CARE HOMES FOR OLDER PEOPLE
Cranford Residential Home 637 Warrington Road Rainhill Merseyside L35 4LY Lead Inspector
Lynn Paterson Unannounced 22nd July 2005 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 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 Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cranford Residential Home Address 637 Warrington Road Rainhill Merseyside L35 4LY 0151 426 6308 0151 426 6415 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cranford Care Homes Limited Mrs Barbara Barr Care Home 24 Category(ies) of OP - Old Age registration, with number of places Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 24 (OP) 2. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI Date of last inspection 8th October 2004 Brief Description of the Service: Cranford Care Home is registered to accomodate a maximum of 24 older persons who need assistance with their personal and social care. The accomodation is provided over two floors, the upper floor being accesible via a passenger lift.The home comprises 5 double and 14 single bedrooms,none of which have en-suite facility,three communal lounge areas, a dining room and conservatory which overlooks the rear garden Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Cranford care home took place over a five- hour period and was carried out on an unannounced basis. For the purpose of the report a tour of the premises was undertaken, care files and other documentation was examined and 16 residents, 2 care staff and the officer in charge was spoken with. What the service does well: What has improved since the last inspection?
Staff have devised a new system of reviewing care needs to ensure that the appropriate care is provided as an ongoing process. New furnishings have been provided in the dining room and large front lounge. The exterior of the premises was being painted at the time of the inspection visit. The rear gardens had been landscaped and made safe for the use of the residents. New kitchen and office equipment had been provided. Staff had produced a home newsletter, which held details of “local news” and events and occurrences within the home. Staff training is ongoing.
Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 6 The home manager has been recently appointed having been promoted from her previous role as deputy manager and is awaiting her registration interview with CSCI. What they could do better:
Care plans did not hold sufficient information about care planning or care provision. The home manager agreed that the plans did not hold sufficient details of care practices or of the agreement of the residents for these practices to be carried out. She stated that as a consequence of our discussion new care plans would be introduced that made sure that care planning and care delivery were detailed and that the plans held signatures of all people who were involved with the plan preparation. The dates on medication records were incorrect at the time of the inspection. Instruction was given to ensure that all records held the correct information and were recorded as per the medication policy in the home. Residents advised that very few activities took place and they lacked stimulation. Resident’s comments included “staff are too busy to provide activities, they have too much to do”. “We play bingo and dominoes sometimes but not very often”.” Staff do not have time to arrange activities”. “look at the staffing levels, 2 care staff to look after us, it is not possible for them to arrange activities as well”. The staff roster showed that one officer in charge and 2 care staff was employed to provide home management and care practices for the residents of the home. Staff advised that they were also responsible for the laundry for the residents. Observations of staff carrying out their duties revealed that they were experiencing difficulty in providing personal care, toileting needs, laundry work and mental stimulation for the residents in their care. The manager was advised that she must ensure that staff, were employed in sufficient numbers and skill mix to meet the needs of the residents of the home. The exterior of the premises was being painted at the time of the inspection and it was noted that the decorator had left ladders paint pots, transistor radio and loose wiring across the front of the premises. It was also noted on entering the building that the foyer entry point floor had a matting material, which was “sinking” in parts and therefore presented as a health and safety risk to staff, residents and visitors to the home. Heath and safety matters were discussed with the home manager during the inspection and it was agreed that a full building risk assessment be carried out as a matter of urgency. It was noted from staff files that the recruitment and selection procedures as stated in the homes policy document had not been fully adhered to and at the time of the inspection one staff file revealed that not all relevant checks had been carried out prior to commencement of duties. The manager was reminded of her responsibilities to ensure that references and checks were carried out
Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 7 prior to the offer of employment to make sure wherever possible that staff were suitable and competent to provide safe needs led care practices to assist and protect the residents of the home. 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 Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 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 standard(s) 3 Prospective residents have a full needs led assessment carried out prior to being offered a placement within the home. Staff who carry out this assessment have knowledge and understanding of the assessment process and of the care provision and aids and adaptations within the home. EVIDENCE: Discussion with the home manager revealed that she has developed a system to make sure that all the relevant information about the needs and abilities of prospective residents were assessed and recorded as appropriate prior to admission. She evidenced that she had full awareness of the registration category of the home, which was to provide care support for persons who needed assistance with their social and personal care and she showed that she had understanding of the usage of the aids and adaptations within the home and how they could assist residents in their daily living. Pre assessment documentation viewed was clear and held all the information necessary for the home to make an informed choice as to the suitability of the home to meet assessed need. Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.9. Care plans held insufficient detail of resident’s health, personal and social care needs. Medication records were inconsistent with dates and signatures of administration. EVIDENCE: Individual plans of care looked at did not hold sufficient details to ensure that all aspects of health, personal and social care needs are identified and planned for. Plans appeared basic and held limited information about care- planning or care practice. Discussions with the home manager revealed that some information about daily living, health and medication and significant events is recorded however documentation seen revealed that the information was stored in various documents and not held together. However general diary records were well kept and were used for handover information purposes. Discussion with staff suggested that some needs were being addressed although this was not recorded on a residents care plan and most of the daily living practices were dependant on staff good memory and clear verbal communication systems. It was agreed that care plans would be overhauled and the format changed to make sure that all relevant information about personal, social and health care would be held together in a care plan.
Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 11 Medication management for the storage of medication was good at the time of the inspection however the medication record sheets held incorrect dates for the administration purpose and as a consequence the dates on the records were inconsistent. It appears that the pharmacy medication sheets had furnished incorrect dates but it is the responsibility of the home to ensure that dates and other information pre recorded on the medication sheets are correct prior to usage as this could place residents at risk of receiving medication at a time that might adversely affect their health and wellbeing. Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.15. Social activities are almost non- existent in the home, however the food provision is wholesome and provides choice and variation of menu. EVIDENCE: Residents spoken with advised that they did not have an arranged activity programme in the home and although care staff tried to arrange Bingo and dominoes, this was not always possible due to the limited number of staff on duty. Comments from residents included “ we don’t have much to do during the day”, “we sometimes play Bingo but the staff are `generally very busy looking after people or washing the laundry”. Staff advised that they did try to arrange activities but they did not have an activities co-ordinator on the staff and due to the shortage of care staff they found it very difficult to arrange activities or outings for the residents. Staff advised that they would like to have more time to interact with residents for general conversations and mental stimulation but found it difficult with the limited staffing levels in the home. Staff were advised that activities must be arranged on a daily basis in consultation with residents to make sure that their lifestyle matches their expectations, capabilities and preferences and satisfies their social and recreational interests. Residents observed having lunch at the time of the inspection, appeared to thoroughly enjoy the prepared meal which was well presented in pleasant surroundings. Residents spoken with revealed that they liked the food, were
Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 13 given varied menus and were afforded choices at all meal times. Residents comments included “the food is always good”, “we are provided with varied well cooked meals”,” the cook knows how I like my fish and cooks it just how I like it”. Menus viewed were found to be varied, interesting and well balanced. Staff and residents said that mealtime arrangements were flexible to accommodate individual preferences. Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16.18 Complaints procedures are clear and complaints are handled objectively with residents being confident that their concerns will be listened to and acted upon. Staff, spoken with, exhibited knowledge and understanding in all aspects of adult protection. However staff recruitment procedures have not been followed in respect of CRB (criminal records Bureaux) checks as used as part of the process to ensure that residents are protected from abuse. EVIDENCE: The complaints procedure was clear and staff and residents spoken with identified that they knew what to do if they needed to make a complaint and of how that complaint would be dealt with. The home complaint book was visible and easy to access. No complaints had been recorded since the previous inspection. Staff records showed that all staff had received training in adult protection and staff spoken with revealed that they had full knowledge and understanding of adult protection procedures. However it was noted that a recent member of staff had been employed without a CRB (criminal records bureaux) check being in place and instruction was given to the home manager to ensure that all appropriate recruitment and selection processes were followed prior to persons being appointed as a staff member of the home to ensure that residents were protected from abuse. Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.20.25.26. Some improvements have been made to the décor and communal furnishings and essential services records appeared to be well maintained. However outstanding building risk assessments do not provide the people living in the home with safe surroundings. EVIDENCE: Since the last inspection the home have introduced a maintenance and redecoration programme and two bedrooms and a small lounge have been redecorated, the dinging room and front lounge have been refurnished and the exterior of the building was in the process of being repainted at the time of the inspection. The gardens have been landscaped with safe ramped access being provided for residents. Maintenance records for fire, water, electricity, gas and moving equipment appeared well managed at the time of the visit. However a tour of the building revealed that painting work was being carried out to the exterior of the premises, the flooring in the entrance foyer was sinking and uneven and resident’s room doors had been wedged open. The manager advised that risk assessments had not been carried out on the building although she realised that the exterior work presented hazards to residents
Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 16 staff and visitors to the home and the entrance flooring looked unsightly and was a trip hazard to all who entered the home. The manager was also aware of the fire safety risks encountered when bedroom doors were held open by a wedge. Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.29. Staffing levels are not sufficient to meet the assessed need of the residents. The procedures for the recruitment of staff do not provide safeguards to offer protection to people living in the home. EVIDENCE: Records show that staff numbers have diminished and staffing levels have been reduced as a consequence. Staff files examined showed that the home had not taken the necessary recruitment checks to ensure protection of residents. Criminal Records Bureaux checks had not been requested for one staff member. Records and observations revealed that the home manager and 2 care staff, were on duty during the inspection to provide management and administration, medication management, personal care, laundry duties and serve meals to the residents. Residents spoken with said that staff at the home were kind and caring but that they were very busy and they had to “wait their turn” for staff to assist them. Residents said that they understood this as 2 care staff could not care for all the residents at once especially if a resident needed the assistance of 2 staff for toileting or personal care needs. Residents comments included “staff work so very hard to assist us”, ”we don’t know how they manage to do so much for us”, ”they are very short staffed but hey work so hard `and keep cheerful”. Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Records show that training has been provided for staff in respect of safe working practices to include relevant legislation. However risk assessments have not been carried out as required to ensure that the health, safety and welfare of staff and residents is promoted and protected. EVIDENCE: Staff records show that staff have received training in safe working practices to include moving and handling, fire safety, first aid, food hygiene, infection control and safe storage and disposal of hazardous substances. Documentation viewed revealed that accidents, injuries and other incidents are recorded and reported as appropriate. However a tour of the premises showed that the manager had not conducted risk assessments on the building exterior and interior and had not complied with the fire safety procedures in respect of wedging open doorways. These actions could impact most unfavourably upon the health, safety and welfare of staff and residents of Cranford Care Home.
Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 2 x x x x 2 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 2 Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 20 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 7 Regulation 15 Requirement The resistered `person shall prepare a care plan as to how the residents needs in respect of health and welfare`are to be met. The registered person shall make arrangements for residents to receive any necessray treatment,advice and other services from any health care professioanl and record details of this on the care records Ther registered person shall make arrangements for the recording ,handling,safekeepingsafe administartion and disposal of medicines received into the care home. The regsitered person shall consult residents about social interests and arrange daily activities within the home in accordance with the residents wishes. The regsitered person shall not employ a person to work at the care home unless necessary references and checks have been completed. The registered perosn shall Timescale for action 20th October 05 2. 8 13 20th October 05 3. 9 13 20th August 05. 4. 12 16(2)(m) 20th October 05. 5. 18 19 20th August 05 6. 19 23 20th August
Page 21 Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 7. 20 23 8. 25 23 9. 27 18 10. 29 18 11. 38 13 ensure that the residents live in a safe,well maintained environement. The regsitered perosn shall ensure that residents have access to safe and comfortable indoor and outdoor communal facilities.Risk assessments to be carried out to the building and exterior to ensure that the premises is of sound construction and kept in a good state of repair,both internally and externally. The registered person shall ensure that residents live in, safe comfortable surroundings.Flooring to the entrance area must be replaced.Fire doors must not be wedged open.Risk assessments to be carried out throughout the building. The registered perosn must ensure that staff are empoyed in number and skill mix as appropriate to meet the assessed need of the residents The registered person must ensure that residents are supported and protected by the homes recruitment and selection policy and practices. Staff must not be employed before references and appropriate checks have been undertaken. The registered person shall ensure that the health safety and wellbeing of staff and residents is protected. Risk assessments must be carried out to the building and fire doors must not be wedged open at any time. 05. 20th October 05 20th August 05 20th August 05 20th August 05 20th August 05 Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 22 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 Good Practice Recommendations Cranford Residential Home F53 F03 S22401 Cranford V228181 220705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Burlington House, South Wing, 2nd Floor Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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