Inspection on 14/12/05 for Cranham

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cranham 17/04/07

Cranham 18/04/06

Cranham 06/09/05

Cranham 21/01/05

Cranham 29/06/04

Cranham 02/12/03

Cranham 11/08/03

Cranham 11/06/02

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cranham 226 Cranham Drive Worcester Worcestershire WR4 9PH Lead Inspector Mrs Yvonne South Unannounced Inspection 14th December 2005 10:30 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 Cranham DS0000018645.V267280.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. Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cranham Address 226 Cranham Drive Worcester Worcestershire WR4 9PH 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) 01905 455474 01905 759006 Heart of England Housing and Care Limited Mrs Margaret Frances Hook Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (45) Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home may also accommodate one named person, under 65 years of age with a physical disability. The Home may also accommodate two named people over the age of 65 years with a learning disability The Home may also accommodate one named person under 65 years of age with a mental disorder, excluding learning disability or dementia. 6th September 2005 Date of last inspection Brief Description of the Service: Cranham is a purpose built home located in the Warndon area of Worcester city, close to local shops and a bus route. The accommodation is divided into five separate units providing bedrooms and communal lounges, dining areas and kitchenettes. These are all on ground floor level. There are no en-suite toilet facilities in any of the bedrooms. Communal toilet and bathroom facilities are provided. Wheelchair access to some rooms is difficult as doorways do not have a clear opening of 800mm and the rooms are not spacious. The gardens are well kept and accessible to the residents. The home provides a residential care and respite service for up to forty-five older people who may have physical disabilities and/or mental health needs. The homes main purpose is to provide a safe, homely environment for older people who are no longer able to care for themselves in the community and to enable them to reach the full potential of their capabilities. The home also provides a day care, bathing and laundry service for older people living in the community. The registered providers are Heart of England Housing and Care Ltd and the registered manager is Mrs Margaret Hook. Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over one and a half hours from 10:30am until 12:00md. and was conducted by the lead inspector for the home and the pharmacy inspector. The registered manager and the lead care assistant assisted the inspectors. They also spoke to six residents and a member of staff. A partial tour of the building and a range of documents were seen. The focus of the inspection was on the requirements and recommendations that had been made following the previous inspection, and medication management. A service questionnaire was sent to the home for completion and return to the Commission for Social Care Inspection prior to this inspection. The manager was asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Eleven responses were received. What the service does well: What has improved since the last inspection? Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 6 Following the last inspection nine areas were identified for improvement. Six of these had been addressed. Staff had benefited from a range of training opportunities that enabled them to provide skilled and knowledgeable care in safety. A new medication administration system has been implemented by the supplying pharmacy (5th December 2005) and staff have been fully trained by the pharmacy in the safe administration of medication. Medication is now stored in two locked trolleys in a secure location. 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. Cranham DS0000018645.V267280.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 Cranham DS0000018645.V267280.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): EVIDENCE: These standards were not assessed during this inspection. Cranham DS0000018645.V267280.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, 8, 9, The complexity of the care plan system in use continues to make maintaining and obtaining information difficult. Care staff should have easy access to detailed guidance that will help them to provide the necessary help residents need. The medicine administration system has recently changed in order to improve the administration of medication; however there has been a sudden increase in medication administration errors. These had been notified to CSCI. The home has good procedures in place and staff have received full training in the correct administration of medication using the new system. The inspection highlighted some areas that required further staff input and training. EVIDENCE: Three requirements were made following the last inspection relating to care plans, care records and medication records. Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 10 The records of one resident were assessed. It was observed that her care plan had been very briefly updated but did not fully describe how the change in her care needs were to be met. An acute care plan had not been brought into use as it was expected to be an ongoing change of need. None the less this could have described the detailed care needed more clearly and effectively. The records of visits by the primary health care team had not been kept up to date. Medication storage is now held in the lead care office instead of in the five individual kitchen units. Two medication trolleys are now used for all medication administration, which are locked and secured in the locked lead care room. The home now uses an individual blister pack Monitored Dosage System with colour coding for the times of administration. The overall storage of medication was secure, neat and tidy with clear identification of individual service users’ medication. Photographs of service users were available for identification. The errors that have recently occurred include the following: • One service user had not received their teatime medication. • Four service users had received two extra doses of their morning medication. • One service user had the same Christian name as another service user and received the wrong medication. The errors highlighted the importance of ensuring all staff are particularly careful when using a new administration system. Some staff are currently undergoing further training. The home now has two staff present for the administration of medication, however this did not prevent the third error from occurring. The Medication Administration Record (MAR) charts should be clear when there are two or more people with the same name in order to prevent confusion. Cranham DS0000018645.V267280.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): EVIDENCE: These standards were not assessed. However it was observed that the home was being trimmed for Christmas and the residents confirmed that they approved and were looking forward to the celebrations. In answer to the question in the residents’ questionnaires that were returned, ‘Does the home provide suitable activities? Six people replied ‘yes’, one person, ‘sometimes’ and two people, ‘no’. Cranham DS0000018645.V267280.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): EVIDENCE: These standards were not assessed during this inspection. Ten of the eleven questionnaires that were returned to the Commission for Social Care Inspection indicated that the respondent was aware how to raise concerns. Cranham DS0000018645.V267280.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, 23, 26 The residents are able to live in comfortable bedrooms and have access to communal facilities but the environment is rundown and in need of investment. EVIDENCE: Four requirements relating to the premises were made following the previous inspection. Three of these had been met. The home was clean and had no offensive odours. Fire doors were closed and infection control practices had been improved. The manager said that work continued to redecorate the residents’ bedrooms but the décor and fittings in the communal rooms were in a poor state of repair. Cranham DS0000018645.V267280.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): EVIDENCE: These standards were not assessed during this inspection. Cranham DS0000018645.V267280.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): 38 The frequency of fire safety training needs to be increased to maintain a constant awareness in the minds of staff and the safety of everyone in the building. EVIDENCE: This standard was not assessed in full. However it was observed that fire doors were closed as required. Approved door retainers had not been purchased but if a resident wished for their bedroom door to be held open the fitting of this equipment would be acceptable. The fire log demonstrated that safety checks were being undertaken and recorded. The manager confirmed that the home had a fire risk assessment. Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 16 Fire safety training was undertaken annually by all staff with an external trainer. However the quarterly training recommended by the fire authority was not being undertaken. This is required and can be undertaken by a competent member of staff in-house for example with small groups, as part of a fire drill or during supervision. An intensive training session is not required on each of these occasions. Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 17 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 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 18 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. 1. Standard OP8 Regulation 15 Requirement Records of visits by the primary healthcare team must be kept up to date. The responsible person must ensure that staff follow the policies and procedures for the safe administration of medication. The cupboards in the kitchenettes must be made safe. All staff must receive fire safety awareness training every three months in accordance with the advice given by the Hereford and Worcester Fire Authority. Timescale for action 14/12/05 2 OP9 13(2) 14/12/05 3 OP19 23 01/04/06 4 OP38 23 14/12/05 Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cranham DS0000018645.V267280.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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