Inspection on 09/10/06 for Cranhill

This inspection was carried out on 9th October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cranhill 10/09/07

Cranhill 07/11/05

Cranhill 22/06/05

Cranhill 27/01/05

Cranhill 18/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Cranhill Weston Road Bath Bath & N E Somerset BA1 2YA Lead Inspector Jill Cornelius Key Unannounced Inspection 9th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranhill Address Weston Road Bath Bath & N E Somerset BA1 2YA 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) 01225 422321 01225 482637 Mr Charles Otter Mrs Virginia Hughes Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate 31 Persons over 50 years of age requiring nursing care Staffing Notice dated 09/11/2001 applies Manager must be a RN on parts 1 or 12 of the NMC register May accommodate one named person aged 49 years: the registration will revert when this person leaves the Home 7th November 2005 Date of last inspection Brief Description of the Service: Cranhill Care Home is situated in a suburban area of Bath and provides nursing care for up to 31 residents. There is easy access to Victoria Park nearby, also to other local venues and shops by car. The building is an older converted property providing single rooms on three floors with lift access. Communal space is in three areas and the forecourt/terrace area in front of the home is also enjoyed by residents. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key visit was conducted unannounced over one day in October 2006 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the residents, ensure the premises are well maintained and to examine health and safety procedure. During the site visit, the records examined included residents care plans, and the records relating to the day-to-day running and management of the home. A tour of the premises was conducted and feedback sought from residents and staff. In addition to key records, surveys were sent to residents and visitors to Cranhill Nursing Home in advance of this inspection. What the service does well: Staff were observed as being respectful, warm in manner and sensitive towards the residents within a relaxed homely environment. The manager and staff have built a good rapport with individuals and are knowledgeable about the care needs of the individuals living in the home. The home is well organised and managed by an effective, stable management team that promote the views and interests of the residents. Residents feel their views are listened to and acted upon. Prospective residents or their families have all relevant information to make a decision about the nature of the home. Prospective residents needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. Links with the community are good and support is given to residents with their social opportunities. Meals are good offering both choice and variety. Special dietary needs are well met. The home is clean, comfortable, and well-maintained. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 6 Residents are protected by a robust recruitment system. Skilled staff that are trained and supported by management care well for the residents. 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. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents or their families have all relevant information to make a decision about the nature of the home. Prospective residents needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. Trial visits give prospective residents an opportunity to assess the nature of the home. EVIDENCE: A statement of purpose and a home guide is made available at the initial stage of enquiry, to prospective residents/families. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 9 The Inspector looked at the pre-admission assessments, which covered all activities of daily living, a full health screen and personal history background. The prospective resident, family and carers are involved in the pre-assessment and all information is used to determine the suitability of the placement. Where possible the manager had also obtained assessments and care plans from other professionals involved for example, social workers and hospital staff. Prospective residents are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. A month’s trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. A telephone enquiry was made during the inspection and the inspector heard the manager inviting the prospective residents’ family to visit the home also explaining that an assessment of care needs would be carried out to ensure the home could meet their care needs. This was arranged for that afternoon at the request of the inquiring family. The home operates a robust admission procedure for residents, in the form of a checklist to ensure the smooth running of this first initial period within their new home. Residents are referred to the Primary Care Trust for assessment for funding under the Registered Nurse contribution or Continuing Health Care (CHC). One resident receives full funding from CHC at present and her husband stays for lunch daily without extra charge. New residents are only admitted following a full pre-admission assessment, which is carried out by the manager. The manager stated that visits to service users homes or the hospital are arranged. Two recent admission assessments were viewed. These contain a full description of the service users needs. Staff members on duty were able to describe care needs of residents. Emergency admissions can be arranged following a full assessment. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Individualised planned care is well documented in terms of health care needs but not in terms of social care needs and there is a lack of documentary evidence of resident involvement in the development and review of care plans. Residents’ health care needs are well met. Staff have a good awareness of individuals needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. Their privacy and dignity are maintained and they can be assured of sensitivity from the home at the time of their death. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 11 EVIDENCE: Five residents care plans were examined to monitor how residents are being supported to meet their needs. Care plans addressed residents’ physical, psychological and health needs. However plans regarding social needs could be further developed. The plans had been reviewed monthly and were updated reflecting the residents’ current needs. The care plans however did not indicate that wherever possible the resident or family had been involved in their development. Health Care needs were well evidenced in the Care Files and included wound care, blood sugar monitoring, and pressure area risk assessments. Information had not been regularly reviewed and updated. Evidence of consultation with residents was observed. Records of the General Practitioner visits/contact with residents and the outcomes were also available. The home had access to pressure relieving equipment and this was documented in the plan of care. Specialist referrals and visits from other professionals were evidenced in care files including Community, Chiropodists, opticians and Dentists. The Inspector was informed that each resident was referred to a GP on admission to the home and an initial first visit was then set up. Although the GP conducts a monthly visit to the home, good working relationships with the GP have been formed and the GP will visit on request. This was evidenced in the health professionals’ documentation. Risks assessments had been developed to identify potential risks including manual handling and the use of bed rails. Evidence that the use of bedrails had been discussed with the individual or their representative and written consent had been sought. It was evident from consultation and observation that the manager and senior Registered Nurse in charge had built a good rapport with individuals and were knowledgeable about the care needs of the individuals living in the home. Residents stated that “staff were helpful” and “looked after them well”. The atmosphere in the home on the day of the inspection was relaxed. Staff, the manager and residents were observed to have good relationships. Staff responded to residents in a sensitive and professional manner. Staff were Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 12 witnessed knocking on resident’s doors before entering confirming respect for the residents’ individual privacy and dignity at all times. The home has a very clear policy and procedure relating to the end of life personal preferences. Staff have supportive links with hospice and other professional staff, the GP and local clergy are readily involved. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Links with the community are good and support is given to residents with their social opportunities. Residents would welcome more activities to provide daily variation. The meals in this home are good offering both choice and variety. Special dietary needs are well met. EVIDENCE: As mentioned at the previous inspection it was clear that the home at present does not provide adequate recreation. The manager who had recently conducted an audit by way of questionnaires given to the residents supported this and had identified that some residents were dissatisfied. The inspector went through the questionnaires with the manager and the resident’s ideas and requests were incorporated into a useful list that the Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 14 manager will now pursue in order to develop varied activities plan. The inspector will look forward to inspect its progression in more detail at the next visit. Discussions with the residents showed that they particularly valued the one to one visits they receive. One resident stated that they “looked forward to this time we can have a nice talk without interruptions”. The grounds and gardens are extensive at Cranhill and the residents take advantage of sitting on the terrace and new lower patio where people can enjoy the views when the weather permits. There is a very pleasant dining room where individuals can enjoy the social advantages of dining together. Other residents through choice or being frail receive their meals in their rooms. One resident stated how they “enjoy their meals in the tranquil dinning room and feel that they are unhurried”. One resident who chose to eat in their room stated that “when some meals arrive it has already been cut up and I am not sure what it is”. With their agreement this was highlighted to the manager who was keen to address this. Residents that required assistance with eating their meals were supported by staff members, this was performed in a respectful, sensitive way, for example without rushing the residents and staff were sat at the same level as the resident. The inspector spent time with the chef and assistants. The chef was able to demonstrate a competent awareness of individual requirements and needs of the residents, including personal preferences. The 4-week menu rota displayed traditional meals and choice was available at each setting. The menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. The chef explained that his assistant spends time with the residents on a daily basis to see if they have enjoyed their meal and if they are happy with the menus. Fresh fruit and vegetables are delivered twice weekly and bowls of fruit are on offer throughout the day. The kitchen was clean, spacious and stores exhibited a good range of foods. Through documentation and discussion the inspector saw that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked before serving. Risk assessments were in place and up to date. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 15 The chef informed the inspector that he was registered to undertake in house training for all staff in respect of food hygiene and a training plan was being developed. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are robust and comprehensive policies in place to manage complaints or allegations of abuse. The home has a satisfactory complaints system in place with evidence that residents feel their views are listened to and acted upon. EVIDENCE: A copy of the complaints procedure is on display in a well-frequented part of the home, which means people will know how to obtain the required information if they want to make a complaint. The complaints policy and procedure is detailed and contains all the required information. Any concern raised by residents and visitors is dealt with immediately; information of the outcome is cascaded down to the staff, through hand over time and recorded in the resident’s notes. Where necessary written confirmation of the outcome and how issues will be resolved is also sent to the relative and families and evidence of this was seen during the inspection. All concerns are logged on a register. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 17 The home has clear policies and procedures for Adult Protection and Whistle Blowing, staffs receive training on Adult Protection during their induction and qualified staff is aware of the procedures to follow. Training in this area needs to be updated. A date was booked for training during the inspection. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is clean, comfortable, and decorated and furnished in a homely way. It provides a safe, peaceful and well-maintained environment for the residents. The number of toilets and bathrooms offer personal privacy. EVIDENCE: Attention has been given to ensure that all areas are homely. Residents had been supported to personalise their bedrooms with pictures and ornaments. Residents are able to bring items of furniture should they wish. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 19 The home offers a variety of communal areas looking onto the well-tended garden. The garden is large and recent hard landscaping has provided residents with the option of using larger areas of the gardens. One resident said “I enjoyed the lower patio to entertain my family throughout the summer” another said how “the path and lower patio gives them a chance to feel like they were going for walk ”. There are sufficient bathrooms and toilets. However, there is ongoing discussion between the manager and the proprietor to have these upgraded. One discussion is to have a walk in shower room. This would enhance the bathing experience for residents’. The home was clean and free from unpleasant odours. The home employs domestic staff on a daily basis. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Adequate staffing levels help to ensure that residents needs are met. Residents are protected by a robust recruitment system. Skilled staff that are trained and supported by management care well for the residents. EVIDENCE: The staffing levels are well supported by the manager and are indicative of the needs and levels of care required by the residents. The recruitment process was examined and staff records examined showed that the home follows a robust recruitment procedure. Records contained application forms, references, and a CRB (Criminal Records Bureau) disclosure. Nurse PIN’s are validated annually. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 21 Although staff training was not inspected fully on this occasion, a short time was spent with the Registered Nurse who is responsible for conducting in house training and organising all training requirements. The home continues to support their staff with their NVQ levels 1,2 and 3 and the enrolling programme continues. The manager and her staff are conscientious in attending training relevant to the care needs of the residents. Recent courses have included, Dementia awareness, Diabetes updates and Infection Control. Other courses booked for this year are Managing People with Eating Difficulties, and Adverting Crisis in Palliative Care. All mandatory training was up to date. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The manager is experienced and competent to manage the care home. Good care practices are promoted and therefore safeguard the health, safety and welfare of the people using this service. Staff are appropriately supervised. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 23 EVIDENCE: It was understood from the manager that the duties of her role include the welfare of the residents, staffing and providing a good service to the residents. Mrs Hughes was appointed as manager for Cranhill Nursing Home in December 1985. She has thirty years experience at management level and is a registered nurse. There was a degree of satisfaction expressed by all of the residents spoken with. During the inspection the inspector spoke to residents who said they continue to be “very happy at Cranhill” and the “staff were patient and respectful”. Based on the comments made and through the inspector’s observation it is evident that the home is run in their best interests and to ensure their needs are being met. Supervision notes were viewed for five staff. These contained areas of care practices and training requirements. Appraisals are being undertaken. The records that relate to fire safety practices and checks were examined and indicate that checks and practices are conducted at the stipulated frequencies. Portable appliance checks and gas heating systems are checked annually to ensure a safe environment for the residents’. Manual handling equipment, wheel chairs and bath aids has all been appropriately serviced. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 x 3 3 3 3 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 3 3 x x x 3 x 3 Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP7 Regulation 15(1) 15(1), 15(2)(c) Requirement Ensure social care needs are included within the plan of care for each resident. Ensure resident involvement in the development and review of care plans is evidenced. Timescale for action 31/01/07 01/11/06 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 OP26 Good Practice Recommendations Replace all washing bowls which have been encrusted by lime scale build-up. Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Cranhill DS0000020276.V309661.R01.S.doc Version 5.2 Page 27 - 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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