CARE HOMES FOR OLDER PEOPLE
Cranleigh Paddock Older Persons Resource Centre Calpe Avenue Lyndhurst Hampshire S043 7AT Lead Inspector
Anita Tengnah Unannounced 6/7/05 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Cranleigh Paddock Older Persons Resource Centre. Calpe Avenue, Lyndhurst, Hampshire, SO43 7AT Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02380 283602 02380 284124 Hampshire County Council Mrs Sheila May Aplin CRH 34 Category(ies) of DE(E)- Dementia over the age of 65 years: 34 registration, with number OP- Old Age: 34 of places Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11/1/2005 Brief Description of the Service: Cranleigh Paddock is a registered care home providing personal care to 34 service users in the older person category. Hampshire County Council owns the service. Accommodation is provided on ground floor level and is didvided in four units. The home is situated in Lyndhurst on the outskirt of Southampton close to local amenities and the New Forest. The home has enclosed gradens that are accessible from each unit and to wheelchair users. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken over a day on the 6th of July 2005. As part of the inspection process, a tour of the building was undertaken. The inspection took place over 5 hours. The inspector spoke to 9 service users, 8 staff, 2 visitors and the deputy manager. The process included examining care records, staff records and discussions with service users, staff and visitors. What the service does well: What has improved since the last inspection?
The home has single lever locks that have been fitted to all service users bedrooms that are appropriate to their needs. Call bells access was available in all service users bedrooms seen at the time of the inspection. As part of the pre- admission process care manager’s assessment were available in a recently admitted service user records.
Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 6 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. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,6 The home has a good pre- assessment process in place to ensure that service users needs are met. The absence of the complaint procedure in the service users’ guide does not provide service users with all the information that they may require. EVIDENCE: Staff reported that all service users have their needs assessed prior to admission to the home. Service users are offered to spend a day at the home and assessed at that time. Care manager’s assessments were also secured prior to admission. Evidence of this was available in record seen for a recently admitted service users. Staff stated that information as per the statement of purpose are available to service users and their families prior to admission. It was noted that the complaint procedure was not available in all the service users’ guide, this was discussed with staff and must be included as part of the information provided. Service users are provided with a written contract, however the amount for the fee charged was not stated in the contract seen. This was discussed at the
Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 9 time of the inspection. Staff reported that this had been addressed and would be reflected in future contracts. The home does not provide intermediate care. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 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 standard(s) 7,8,10 Arrangements are in place such as care plans and risks assessments, however the lack of regular review may be detrimental to the welfare of service users. The arrangements to meet the health care needs are well managed. EVIDENCE: Arrangements were in place to meet the assessed needs of service users. Care plans were formulated and included risk assessments and manual handling assessments. Staff discussed that a new care planning documentation was being developed; a copy of this was seen. Discussion was undertaken with regards that an individual care plan should be in place for each care need identified. There was evidence in one care plan seen that care plans were formulated with the involvement of service users or their families. However this was not reflected in other care plans. The home must ensure that advocates/ families are involved in formulation and any reviews of care as service users due to their mental incapacity may not be able to participate in this process. The home also provides respite care that is an invaluable service in supporting families and service users to remain in their homes for as long as possible. The inspector viewed one record for a service user that was receiving respite care.
Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 11 It was noted that there was no record of any review of the assessed needs and care plans on a recent admission. This was discussed with staff, as the care plans may not reflect the service user’s current needs. Staff must ensure that care plans are reviewed and updated to reflect any changes in the needs of service users. Service users are registered with the local GP and staff reported that they are well supported by the district nurses that attend the home regularly. One service user had recently returned to the home following a fractured femur. Arrangements were in place and included a “nursing” bed that was adjustable and staff reported that it made it easier to use the hoist. The inspector spoke to 9 service users and two relatives as part of the inspection. Positive reports were received regarding the care that they were receiving. Comments from service users included “Best home around”. A male service user added that “nothing is too much for the staff“ and he receives help with shaving and washing as required. Another service user told the inspector that she holds a key to her room. Comments from 2 service users included” We love our rooms, as it was not far from the kitchen” and” they can make drinks as required”. Two sisters stated that it was nice for them to live together and they spent most of the day in each other’s company. Service users spoken to confirmed that they have autonomy and choice with regards to activities of daily living. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 The meals were varied and appeared well balanced. Some service users have a varied social life, however the lack of staffing impinged on daily activities for those that are less able. EVIDENCE: Staff reported that there are varied activities that are available for service users. Two service users said that they attended church on a monthly basis and staff would arrange transport when they went out to see a show. External entertainers visit the home at intervals. The mobile library visits the home on a fortnightly basis and service users reported that there are a variety of books that they can choose from. Two service users stated that they attend the community club and also the local Baptist church for lunch. They also attended fetes and crafts shows in the village, thus maintaining links with the community. Staff reported that they undertook daily activities for service users. However due to staff shortages this was difficult to manage and happened on an ad hoc basis depending on their workload. Service users spoken to stated that, “staff
Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 13 do try, but there are always busy and do not have time for activities”. This was highlighted at the last inspection and there have been no changes. It was evident that service users that are able to go out have the benefit of integrating in the local community and have a varied social life. However this did not apply to all service users group accommodated. The provider must ensure that service users are given choice and there are suitable activities for all service users to meet their needs. This staff agreed would be of benefit to service users. The home has an open visiting policy. A record of all visitors to the home was available. Service users spoken to stated that there was no restriction on visiting times and they have the choice of seeing their friends/ relatives in private or in the various communal areas at the service. Daily newspapers were available. Two visitors spoken to stated that they visited the home 2-3 times per week and at different times as there was no restriction on visiting and were always welcomed.. The home has a planned menu. Nine service users were spoken to with regards to meals and they all commented that meals were very good and choices are offered. The daily menu for lunch was displayed in each unit. Hot and cold drinks are available at all times. Staff reported that snacks were available for supper, however this was not recorded on the menus seen. Lunch was observed being served. Meal at lunchtime appeared well balanced, nourishing and nicely presented. Service users reported that the food was “very good” and a choice was available. One carer was observed to be available to offer support with meals as required. Staff reported that in one unit there were three service users that required help with their meals, however there was only one staff member allocated to each unit. This staff stated made the tasks difficult due to staff shortages. The inspector also observed serving dishes being washed in the unit prior to being sent to the kitchen. The chef reported that she did not have enough staff in the kitchen to undertake this task. This was discussed with the person in charge and remedial actions will be taken. It was also reported that there are no kitchen staff after 2 pm and care staff are responsible for evening meals. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has satisfactory procedures in place and staff are aware of the needs to report any allegation of abuse. Systems are in place to protect the welfare of service users. EVIDENCE: The home has policy and procedures in place for dealing with complaints. Service users and two relatives spoken to reported that they were happy with the care provided. They stated that they would approach the carers or the person in charge if they had any issues. The complaint log was seen and the home had received one complaint that had been resolved. It was noted that the complaint procedure was not included in the service users’ guide seen; this was discussed with the person in charge and should be put in place in order to inform practice. The home has in place the Hampshire adult protection procedures. Staff were confident in how to deal with any allegation of abuse. Training in adult protection was available. Record shows that the majority of care staff have undertaken such training. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21,25. The standard of décor and the furnishing were good with evidence of future planning. The home presented a warm and homely environment that provided service users with an attractive place to live in. EVIDENCE: A tour of the building was undertaken as part of the inspection procedure. The inspector found that the home was warm and welcoming. Service users’ bedrooms seen reflected that they are encouraged to bring in items of personal belongings. One service user also held the key top her room. The inspector was invited to see her room that was personalised as well as 6 other bedrooms seen on the day. Three service users commented that they liked their rooms with all their belongings around them. One service user reported that she particularly liked
Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 16 her room, as it was close to the kitchen area where she was able to make herself drinks as she wished. Furnishing was clean and appropriate to service users needs. All bedrooms were fitted with single lever locks and call bells were available in all bedrooms seen. There were sufficient assisted bathrooms and toilets to meet the needs of service users, including some that were close to the communal areas. Staff reported that the home had purchased a number of nursing beds that allowed them to care for service users that are less mobile and required hoists. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The staff have good understanding of service users support needs, this was evident from positive relationships that have been developed. However the lack of staffing may be detrimental to service users welfare and needs not met. The lack of evidence for staff checks is detrimental to the safety of service users. The home has a well- managed training plan and support staff in maintaining their skills. EVIDENCE: The home has a duty rota and a separate one for ancillary staff. The home has a group of staff that have worked therefore a long time and this was recognised by service users spoken to. They commented that staff were kind and “ always there to help”. It was evident that staff had developed good relationship with service users. The inspector spoke to 6 carers as part of the process of inspection. Staff reported that night duty system was due to change soon and that would allow for 3 waking staff on nights. At present there are two waking staff and a senior staff member does the sleeping in. Staff reported that morale remains low due to staff shortage. Staff reported that recently when the laundry staff was on holiday, there was no additional
Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 18 cover. Carers have to undertake the laundry duty at the weekend. Carers are also responsible for service users meals as there are no kitchen staff after 2pm. The provider is required to ensure that there are adequate staff at all times to meet the needs of service users. Care staff hours must not be eroded by noncare duties, as this may be to the detriment of service users. The inspector looked at the records of two staff that had been recently recruited. Applications forms were completed and references were obtained. However there was no evidence that Criminal Record Bureau checks and POVA clearance for 2 staff records seen. It was reported that these are undertaken by head office. One carer record seen did not contain evidence of his eligibility to work as his work permit was for another company. The provider is required to ensure that all checks are undertaken prior to employment and records must be maintained as per schedule 2. The home has an ongoing training programme in place. This was well managed and good records were maintained of training undertaken by staff. These included adult protection, medication, infection control, dementia care and managing challenging behaviour. There was a good system of induction in place. Staff reported that all new staff had seven days induction spread over one month and worked as supernumerary for up to two weeks. Induction records were available. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38. The home has a process of auditing care in place; consultation with service users and staff is needed to reflect an open and inclusive practice. The poor procedure with regards to storage and dating of food can be detrimental to service users’ welfare. EVIDENCE: Reports as per regulation 26 are sent to the Commission on a monthly basis. Staff reported that the previous service manager had a good relationship with service users and staff. It was reported that recently as part of the regulation 26 visits, staff and service users views are not sought. This may be as the service manager is new and this system has not been developed. The view is that in order to have a realistic outcome, service users and staff views should be sought and should form part of the process of auditing the care delivery. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 20 The kitchen area was clean and well maintained. However there were a number of items in the fridge that had been transferred from catering size containers to smaller jars. These did not contain the date of opening or expiry dates. These also applied to dried foods that were not labelled and no dates of opening were recorded. This was discussed with the chef who is aware that all food must be labelled and dates of opening and expiry dates must be recorded. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x 3 x x x STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(2) (b) Requirement The manager is required to ensure that assessments and care plans are reviewed and updated on a regular basis to reflect any changes in the needs of service users. The provider is required to ensure that activities are available to suit their needs. The provider is required to ensure that there are adequate staff, including domestic staff at all times to meet the needs of service users. This is a repeated requirement from 11TH January 2005. Timescale for action 30/08/05 2. 3. 12 27 16(2) (n) 18(1) (a) 30/08/05 30/08/05 4. 29 19(1) 5. 38 16(2) (j) The provider is required to 30/08/05 ensure that all checks are undertaken prior to employment. Staff records must be maintained as per schedule 2. The provider must ensure that 30/08/05 there are clear procedures in place and food are stored correctly. Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 23 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 Good Practice Recommendations Cranleigh Paddock Older Persons Resource Centre H54 S34267 Cranleigh Paddock V234268 060705.doc Version 1.30 Page 24 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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