CARE HOMES FOR OLDER PEOPLE
Cranford Residential Home 637 Warrington Road Rainhill Merseyside L35 4LY Lead Inspector
Debbie Corcoran Unannounced Inspection 24th January 2006 10:00 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 Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 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.V282186.R01.S.doc Version 5.1 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 Barbara Barr Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users to Include up to 24 (OP) The service shall, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 22nd July 2005 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. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over a period of approximately 5 hours. It was an unannounced inspection and carried out as part of the regulatory requirement for care homes to be inspected at least twice per year. Throughout the inspection six residents were spoken with on a one to one basis and a number of residents were spoken with on a small group basis. The manager of the home was spoken with at some length and a tour of the home was carried out. Service user plans, staff files, health and safety records and other relevant records were examined in some detail. What the service does well: What has improved since the last inspection?
The home has introduced a new format for assessment of needs and care planning. These formats are quite good, and if completed appropriately, they should allow for a significant level of information to be recorded on the needs of the residents and on how to meet the person’s needs.
Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 6 Staff recruitment and selection practices have improved and references and other checks are being carried out. Medication administration records are being maintained accurately. 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.V282186.R01.S.doc Version 5.1 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 Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 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): 3, 6 Residents needs are assessed before they move in to the home in order to ensure that the home can meet the person’s needs appropriately. EVIDENCE: A number of resident’s files were examined in order to determine how residents needs are assessed before they are offered a place and move into the home. The records examined on this occasion showed that when a prospective resident is referred to the home then an assessment of the persons needs has been attained from Social Services. There was also evidence that senior staff at the home carry out an assessment of the residents needs alongside this. The home has a new format for assessment and this is quite detailed and allows for a good level of information on the needs of the resident. The manager should ensure that all assessment information is signed and dated by the person carrying out the assessment. The manager reported that home has provided intermediate care on a small number of occasions in the past. The last occasion was approximately 12 months ago. This standard could not therefore be practically assessed.
Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 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, 8, 9, 10 There is little consistency in the quality of care planning and a number of residents do not have a care plan. Care plans are not being reviewed regularly. Residents feel that their health and care needs are being met and that staff respond quickly in seeking medical support. The way in which health related information is recorded needs to be reviewed. Medication is generally well managed and recorded. However, there is some room for improvement in the storage of medication. EVIDENCE: The service users who were spoken with reported being “happy” with their care and described staff as “helpful” and “nice”. Care plans for four of the residents were examined. These showed that new care plans are being introduced since the previous inspection. The new format for the care plans is quite good and allows for a good level of information on the needs of the resident. However, as this is a period of change the information in some of the plans was minimal, one care plan was blank and a number of service users did not have any form of a care plan. The manager reported old style care plans have been taken out of some resident’s files to
Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 10 make room for new ones. The manager must ensure that all service users should have a comprehensive and up to date care plan at all times. Staff use a daily report book as a means of communicating a change in the needs of the service users. Whilst this practice is a good idea it should only be used as a means to compliment the information in resident’s care plans and should not prevent staff from reading and being clearly familiar with the information in the resident’s care plan. Care plans should reflect the assessed needs of the residents and where a risk has been determined as part of a risk assessment then this information should be reflected in the person’s care plan. For example if a service user is prone to falling then a falls risk assessment should be carried out and the resident’s care plan should include information for staff on how to prevent the person from falling. Resident’s care plans should be reviewed on a monthly basis. There was no evidence to indicate that regular reviews are taking place. This was discussed with the manager and needs to be implemented. Risk assessments are in place for some of the residents. However some of these are dated as being completed over 3 years ago and there is no indication that they have been reviewed. Where a service user is restricted in anyway then this must be clearly recorded as part of their assessment and care planning and agreed on a multi disciplinary level. A number of residents were asked about the support which they receive with healthcare. All residents asked reported that the staff are quick to respond in seeking medical assistance. Resident’s records do not always clearly identify when the person has been seen by a G.P, nurse, chiropodist etc. This information is located in a number of different documents or in some cases has not been recorded at all. The manager must therefore introduce a system by which it is clear to see when and why a resident has been supported with any aspects of their health and information as to the outcome of this support. This record should also be used to identify that residents are being supported with regular health checks. The inspector advised the manager to look at a means of analysing information on falls and ensure that risk assessments are in place to prevent service users from falling. Medication administration and storage was checked. The records and storage were generally good and well organised. Two issues for address were the safe storage of eye drops and the safe storage of prescribed creams. This was discussed with the manager at the time of inspection. Medication was reported to be administered only by staff who have been provided with medication training. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 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): 13, 14, 15 Residents are able to receive visitors at all reasonable times. Residents can maintain their community links where they are able to do this independently or supported by a relative or friend as staffing levels do not allow for staff to support with this. Residents are making daily choices as to their routines. Residents could be encouraged to make more decisions on the running of the home. Mealtimes appear to be a well organised and pleasant time of day. EVIDENCE: Residents spoken with said that their family/ friends are made welcome at the home and there were a number of visitors to the home throughout the inspection. The residents can access the community as they wish within their abilities or dependent upon the support of their family or friends. The staffing levels do not allow for staff to be able to support the residents with community access other than for essential trips. Residents stated that they are making daily choices as to when to get up and when to go to bed and what they prefer to eat. The manager should look to set up regular meetings with or for the residents so as to further facilitate resident’s choice and contributions to the running of the home. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 12 The standards for meals and food was not fully assessed on this occasion as this was assessed at the previous inspection. However, it was noted that the residents were complimentary about the food and were served a nicely presented meal which was reported to be appetising. The dinning area is a pleasant room and the mealtime appeared to be a well organised, nice, relaxed time of the day. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 13 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): These standards were not assessed on this occasion. EVIDENCE: Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 14 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): 20, 23, 24, 25 The home is generally well presented and there are a number of communal rooms which residents can choose to use. Resident’s bedrooms are personalised and presented to an appropriate standard on the whole. Safe working practices are adopted to ensure the safety of residents, staff and visitors. EVIDENCE: The home is situated in a pleasant location on a main road in Rainhill, Merseyside. The home is presented to a satisfactory standard. There are two main communal lounge areas, a large dinning area which is nicely presented and a quiet conservatory area. The home offers an additional lounge which is an area where residents can meet their relatives / friends in some privacy. The home has a large garden at the rear which has been landscaped and there is a ramp for easy access to this. During a tour of the building a number of resident’s rooms were checked. The bedrooms seen were nicely presented and were personalised with the resident’s own belongings. One bedroom was in need of redecoration and
Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 15 refurbishment, this particular room was discussed with the manager at the time of the inspection. A risk assessment is in place for staff to follow safe working practices. This needs to be expanded upon to include any risks associated with the environment/ building. Health and safety checks were up to date and there was evidence that some staff have been provided with training in health and safety related topics. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 16 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 Care staff are very busy in meeting the personal care needs of the residents and daily routines/ tasks concerned with the running of the home. Some members of staff have had good training opportunities whilst training opportunities are poor for others. Staff recruitment and selection procedures are good on the whole and aim to protect residents. EVIDENCE: At the time of inspection there were fifteen residents living at the home. There were three care staff on duty one of whom was partly responsible for domestic duties. Staff were observed to be very busy in attending to the needs of the residents. Based upon observations at the time of inspection and on conversations with residents staffing levels do not allow for any amount of one to one time for residents outside of direct ‘hands on’ care and support. The residents gave good feedback on the staff and their qualities but some felt that the staff were too busy most of the time. The manager should carry out a piece of work in order to demonstrate how the staffing numbers are calculated to meet the assessed needs of the service users. A number of staff files were examined in order to determine the level of training which staff have received. Two members of staff have been provided with training in pressure area management, first aid, food hygiene, moving and handling, continence awareness and fire safety. Whilst there were some examples of staff having been provided with good training opportunities there were also examples were staff have been provided with very little training. The
Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 17 manager should produce an up to date training record for each member of staff and identify training needs for individuals and for the staff team as a whole and implement planning for training in response to this. There are a total of seventeen members of care staff on the team. Seven care staff have attained a National Vocational Qualification (NVQ) in care and six members of the team are awaiting their results after undertaking the award. Staff files were examined in order to assess the appropriateness of the staff recruitment and selection procedures at the home. The staff files evidenced that potential new employees are providing references and the manager is applying for a protection of vulnerable adults check. A new member of staff has provided a Criminal Records Bureau check however, this check has not been requested by the home and has been provided through a check carried out by a previous employer. The requirements for Criminal Records Bureau checks were discussed with the manager. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 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 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, 36, 38 A number of management practices need to be put in place. These include ensuring a means of quality assurance and ensuring staff are regularly supervised and have their work appraised. Service users are supported to manage their money only where this is necessary and systems are in place to record transactions. Health and safety checks and records are in place which aim to protect residents, staff and visitors. EVIDENCE: The manager has attained an NVQ level 4 in management and has made an application for registered manager of the home. This is being processed by the Commission. The manager has worked at the home for a significant number of years and was deputy manager prior to taking over the manager’s post. The feedback from residents on the quality of the service provided at the home was good. The manager should look to introduce a means of quality assurance
Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 19 and monitoring of the standards at the home which includes surveying residents and their representatives on the quality of the service and using this information to determine the future development of the service. The manager gave an example of when surveys have been used but there is no indication as to the results of the survey or whether or not the findings were published. The manager should also produce an annual development plan which includes outcomes for the service users. The manager provided information on how residents are supported with their money when this is required. Resident’s relatives deal with their money for the vast majority of residents. A record is maintained of the residents personal spends and receipts are maintained wherever possible. Staff are not currently receiving regular recorded supervision or having the opportunity of an annual appraisal. This needs to be addressed. Safety and maintenance certificates were checked for fire equipment, moving and handling equipment and gas and electricity and all were found to be up to date. Fire alarm tests are carried out regularly. However the manager must review the frequency of firs drills. The temperature of the hot water in one of the communal baths was in excess of a safe limit. An immediate requirement was given for the water temperature to be regulated to close to 43 c. Since the time of inspection the manager has addressed this and has ensured that thermostatic controls are fitted to all baths. A risk assessment is in place for safe working practices. This should be developed to include risks associated with the environment of the home. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 20 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 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x 3 x x 3 3 3 x STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 24/05/06 1. OP7 15 2. OP7 15(2)(b) 13(4)(c) 13 3. OP8 4. OP9 13 5. OP27 18 (1) (a) The registered person shall ensure that each resident has a care plan. Care plans must include sufficient details as to how to meet the health and social care needs of the resident. Care plans must be regularly reviewed. The registered person shall ensure that risk assessments relating to the resident’s care are reviewed on a regular basis. The registered person shall make arrangements for residents to receive any necessary treatment, advice and other services from any health care professional and record details of this on the care records The registered person shall make arrangements for the appropriate storage of all prescribed medications. The registered person shall carry out a review of staffing levels and provide evidence of how staffing levels are being calculated in order to meet the
DS0000022401.V282186.R01.S.doc 24/04/06 24/04/06 07/03/06 24/03/06 Cranford Residential Home Version 5.1 Page 22 6. 7. OP38 OP38 13 (4) (a) 13 (4) 8. OP36 18 (2) 9. OP30 18 (1) 10. OP24 23 (2) 11. 12. OP38 OP33 23 (4) 24 assessed needs of the residents. The registered person shall ensure water temperatures are appropriately controlled. The registered person shall ensure a risk assessment is carried out on the environment of the home. The registered person shall ensure that care staff are provided with regular recorded supervision. (c) The registered person shall review staff training opportunities for all members of staff and to ensure that staff receive training appropriate to their duties. (d) The registered person shall ensure that one of the resident’s bedrooms is redecorated and refurbished. (iii) The registered person shall ensure that fire drills are carried out on a regular basis. The registered person shall establish and maintain a system for reviewing and improving the quality of care provided at the home. 24/01/06 24/03/06 24/05/06 24/04/06 24/04/06 24/03/06 24/05/06 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 OP14 Good Practice Recommendations The registered person should consult service users on the introduction of residents meetings. Cranford Residential Home DS0000022401.V282186.R01.S.doc Version 5.1 Page 23 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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