CARE HOMES FOR OLDER PEOPLE
Cranford Nursing Home 15 Cranford Avenue Exmouth Devon EX8 2HS Lead Inspector
Anita Sutcliffe Unannounced Inspection 15th November 2005 07:30 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 Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 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. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cranford Nursing Home Address 15 Cranford Avenue Exmouth Devon EX8 2HS 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) 01395 263295 01395 267273 csampford@tiscali.co.uk Baystone Limited Mrs Elizabeth Caroline Mary Sampford Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 30/9/1996 Registered for 26 - Elderly General Nursing Care Date of last inspection 5th July 2005 Brief Description of the Service: Cranford Nursing Home is a detached 1920s building in a quiet residential part of the East Devon town of Exmouth. It provides residential accommodation to 26 older people who require nursing care. It is situated in attractive gardens. Accommodation is provided on two levels, and has a passenger lift and large staircase. Accommodation is provided in 24 single and 1 double room. 22 single rooms have en suite facilities. The home has a large, welcoming reception hall where seating is provided. Baystone Ltd. owns the Home and the responsible individuals are involved in its day-to-day management. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection began at 7.30 am and took place over 5 ½ hours. The morning routine was observed, during which four service users (residents), several staff, and the owners Mr. And Mrs. Ward, were with spoken with, some at length. The care of 2 residents was examined in detail. This involved meeting them, visiting their room and reading records associated with their care. Most of the home was visited, including the sitting room, dining room, some bedrooms and the staff room. Medication was examined and the fire safety, recruitment and activities records read. Standards looked at on this occasion were the key standards not included at the July inspection and those where the need for improvement had been identified. The home is currently without a manager. Registered nurses were in charge of care at the home, and the inspection feedback was given to the nurse in charge and Mr. Ward, the responsible individual. What the service does well: What has improved since the last inspection? What they could do better:
Residents could think of nothing that staff could improve. One resident would prefer an improved outlook from her room, but this is already being addressed. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 6 Staff do not handle medication so that regulation and guidelines are fully met. This was not improved on the last inspection when good practice recommendations had been made. On this occasion, tablets were found on a floor, not all medicines were checked into the home, hand written entries were not always signed, or have two signatures to further ensure safety, a resident keeping some of her own medication had not had risks for this assessed and cream prescribed for a resident was being used by another. Care provided is of a high standard and records of care given are satisfactory. However, staff do not understand care planning, which should be used so as to provide consistency when meeting health, personal and social care needs in line with the wishes of the resident. This was discussed and the home are considering this as a training need. 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. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 7 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 Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 8 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): Not inspected on this occasion. Key Standards 3 and 6 were met at the previous inspection. EVIDENCE: Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 9 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&9 Good assessment of residents needs was not transferred into a care plan that informed staff how to continue meeting those needs. In general procedures in relation to medication are satisfactory. However, medication practice at the home does not fully protect residents because not all staff follow current medication policy. EVIDENCE: The care of two residents was looked at closely. It was clear that care, although well delivered, is not planned at all. The ‘what’, ‘why’, ‘how’ and ‘when’ are needed so that care is delivered in a consistent way in accordance with residents’ wishes and good nursing practice. Records of events and outcome were quite satisfactory, and residents were very happy with their care. Comments included “the care is very good and the girls are lovely. I could not be in a better place”. The handling of medication continues to need attention. On arrival 2 tablets were found on the sitting room floor, which must indicate that the resident to
Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 10 whom they were given had not taken them, or the nurse had dropped them. Medicines were not always checked into the home, so they could not be effectively audited so as to monitor use. Some hand written entries were not signed or dated, and not all those that were had two signatures to indicate that two staff had checked that they entry was correct. A resident who keeps some medicines in her room had not had this assessed in a structured way, and another resident was using cream prescribed for another. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 11 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 & 14 Residents are well supported to have a fulfilled life at Cranford. EVIDENCE: Residents were very satisfied with their daily life at the home and confirmed that they have control over their lives. A member of staff felt the home’s biggest achievement was “empowering independence”. It was clear that individual interests are encouraged and promoted. Assistance is provided to go shopping; regular activities include exercise, reading, music and board games. The garden is easily accessible and residents were observed enjoying it. Records showed that individual social and welfare needs are well assessed and understood. Meeting them needs to be planned as with health care (see standard 7). Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 12 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): Not inspected on this occasion. The key standards 16 and 18 were met at the previous inspection. EVIDENCE: Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 13 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 The home is clean, pleasant, well maintained and meets residents needs. EVIDENCE: Cranford meets the challenge of a homely environment whilst adapted to meet the needs of highly dependent residents. There is a good supply of specialist equipment to promote independence and enable safe working practice. The home is warm, very clean and comfortable. Some bedrooms are like small apartments, and most residents like their room very much. The grounds and gardens are accessible and attractive and the home is maintained and upgraded to a high standard. Currently all the windows are being replaced so as to increase light, warmth and ventilation. One resident commented on how much this had improved her room. Fire safety records were examined; they indicated that fire safety was being addressed properly at the home.
Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 14 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): 28, 29, 30 Residents needs are properly met through the skills and training of staff. Residents are protected by robust recruitment practice. EVIDENCE: Nursing and care staff are encouraged to undertake training and learn new skills. Many courses were advertised and records listed previous training received. The home has a high proportion of care staff qualified to NVQ level 2 or above. Staff spoke of training they have received and residents felt most staff were extremely competent. The records of two recently employed staff were examined. Each contained the information considered necessary to recruit staff who are suitable and safe to work with vulnerable adults. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 15 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 & 35 There is currently no registered manager at Cranford. Residents’ financial interests are safeguarded by practices at the home. EVIDENCE: The registered manager has recently left the home, but a new manager is due to start early December. Currently nursing staff are managing care and the responsible individuals for the home visit frequently, as they did during the inspection. Work is well supported by the home’s administrator. Cranford does not keep valuables or money for any resident. Each has lockable storage space within their room, and they are invoiced for money spent on their behalf. Support and advocacy are provided as necessary, but most have family or professional financial support. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X X Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 17 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. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 20/11/05 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. [This refers to: - tablets having being found on the lounge floor -medication not being signed into the home on arrival -creams prescribed for a resident being used by another resident -no assessment of risk in place when a resident was keeping external medicines in her room] Requirement 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 OP7 Good Practice Recommendations Care plans should be expanded to clearly show how
DS0000026689.V265454.R01.S.doc Version 5.0 Page 18 Cranford Nursing Home 2. OP9 identified needs will be met. Hand written drug charts should be signed by two people. Cranford Nursing Home DS0000026689.V265454.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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