CARE HOMES FOR OLDER PEOPLE
Craignair 3 Blundellsands Road West Blundellsands Liverpool Merseyside L23 6TF Lead Inspector
Mrs Trish Thomas Unannounced Inspection 22nd June 2006 11:00 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 Craignair DS0000005411.V295370.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.V295370.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) 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.V295370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 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. The service is registered to admit one named service user under pensionable age. 05/12/2005 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 is £450.00 - £465.00 per week and extras charged for are listed in the body of this report. Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit took place over a five-hour period and the methods used were direct observation, discussion with residents, visitors, the manager, Mrs. Bernadette Neale, and staff. Reference was made to the pre-inspection questionnaire and records compiled in the home. Special attention was given to the home’s recognition of residents’ diversity and the means of addressing this through policy, procedure and training. Three care plans were tracked and the accommodation and service provided to the individual residents were assessed. What the service does well: What has improved since the last inspection?
The staff training programme has progressed and staff have received updates in emergency aid training. Bedding and curtains have been replaced and new chairs have been provided. The external fire escape has been maintained and painted. The range of activities on offer has been extended and a designated person now co-ordinates activities
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 6 What they could do better:
The home’s emergency procedures must be updated to include clear instructions on staff responsibilities when an accident occurs and serious injury is suspected. The home’s primary responsibility is the welfare of residents, and in such situations, they must not be moved and an ambulance must be called immediately. The manager must provide CSCI with a copy of the revised procedures. The manager must ensure that provider complaints investigations are supported by written evidence. Regulation 22 requires that complaints made by residents or on their behalf, must be “fully investigated.” The outcomes of investigations cannot rely on unsubstantiated hearsay statements but must be substantiated by witness statements, home’s records and /or supporting written evidence. To support the home’s responsibilities and accountability regarding the welfare of residents of high dependency and those who are diabetic, the manager must arrange for a care plan to be updated with regards to pressure care/monitoring and for individual diabetic residents, their diets must be recorded daily. Residents’ assessments carried out by home’s staff must have the correct date recorded, as evidence that information relating the condition of a resident is up to date and accurate. Medication administration records must be accurately maintained to ensure that an audit trail of used and unused drugs is on record. Staff must not leave gaps but record the appropriate code if medication is refused or the resident is in hospital. To ensure that staff have awareness of residents’ diversity and the necessary knowledge in following procedures, where abuse is suspected, one requirement and one recommendation are made for related training in diversity, and Local Authority Adult Protection Procedures. To protect residents from risk and to ensure equipment is in good order, the fire systems testing in the home must be carried out weekly and recorded. The home’s certificate of registration is out of date. Application must be made to CSCI to have the certificate amended in accordance with the age and category of service provision. The variation set out on the current certificate, for a resident under the age of 65 was for a named person, who has since been discharged. Craignair DS0000005411.V295370.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. Craignair DS0000005411.V295370.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.V295370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to this service. The home admits new residents only on the basis of a full professional assessment to which the prospective resident, their representative and relevant professionals have been party EVIDENCE: Three case files were checked. A professional and homes assessment had been carried out for each individual. The senior member of staff on duty confirmed that all residents who are admitted to the home, are assessed as having dementia by relevant mental health professionals (eg. approved social workers and the psycho-geriatrician). In addition, the homes assessment format includes areas of need such mental health, mobility, oral health, continence, diet, weight, personal care and health care. The relatives of two residents commented and said that an assessment had been carried out for their relatives prior to admission. One resident whose care plan was tracked,
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 10 was awaiting transfer to a nursing home, due to increased level of dependency. Craignair DS0000005411.V295370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to this service. Shortfalls were noted regarding standards 7 and 9 but in general, the home was meeting the standards regarding the systems in place for care planning, health care, managing medication and respect for residents’ privacy and dignity. EVIDENCE: Care plans were in place for all residents and those for three residents were tracked. Care plans follow a standard format (assessment, action plans and reviews) and were secured and well organised. All care plans are reviewed at a maximum of four weekly intervals, sooner if necessary. Details include personal and contact details, religion and a brief personal history. All residents are registered with local G.P.s and there are records of referrals for physical and mental health support and paramedical services from relevant professionals. Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 12 Residents did not comment in depth on the quality of care but they looked well cared for and relaxed. A visiting relative said that the home is “second to none.” Shortfalls were noted regarding records of pressure care monitoring for one resident and the home’s assessment for one resident had not been dated. The medication is stored in a locked trolley, which is secured to the wall in the dining room. The mediation administration records were read and, in one of the sample reviewed, gaps were observed. Staff had not signed whether one drug had been administered or refused. The senior on duty confirmed that unwanted medication is returned to the pharmacy and there were no out of date drugs in store. Designated staff administer medication and have received relevant training and the training records were seen. From direct observation and from speaking with staff on duty and visitors, it was evident that residents’ privacy and dignity is respected in care giving and in their daily lives. Records are secured at all times and staff expressed awareness of the home’s confidentiality policy. Craignair DS0000005411.V295370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to this service. As far as it is possible to judge for residents who do not have capacity to comment in depth, the lifestyle experienced in the home appears to satisfy residents’ social cultural, religious and recreational interests and needs. EVIDENCE: Activities diaries are posted on the notice board. Those activities on offer include reminiscence, films, live musical entertainment, carpet boules, croquet, dominoes, pet therapy, visiting school musicians, memory joggers, poetry, crosswords, skittles and jigsaws. The manager said that residents and daycare service users (up to four) join together in the range of in-house activities and a member of staff is allocated to co-ordinate social events. In addition to activities such as board games, quizzes and sing songs, some residents were go for walks with staff others use the garden, which is well maintained and secure. A visitor said her relative’s religion has been of important throughout life. Despite increased frailty and memory loss, support from visiting ministers continues for that resident. In the care plans which were tracked, residents religious affiliations/non belief were recorded.
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 14 In a sample of quality assurance questionnaires for the current year, which were read, there were good scores for activities on offer to the residents. Residents have access to advocates who would act in their best interests in the absence of family support and the home has an equal opportunities policy. There is a four-weekly rotating menu and an alternative menu, recording cereals and cooked breakfast, light lunch and a main evening meal. The food stores had good stocks and kitchen records were well maintained. The kitchen was hygienic, well organized, well ventilated and in reasonable decorative order. All kitchen equipment was in working order and utensils and appliances were clean. The dining room was clean and new flooring has recently been laid. There are sufficient places in the dining room for the residents and a minority were seen having their meal in the lounge. For residents who are diabetic, their individual diets must be recorded and a requirement is given in the relevant section of this report. The relatives of two residents were spoken with and they said that they are always made welcome on their visits to the Craignair and are kept informed of the individual resident’s health and general progress. Craignair DS0000005411.V295370.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality of this outcome was poor. This judgement has been made using available evidence, including a visit to this service. The home has systems for investigating complaints but in practice, they are not being used effectively in providing evidence of the outcomes. Although staff have in-house training in protection of vulnerable adults, they lack understanding of Local Authority Adult Protection Procedures. EVIDENCE: The home has a complaints procedure, which is provided to residents/representatives on admission to Craignair. Two visiting relatives said they had never had cause to make a complaint and they were satisfied with the service which one described as “excellent”. Both said that the manager and staff were approachable and they would feel comfortable in expressing their concerns to them if necessary. There have been two complaints made against Craignair via CSCI, since the last inspection. These were investigated by the provider/manager (Mrs. Neale) through the home’s complaints procedure. Neither complaint was upheld. The complaints investigations have been reviewed by CSCI. The outcomes were not always backed by written evidence, such as reports and witness statements. In one instance, the response to the complainant had not been sent to the complainant but to another member of the resident’s family. A requirement is made regarding the methods to be used in complaints investigations, in the relevant section of this report.
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 16 The home has adult protection and whistle blowing polices and staff have received in-house video training in protection of vulnerable adults but have not received training in Sefton’s adult protection procedures. This training had been arranged by the manager, at the time of inspection, but had not yet been completed and a requirement is given in the relevant section of this report. A health & safety requirement identified in reviewing one complaint is made under Care Home Regulations 12 and 13. Craignair DS0000005411.V295370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. The quality of this outcome was good. This judgement has been made using available evidence, including a visit to this service. Residents live in a clean, comfortable and well-maintained environment. EVIDENCE: A tour of the premises was carried out. The building is clean, homely and well maintained both internally and externally. Residents bedrooms are personalised and comfortable, bedding and curtains have recently been replaced. New flooring has been laid in the dining room and new chairs and curtains have been purchased for the lounges. Decoration is ongoing as bedrooms become vacant. The grounds are well stocked and in good order, the rear is secure with seating and shade for residents, and there is an ample car park at the front of the building. QA questionnaires stated satisfaction with the home environment. There is comfortable seating for residents in two lounges and they have freedom of movement between the lounges and dining room and the hallway, where further seating is provided near the front door.
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 18 Two visitors said that the home is always clean and comfortable and the gardens are beautiful, whatever the season. Domestic staff are employed and receive training in infection control and Food Hygiene. There are procedures for health & safety and C.O.S.H.H. and cleaning materials and utensils were stored securely. The home employs three domestic staff who work a total of 67 hours a week. A maintenance person is employed for 19.5 hours a week. Craignair DS0000005411.V295370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff. EVIDENCE: Four members of staff commented during the inspection. They confirmed that they receive formal supervision every two months. One member of staff said, We find supervision very useful.” There are also regular staff meetings. Over fifty percent of staff have NVQ level 2 or above. Training undertaken by staff since the last inspection includes, Health & Safety in the Care Home, Infection Control, Management of Aggression, Moving & Handling, Delivery and Recording of Medication, Emergency First Aid, Dementia Care, Food Hygiene, Adult Protection training in the local authoritys procedures will be required for staff, this has been arranged by the manager with social services, but is not yet completed due to demand. The manager said that training in WhistleBlowing has also been arranged. Staff have not received training in Equal Opportunities/ Diversity and this training will be a recommendation of this report. Staff files were well maintained. The home has a robust recruitment policy which is adhered to. Staff are vetted and schedule 2 requirements for documentation were in place in the files which were inspected.
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 20 Staff Rosters contain the staff members full names record required staffing levels and additional ancillary staff. There are three care staff ( one day-care assistant) during the day and two night staff from 8pm. Craignair DS0000005411.V295370.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to this service. The home meets the standards regarding management and administration and maintains satisfactory health & safety records. Fire safety system checks were not being satisfactorily maintained, a requirement from the last visit has not been met and the home’s certificate of registration requires updating. EVIDENCE: Mrs. Neale is the joint owner and registered manager of the home and she is supported in her duties by an acting deputy manager. Staff on duty said they felt supported by the manager and a visitor said she is helpful and approachable.
Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 22 Staff receive formal supervision (one to one) at two monthly intervals. Three members of staff confirmed this and notes were held on their files. They said they find supervision useful in support of their knowledge and skills and the home’s procedures.. The home has a quality assurance system managed by an external agency and examples of questionnaires completed by residents/representatives, staff and professional visitors were seen. Responses were generally satisfactory. The manager states in the home’s pre-inspection questionnaire, that residents’ finances are managed by their representatives and the home has no involvement. Additional charges are stated as “alcohol, tobacco, taxis, dry cleaning and private chiropody”. A variation remains in place for a named resident who has recently been discharged from the home. The manager must arrange for the home’s certificate of registration to be amended. Two areas of the building were checked for tripping hazards following falls to two residents. No such hazards were observed. In response to a complaint, a requirement is made that a copy of the home’s updated accident/emergency procedure is provided to CSCI. It must be made clear to staff through written instruction, that moving a resident who has fallen, where serious injury is suspected and any delay in calling an ambulance, pose a serious risk to the resident’s health, safety and welfare. Staff have received emergency aid training/updates in response to requirements made as result of a complaint. Health and safety certification was checked and was satisfactory other than as follows : Fire Book: last fire systems test 06/06/06 previous 26/05/06. These are required to be carried out weekly. Craignair DS0000005411.V295370.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 1 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? 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 OP38 Regulation 13(4) 12 (1) (a) Requirement The manager must provide staff (copy to CSCI), with emergency procedures to be followed in case of fall or accident, when serious injury is suspected. Requirement outstanding from the last visit (March 06) and an extended time limit is given. The manager must ensure that pressure care monitoring for a resident of high dependency is recorded on the care plan. The manager must ensure that the individual diets of diabetic residents are recorded daily. The manager must ensure that assessments carried out by home’s staff are dated. The manager must ensure that medication administration records are accurately maintained (ie. that administration/refusal or absence in hospital etc. are indicated with the appropriate code). The manager must provide evidence that any complaint
DS0000005411.V295370.R01.S.doc Timescale for action 28/07/06 2. OP7 15(1) 28/07/06 3. 4. 5. OP7 OP7 OP9 15 (1) 15 (1) 13 (2) 28/07/06 28/07/06 28/07/06 6. OP16 22 (3) 28/07/06 Craignair Version 5.2 Page 25 7. OP18 13 (6) 8. 9. OP37 OP38 17 23 (4) made under the complaints procedure is fully investigated through provision of witness statements, reports and supporting documentation. The manager must ensure that all staff receive training in Sefton’s Adult Protection Procedures. The manager must arrange for the home’s certificate of registration to be amended. The manager must ensure that the testing of fire systems within the home is carried out weekly. 28/09/06 28/07/06 28/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations The manager should arrange for staff to received training in equal opportunities/diversity. Craignair DS0000005411.V295370.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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