by the doctor when the resident was not eating but they were currently eating well. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 14 A nutritional risk assessment had been completed which requires staff to answer questions and allocate scores to each answer to reach an overall decision on whether the resident is of low, medium or high risk of poor nutrition. It was found that this assessment had not been completed correctly resulting in the incorrect scoring being recorded. The incorrect completion of the form results in a false level of risk being identified and could result in insufficient actions being taken by staff to address this problem. It was however clear in this case that appropriate actions had been taken by staff to monitor and manage this persons weight fluctuations. The manager agreed that the care plan documentation was in need of review to show that the low weight of this resident had been identified and to show the staff actions and monitoring that was required and that was being carried out to manage this. A continence care plan stated that the resident was incontinent and wore a pad day and night. There was no indication as to how this incontinence should be managed for example how often the resident may need to be assisted to the toilet to manage their personal care or what size pad they were to wear. It was evident from speaking to staff that they knew to toilet residents before and after a meal but it was less clear how it was managed in between times. The same applied to washing and bathing, care plans stated that residents needed assistance from staff but did not state how often or whether they were to have a shower every day, or a strip wash or a bath on a particular day each week etc. Staff spoken to were able to confirm that each morning there are around six residents who are given a shower in addition to those residents who are assisted with a wash. This information needs to be made clear within the care plans so that the records clearly demonstrate how personal care is being managed. It was evident from daily records that staff were recording each day when residents were being given a wash. No concerns in regards to the personal appearance of residents were identified on the day of inspection. All residents had clean hair, nails and skin and looked well kempt. One care plan file contained a visit sheet from the District Nurses showing that they had been in to apply dressings to a resident’s skin due to soreness. There was no care plan in place showing that this resident had developed sore areas and showing how this was to be managed. Staff had written on the sheet that the nurse had said Cavilon Cream should be applied to the areas prone to soreness. The Medication Administration Record (MAR) was requested to check this was being done. Staff said this resident was not on any medication, it was therefore not evident this instruction was being carried out. The resident was observed to be frail and of a low weight with no mobility, it was therefore likely that this resident was at risk of developing sore areas due to the pressure of sitting for long periods. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 15 A pressure sore risk assessment had been completed for this resident which showed a score of 10. This meant that the resident should be checked daily for early signs of bedsores. On the back of this form there were two dates one 21.5.08 stating “no change” and 3.7.08 stating “no change to pressure sore assessment”. It was clear from viewing the district nurse visit sheet and the information contained in the care plan there had been significant changes to the skin for this resident. It was therefore not clear why this was not reflected within the risk assessment. On observing the resident they were seated on a pressure cushion to help relieve the pressure on their skin. This also was not documented within the care plan for skin which is important so that all staff know to do this. The daily records were viewed to see if staff were monitoring the skin as the risk assessment suggested. There was no indication from daily records that staff were checking the skin. On speaking to staff they said that when they had provided personal care to the resident that morning they had not noticed any sore areas. It is important that staff record the condition of the skin for those people prone to developing pressure damage to the skin so that prompt action can be taken to prevent further deterioration. Another care plan checked for skin showed some of the same problems as above. It was clear the district nurse had been visiting a resident who had developed sore areas on their heels. The care plan in place did not show this. The care plan said “X’s skin is in good condition” and “no district nurse intervention necessary” when in fact the district nurse was seeing the resident to apply dressings. The pressure sore risk assessment did not mention that the resident actually had sores on their heels. Falls risk assessments had been completed for each resident but it was not clear this was sufficiently detailed to ensure risks were being clearly identified and acted upon. One falls risk assessment viewed was not dated so it was not clear if this was current information. The first question was “is there a history of any fall in the previous year and this was ticked “No”. On viewing the accident records in the home it was evident this resident had fallen five times this year. On the back of the form under the review it did say the resident had fallen in June 08 but stated for May 08 “no change” when in fact the resident had fallen in May and had banged their head on a wall. If risk assessments are not completed and updated with accurate information this could lead to insufficient action being taken to prevent the risk of residents falling in the home. It was evident that the manager had made contact with a GP for another resident who had fallen numerous times in the home and their medication had been changed as a result. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 16 A discussion was held with the manager in regard to care plan reviews to ensure that when changes to residents care are identified these are incorporated into care records to ensure there is no oversight in care given to the residents. Records showed that residents are seeing opticians and the chiropodist when needed. A review of medication was carried out. The home has a medication trolley, a small medication room, a medication fridge and a cupboard to store all medication appropriately. It was found that those medications contained within the blister packs were being managed well but any medications that were in separate boxes were managed less effectively and it was not always clear that residents had received this as prescribed. It was found from some tablet counts that the medication administration records had not been completed appropriately. Some records had been signed when the medication was not administered, some were not signed to show if a tablet had been destroyed and some medication had been given and not signed for. It is important to account for all medicines so that we and staff within the home can be sure that each person is receiving their medication as prescribed by the doctor. There was also evidence that showed that staff had not fully understood the amount of Warfarin medication that should have been given. Records showed that a resident had been given less than the doctor had prescribed. This could result in this person’s health deteriorating and further treatment would then be required. A cream prescribed for one person had not be stored or applied as required which could result in the cream being less effective in treating the residents condition. Eye drops had not been dated when opened. We were told that they are returned to the pharmacy at the end of a 28 day cycle so would not be used beyond the 4 week date. It is good practice to date eye drops once open to reduce the risk of mistakes and to ensure they are always used within the required timescales. It was noted that one medication was available in a blister pack as well as a packet. Staff investigated this and showed the inspector a record showing that the doctor had increased the medication. There was no record to show how much the doctor had increased this by to be sure the resident was receiving the correct dosage. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 17 It was not evident that the home keeps copies of the prescriptions to ensure they can effectively audit medications. Staff said that they would request copies of prescriptions from now on so that they always had a record of what had been ordered. There were no concerns with direct care given in regards to the privacy and dignity of residents. It was however noted that there were no screens in one of the double rooms. There was a commode in this room and the manager confirmed that one of the residents did use this. It is important that suitable screening is provided in double rooms to protect the privacy and dignity of the residents. It was also noted that communal toilets had no locks on them which also would prevent the privacy of the residents when in use. The manager agreed to review this. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 18 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 were assessed. Quality in this outcome area is good. Residents have access to social activities and are able to exercise some choices regarding their care. Residents enjoy the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Social activities are provided and the manager said that there is an Activity Coordinator in post who works each afternoon. This person is not specifically identified on the duty rota as an Activity Co-ordinator and the manager said she works as one of the five cares on duty in the afternoon but co-ordinates the activities. At the time of inspection this person was not on duty. Staff spoken to said that they try to do something different each day with the residents. They said this includes exercises, ball games, skittles and painting. The manager provided records of social activities that can be provided and also had records of those residents who had participated in activities. These showed that in July most residents had participated in sing a longs, manicures Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 19 or pedicures, film afternoons, playing cards, listening to music and looking at books. The Annual Quality Assurance Assessment (AQAA) document provided by the home shows that the manager is also continually looking at providing a wider and more varied range of activities. Residents can access church services if they wish which are organised regularly by the home. The manager said that more outside entertainment had been organised and they were in the process of trying to raise funds for a mini bus so that they could take the residents out. Care files contained “Getting to know you” forms and these listed information such as names of family members, significant events, past holidays, past occupations, magazines they liked to read, how often they like their hair done, specific clothes they like to wear and hobbies etc. This information helps staff to focus their social activities according to the needs of the residents. The manager explained that one resident in particular liked to paint and the home had obtained painting materials to enable them to do this. On the day of inspection residents were observed to listen to music and there was an attempt to get them to join in a sing a long. During the morning when the music was playing a member of staff was feeding a resident and she could not hear the residents over the music so turned it down. Later in the morning another member of staff came into the lounge and turned it up. At this point the residents seemed to enjoy the music and one person started to sing a long to it. A short time later a member of staff turned the music back down again. The residents in the room were not asked if they were happy for it to be turned down and immediately stopped singing. Some of the residents in the room were clearly capable of making this decision and should therefore have been asked. Residents on the whole seemed content and enjoyed any staff interaction when staff members came in and out of the lounge areas. Some residents were asleep for periods of the day, others were interested just to sit in the lounge and see what was going on. One person kept calling out the name of their son and another resident kept telling them they were at work. One resident sat holding the hand of another and one person was chattering away to themselves. Some residents chose to sit in the quiet sensory room and others had dolls and soft toys and were content to sit holding these. Some residents had visits from family members and staff were seen to make them feel welcome. At lunchtime residents were assisted into the dining areas. Due to one of the lounges being closed for decoration the two remaining dining rooms were being used to full capacity. Some residents who needed to be fed were seated Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 20 in the lounge areas and these people had their meals an hour before the other residents. Some residents had their meals in their rooms. Those residents that needed to be fed were observed to be assisted sensitively and slowly. A member of staff who was feeding a person with no vision made sure they told the resident each time they were putting a spoonful of food into the persons mouth. The meal on the day of inspection was shepherds pie with swede, carrots, potato and gravy or toad in the hole. The meals looked appetising and many of the residents were able to eat independently with prompting from staff. For those residents on soft diets, the meals were liquidized with each portion of food being liquidized separately so that this looked more appetising. The puddings served were yoghurts or jam tart and custard. Comment cards received by us from residents showed that two residents “always” liked the meals, two “usually” did and one person did not answer but a relative had commented “I must say I haven’t seen any meals but the menu always seems varied and well balanced ingredients used”. The cook was aware of those residents who were on soft diets and a list of these was on display on the kitchen wall. She also was aware of those residents who were diabetic and advised a sugar alternative is used for these residents when required. Records were being kept of meal choices made by residents so that it was clear what they had been given each day. The kitchen was viewed and there were branded tins of soups and fresh fruit and vegetables available. The freezers stocked the joints of meat and other foods. The cook explained that she purposely gets a branded tin of peas for one resident who had requested these which shows that individual resident choices are respected. The kitchen was in constant use throughout the day but was clean and well stocked. Records showed that the fridges were operating at the recommended levels for the safe storage of food although they were not clearly dated to show the records were current. Some of the dried foods such as “Angel Delight” and “suet” were in opened packets as opposed to sealed containers and this was brought to the attention of the cook. Both semi skimmed and full fat milk was available in the home to offer residents a choice. Menus showed that there are two choices of main meals given each day. The menus did not give a full reflection of all meals, snacks and drinks being provided and the manager agreed to review this. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 21 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 were assessed. Quality in this outcome area is adequate. Appropriate procedures are in place to manage any complaints but procedures regarding allegations of abuse need updating to ensure any allegations are managed effectively to protect 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. Since the last inspection the provider has added the address and contact details so that any complainants know where to write to should they need to raise a concern. All comment cards received by us from residents stated they knew who to speak to if they had a concern. Since the last inspection we have received no complaints about this service. Records seen showed that the home also had not received any complaints. There was an allegation made against a member of staff by another member of staff in regard to the treatment of a resident. The home took this allegation seriously and undertook an investigation into this. A full and detailed report of Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 22 this investigation was sent to us and this showed that the incident involving the member of staff was appropriately investigated and was not upheld. There were issues regarding the timings of investigation and the involvement of Social Services which were discussed with the home and they are now fully aware of their responsibilities regarding this. The policy and procedures in the home however do not fully reflect the processes now in place for managing any allegations of abuse and therefore need to be reviewed. Staff spoken to knew that any allegations of abuse needed to be reported to the manager and us but were hesitant in their responses when asked what to do about any resident who may have been affected by this. The manager agreed to provide refresher training to staff on this matter. During the last inspection a resident was found to have locked themselves in their room and could not remember how to get out. A requirement was made for the locking mechanisms on the doors to be looked at to ensure this could not happen again. This has not been done. The manager advised that the resident concerned had now left the home and there had been no further incidents. Risk assessments for remaining residents were not evident. The provider agreed to look at this as a priority following this inspection. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 23 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 and 26 were assessed. Quality in this outcome area is good. The home is subject to ongoing refurbishment but is comfortable and homely for the residents. Some attention is needed to the systems for cleaning clothes to ensure all items are fully clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident bedrooms are located on three floors (lower ground, ground and first floor). Access around the home is via a variety of staircases, which have stair chairs; there is no shaft lift to support wheelchairs and corridors are not very wide to effectively support residents confined to the use of wheelchairs. There are three main lounge areas and a smaller room which has been adapted to a sensory room. The home has a variety of equipment and adaptations including handrails, grab rails, hoists, adjustable beds, raised toilet seats, new sit on weighing scales Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 24 and wheelchairs to assist residents around the home as required. There is a hairdressing sink is available in one of the toilets by lounge 3 that is used to provide a hairdressing service to the home. There are communal toilets located close to the lounge and dining areas so they are easily accessible to residents although these do not have locks on them to ensure their privacy. There is an attractive enclosed paved garden area with various tables and chairs for residents to use in finer weather. There is a ramp that is available for those residents who use wheelchairs to access the garden and some bedrooms have steps and handrails directly from their room into the garden. The lounge areas are pleasantly decorated and homely and since the last inspection the carpets and curtains have been replaced in two of the lounges. On the day of inspection work was being undertaken to decorate the third lounge. All residents that usually sit in this lounge were using the other two lounges. There are old-time pictures on the walls in all communal lounge and dining areas and a stereo with CDs and a television. There are also tape recorders available with cassettes. The televisions are not large screen so some residents could find these difficult to see clearly depending on where they are sitting. Each lounge has a Month and Day flip calendar so that residents can orientate to the time of year but it was noted these had not been updated in either of the two lounges viewed. One said it was Sunday and the other Saturday when the inspection day was actually Tuesday. On arrival to the home it was found the lounge areas had food debris on the carpets and chairs. This was not cleaned before residents started to be seated in the lounges. One resident who was sat on a chair with dried food on it noticed this when they stood up and touched it with their fingers. The manager explained circumstances that meant the cleaner for the home had needed to leave without notice and they had only just managed to replace them. Since the last inspection there has been a new call bell system fitted and curtains have been replaced in some of the bedrooms. Two new boilers are now in place with thermostatic control valves in all bedrooms so that residents have some control over the temperature of their rooms. During the tour of the home it was found that bedrooms were suitably decorated. Bedrooms viewed contained personal items to make them homely and most were clean and tidy. There was the occasional area of scuffed wallpaper or marked paintwork. One bedroom had a strong unpleasant odour and there was one item of dirty underwear in their drawer. There was also a named item of clothing that was different to the person occupying the room. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 25 The manager said that this item of clothing had been donated to the person in the room and that this room had had a new carpet and mattress but they had not been successful in removing the odour. This will need to be further addressed. The manager said that when the bedrooms became vacant they were usually decorated as it was difficult to decorate rooms when the home was full and residents were occupying the rooms. The manager produced a refurbishment plan for the home for this year and none of the bedrooms were on this list for redecoration. This will need to be considered to ensure bedrooms do not begin to look tired and worn. The home had taken action to decorate the room identified as “stark” at the last inspection and the manager reported in the Annual Quality Assurance Assessment forwarded to us that some had been fitted with new curtains and new beds. In one room there was a deflated cushion on the chair which would not adequately support the resident, the manager agreed to change this. In another room the sides and bottom of one of the cushions on the chair was stained and sticky and in need of cleaning. Several of the bedrooms checked had items of stained underwear in the drawers despite them having been through the cleaning process. This was discussed with the manager with a view to ensuring the current laundry systems are effective in suitably cleaning underwear. The laundry was viewed and was well organised for managing a dirty to clean flow of washing. Separate containers were available for both clean and dirty laundry and gloves were available to maintain good infection control practices. The hand wash sink had liquid soap and paper towels for staff to wash and dry their hands. There is still only one washing machine to cater for all laundry needs of the home and the manager said this remains something that they are going to review. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 26 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 were assessed. Quality in this outcome area is adequate. Some attention to staffing records is required to demonstrate care and services provided to residents are effective at all times. Staff training is provided but records need to demonstrate this is happening 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: Since the last inspection the providers have employed a new manager for the home. In addition to the new manager there is a deputy manager and care manager. The manager confirmed that they aim to provide six care staff between 8am and 1pm, five carers between 1pm and 9pm and two waking night carers plus one person on call to care for 35 residents. The manager of the home works in a supernumerary capacity. The manager said that there were 35 residents in the home with no residents being in hospital. On the day of the inspection all managers were on duty and the providers also visited the home for periods during the day. Staff during the inspection were noted to be friendly, kind and caring towards residents. Since the last inspection staff have been issued with new uniforms which have helped residents and visitors to be able to identify them more easily. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 27 Duty rotas showed that most of the time the staffing arrangements planned for the home are being met with occasional times when they are not. Times when they are not are usually due to staff sickness and this being short notice. Duty rotas show that there are mostly six carers on duty plus the care manager during the mornings and five carers in the afternoons. There are always two night staff indicated to be on duty plus a person detailed to do night cover (on call). On one day a night cover person is not indicated and on another day the person is shown as sick on the separate sheet to the duty rota. On the day of inspection there were sufficient staff on duty to care for the residents. Comment cards received from residents showed that they all felt there were staff available when they needed them and that staff always listened and acted upon any requests made of them. Two letters received by us from relatives of residents were complimentary of the staff, one said “every member of staff is truly devoted to their job and very caring” the other stated “I can honestly say that I never observed the carers treating residents with anything but respect, patients, humour and kindness”. A comment card received by us stated: “I had a very difficult time making the decision to move X to Craighaven, X was very agitated in the beginning. Every member of staff were professional and understanding. I was especially grateful to the time spent one to one with me”. Duty rotas showed that some staff are not working with a sufficient break between shifts. For example a member of staff is working a morning shift then coming back at 9.30pm to complete a night shift. Another member of staff is working an 8 – 2pm shift then coming in to do a full night shift. This is considered poor practice as there is an insufficient break between shifts. This matter was raised at the last inspection to the home and actions should now be taken to address this to ensure this does not impact on the care of residents. Not all staff who are rostered to work are listed on the duty rota. For example when someone is sick or on holiday they are listed on a separate sheet and if they become sick when they have been rostered to work they are tippexed off the rota and another name written in. This does not give an accurate reflection of staffing arrangements for the home and is difficult to get a clear picture when auditing staffing for the home. Duty rotas also contained first names as opposed to full names and not all staff designations had been detailed. This again makes it difficult to ensure there is an effective audit trail and to see how senior staff are covering the home. The manager is not detailed on the duty rota to demonstrate she is working in a supernumerary capacity consistently. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 28 The Annual Quality Assurance Assessment provided by the manager shows that the home employ 29 care staff. The manager states that 50 of these staff have attained a National Vocational Qualification (NVQ) II or III in Care. Training records within the home are all held on separate files both on the computer and within their files so it was difficult to confirm those staff who had completed their NVQ training. This also applied to staff statutory training such as moving and handling, food hygiene and fire training. Some records seen did not show that staff had completed fire training or food hygiene training and it was difficult to assess how many staff had completed this and how many had not. The manager agreed to look at preparing an at-a-glance training schedule to clearly show all training completed by staff. Systems were in place for new staff to complete induction training but not all records viewed contained evidence that this training had been completed. It was also not clear if the induction training provided was based on the Skills for Care Council common induction standards as required. Staff spoken to said that they felt the induction training they had been provided with was sufficient for them to feel confident in caring for the residents. The staff files were viewed for three members of staff to confirm that suitable recruitment procedures are in place to ensure the protection of the residents. It was found that all had application forms and a Criminal Record Bureau check but for one person, two written references had not been obtained prior to their employment. It was also not clear that an appropriate Protection of Vulnerable Adults (POVA) check had been received for one person prior to their employment. The manager advised that she had started to compile check sheets for the files to ensure all of the appropriate information is obtained prior to staff starting at the home. Copies of these were evidenced in the newer files. The manager agreed to follow up missing information on those files identified and acknowledged the importance of ensuring this is in place. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 29 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 were assessed. Quality in this outcome area is good. The home is managed by a person of good character who aims to provide a service which is in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a new manager has been appointed to the home. She commenced her role of manager on 1 November 2007 and has recently become registered with us. The manager advised that she has attained the Registered Managers Award since being in post and she previously worked in the home so knew the residents in the home well. Staff spoken to said they felt well supported by Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 30 the manager. One person said the new manager was “fantastic” and the atmosphere amongst the care staff was now “much better”. This inspection identified that there are some issues which are outstanding from the previous inspection which need to be addressed. Failure to action these could impact on residents receiving effective and safe care. Since the last inspection action has been taken to implement a quality monitoring system. Questionnaires were sent out to eleven relatives to complete with the residents. Of these, seven were returned. An outcome report had been completed and this was shown to the inspector. This showed that 100 of residents felt happy in the home and felt all of their needs were being met. They all also felt that staff were friendly and helpful and the manager was available when needed. The report showed that as a result of comments received there had been several actions taken, this included refurbishment of ensuites and the fitment of towel rails in each room, the repair of TV aerials and blinds, and hand cleansing gel at the doorway. The manager advised that further questionnaires would be sent out to ensure all families and residents had an opportunity to comment on the care and services provided. It was evident that the manager had also recently set up a Dementia Awareness evening for relatives which she advised was well attended. Other meetings with relatives are not held but the manager said she saw many of the relatives that visited and frequently spoke to them. Staff meetings were being held regularly so that issues relating to the day-today management of the home could be discussed and any actions implemented. A review of staff monies showed that these are being appropriately managed and monies recorded on the records tallied with those actually available. It was noted that receipts for hairdressing and chiropody consisted of a list of residents with ticks beside them that were signed by the person who had provided the service as opposed to each resident being issued with a receipt for the service they had received. This system is not fully robust to ensure the protection of residents and also present problems in regard to data protection. The manager agreed to review current receipt systems in place. Staff undertake health and safety training and there are also regular health and safety checks carried out by the home. Records viewed showed that checks had been carried out as required on hoists, stairlifts, fire alarm, electrical portable appliances and gas. The manager advised she was in the Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 31 process of updating the fire risk assessment for the home and had taken advice from the fire officer on this. Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 32 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.V369396.R01.S.doc Version 5.2 Page 33 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 3 X N/A 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 34 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 13 Requirement Where there are recognised risks to residents including mobility, skin integrity and weight, the home must be able to demonstrate appropriate actions have been taken. Records must show an appropriate description of these risks as well as the actions to be taken by staff to minimise these risks. Clear and concise information must be available in what way the daily needs of residents are to be managed such as incontinence to prevent the risk of sore areas developing on the skin and to maintain the residents dignity. Medications must be administered to each resident as prescribed by their GP and recorded accurately on the MAR sheets. If a medication is not given, records need to state clearly why. Staff must move and handle DS0000063561.V369396.R01.S.doc Timescale for action 15/10/08 2. OP7 13 30/09/08 3. OP9 13(2) 31/08/08 4. OP30 18 30/09/08 Version 5.2 Page 35 Craighaven Residential Home residents safely at all times. Staff training needs to be reviewed in this area to ensure residents and staff are not placed at risk of injury. 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 contain the summary inspection report so that prospective residents and their representatives can make a fully informed choice to stay at the home. Care plan reviews need to demonstrate how each care need has been reviewed and clearly show any changes in the resident’s health that could impact on the care being provided. Where changes have been identified such as a change in weight this needs to be clearly demonstrated with the actions that are to be taken as a result. It is advised that suitable screening is provided in double rooms and the use of suitable locks are considered on communal toilet doors to maintain the privacy and dignity of the residents. The menus for the home should be reviewed to show all meals, snacks and drinks available. Policies and procedures linked to the management of abuse need to be reviewed to reflect current guidance. Staff also need to be fully aware of these procedures and how they should support residents if they are affected by this. 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 cause them distress. DS0000063561.V369396.R01.S.doc Version 5.2 Page 36 2. OP7 3. OP10 4. 5. OP15 OP18 6. OP18 Craighaven Residential Home (Timescale of 20/09/07 not met) 7. OP26 All areas of the home need to be maintained in a clean condition at all times. This includes chairs and seat cushions and carpets. The odour in the bedroom identified at the inspection needs to be removed. 8. OP26 The washing of residents underwear needs to be effective in ensuring underwear is suitably clean. A review of current practices needs to be undertaken to ensure this happens. A review of staff working double shifts such as a day shift followed by a night shift needs to be undertaken as this can result in staff being less effective when caring for residents due to fatigue. 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. (Outstanding from previous inspection) 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. (Outstanding from previous inspection) In regard to the management of resident monies, each resident should be given a receipt for any transactions carried out on their behalf such as those for chiropody and hairdressing. This is to confirm that resident’s personal allowances are being managed appropriately by the home. 9. OP27 10. OP29 11. OP30 12. OP35 Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Craighaven Residential Home DS0000063561.V369396.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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