Inspection on 06/09/05 for Cranham

This inspection was carried out on 6th September 2005.

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 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 14/12/05

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 Annie OMara Unannounced 6 September 2005 08:00am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cranham Address 226 Cranham Drive Worcester WR4 9PH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01905 455474 01905 759006 cranham@heartofengland.co.uk Heart of England Housing and Care Ltd Mrs Margaret Frances Hook Care Home 45 Category(ies) of DE(E) Dementia (over 65) - 45 registration, with number OP Old Age - 45 of places PD(E) Physical Disability (over 65) - 45 CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may also accommodate two named people over the age of 65 years with a learning disability. 2. The Home may also accommodate one named person under 65 years of age with a mental disorder, excluding learning disability or dementia. 3. The Home may also accommodate one named person, under 65 years of age with a physical disability. The registered manager was advised that if these named people no longer lived in the home the Commission for Social Care Inspection should be formally notified in order that the registration can be amended and an amended certificate of registration can be provided.. Date of last inspection 21 January 2005 Brief Description of the Service: Cranham is a purpose built home located in the Warndon area of Worcester city. The accommodation is divided into five separate units all on ground floor level. Access aroound the home is made easier with the provision of rails in the corridors. There are no en-suite toilet facilities in the home. The home is situated close to local shops and a bus route. 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 home also provides a day care, bathing and laundry service for older people living in the community. 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. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over four hours during a weekday morning and was undertaken by two regulatory inspectors and a pharmacy inspector. Seven residents were spoken to and one visitor to the home. Care records were looked at and some management records examined. What the service does well: Prospective residents are assessed thoroughly prior to being admitted to the home. The relationships between staff and residents are good and residents think highly of the service they provide. Comments about the staff included “fantastic”, and “they treat you as you as you would expect to be treated”. Residents are encouraged to have their say in the home and systems are in place to help them. The residents receive prompt attention to their health care needs. The food served to the residents is of a high quality and residents enjoy the choice available to them. Comments included “food is brilliant, you can have what you want”. There are good arrangements in place to help ensure service users always receive the medicines prescribed for them and that these are stored safely. The records seen were an accurate reflection of what medicines had been administered, received and returned. The home has strong systems in place that protect the people who live in the home from any sort of abuse and protect their rights. Records are well maintained and this provides clear information and guidance to assist the staff that are well supported by the seniors and provided with good training. The home is well managed and people are encouraged to make their views known and raise any concerns they may have with confidence that they will be listened to. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 6 What has improved since the last inspection? 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 E52 S18645 Cranham V243902 240805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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 standard(s) 1, 3, 4 The information provided about the home and the assessment processes ensure that the home can meet the individual needs of the residents. EVIDENCE: Information is available about the services provided by the home. Residents are assessed prior to them moving into the home to ensure that the home will be able to meet their care needs. Assessment forms seen were filled in fully, signed and dated. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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 standard(s) 7, 8, 9, 10. Health care arrangements and care planning processes ensure that residents’ care needs are met by the home. EVIDENCE: Care plans were in place for all residents and indicated that their personal and health care needs had been thoroughly assessed and monitored. There was evidence that they were regularly reviewed and residents who were spoken to about them were able to confirm this fact. One care plan seen had not been up dated following a change in arrangements regarding administration of medication and another had not detailed a change in continence needs. The record of medical visits had not been kept up to date on a care plan and activities records were seen to be kept sporadically. Risk assessments were in place and generally the standard of recording was good. Residents who were spoken to expressed complete confidence in the way staff responded to their health needs. One resident described the personal care as being, “right on the dot”. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 10 Medication storage in the lead care office and also the five units was inspected. The overall storage of medication was secure, neat and tidy with clear identification of individual service user’s medication. The majority of medicines audited had been administered as prescribed and recorded accurately. A few discrepancies were found, which included no signature for administration or code for refusal. This was amended on one chart during the inspection. The home currently only has sight of the prescription after it has been dispensed, which causes problems in excess orders of medication not required. Residents spoken to said that staff always knocked on their bedroom doors and were very polite. Comments included “staff are fantastic, they are very respectful” and “they treat you as you would expect to be treated”. Observations during the visit indicated that staff were friendly and polite and offered residents choices. The home described by one resident as being “top of the pile”. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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 standard(s) 12, 13, 15. Residents are able to choose how they live their lives at the home and the provision of food meets their individual likes and needs. EVIDENCE: The residents confirmed that they were able to do as they chose during the day and there were no restrictive routines. The residents were happy with the activities provided and all said they had enough to do if they wanted. There was no up to date program of activities but none of the residents expressed any concern about their provision. A church service was very well attended during the visit, and one resident was able to give details of how they maintained community links. The garden area was used extensively during the summer months. Several residents were on the advocacy committee for all of the Heart of England homes and there were also regular residents’ meetings where “we can have our say”. Visitors were welcomed into the home and residents confirmed that they could see their relatives in private. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 12 All residents spoken to were very happy with the food provided at the home and confirmed that they had plenty of choice. Comments included “food is brilliant, you can have what you want”, “always served hot”, and “plenty of choice”. Drinks and snack were always available. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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 standard(s) 16,17,18 Residents have the information they need to help them express their concerns and they do so. Residents’ legal rights are respected and protected. The policies and procedures that are in place and implemented help protect vulnerable people. EVIDENCE: A complaints procedure was seen to contain all required information and advice with the exception of a time scale. It was advised that a sentence should be inserted advising the reader that a complainant would receive a response within 28 days of receipt of their complaint. Records were seen of five complaints that had been received since the previous inspection. Following investigation by the home, four were considered to be justified and one was not justified. Appropriate action had been taken. Information regarding advocacy services was displayed on notice boards in the home and the manager said that advocates supported two of the current residents. People were registered on the electoral roll and were assisted to exercise their vote either in person at the polling station or through a postal vote, as they wished. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 14 It was observed that policies and procedures were readily available in the reception area that contained information and guidance for staff to protect the vulnerable adults who lived in the home. To date these had not needed to be implemented however staff had received relevant training and it was demonstrated that the lead care assistant on duty was aware of what action she should take if concerns were brought to her attention. The policy and procedure advising staff on understanding and responding to residents who were verbally and/or physically aggressive was not seen. There were no current behavioural concerns. Of the thirty-five people who lived in the home twenty-five had personal monies held for them in safekeeping. Some people used the facility as safe storage while the money of others was managed for them by the home. The money could be accessed through the managers on Monday to Fridays during office hours and outside these hours by previous arrangement. Secure storage was acceptable and records were well maintained. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 The building is in need of extensive work although work has been carried out to provide some level of comfort for the residents. EVIDENCE: The décor of the home is fatigued and the building is in need of extensive refurbishment. This is recognised by the registered persons and discussions are being held with residents and relatives as to the future plans. Some cosmetic work has been undertaken to brighten up the home. Items, which need addressing in the short term, are as follows: The windows throughout the home were seen to be dirty. Several of the kitchenettes had food and a drink stains on the walls. Kitchen cupboards in the kitchenettes were in a poor state of repair and could be a health and safety hazard, for people to catch themselves on, and as a trap for bacteria. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 16 One bedroom door was observed to be wedged open. This had also been observed during the previous inspection. However some residents required their doors to be open. Therefore the view of the Fire Authority had been sought. They advised that the onus was on the home to have suitable risk assessments and management procedures in place to ensure that safety and escape routes were not compromised in the event of a fire. The clear advice given was that bedroom doors should be kept closed at night. The Fire Authority has confirmed that there has been no change to this advice as a measure of protection is provided by the construction of the building and the location of fire doors in corridors. However they strongly support the Commission for Social Care Inspection’s recommendation in this report that doors are only held open by sonic door retainers. The fire door arrangements and signage outside the laundry room was confusing and several doors had keys in them. However these were not fire doors. The areas behind the washing machines had collected a lot of dust, which could be a fire hazard. Some paving slabs in the garden were uneven and could be a tripping hazard. Staff were observed using gloves and aprons when handling food or providing personal care. Residents confirmed that staff were always very hygienic when carrying out care tasks. It was noted that commodes were transported uncovered through the home. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The recruitment policy and procedure is implemented to ensure suitable staff are recruited to provide the service the residents need. Sufficient numbers of suitably trained staff are available to ensure needs are met and people are protected. EVIDENCE: The duty roster that was assessed indicated that staffing levels were acceptable to meet the current needs of residents. It was advised that the roles of staff be more clearly identified on the document. The manager said that twenty-three care staff were currently employed of whom eight had qualified to NVQ level 2 and three had qualified to NVQ level 3. Six other people were undertaking courses. When successfully completed this would bring the number of qualified staff over 50 . The commitment to training was a credit to the home. The records of two recently appointed staff were inspected. They contained the relevant necessary information. The manager said that there were no staff vacancies. A clear staff training matrix/training and development programme was seen that clearly indicated achievements and needs. Induction training manuals were given to newly appointed staff and they were supported to complete them. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 18 A requirement was made in the previous report concerning the provision of foundation training. The organisation does not have a suitable programme. However the inspector was aware that changes to this standard were imminent and therefore this requirement has not been assessed or repeated during this inspection. The changed standard will be assessed during the next inspection. The manager has every expectation that all staff will receive more than three days training during the year. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 - 37 Residents live in a well managed home and are given support and opportunities to express themselves and influence the service they receive. Their financial interests are protected through the implementation of sound policies and procedures. Good record keeping, monitoring, support and provision of training ensure the interests of staff and other people in the home are safe guarded. EVIDENCE: A suitably experienced and qualified person, who had been registered by the Regulatory Authority, managed the home. She was also responsible for a supervisory/advisory role in a second home. The Commission for Social Care Inspection had been made aware of this situation and had accepted its shortterm nature. The manager was well aware of her responsibilities and extent of her authority. Support from the provider’s central office was said to be good. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 20 An open door policy was described and good relationships were said to exist between residents, their relatives and the home. The comments and complaints procedure, meetings, questionnaires and quality assurance system provided ample opportunity for everyone to express their views, make suggestions and raise concerns. There was a residents’ committee and representative and in addition the home had achieved the kite mark for ‘Having Your Say’ and a notice displayed indicated that residents had been invited to attend a meeting with the board to discuss the home and service. Documents demonstrated that the quality assurance programme was implemented and audits were regularly carried out. Questionnaires from residents were analysed and responded to and views were published. The annual development plan for the home was being up dated and the manuals of policies and procedures were under review. An acceptable insurance certificate was displayed and acceptable financial procedures were in use. Records of all transactions were on computer and the home received regular information to enable them to budget effectively. No hard copy of transactions was held. It was recommended that inquiries be made to ascertain if the computer had a back up system that could be relied on in the event of theft or the computer ‘crashing’. Residents’ monies were well managed. The home was not agent or appointee for anyone. The manager said that if necessary an advocate would be sought or Social Services contacted to support the resident. The manager confirmed that all staff received supervision. The staff team was shared between the senior team and a programme, monitoring tool and records were seen to be maintained. Not all records were seen by the inspectors but the manager confirmed that records required by regulation were being maintained. Standard 38 was not assessed. However the fire log was inspected. Fire safety systems and equipment were being checked and staff were receiving appropriate training. A Fire Risk Assessment for the home was available but not checked on this occasion. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 x CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Care plans must be kept up to date as residents care needs change. Timescale for action Immediate 2. 8 15 Records of visits by the primary Immediate healthcare team must be kept up to date. The responsible person must ensure that staff sign for the administration of medication immediately after they have administered medication or document a code including a reason for refusal. Immediate 3. 9 13(2) 4. 5. 19 23 All areas identified as being in need of cleaning during the inspection must be attended to. The fire door arrangements outside the laundry room must be reviewed to ensure that there is safe egress from the building in the case of fire. The cupboards in the kitchen must be made safe. Immediate 6. 19 23 Immediate 7. 19 23 31st October 2005 CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 23 8. 19 23 The registered providers must inform the Commission for Social Care Inspection of their plans for the home when they are known. Infection control practices must be reviewed so that infected material is not carried uncovered in the home. 31st December 2005 Immediate 9. 26 13 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 23 Good Practice Recommendations If residents require their bedroom doors to be held open suitable door retainers such as sonic door retainers should be used instead of wedges. CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI CRANHAM E52 S18645 Cranham V243902 240805.doc Version 1.40 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. 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