CARE HOMES FOR OLDER PEOPLE
Craignair 3 Blundellsands Road West Blundellsands Liverpool Merseyside L23 6TF Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 16th April 2007 10:30 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 Craignair DS0000005411.V336349.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. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Craignair Address 3 Blundellsands Road West Blundellsands Liverpool Merseyside L23 6TF 0151 931 3504 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) craignair12@btconnect.com Mrs Bernadette Neale Mr Stephen John Neale Mrs Bernadette Neale Care Home 21 Category(ies) of Dementia - over 65 years of age (21) registration, with number of places Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 21 DE(E). The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 22nd June 2006 Date of last inspection Brief Description of the Service: Craignair is a care home for 21 older people with dementia. The service is provided in a converted Edwardian house and provides care and accommodation in a homely setting. Home cooked meals and a laundry service are also provided. All residents are registered with a local G.P. The home is staffed throughout the day and night. Nursing care is not provided and care staff undertake NVQ training in direct care, training related to dementia care and mandatory training. The home also provides 4 day-care places for people with dementia who live in their own homes. Craignair has a spacious and secure garden and is situated in a pleasant residential area, close to a train station and bus routes. The home is owned by Mr. S. and Mrs. B. Neale, and Mrs. Neale is also the registered manager. The current scale of charges in Craignair is £470.00 - £485.00 per week. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over a six-hour period. The methods used were, speaking with the residents, staff and the registered manager, Mrs. Bernadette Neale. A tour of the building and gardens was carried out and time was spent with residents in discussion and observation. Records compiled in the home relating to care practice, staffing, health and safety and quality assurance were read. What the service does well:
Respect for residents’ diversity was in evidence in Craignair through support for their religious needs by recording them and arranging for ministers of the church to attend. The way in which the service is provided supports the residents’ mental and physical frailty. The staff group is experienced, trained, well supported by management and have developed good levels of knowledge and skills in supporting the residents of Craignair. The relative of a resident was contacted for comments on the service provided to her mother. She said, “I can’t praise Craignair highly enough. My mother is content, everyone is well looked after and there is plenty of social stimulation through activities.” She said the home is always clean and the staff are friendly and keep her informed of her mother’s progress. Each resident has a written contract/statement of terms and conditions with the home and have been admitted to Craignair following a needs assessment. Contracts of residence are clear and in plain English and state the fees, resident’s/local authority/representative contribution and notice periods. Residents’ privacy and dignity is respected and their mental and physical health care and social support needs are met. Residents’ care files, which were read, were well maintained and provide evidence of action plans in response to the needs identified in assessments. Residents looked well cared for, one resident said, “The staff are very good. They look after me.” Residents appeared relaxed and appeared to be benefiting from the care and support provided in Craignair. The lifestyle in the home meets the residents’ needs and is in accordance with their mental and physical capabilities. The training and supervision carried out in Craignair, is having positive effects on residents’ wellbeing. Staff contacts with residents during the visit, were positive and supportive in encouraging and motivating them to take part leisure activities. The outcomes to residents were beneficial as they were exercising, chatting with one another and
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 6 concentrating, in accordance with individual capacity. Some residents preferred not to participate in activities, remaining in one of the quiet areas, which is evidence that they enjoy their rights of freedom of choice, freedom of movement and freedom of association. The building is homely, clean, well maintained and fit for its purpose having communal areas, which meet the specific needs of residents who have dementia. The home has recently been extended to provide additional communal space. The new room is decorated and furnished to a high standard and increases residents’ comfort and choices. Craignair is well managed in accordance with the best interests and welfare of residents. Mrs. Neale has created systems for the management of residents’ files, staff support and health and safety. The home has policies and procedures in place for staff guidance in care, health and safety, confidentiality and protection. Craignair has now reached the point of having excelled in some of the standards due to strong management and team effort. There is a training and development plan for staff of Craignair. There were records (including certification) of achievements in NVQ (over 50 of staff have this qualification), and mandatory courses in accordance with their job descriptions and responsibilities. What has improved since the last inspection? What they could do better:
No Requirements or Recommendations made. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ contracts clearly define their the terms and conditions of residence and fees payable, and residents have been admitted following an assessment of needs, carried out by people who are trained to do so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 2,3. Craignair does not provide intermediate care and will not be assessed against standard 6. All residents have a contract of residence, which states the fees payable and their personal contribution. The contracts include rights and obligations of the resident and registered provider and notice periods. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 10 Residents have been assessed with dementia, and their care files contain written pre-admission assessments carried out by social workers. Craignair has a written format, which is used by staff to carry out a further assessment. This is to ensure that the home has the skills and facilities to meet the (prospective) resident’s assessed needs. The assessment covers personal care and physical wellbeing, sight, hearing and communication, mobility, history of falls, continence, medication and mental state and cognition. The outcomes of assessments form the basis of each individual’s care plan. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ privacy and dignity is respected and their mental and physical health care and social support needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7, 8, 9, 10. All residents have a care plan, which sets out in detail, the action to be taken by care staff to ensure that the person’s mental and physical health, personal care and social needs will be met. Three care plans were tracked, the outcomes of their assessments being checked against action plans. There were action plans in place to meet every identified need, supported by risk assessments and the care plans had been reviewed on a monthly basis. A resident said, “The ‘girls’ (staff) here are really good, nothing is too much trouble, they help me a lot and bring round cups of tea. It is my home now.”
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 12 Many of the residents were unable to comment through mental frailty but they appeared well cared for. All the people who live in Craignair are registered with local G.P.s and their health plans showed referrals to paramedical services, including chiropodists, opticians and to specialist mental health services including approved social workers, community psychiatric nurses and the mental health consultant. There was evidence that staff had provided support in behavioural management and the records of incidents and actions taken to address them were well maintained. The home has a written procedure for managing residents’ medication. The assistant manager described the system and the medication of two residents was checked. There were stocks of all drugs recorded on their Medication Administration Records and the amounts in stock balanced with the numbers recorded as administered. There was evidence in care plans that the medication prescribed for residents is reviewed through their G.P.s. There are systems for the audit and return of un-used medication and secure storage facilities. Staff said they had received relevant training and instruction. Staff were showing respect for residents’ privacy throughout the visit, by supporting them discreetly, with toilet and bedroom doors closed. Residents looked well cared for and careful attention had obviously been paid to their personal grooming and clothing. They have freedom of movement within the home and there were staff in attendance to supervise their safety and comfort, at all times. Residents’ records and care files are stored in secure areas and the home has policies on confidentiality and access to personal files. Staff who were spoken with were aware of best practice in supporting residents’ privacy and dignity. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The lifestyle in the home meets the residents’ needs and is in accordance with their mental and physical capabilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12, 13, 14, 15. Records are maintained of leisure and social activities. There is a supply of craft equipment and games, books and newspapers, to stimulate interaction and interest. During the visit, a number of residents were dancing in the lounge and several were playing a ball game in the garden with staff joining in. The activities stimulated laughter and conversation between the residents who were enjoying the warm weather and each other’s company. Hot and cold drinks were served to residents throughout the day. There was evidence in residents’ files that they have visitors and have been on outings with their families and staff. Ministers visit to support residents’
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 14 religious needs through administering communion regularly and they have access to support through local advocacy services if needed. Residents’ files contained their preferred rising and retiring times and they are consulted before meals as to what they would like to eat. The preferences of those residents who showed no interest in participating in social activities were respected. Some were moving freely between the three lounges, dining room and garden and appeared relaxed and in good health. There were records of menus, which demonstrate a varied and balanced diet for residents with choices and alternatives on offer. There were good stocks of breakfast cereals, hot and cold drinks, fresh fruit and vegetables and chilled and frozen foods in stock, and these had been appropriately stored in the larder, fridge and freezer. Residents said the food is good, one comment was, “They feed me very well.” Meals are served in the dining room, which provides a pleasant environment with enough tables and seating for the residents. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. The registered providers have taken action in response to a complaint, and the POVA procedures followed in Craignair are supported through staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16, 18. Craignair has a complaints procedure, which is given to residents (when they move in), and their representatives. The procedure gives lines of responsibility and timescales. There have been no complaints to CSCI about Craignair, in the last twelve months. A complaint was resolved in March 2006 and the registered providers, Mr. & Mrs. Neale, carried out remedial action without delay, to address a breach in regulation, by amending the home’s emergency procedures. The home has procedures for Protection of Vulnerable Adults and “whistle blowing.” A copy of Sefton’s POVA procedure is held on the premises for staff guidance. Staff have received POVA training and those who were asked, were aware of the indicators of abuse and the procedures to be followed if abuse of a resident were to be suspected. Mrs. Neale said that to ensure that the POVA procedures are adhered to, training in the home’s “whistle blowing” policy is in progress.
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 16 Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is excellent. The building is homely, clean, well maintained and fit for its purpose having communal areas, which meet the specific needs of residents who have dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 19, 26. Craignair is a converted dwelling house in a quiet residential area of Blundellsands. The recent addition of a ground floor extension adjacent to the dining room, has provided extra day space for residents. The extension has been designed in the style of the existing building and extends the range of choices available to residents, for quiet and activity areas and with space for residents to move around in freedom and safety. The décor and furnishings are
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 18 to a high standard and residents were seen relaxing all three ground floor lounges and the dining room. There are well- maintained gardens at the front and rear of the house, with ramped access from the back door. Residents’ bedrooms are highly personalised and there are toilets and bathrooms situated throughout the three floors for residents’ convenience. The building is checked daily and any necessary remedial work is noted in the maintenance book and carried out by the handyperson. The home also employs a gardener and the rear garden is well planted with an extensive lawn and shaded areas for residents. The front garden has been landscaped since the extension was built and gives a very good first impression of the home. There is an ongoing maintenance and improvement programme for this home. Designated domestic staff are employed at Craignair and the home was clean and hygienic at the time of the visit. There are procedures in place for the control of infection and the laundry and kitchen were clean and well organised with equipment in working order. There are plans to replace the kitchen fittings as part of the refurbishment programme. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is excellent. Staff are vetted and have the training and skills to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27, 28,29, 30. There were three care staff on duty at the time of this un announced visit, in addition to domestic and cooking staff. The appointed manager, deputy manager and administrator were on duty and the registered providers, Mr. & Mrs. Neale, were also on the premises. Mrs. Neale is also the registered manager. There was evidence in the training schedule and in staff files of a training and development plan for staff of Craignair. There were records (including certification) of achievements in NVQ (over 50 ), and mandatory courses in accordance with their job descriptions and responsibilities. The training and supervision carried out, is having positive effects on the standard of service provided in Craignair. Staff were observed in the lounge and gardens supervising residents, and their contacts with residents were positive and supportive in encouraging and motivating them to take part in dancing and a
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 20 ball game. The outcomes to residents were beneficial as they were exercising, chatting with one another and concentrating, in accordance with individual capacity. Some residents preferred to relax inside, in one of the quiet areas and there was a member of staff supervising them. Three staff files, which were read, were maintained to a satisfactory standard and were well organised and secure. Mrs. Neale confirmed that all staff have CRB clearances and evidence was seen on each file. There was evidence in the files of applications form, dates of employment, two references, identification, job descriptions and contracts of employment. Mrs. Neale said that staff receive regular supervision (one to one) and the last staff meeting was held on 19th March 2007. Staff said they feel well supported by management. One member of staff in particular said she is very happy in her work and enjoying the level of responsibility within her remit. She said she has been well supported by Mrs. Neale and the staff team. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is excellent. Craignair is managed in residents’ best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 31, 33, 35, 38. Mrs. Neale has over ten years experience as joint registered provider and registered manager of Craignair. Mrs. Neale has established formats and systems to support the effective running of the home using National Minimum Standards as her benchmark. Elaine McNeice is the appointed manager with a view to applying for registration. Mrs. McNeice has several years of
Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 22 supervisory experience in residential care, and has a management qualification. There is also an assistant manager who has worked in the home for several years. Mrs. Neale said that she distributes quality questionnaires to residents/relatives and staff every six months. Responses on the latest questionnaires (dated 9/3/07) were read. Mrs. Neale confirmed that any negative outcomes identified would be addressed. The responses, which were read, on the quality of service from residents and relatives, were positive. Mrs. Neale said there is also an annual quality review of the service carried out by an external agency. Mr. Neale provided information on fee levels and contracts of residence. He confirmed that the registered providers have no involvement in residents’ finances and do not hold any personal allowances on their behalf. Health & Safety certification was in good order, records which were read include the following, Gas safety certificate 9/3/07 : Electrical certificate 21/3/07 : Portable appliance tests 6/3/07: Lift (serviced three monthly) : 22/2/07 The lift was called and was in working order : Sefton Environmental Health Officer’s visit 1/12/06. Fire systems tests 19/4/07 (weekly) Extinguishers tested 19/4/07 Fire Drill 28/3/07 A record of accidents to residents/staff is kept and these were satisfactorily maintained. Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 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 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 4 X X 4 Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Craignair DS0000005411.V336349.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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