CARE HOMES FOR OLDER PEOPLE
Cranford Residential Home 637 Warrington Road Rainhill Merseyside L35 4LY Lead Inspector
Mrs Lynn Paterson Unannounced Inspection 9:20 23 th June 2006
rd 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 Residential Home DS0000022401.V295332.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. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cranford Residential Home Address 637 Warrington Road Rainhill Merseyside L35 4LY 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) 0151 4266308 0151 4266415 Cranford Care Homes Limited Mrs Dianne Jones awaiting registration Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users to Include up to 24 (OP) The service should, employ a suitably qualified and experienced manager who is registered with the CSCI. Date of last inspection Brief Description of the Service: Cranford Care Home is registered to accommodate a maximum of 24 older persons who need assistance with their personal and social care. The accommodation is provided over two floors, the upper floor being accessible 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. Fees charged are currently £360.00 per week. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of Cranford Care Home was undertaken on 23rd June 2006 and was carried out over a five-hour period. The inspector met with the manager, senior carer, two care staff members, cook and domestic staff and 17 of the 18 residents living in the home. Records care files, policies procedures and other documentation was examined and a tour of the premises carried out. Fieldwork included case tracking five residents, which involved reading all documentation relating to the residents daily living and speaking with the residents and staff who were associated with their care. Discussions were also held with 4 residents representatives who were visiting the home at the time of inspection. What the service does well:
Records viewed and discussions held with the manager and senior carer revealed that care plans and residents records have been updated to a high standard and those viewed were seen to be clear, consistent and easy to follow. Residents said they were offered a choice of nutritious meals, which they enjoy. They said the cook visits residents daily, discusses options available. Staff said residents were asked their opinion of the food on a monthly basis. This shows that the service values the resident’s opinion. Comments made by the residents regarding food included “its very tasty”, “I love the food here”, They ask what we want to eat and get it for us” and “they’ll always find something nice for me if I don’t want what’s on offer”. Records showed the service develops staff by offering training to all. Much of this training is designed so that staff, know how to care for the residents needs. Staff spoken with showed they had good understanding of the residents care requirements and had the experience training and understanding to fully meet all assessed need. Documentation examined revealed that the home operates a quality assurance system in which residents and their representatives are asked to provide their views about the running of the home and the services provided and residents spoken with said they felt included in all aspects of the decision making in the home. Records showed that the manager acted on all information obtained in Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 6 the quality assurance process, which indicated that resident’s views are listened to and service provision amended as appropriate. What has improved since the last inspection?
It was noted that the manager and staff had addressed the twelve requirements made at the previous inspection and as a consequence had effected great improvements in the areas recorded below. Staff members have approached relatives to ensure residents care plans are signed. This helps to include relatives in the care process when appropriate. All care records are audited monthly by senior staff within the home. This ensures that they are fully aware of all occurrences and changes in the residents care. It was noted that there had been a vast improvement in the care planning and recording systems since the previous inspection and discussion with the manager and her deputy identified that they had worked tirelessly to ensure that the care plans were an accurate reflection of the care needs and care practices in place to meet these needs. This great improvement to the overall system was seen to be commendable. The manager has attended updated training in Adult Protection and has cascade knowledge gained form this to all staff of the home. Risk assessments are now carried out in all relevant areas. Staffing levels have improved with the manager now having time to carry out her management role. Staff training has been developed to ensure that staff, receive training pertinent to their role. Staff and residents meetings are now held on a regular basis to ensure communication systems are open and transparent. Staff supervision and appraisal systems have been reviewed and supervision records are now more detailed. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 7 What they could do better: 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 DS0000022401.V295332.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 Cranford Residential Home DS0000022401.V295332.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are not offered accommodation in the home until a full needs led assessment has been carried out to ensure the home can meet all assessed need. EVIDENCE: Pre admission documentation looked at was clear and detailed information about the home and its service provision and the home statement of purpose held details to include staffing levels and the ethos of the home. Information recorded in the statement of purpose included information about the ethos of the home, which was to treat all people with respect and dignity and carry out care practices to meet individual need. Residents said they were able to read about the home before they visited to look around. Three residents spoken with said when they had decided they wished to live at Cranford Care Home they received a home visit to assess their needs before being offered a place there. One resident said “I visited the
Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 10 home before I came with my daughter. The staff showed me around and it felt like home”. Assessment documentation seen confirmed that pre admission assessments were carried out prior to residents being admitted to the home. Assessment procedures included utilising information from the prospective resident, their representatives and any other professional to enable full details about choices, preferences and abilities to be noted and used as the basis for a plan of continuing care. Staff advised that they attempted to gain as much information as possible about the residents prior to them coming into the home to enable staff to organise any aids adaptiaons or other provisions that may be required in order to meet assessed need. Cranford Residential Home DS0000022401.V295332.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 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to the service. Care planning and care delivery is excellent however the medication management was seen to be poor with records and medication audits being neglected. Medication processes must be reviewed to ensure the well being of the residents. EVIDENCE: Eighteen care plans were viewed and four were examined in detail and it was noted that the information held on plans was excellent. Care plans detailed preferred lifestyle of the residents to include social interactions, personal development and the level of support needed in respect of personal and health care need. Plans also had full information as to how care was to be delivered. All plans held evidence of risk assessments being in place and care plan reviews being undertaken on a monthly basis. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 12 Plans and reviews held signatures of all who were involved in the process to include residents, staff, resident’s representatives and any other significant people. Staff spoken with and observed carrying out their care practices identified they were able to interact well with residents and provide support and motivation to enable residents to be assisted in a discrete and dignified way. Residents spoken with said “I love it here the staff are kind and helpful”, ”We are well cared for here”, “staff are so nice they know what we want and help us all the time”, “I don’t know what I would do without them”. Whilst the general care and support was seen to be of a high standard, the medication management was poor. Eighteen medication records sheets were examined and five of these records were incorrect. The home medication policy states staff, which administers medication should record their signatures on the medication sheets when medication is being administered or record reasons for any non-administration. Five medication record sheets were without staff signatures or reasons for non–administration and therefore the records could not give an accurate reflection of resident’s medication intake. Furthermore medication tablet counts were incorrect and medication deliveries were not recorded as and when they were brought into the home. The issues surrounding medication management were discussed with the manager and it was agreed that urgent action was needed to ensure good practice in this area. The manager advised that she would book all staff on to refresher training in medication management and would introduce a quality assurance system to enable random checks to be made on medication recordings on a weekly basis. It was said that this would enable the manager to notice any errors and deal with the issues immediately. Cranford Residential Home DS0000022401.V295332.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): 12.15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are provided with a varied lifestyle that reflects their choice and capabilities. Food provision is wholesome nutritious and enjoyed by the residents of the home. EVIDENCE: Menus were viewed. A discussion was held with the cook. A tour of the environment was undertaken. Brief discussions were held with three residents. A menu board was completed on a daily basis stating what the choice of meals will be for that day. Residents said staff visited all residents each morning to offer the choice to each resident. Staff confirmed this to be true. The diet on offer is wholesome and nutritious. Five residents confirmed that they enjoyed the food on offer. The manager and cook stated that monthly food satisfaction surveys were carried out to ensure that the residents were happy with the standard and choice of food available. Residents spoken with said they were able to have drinks and snacks throughout the day and night and were able to buy their own snacks and drinks and have them when they wished.
Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 14 Activities notices throughout the home identified that the home has a daily programme of activities to stimulate and motivate the residents. Residents and their representative spoken with said that the activities included Bingo, Dominos, Quizzes, discussion groups and outing, weather permitting. Cranford Residential Home DS0000022401.V295332.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Complaints policies are in place and residents know about the complaints system and are confident any complaints will be listened to and dealt with quickly. Staff are trained and knowledgeable in all aspects of adult protection EVIDENCE: The complaints policy identified the complaints process and residents spoken with advised that they knew how to complain if they wanted to. Residents spoken with said that the home manager and staff asked them each day if they were all right and if they wished to speak/complain about anything. Residents revealed they felt comforted by this attention and were never afraid to speak their mind. The complaints book was viewed and it was noted that no official complaints had been recorded since the previous inspection. Staff spoken with, were clear in their understanding of what constituted adult abuse, and of what to do if they suspected abuse was taking place. Staff training records revealed that staff, were provided with ongoing adult protection training and staff said they found the training to be useful and informative. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 16 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): 19.25.26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home environment is clean, safe and well maintained. EVIDENCE: Cranford Care Home presents as a large two-storey building that has been adapted and extended to accommodate twenty-four older people who are in need of assistance with their daily living. The home has aids and adaptations in place and carries out continual risk assessments to ensure that the home provides a safe and well-maintained environment for all who reside in the premises. The manager advised that a maintenance person is employed to carry out the general maintenance of the building and contractors have been utilised for any “specialist” work that needed to be carried out.
Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 17 A tour of the premises identified that an upstairs bedroom window was “frosting” and a stair carpet was stained and dirty. The manger advised that this would be passed to the registered provider for appropriate action. The overall environment presented as clean and hygienic at the time of the visit. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 18 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): 27.28.30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff are supplied in sufficient number and skill mix to meet the assessed need of the residents currently living in the home. EVIDENCE: Staff records viewed showed that staff were not employed in the home without the appropriate checks being undertaken to include Criminal Records Bureaux (CRB) checks and appropriate references being provided. Staffing rosters revealed that the staffing levels and skill mix were adequate to meet the assessed needs of the current residents of the home. The manager advised that the home recognises the importance of NVQ training to the home and for individual’s personal development. Staff spoken with said they had been encouraged and supported to undertake training, which they felt made them feel valued. Residents and their representative spoken with advised that they felt the staff were most competent in their roles and comments included “they really know what they are doing”, “they work very hard and do a good job”, “we receive first class care from very nice people, although to see a man carer in here sometimes would be nice”.
Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well managed in the best interests of the residents. EVIDENCE: The home manager is waiting registration from CSCI and is not therefore identified as the registered manager of the home. However it was noted that she had introduced policies and practices into the home, which were seen to be of a high standard. These included new care assessments documentation, staff supervision and appraisal policies and monitoring systems for service delivery. The manager has achieved a level four NVQ management award and has many years experience of working in the care of the elderly. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 20 Documentation viewed revealed that residents meetings are held to ensure that residents and their representatives are aware of all that is happening in the home and residents spoken with said” they always knew what was going on”. Residents said they were given questionnaires to complete as to what they felt about the home and how they felt things could improve. Staff said they felt the home was run efficiently and they were supported by the manager who they said, “Was very good at her job”. Residents said they felt safe and protected in the home. Staff said they were always given full information about the home and received daily briefings and attended staff meetings to enable them to carry out their practices in an efficient and caring manner. Little information was available about resident’s finances. However the manager advised that in general residents families held responsibility for finances, although residents were provided with a hard backed book in which they could record any payments for hairdressing, newspapers or any other general expenses and their families could “top up the balance” as required. Health and safety issues were discussed with the manager and staff and they identified that an ongoing training programme is in which includes health and hygiene, health and safety, first aid, fire food hygiene moving and handling, safe storage and hazardous substances. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 23 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 Timescale for action Medication management systems 30/07/06 must be improved to ensure that medication administration storage, intake and disposal of medication is carried out as per the polices and procedures of the home. All staff must receive medication refresher training to ensure they fully understand the protocols involved. The window in bedroom 12(a) must be replaced. 30/07/06 Requirement 2. OP25 17 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 OP19 Good Practice Recommendations It is recommended that the stain carpet on the main stair well be replaced/refurbished. Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 24 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
© 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 Cranford Residential Home DS0000022401.V295332.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
