Inspection on 19/06/07 for Cranham Lodge

This inspection was carried out on 19th June 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 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 Lodge 21/06/06

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Cranham Lodge Folland Avenue Hucclecote Gloucester Glos GL3 3TA Lead Inspector Paul Chapman Unannounced Inspection 19th June 2007 09:00 Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 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 Lodge DS0000067012.V337409.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 Adults 18-65. 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 Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranham Lodge Address Folland Avenue Hucclecote Gloucester Glos GL3 3TA 01452 610644 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) www.brandontrust.org The Brandon Trust Mr David Martyn John Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1), Physical disability (7) of places Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2006 Brief Description of the Service: Cranham Lodge is a purpose built-detached bungalow, which provides care and accommodation for seven adults with learning and physical disabilities. The home is located in the community of Hucclecotte close to amenities on the outskirts of Gloucester city centre. The bedrooms and communal rooms are adapted to meet the needs of the people living in the home, this includes specialist equipment to meet their physical disabilites. The home has its own transport. The home has a large garden which is laid to lawn. The home has a spacious lounge and dining room. The home is run by Brandon Trust and Advanced Housing manage the property. The home has a Statement of Purpose. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived at the home at 9 o’clock on the morning of the 19th June 2007. On arrival the registered manager, one of his deputies and two other staff were present. The registered manager was with the inspector throughout the day. The care of three people was looked at in depth that included looking at their financial, medication and personal records. Three staff were interviewed about the care they provide. Other records examined included staff files, health and safety information and quality assurance records. The registered manager completed the CSCI AQAA (Annual Quality Assurance Assessment) providing us with detailed information about the home. The CSCI did not receive any completed surveys from relatives or other professionals. What the service does well: 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 Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person referred to the home would be thoroughly assessed to ensure that their needs could be met before they moved in. EVIDENCE: A requirement of the previous inspection report was for the manager to develop a Statement of Purpose for the home that complied with the regulations, and send a copy to the CSCI. This has been achieved. No one has been admitted to the home since the previous inspection was completed. The home has a procedure for the manager and staff to follow in the event of a person being referred to the home. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are identified in their care plans which are detailed and enable staff to meet those needs consistently. People are supported to make decisions and where they are unable to make a decision they are appropriately supported. Risk assessments ensure that potential risks to people are identified and minimised. EVIDENCE: Care management plans and other documents for three people living in the home were studied in detail. All of the files seen contained a good range of care plans that provided staff with enough detail to meet each person’s assessed needs. An example of the care plans available included: Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 10 • • • • • • • • • • • • • • Methods of communication. Behaviour management. Personal hygiene. Exercise programme. Medication. Eating and drinking. Friends and family. Leisure activities. Maintaining a safe environment. Mobility. Moving and handling. Pressure care. Sleep. Travelling in the homes minibus. At present all of the care plans are reviewed monthly by key workers. The care plans seen showed that people’s care needs change rarely, and it was discussed with the manager whether the frequency of review could be changed. It was suggested that plans could be reviewed every three months. This becomes a recommendation of this inspection report. Staff maintain detailed daily notes that cover areas including diet, activities and personal care. These provide good evidence of the work completed by the staff and provide a detailed picture of people’s extensive needs. All of the files seen contained an Essential Lifestyle Plan (ELP) that identified what people wanted to achieve and what was important to them. People living in the home have severe learning disabilities and care files provided good examples of the manager and his team using a “best interest” document to make a decision about a person’s medical needs. This document is used where it is judged that people do not have capacity to make a decision for themselves. Some people are able to make gestures to support their decisions, this is made easier by the very experienced staff team that know the people very well. Detailed risk assessments were available to support care plans where they were required. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to lead active and varied lifestyles by the staff team. Staff support people to maintain relationships with their relatives and friends. The food and meals offered to people are varied and staff provide the appropriate support to people to minimise potential risks. EVIDENCE: A notice board in the home’s dining room timetables the regular activities of people. Activities completed regularly included: • Aromatherapy • Horse riding • Parachute • St Vincent’s day centre • Hydrotherapy Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 12 • Use of a soft room These activities were confirmed by the daily notes completed by the staff and through reading peoples notes. On the day of this site visit staff took some people out to go strawberry picking. Other activities being completed included attending a social club, attending music sessions and having meals out. Family and friends are welcome at the home and staff support people to maintain relationships. Staff gave examples of them collecting parents to bring them to the home. The majority of the people living in the home have family contact to varying degrees. The home has access to its own transport. The inspector was present during lunch and observed the staff members on duty supporting people to eat their food. As mentioned earlier in the report each file examined had a care plan relating to people’s eating/food. Each person is supported by staff to eat, and meals need to be liquidised to minimise the risk of people choking. The menus seen showed that a good range of food and meals were available to all of the people living in the home. Where ever possible people are supported to make choices about what they would like to eat. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are assessed and care plans enable staff to meet personal care needs appropriately. Other healthcare professionals are used effectively to meet people’s needs. Medication administration minimises the potential risks to people. EVIDENCE: All of the files examined contained care plans giving staff detailed instructions about meetings peoples assessed needs. People’s daily notes provided evidence that care plans were being followed, and people’s needs were being met. All of the files examined provided good evidence of the home making good use of other professionals and people’s health needs being assessed. The notes seen relating to appointments with other professionals provide good detail of the need to see them and the outcome. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 14 Medication administration was examined and seen to be managed effectively. The requirements of the previous inspection report have been addressed including the recommendation to purchase a BNF (British National Formulary). Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and staff have a good understanding of visual prompts that maybe shown by people that are not able to verbalise that they are unhappy. EVIDENCE: No complaints have been made since the previous inspection was completed. A copy of the complaints procedure was displayed on the wall in the entrance hall. It is difficult for people living in the home to make a complaint due to their communication difficulties. The inspector spoke to staff about this asking what other thinks could indicate someone was unhappy. Staff gave examples of what they would look for and the actions they would take. Explanations given were detailed and help to minimise potential risks to people. Training records showed that staff have completed training in the safeguarding of adults. People living in the home do not manage their own finances and this is the responsibility of the manager and staff. Records were examined and provided a clear audit trail of income and expenditure. All account balances were correct at the time of this inspection. A recommendation would be that all transactions have 2 signatories. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is decorated to a good standard throughout and meets the needs of the people currently living in the home. EVIDENCE: All of the accommodation is provided on one floor and is purpose built for people who use wheelchairs. The communal areas are large and spacious allowing people to move around freely. In the entrance hall is a small soft area and a fish tank. The home has a separate lounge and dining room. Communal areas contained a range of furniture and associated electrical items including TVs, DVD player and sky/cable. Each person has their own bedroom and all of the bedrooms were seen to be personalised with people’s possessions and had been decorated in different colours and styles. Staff have taken responsibility for decorating some of the Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 17 bedrooms. Most of the bedrooms have specialist adaptations that enable people to be mobile these include the use of hoists and adjustable beds. Bathrooms have been especially adapted to meet the needs of people living in the home. Equipment available includes a shower table, hoists and an assisted bath. All of the equipment is appropriately serviced by a qualified engineer. Each of the bedrooms contained the person’s observation and communication care plan. This showed staff what different facial expressions and gestures meant. This is a good practice. To the rear of the property is a good-sized garden and the manager explained that they employ contract gardeners to maintain it. The manager stated that the service provider has a decoration programme and the home is due to be decorated later this year. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are not put at unnecessary risk by the home recruitment practices. Staff training minimises the risk of peoples needs not being met by the staff team. Staff are available in sufficient numbers to meet peoples needs. EVIDENCE: There are two senior/deputies that support the manager. One of the seniors is responsible for organising training and they spent time with the inspector explaining planned and completed training. The records of training are well organised for all of the staff and showed that the team had completed not only mandatory training but other specialised training to meet the specific needs of people in the home. All of the staff spoken with are completing, or have completed their NVQ’s (National Vocational Qualification) at levels 2, 3 or 4 in care. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 19 The staffing rota was examined and showed that normally there are 3 staff on each shift, sometimes there maybe 4. The rota showed that staff sickness was minimal. Staff files were examined and all of the documents required by these regulations were present. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have good outcomes in the care they receive due to a committed team that have the necessary training, experience and skills. The provider has implemented a quality assurance system should involve regular monitoring, and meeting identified goals for continuous improvement. EVIDENCE: The registered manager is appropriately qualified and has extensive experience of working with this client group. They have been the manager of the home since it opened. Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 21 Speaking with the staff on duty it was clear that the team have a lot of knowledge about the people they support and that as a team they are motivated and supportive of each other. These elements together mean that the outcomes for people living in the home are good. Brandon Trust have a quality assurance system that asks the registered manager to set goals for what they will achieve during a twelve month period. The manager completed this with their line manager in January 2007. Two of the goals had been achieved, while others still needed to be addressed. It is difficult to involve the people living in the home in this process due to their complex disabilities. Examination of the health and safety records showed the following areas had been addressed: • • • • • • • • A fire risk assessment Firs safety training 2 fire drills completed Emergency lighting checked regularly Fire alarms checked regularly each week Accident book completed thoroughly Fridge and freezer temperatures recorded daily COSHH cupboard was secure and risk assessments/data sheets in place Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Cranham Lodge DS0000067012.V337409.R01.S.doc Version 5.2 Page 23 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 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. 2. Refer to Standard YA6 YA23 Good Practice Recommendations The timescale for reviewing care plans should be looked at by the manager as monthly review is to frequent and may be de-valuing the process. All transactions for expenditure of people living in the home should be signed by 2 members of staff. 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