Inspection on 17/04/07 for Cranham

This inspection was carried out on 17th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cranham 18/04/06

Cranham 14/12/05

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 Yvonne South Key Unannounced Inspection 20th April 2007 09:30 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.V335434.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. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 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 cranham@heart-of-england.co.uk www.heart-of-england.co.uk Heart of England Housing and Care Limited Dawn Jeanette Hooper 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.V335434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18th April 2006 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. Information regarding the home is available in the Statement of Purpose, Service Users’ Guide and inspection reports that are available in the reception area, and copies are provided for all prospective residents and on request. The pre-inspection questionnaire, completed by the manager on 13.04.07 stated that the current scale of charges for the home were £380.00 per week for a single room and £390 per week for a double room. Additional charges were made for individual personal expenses such as newspapers, toiletries, hairdressing, transport, private telephones and TV aerials. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that incorporated information received by the Commission for Social Care Inspection since the previous inspection, which took place on 18.04.06, and the information obtained during fieldwork on 17.04.07. The fieldwork took place over nine and a half hours, during which the inspector spoke to five residents and three staff. Documents were assessed and a partial tour of the premises was also undertaken. The registered manager gave assistance. Prior to the fieldwork the home was asked by the CSCI to complete and return a pre-inspection questionnaire and to distribute questionnaires to the residents and health care professionals seeking their opinions of the service. To date eight responses have been received from residents, two from health care professionals and three from relatives. The focus of this inspection was on the key National Minimum Standards and recommendations that arose out of the previous inspection. What the service does well: What has improved since the last inspection? Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 6 Four requirements were made in the last report. These have all been attended to. Medication records have been improved and the premises are in the process of major redecorative improvements. Kitchenettes have been redecorated and had new furniture fitted and toilets, bedrooms, lounges and dining rooms have been redecorated. The management team has been strengthened and is nearly complete with recruitment for a final member underway. 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. The summary of this inspection report can be made available in other formats on request. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 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.V335434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 An intermediate care service was not provided therefore standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information and support is available so that people are helped to make a decision regarding their future. Their needs are assessed and they are only offered a place if the home can provide the care they need. EVIDENCE: During the fieldwork it was observed that the Statement of Purpose and Service Users’ Guide for the home were readily available. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 9 People confirmed in the questionnaire responses that they had received the information they needed to help them make a decision regarding residence in the home. One resident said that they had spent five hours in the home prior to making a decision. Care records were assessed for three people. They confirmed that needs had been assessed prior to a place being offered. The pre admission assessment formed the basis for the initial care plan. In a few cases the need was identified but was not supported by a plan. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Instructions and guidance is available to staff so that people receive the care they need and their prescribed medication is administered safely. EVIDENCE: Care records were assessed relating to one new resident, one ill resident and one resident identified prior to the fieldwork. It was observed that comprehensive care plans were in place that gave the staff information and guidance regarding the care needed. The plan for the new resident was being developed as information became available and the plan for the ill resident needed an up to date pressure care plan Some omissions were identified such as attendance at day centres. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 11 All plans and risk assessments underwent continuous review/evaluation. This method of recording can be labour intensive. There is a risk that changes to the plan can be absorbed and hidden in the daily evaluations. The manager said that they were about to change their system to maintain a daily record of care and review the plans separately once a monthly or as needed. This should prove to be more efficient. Good records were maintained of visits and guidance given by health care professionals. However some people had concerns regarding communication and the manager said that she was aware of this. Work was in progress to address the matter. One relative was concerned that he had not received information regarding his mother. The manager stated that the resident’s niece was in frequent contact with the home and was kept fully informed. It would appear that information was not then passed on. Another health care professional stated in the questionnaire response that she considered it to be: ‘A lovely home. Very organised management team.’ Residents considered that they received the care they needed. One questionnaire response read: ‘I couldn’t wish for better care.’ Another response stated: I have only got to ask for them to get the doctor in and within a couple of hours he is here.’ Since the last inspection the Commission for Social care Inspection had been notified of four medication errors made by staff. No one had come to harm. Appropriate people had been notified and investigations undertaken. Where necessary action had been taken to prevent a reoccurrence. It was observed that the home had acceptable storage for medication and trained staff administered medication to those people who were unwilling or unable to manage their own. Medication records were well maintained. However it was observed that when hand written additions and amendments were made they were not signed by the author and the witness to ensure accuracy. In addition statements were not made regarding allergies. If these are not entered by the pharmacist they must be written in by the trained staff. The three requirements made in the report following the last inspection had been met. It was observed that staff respected the residents and their right to privacy. People knocked on doors and waited before entering. Visitors, telephone calls and mail could be received in private. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 12 Residents’ questionnaires, and those who spoke to the inspector, confirmed that they were happy with the care they received. However there was little indication that either they or with their consent, their supporters, had been involved in the care planning process and reviews. Cranham DS0000018645.V335434.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information and support is available so that residents are able to make choices regarding social activities, maintain their commitment to their faith and select meals that they enjoy. EVIDENCE: It was observed that the pre-admission assessments sought information regarding the prospective resident’s social contacts, faith and culture and interests and activities. These needed to be more thoroughly incorporated into care plans and updated as abilities and interests changed. The questionnaires indicated that activities were arranged and one person commented; ‘Yes there are many but I don’t take part. I prefer to read in my room’. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 14 It was observed that some residents liked to pass their time in the communal lounges while other preferred to stay in their rooms. Everyone was free to come and go as they pleased. The pre-inspection questionnaire indicated that a wide range of in-house and community activities and social events took place in which residents could choose to participate if they wished. Some of the current residents belonged to the Roman Catholic Church or the Church of England. Services were held in the home fortnightly for those who wished to attend. The manager said that the Priest visited when requested and the home had good links with the local church. The sample menus indicated that a varied and nutritious choice of meals was offered to residents. The residents told the inspector that the food was acceptable and alternatives to the menu were provided if required. One resident said in the questionnaire response that: ‘The food was very good. Another comment was that ‘B’ had a good appetite and enjoyed his meals. Cranham DS0000018645.V335434.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information and support is available so that people can raise any concerns they have. Staff are well recruited and trained so that they can provide the support needed and take action as necessary if concerned themselves. EVIDENCE: The Statement of Purpose and Service Users’ Guide contained copies of the complaint procedure used by the home. The questionnaire responses indicated that most people knew who to speak to if they were not happy and how to make a complaint The pre-inspection questionnaire stated that the home had received six complaints in the past twelve months. These had been partially warranted. The records indicated that these complaints had concerned care practice, attitude, catering, medication and laundry and housework. All complaints had been investigated and where necessary action had been taken and apologies tendered. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 16 A resident asked to speak to the inspector regarding a complaint. This resident preferred to stay in her bedroom rather than use the communal rooms. However she wanted to have her bedroom door open, as she was afraid of becoming ill behind the closed door. As the fire regulations require bedroom doors to be fire doors they must either be kept closed or held open by door retainers linked to the fire alarm. The resident was aware that such door retainers could be purchased and they are a common feature in many homes. . However she believed the provider should supply this equipment not herself. The manager is aware of this conflict and is seeking to resolve the issue. Three staff were interviewed by the inspector. They all confirmed that they were aware of the correct action to take if they received a complaint or had a concern regarding the possible abuse of a resident. They had undergone an acceptable recruitment process that had included application forms, interviews, references and checks by the Criminal Records Bureau and the Protection of Vulnerable Adults list. In addition the home requires staff to make an annual declaration regarding any cautions or convictions they may have incurred during the year. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and gardens are well maintained and appropriately equipped so that the needs of the people who live the home are met and they can live in pleasant, comfortable surroundings. EVIDENCE: A partial tour of the home was conducted and it was observed that improvements to décor, furnishings and fittings had been made to many areas in the home. Toilets, bedrooms, lounges and dining areas had been redecorated and the kitchenettes on each unit had been refurnished. Work was in progress to redecorate the corridors. It was observed that some carpets were in need of replacement and the manager said that they were included in the refurbishment programme. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 18 The home was clean, tidy and free from offensive smells. A resident stated in the questionnaire response that the home was ‘very clean. The cleaners do a wonderful job.’ However a relative considered that; ‘Commodes should not be left in rooms whilst patients are eating.’ It was observed that the laundry was well equipped but it was apparent from the complaints concerning the laundry that the sorting and returning system was not working efficiently. The manager said that they were aware of this and were working on alternative systems to improve the service. It was observed that personal protective equipment was appropriately placed around the home and the staff confirmed that they had received training in infection control. This was supported by their records. Residents were enjoying the good weather sitting in the shade under a gazebo in the attractive garden. They were most complimentary regarding all aspects of their care and the home. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well recruited and trained so that the residents receive the care they need and live safely in the home. EVIDENCE: The duty rostered indicated that there were sufficient staff on duty to meet the current needs of the residents. Staff confirmed that they considered the staffing levels to be ‘OK’. However the three questionnaire responses from relatives all stated that at times they considered that there were not enough staff on duty. The pre-inspection questionnaire stated that the home employed twenty-eight care staff and ten ancillary staff. Eleven care staff had National Vocational Qualifications (NVQ). This is slightly under the 50 required by the National Minimum Standards. However nine other staff were undertaking courses. The inspector interviewed three care staff that confirmed that they had under gone an acceptable recruitment process, induction and subsequent training. Their statements were supported by their records. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 20 They had good knowledge of the care needs of selected residents. The manager confirmed that a total review of everyone’s training in moving and handling was in progress and a training matrix was available on which the training needs budget was based. The pre-inspection questionnaire indicated that staff had access to a good range of training subjects and there were plans for further training in the future. Since the last inspection ten staff had left the home for a variety of reasons. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service is well managed and the home well maintained so that the needs of the residents are met in safety and comfort. EVIDENCE: The home is managed by an experienced and well-qualified registered manager. She is thought well of by the residents, staff, and health care professionals. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 22 Good systems, policies and procedures are used for the efficient running of the service. The pre-inspection questionnaire indicated that these were reviewed at intervals. The quality assurance system in use in the home included annual questionnaires seeking views regarding the service. The results of the questionnaires had been analysed and published. Copies were readily available. In addition the manager said that audits were undertaken of systems in use that included care, health and safety, training, complaints and compliments, accidents, equality and diversity. Weaknesses were identified and then addressed. A programme of audits was not available. This would demonstrate if all aspects of the service were being audited and reviewed. Implementation of the financial procedures ensured that the residents’ financial interests were safe guarded. Security was acceptable. The pre-inspection questionnaire indicated that systems and equipment were appropriately maintained and serviced. Risk assessments for the home were seen and were being reviewed. Staff said that they were receiving training in health and safety matters including fire safety and their records supported this. Accidents were well maintained and analysed for trends and preventable incidents. Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 23 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP30 Good Practice Recommendations The training programme should continue towards meeting and maintaining a minimum of 50 percent of care staff with National vocational Qualifications. Fire door retainers, either electronically linked to the fire alarm system or sonically activated, should be provided for those residents who wish to have their bedroom doors held open. 2 OP22 Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 25 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cranham DS0000018645.V335434.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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