Inspection on 21/06/06 for Cranham Lodge

This inspection was carried out on 21st June 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cranham Lodge 19/06/07

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 MIXED CATEGORY MAJORITY ADULTS 18-65 Cranham Lodge Folland Avenue Hucclecote Gloucester Glos GL3 3TA Lead Inspector Kath Houson Key Unannounced Inspection 09:30 21st June & 18th December 2006 Cranham Lodge DS0000067012.V300595.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.V300595.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 and 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.V300595.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.V300595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 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 in the outskirts of Gloucester city centre. There are bedrooms on the ground floor and all the rooms are adapted to meet the needs of the residents to include specialist equipment to meet the needs of physical disabilites. The home has transport appropriate for the residents’ use. The home has a large garden which is laid to lawn. The home has a spacious lounge and diner. The home is run by Brandon Trust and Advanced Housing manage the property. Accurate information about fees was obtained during the inspection and range from £276.12 per week. A copy of the home’s statement of Purpose was not available on this occasion. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The unannounced inspection took place over two separate days and was concluded one day in December 2006. The registered manager was available during the first and second visit of this inspection and was able to assist and provide all relevant documentation on request. During the first visit the pharmacist inspection carried out an inspection which is included in this report. The reason for this visit was to carry out an inspection by a CSCI pharmacist inspector of the arrangements for handling of medicines (Standard 20 of The National Minimum Standards – Care Homes for Adults 18 -65). This forms part of the key inspection of the home and was at the request of the lead inspector. Medicine stocks and storage arrangements, Medication Administration Record (MAR) charts and other records and procedures relating to medication were looked at. The manager and three other members of staff were spoken to. The inspection took place on a Monday over a 5¼ -hour period. Twenty one-key and one-non key standards were examined. This included an examination of documentation; three residents’ were case tracked, a tour of the environment and a short discussion with a staff member. A short succinct feedback was given to conclude the inspection visits. The process of “case tracking” ensures that the experience of the residents’ can be captured during the inspection. This involves an analysis of how residents’ are supported in making choices and the quality of the service. The home has had a recent change of service provider from Mayfield to Brandon Trust and therefore much of the documentation was being transferred over. The inspector would like to extend her thanks to the service users, staff and management for their assistance with the inspection. What the service does well: The service provides comfortable and safe accommodation for residents’ with complex needs. The service additionally has a long and stable staff team. The staff team were observed to be caring and considerate towards the residents’ during both inspection visits. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 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 Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s current Statement of Purpose did not accurately reflect the service being provided which could be misleading to users. EVIDENCE: The homes manager described the admission procedure and the relevant steps taken to ensure that those individuals whose needs can be meet are admitted into the home. The process includes information gathering and input from the relevant health professionals. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 9 The manger needs to ensure that an updated Statement of Purpose is kept under review, revise the Service User Guide and to notify the Commission for Social Care Inspection (CSCI) of any such revision within twenty-eight days. The Statement of Purpose is to incorporate items in schedule one of the National Minimum Standards (NMS). Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans reflect the resident’s needs and staff team provide support where necessary. Risk assessments encourage the residents’ to participate in an independent lifestyle in a safe manner. Records are securely kept within the home which safeguard resident’s confidentiality. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three of the residents’ care plans were case tracked. The aim of case tracking is to get an insight into the resident’s experiences of their journey through social care. The care plans contain information about the residents’ care needs. The selected care plans each had photographs and detailed accounts on input from other health professionals. For instance, the residents have complex needs and protocols are written with the assistance from other health professionals. The residents’ are encouraged to participate in an independent lifestyle. During the second inspection visit the home was nicely decorated with Christmas streamers. The home was also preparing for a Christmas party which the residents’ had invited other friends from neighbouring care homes. Risk assessments are regularly reviewed signed and dated. Some residents’ are able to gesture in an attempt to make decisions. The staff team have a good knowledge of the residents’ and are able to provide assistance where necessary. During the inspection it was observed that the staff team were caring and addressed the residents’ with respect. The staff team are provided with guidance on how to perform specialist tasks. All records are securely kept safe and secure within the home. This ensures that information safeguards the resident’s confidentiality. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 13 Residents are given support to access activities that reflects their needs. Appropriate support is provided to residents’ to maintain and develop contact with the local community. The home provides a varied and specialised diet for residents who have complex needs. EVIDENCE: The home has an activities board placed in the kitchen and is colour coded. Each activity has a different colour and placed on a particular day for a resident wishing to attend the chosen activity. Residents’ attend the sensory room in Worcester in which the home provides the transport. Residents’ also have access to the Leonard hydrotherapy pool, hot tub and multi-sensory rooms and Saint Vincent’s day centre. Information extracted from the preinspection questionnaire, demonstrates that the home has increased since the last inspection the range of activities such as joining music groups and music therapy. The residents are also encouraged to maintain contact with friends and family. The registered manager said that friends are encouraged to come for tea and that the home provides this support. This support is provided via collection and pick up to and from activities. The resident’s daily entries offer some information on the care provided and include monitoring of health care needs. Care plans include as far as possible how preferences and routines were seen and respected. The staff team place an emphasis on knowledge and have an understanding of resident’s needs thus promoting independence. During a discussion with staff, examples were provided to solve health care needs. The home provides a four weekly menu. Menus provided evidence of variety and a balanced diet. The residents’ are offered soft pureed meals. Depending on their health care needs and also given high calorie food supplements. Accurate food diaries are kept and documented adequately. This was evident during the inspection. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. Quality in this outcome area regarding medication is adequate. This judgement has been made using available evidence including a visit to this service by a pharmacist inspector. Personal support is offered in a manner that responds to residents needs. Resident’s physical and emotional needs are met. The inspection showed that arrangements are in place for the management of medicines but there are some issues where improvements and more attention to detail are needed to make sure of the safety of all residents and the records demonstrate this. Improvements have been made to the medication policy to ensure that medication errors are kept to a minimum. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 15 EVIDENCE: An improvement to the care plans can be seen during the second inspection visit. Care plans contained detailed guidance for staff to follow. During a discussion with staff they described the resident’s personal care to be individualised and dependant on the resident’s choice. Any changes to care plans are conducted with input from other health professionals and this is documented. Throughout the inspection visits staff demonstrated an awareness and importance of maintaining the resident’s dignity and privacy. In previous inspections that issue of personal care has been addressed and supported by other health care professionals. The care plan is more detailed and consistent recording of personal care regimes have improved. A recent medication error had occurred and was discussed with a member of staff. The manager must ensure that medication errors are kept to a minimum to safeguard the residents at the home. The manager had recently written a brief medication policy that he submitted to the staff on the second day of the inspection visit. Documentation also revealed how medication should be administered to residents’ with complex needs. The administration of medication with food is only carried out after discussion and approval, from the GP, care reviews and in the best interest of the user. The storing of medication is adequate and each resident has individual safes in their bedrooms in which external medications are stored. The medication cabinet is secure. A pharmacist report based on inspection conducted on 21st June 2006 is included in this section. Staff are trained and assessed as competent to handle medicines. Training is also provided for giving medicines in a more specialist way. Three staff spoken to knew about the medicines they used. There is a medicine policy and procedures but the new providers will need to define which procedures are used as two files were seen. Homely remedies are stocked and there is a protocol for use signed by a doctor. Some items need better definition (just stating the brand name for example does not fully describe the medicine, as there may be several different products within the same brand name but with different effects. ‘Cough mixture’ is also not sufficient). There is a stock record book for these medicines but a check showed recorded balances did not agree with the stock in the cupboard. The storage arrangements for medicines in the office are satisfactory. To fully comply with the law the inner cupboard for controlled medicines needs fixing to the solid wall with two rag bolts if medicines in this class are used in future. Some medicines are stored in a cupboard in the laundry room but the door hinges and quality of lock are poor and this is not a suitable place to keep Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 16 medicines. Boxes of PEG feeds were stored on the floor, which is poor practice. Medicines in the fridge must be stored in a fixed locked container to make sure only authorised staff can gain access to them. Creams and ointments in use are stored in bedrooms. Most did not have a date written on the label when first opened to use. A few were dated but two were beyond the expiry date. Liquid medicines now had an opening date and use by date recorded. It is good practice to write the opening date on any medicine container when first opened. Audit checks of some medicines where possible were generally satisfactory. During the current month three examples were found where the record on the medicine administration records chart did not agree with the tablets remaining in monitored dose system (MDS) packs. Regular audits checks are needed to identify issues such as this. A buccal administered medicine for emergency use for one resident was not in stock, as three doctors involved in the care cannot agree to provide a prescription. The manager has directed to use another persons stock. This is illegal and places the resident and staff at risk as there is no evidence the medicine is being given in accordance with the directions of a doctor (the only authority to give). The PCT could be asked to help resolve this. These medicines must be moved and kept in the main medicine cupboard. One bottle of this had been stored with the lid off resulting in the product degrading and not fit to use. Printed forms to record medicine administration are provided by the pharmacy. Most records for medicines given by mouth were well recorded. Records for medicines used externally were not consistent. X or O were often entered on the chart but what this meant was not defined. Handwritten entries on the records were not signed by the person making them and a signed check by a second staff member is needed as a check that the information has been copied correctly. Some handwritten charts did not have the dates fully recorded. Some medicines are prescribed ‘as required’ or ‘as directed’ which does not give staff sufficient information as to the intended use. There are protocols in place for laxatives but not for other medicines. Use of creams and ointments were not included in care plans. Staff give medicines to two residents via a PEG tube. There are some protocols in place but ‘give medication’ is not sufficient so exact details need to be included. The doctor’s directions on the prescription must include ‘via PEG tube’ to authorise staff to give in this manner. Some medicines still printed on the MAR charts are not current which is confusing to staff and may place residents at risk. Use of an indigestion mixture for one resident was not according to label directions for example. The use by date on this bottle was 16th June 2006. Details of residents’ preferences for taking their medicines are recorded and ‘best interests’ statements have been put in place. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 17 There are records for medicines received and returned to pharmacy but the last record of returned medicines was in November 2005 - all medicines leaving the home must be recorded including items remaining in the MDS packs at the end of the month. A nebuliser machine used to give medicines to one resident was last recorded as serviced in September 2005. An up to date medicine reference book such as the latest edition of the BNF is needed. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure. The staff have received training that ensures that the residents are kept free from abuse and neglect. EVIDENCE: There have been no reports of complaints about the home in the last twelve months. This would reflect that the home is operating at an adequate standard. The home has a generic complaints procedure that is placed at the entrance door with the feedback forms. Information extracted from the providers monthly reports on the conduct of the home indicate that the staff team have received protection of vulnerable adults training. This was highlighted at the previous inspection and has now been addressed. It is however important for the manager to ensure that detailed accounts on methods of the residents communication skills is crucial Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 19 and would provide the staff with extra information to support residents who may have difficulty in expressing their view in a unconventional manner. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a comfortable and safe environment. The home smells fresh and clean. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 21 EVIDENCE: During the second visit the home was decorated with Christmas trimmings. The atmosphere was warm and cosy on arrival. The staff were preparing for a party. The home was formerly known as the “party home” in which the home would send out invites to other residents’. This is a good extension of the resident’s social life and thus further encourages friendships from other homes. All communal areas were examined during the inspection. Communal areas were clean and free from offensive smells. The home is a purpose built bungalow that has been adapted to meet the needs of users with a learning and physical disabilities. Some residents’ were observed spending time in both the lounge and dining area. Resident’s have their specialist chairs and adaptations that reflect their needs and promote independence. The selected bedrooms show individualised styles and preferences. Each bedroom far exceeds the national minimum standards with ample room for wheelchair users. The home has a well-equipped laundry/sluice room. The manager must ensure that a more appropriate place to store temperature sensitive PEG (see the staffing section for explanation to this procedure) feeds are addressed. The laundry/sluice room would seem too warm to store PEG nutritional supplements that are sensitive to room temperature changes. This was highlighted in the previous inspection. The home was clean and fresh at time of inspection. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment practices which are in place support and protect the residents’. The training programme is in place to maintain further and continued development of the staff team. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home has a long-standing staff team. The staff team provide good support to the manager of the home. Discussion with the staff and observation provided additional evidence that staff have a good understanding of the resident’s needs. The staff team described how well they work with each other and how good the communication is between the staff team. All members of staff are qualified to give medication and certificates were seen to confirm that the staff team were successful in their training. Key workers have the task of reviewing the care plans and the risk assessments. The manager has the task to sign the completed task. It was noted that some of the residents are P.E.G fed which the staff team are given assistance from the local District Nurse and the dietician from Gloucester Royal Hospital. This is a procedure conducted by a specialist and the procedure means Percutaneous Endoscopic Gastrostomy (PEG) is a surgical procedure for placing a feeding tube without having to perform an open operation on the abdomen (the stomach). This is usually agreed in a best interests meeting and approved with other health professionals. The staff team are aware of the implications and the specialist training that accompanies this task. Possible complications include wound infection (as in any kind of surgery) and dislodging or malfunction of the tube. The staff discussed that they have developed positive relationships with the local GP and District Nurses. The manager discussed that they are still able to provide care and meet the needs of the residents’. The staff recently had an away training day which proved to be successful. Reference to this was made in the recent providers monthly visit, the manager had made a comment of the day and the staff members during the inspection. According to information from the pre inspection questionnaire, approximately 33 of care staff are qualified with NVQ level two and above. According to the National Minimum Standards 50 of care staff including any agency staff in the home will achieve an NVQ level two. Although the figure submitted is an approximation it could be seen as a positive step for the manager to share with CSCI any future plans about staff training/qualifications. Information taken from the recent providers monthly visit for November 2006, show that staffing levels were insufficient. The manager must ensure that all times that there are staff working in the care home in such numbers as appropriate to meet the health and welfare of the residents’ needs of users. One staff file was examined since there have been no new staff members to the team. The residents are supported and protected by the home’s recruitment policy and procedure. The file contained the relevant information Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 24 required as part of the recruitment procedure. Although the standard for staff supervision was not assessed on this occasion, it would appear that supervision of staff takes place on a regular basis and the notes were available. On the whole the staff team are effective in the task they perform and competent in supporting the residents’ who have complex needs. The members of staff enjoy working with each other and this was observed during the inspection visits. The manager has a good supportive team. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 26 The home is adequately managed and the residents benefit from good quality care. Reasonable systems are in place for self-monitoring although further work needs to be considered if any improvements need to be made. Adequate systems are in place to ensure that the home is a safe place to live and work. EVIDENCE: The registered manager who has had many years experience manages the home. The home has a strong dedicated team of care workers who additionally provide support to the registered manager. The manager must ensure that is aiming to have regular staff meetings every six weeks. On appearance the notes from meetings are inconsistent. Staff said that “… is trying to have staff meetings every 6 weeks.” The new medication policy that was written by the manager and was handed out on the second day of the inspection visit would have benefited from consultation with staff team. The home has a direct quality assurance questionnaire for the residents’ that the key worker completes on behalf of the resident. Although the concept is a positive starting point it does not provide an objective view. For instance, asking the key worker if the resident is treated with respect at all times leaves room for a bias response. Additionally feedback forms are placed at the entrance of the home that can be picked up by visitors. There appears to be a lack of consistent and regular information gathering in the form of self-audit that would highlight any positives or negatives the service may have. The manager has discussed that the provider has a proforma on which the home can make comments, next step the issue would be to obtain regular feedback form people outside of the service. This matter needs to be addressed so that a picture can be obtained about the quality the service provides. The manager was able to show the homes safety checks were being completed, and that a handover book was seen. On the whole there are room for improvements to be made. The homes strengths are that there is a strong committed staff team whose knowledge of the residents’ is good and can provide good quality care. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 27 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. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 2 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 2 43 X 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cranham Lodge Score 3 3 2 X DS0000067012.V300595.R01.S.doc Version 5.2 Page 28 No 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 YA1 Regulation Requirement Timescale for action 18/12/06 4 (1) The registered manager shall (a,b,c,)(2) compile in relation to the care home a written Statement of Purpose which shall consist of: • A statement of the aims and objectives of the care home • A statement as to the facilities and services which are to be provided by the registered person for services • A statement as to the matters listed in schedule one. • The registered manager shall supply a copy of the statement of purpose to the CSCI and shall make a copy of it available on request for inspection by every service user and any representative of service users. 14 (d) The registered manager have confirmed that having regard to the assessment the care home is DS0000067012.V300595.R01.S.doc 2. YA19 18/12/06 Cranham Lodge Version 5.2 Page 29 3. YA20 13 (2) 4 YA39 24 (1) (a) (b) 5. YA20 13 17 suitable for the purpose of meeting the service user’s needs, in respect of their health and welfare. The registered person shall make 18/12/06 suitable arrangements for the storage for specialist nutritional liquids that are used for P.E.G feeds. The registered manager shall 18/12/06 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. Review the arrangements for the 21/06/06 management of medicines in the home to address the issues identified in the report and make sure that • All medicine records are complete and accurate; Medicines in the fridge are kept securely and medicines • are not kept in the laundry room; • Medicines are only used for the person for whom they are prescribed and in accordance with the directions of the doctor; • Routine audit checks are in place to show that medicines are given and recorded correctly; Care plans or protocols reflect the use of medicines prescribed to use ‘as required’ or given in a specialist way; Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 30 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 YA20 Good Practice Recommendations Obtain the latest edition of the British National Formulary. Cranham Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Lodge DS0000067012.V300595.R01.S.doc Version 5.2 Page 32 - 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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