CARE HOMES FOR OLDER PEOPLE
Cranmer Court Farleigh Road Farleigh Common Warlingham Surrey CR6 9PE Lead Inspector
Pat Collins Unannounced Inspection 31st May 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 Cranmer Court DS0000065906.V296810.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. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cranmer Court Address Farleigh Road Farleigh Common Warlingham Surrey CR6 9PE 01883 627713 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) Cranmer Court Limited Mrs Margaret Elaine Faulkner-Shotter Care Home 56 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (56), of places Physical disability (5), Physical disability over 65 years of age (20), Sensory Impairment over 65 years of age (15), Terminally ill (5), Terminally ill over 65 years of age (5) Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. For the age range of service users within categories PD and TI to be between 55 and 64 years. For no more than a total of five (5) service users to be accommodated at one time within categories TI or TI (E). N/A Date of last inspection Brief Description of the Service: Cranmer Court is a new purpose built care home for older people of both genders over 65 years of age. Service provision is for people with moderate, severe or complex nursing needs. A small number of service users from the age of 55 years may also be accommodated. The home offers long and short term care also respite, palliative and convalescence care. Cranmer Court is part of a group of seven care homes in Surrey operated by the same organisation; it is also part of a network of care homes, specialist centres and independent hospitals operating in England and Scotland. The building was completed in January 2006 to a high specification. The home is situated in its own landscaped gardens, overlooking Farleigh Common. Located on the edge of Warlingham village, community amenities and local and larger shopping facilities are accessible. The Kent and Surrey border is also nearby. Countryside, towns, parkland and the coast are all within easy travelling distance of the home. The home has a wheelchair accessible vehicle. Bedroom accommodation is in single en-suite spacious rooms on both floors, accessible by two passenger lifts. Communal lounges and dining rooms are also available on both floors; also fully equipped assisted bathrooms and shower rooms. A dedicated recreational therapy/activities suite is available on the ground floor. A full time registered nurse-manager is responsible for the dayto-day management of the home. Weekly fee charges ranged between £750 and £900 as of May 2006. Additional charges were payable for private physiotherapy, complimentary therapy, chiropody, hairdressing, guest meals, newspapers and magazines, escorts and telephone calls. Prospective service users and their representatives are informed of the home’s services and facilities in a service users guide document which is available in the reception area. A copy of the latest inspection report will be also displayed in this area in due course and available to the public from the home or the Commission for Social Care Inspection (CSCI).
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first key inspection of the home since its registration in January 2006. This brings together the cumulative assessment, knowledge and experience of service provision at Cranmer Court since that time. It takes into account the findings of an unannounced inspection visit undertaken by one regulation inspector on 31st May 2006. The duration of the same was ten hours and all key national minimum standards for older people were inspected. A tour of the premises was undertaken and records, policies and procedures were sampled. Discussion took place between the inspector and the registered manager, regional operations director, regional manager, a general practitioner and with members of staff. The inspector also consulted a number of service users who gave feedback on their care and life in general at the home. Three visitors expressed their views about the home at the time of the inspection visit. Written comments received after the inspection visit from nine service users, fifteen relatives/visitors, four placement professionals and the general practitioner also informed the inspection process. The inspector would like to thank all who contributed to the inspection process. What the service does well:
The atmosphere of the home was warm and welcoming at the time of the inspection. Staff consulted were aware of service users needs. Observations confirmed that staff were professional and friendly in their approach towards service users and visitors. Feedback from service users and their representatives/visitors was positive about staff. Examples of comments received were “ staff are efficient, helpful and thoughtful”, “ staff are excellent and very friendly”, also “ it appears to be a well run home. Staff are very friendly and nothing is too much trouble”. A high level of satisfaction was expressed with the standard of information made available to prospective service users and their representatives on which decisions about admission were based. Also regarding the standard of medical care and support. Some service users stated they received the care and supported they required from staff. Standards of cleanliness and hygiene at the home were stated by service users and staff to be at all times high. Service users’ representatives reported being welcomed by staff at any time. They stated they were informed of important matters affecting their relative/friend. They reported being consulted as appropriate about the care of their relative/friend if unable to make decisions themselves. There was understanding of equality and diversity issues in staff recruitment procedures and practices; also in the home’s admission procedures and general operation. Care plans agreed on admission demonstrated how diversity
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 6 needs would be met, for example age appropriate activities, promoting social models of disability, special dietary preferences and respecting and supporting all religious beliefs and all cultural backgrounds. The organisation was planning training for all staff on equality and diversity to further promote best practice. The home’s spacious activity suite was equipped with microwave and tea making facilities, also computer equipment for service users’ use. A wellequipped hairdressing room was also available and large screen televisions provided in communal lounges. An activity programme was in place and a copy placed in each bedroom as well as being prominently displayed in communal areas. A care assistant had delegated responsibility for producing and coordinating the home’s activity programme. This was additional to responsibilities related to her role as care assistant. The inspector was informed that the activities programme was continuously being developed. Part of the admission procedures included completion of individual biographies for service users. It was noted that effort had been made to incorporate service users known interests into the activity programme where possible. An individualised approach was also evident in trying to meet social care needs. Further information regarding the content of the programme and how this was managed is detailed in the body of this report. Management and administration systems supported efficient and effective management of the home. Staff recruitment procedures safeguard service users. There was a staff induction, training and development programme, which ensured staff’s competence to provide safe and appropriate nursing and personal care. A varied, nutritious menu was available affording choice and ensuring dietary needs were met. Arrangement for maintenance promoted the health, safety and welfare of service users and staff. What has improved since the last inspection? What they could do better:
Responses in comment cards received from service users and relatives/visitors confirmed some individuals considered the home’s staffing levels to be inadequate. Examples they gave to illustrate this point were delayed response times in answering call bells at night and staff interrupted and called away whist in the middle of attending to personal care needs. Nurses and care staff
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 7 consulted by the inspector, including night staff, however expressed their view that the home’s staffing levels and skill mix was usually adequate. They acknowledged there could be occasions when there was pressure on their time however had emphasised this was not a daily occurrence. They referred to dependency levels at the home fluctuating on a day-to-day basis in response to changes in the needs of service users. Admissions and discharges also were stated to temporarily increase staff’s workload and impact on dependency levels. It was noted that although occupancy levels were low there had been a significant number of admissions and discharges related to the home’s respite and convalescence service provision. Numbers of respite and permanent service users were gradually increasing. The staff group was stable and recruitment to staff vacancies was ongoing. Feedback from a relative indicated that all staff might not be adequately trained to understand and respond to the needs of service users with a hearing impairment. The building does include specialist equipment in communal lounges to aid service users with hearing impairment. A number of service users and relatives commented that communication within the home could be at times problematic. Feedback from a Care Manager however confirmed that communication from the home with herself had been excellent; also and a very distressed relative of the service user she had placed at the home had been very sensitively supported by staff. Service users comments about meals were overall favourable with most respondents stating they “usually” liked the food. One service user commented that the food was “varied and appetising”; another considered it “good but sometimes bland”. One service user however expressed the view that “the food was poorly cooked”. Whilst evident that the care assistant responsible for coordinating activities was highly committed to making provision of a stimulating environment, feedback from individual service users confirmed expectations were not always fully met. It was stated that sometimes activities were cancelled. At the time of the inspection the care assistant taking the lead on this programme was on leave that day. She had recorded in the communication book for staff on duty to deliver the day’s activities programme in her absence. It was noted that no activities took place that day or the day before. It is acknowledged that on both days’ unexpected events, that is the unannounced inspection and an unannounced review by a care manager taking up staff’s time for several hours might be the reason for the activities being cancelled. It was noted that a full time activity organizers post was within the staffing structure. The manager confirmed the intention to increase the hours available designated for delivery of activities as occupancy levels increased. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 8 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. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 9 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 Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good quality literature was accessible to prospective service users and /or their representatives about the home’s services and facilities. This enabled an informed choice of home that is suitable to meet individual needs. A minor amendment was needed to the Statement of Purpose to ensure accuracy of information. Discussed was the need to provide information about the home in formats accessible to service users with severe visual impairment. Comprehensive needs assessments formed the basis of all admissions to the home. Contracts had been provided by the home to individual’s who were self – funding. Those funded by other agencies had not received a copy of the signed contract between the home and those agencies or any other statement of terms and conditions of residency. EVIDENCE: The home’s Statement of Purpose and Service Users Guide documents were on display in the Information folder in the reception area. These contained all statutory elements and a copy of the Service Users Guide was available in all bedrooms. Discussed was the need to ensure accessibility of information
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 11 contained in these documents and the complaint procedure and other significant information, for example menu content and fire procedure for a service user registered visually impaired. These documents and the brochure were accessible to prospective service users and their representatives, enabling informed judgements about the home’s suitability to meet individual needs. Other information available in the binder was the complaint procedure and a specimen contract of residence. In due course a copy of the latest CSCI inspection report will also be available in this binder. Areas of discussion with the manager and staff included the management of enquiries from prospective service users or their representatives, which was satisfactory. The company’s policy for payment of a non – returnable deposit equivalent to a week’s fee to secure placements was also discussed and clarified. This deposit was understood to be deducted from the first month’s fee payment. The manager ensured prompt notification to the Primary Care Trust of all admissions so that assessments could be carried out for determining the amount of nursing contribution to be paid by the health service. Systems were satisfactory for compliance with regulations for informing service users of the amount of nursing contribution to be paid in respect of nursing care. Also in deducting the same in the calculation of fees. Contracts had been supplied to service users who were self funding only. It was positive to note the comment from a service user that the contract had been fully explained by staff. Pre-admission assessments were carried out for all service users prior to admission. A summary of health and social care assessments was also obtained for individuals funded by care management or by continuing care payments. On the files sampled pre-admission assessments had been fully completed and were comprehensive in content. Staff had the necessary information to prepare for admissions and to ensure any necessary equipment was available; also to produce a preliminary care plan. The admission procedures also included comprehensive assessments of risks from which care plans were generating as necessary. Records included medical information and reports from relevant professionals involved in the care of each service users prior to admission. Relatives and where practicable service users were asked to complete a biography. This enabled staff to try to accommodate individual aspirations and expectations and underpinned arrangements for meeting social care needs. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 12 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, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that service users received was mostly in accordance with individual needs. Further assessment and development of care plans was necessary for a named service user. The principles of respect, dignity and privacy were being put into practice at the home. Medication policies, procedures and practices were compliant with statutory requirements. EVIDENCE: The inspector carried out a process of case tracking the care pathways of three service users accommodated. All three had been admitted on the basis of full needs assessments carried out prior to admission. At the time of admission risk assessments and nutritional assessments were carried out. These incorporated risks of developing pressure sores, of falls, moving and handling practices and assessments undertaken to establish needs for equipment. Pressure relieving equipment for pressure sore prevention, details of hoists, sling sizes, use of hip protectors and walking aids were recorded in the relevant care plans generated from the assessments. Weights were recorded
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 13 and monitored and as required care plans produced to address weight loss or special dietary needs. As part of the admission procedures service users had been consulted/or as appropriate their relatives, to determine wishes relating to their involvement in care planning. Though most care plans sampled were detailed and holistic in content and regularly reviewed, the inspector noted one in need of further development. This was fully discussed with the manager and regional manager at the time of the inspection. Specifically it was necessary to ensure that the bedroom environment of one individual who was severely visually impaired was suitable to meet her needs. It was noted that this individual might not be able to use the lockable facility in her room for safeguarding money and valuables. Consideration could be given to requesting an assessment of the environment for this individual from the Surrey Association For Visual Impairment (SAVI). Also discussed was the need to ensure accessibility of information in the home for this person, in particular the Service Users Guide, fire procedure, menu, care plans and activity programme. It was noted that the home had not obtained all equipment necessary to meet the needs of this individual though identified to be required prior to admission. The manager acknowledged that this had been an oversight and action was being taken. This individual had also fallen since admission and attributed this accident to staff not leaving the call bell within easy reach of her chair. Risk assessments and care plans had not addressed this area of need. The manager confirmed that this individual and her representative had since requested provision of a pendant attachment for the call bell system, which was being pursued. Such provision would be beneficial to other service users, for example, when sat in the garden. Despite these shortfalls this service user and her representative emphasised overall satisfaction with the conduct of the home and standards of care. During the course of the inspection service users mostly expressed satisfaction with standards of care and support and in general regarding the conduct of the home. Comments received included “ I would recommend this home to anyone”, “highly impressed by the home in every way, the home is like a good 3 or 4 star hotel but with better service and more attentive staff. It should be used as a benchmark for others to be measured against”. Some comments from service users and relatives however highlighted areas of dissatisfaction specifically relating to communication described as “sometimes patchy” and “staff do not appear to be trained in dealing with people with hearing impairment”. Adverse comments were also received from one relative of a former service user who stated that the delivery of nursing and personal care when the manager was on holiday did not meet expectations. Evidence available at the time of the inspection confirmed that the health care needs of service users were well met. They were mostly registered with one health care practice. The inspector met briefly with the link general practitioner (GP) from this practice who routinely visited the home weekly and as
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 14 necessary at all other times by request. The inspector was informed by the GP that she was notified by staff of all new admissions. New service users on permanent placements tended to register with the medical practice and she would meet with them during her weekly visits. It was stated that arrangements could be made to accommodate requests to see a male GP. Respite service users living locally usually remained registered with their own GP’s. Respite users who were not local residents could register as temporary patients if they needed to consult a GP. The home’s GP spoke highly of the home describing positive professional relationships with nursing staff to the benefit of service users. Observation of record keeping demonstrated clinical and nursing care was appropriately recorded. Arrangements for health and personal care ensured that service users’ privacy and dignity were respected at all times. Discussed were the benefits of displaying service users names on bedroom doors to support orientation for service users and visitors also staff. It also is useful to enable service users to be appropriately addressed. The decision not to display names on bedroom doors was underpinned by confidentiality principles. Whilst operationally this was working whilst occupancy levels were low this may need revision in consultation with service users at a later stage. Medication practices and procedures were fully compliant with regulations and standards. Treatment rooms were situated on both floors containing secure storage for medicines, including controlled drugs and cold storage. A monitored dosage system was in operation and medication records satisfactory. Observations identified that storage in the medication trolley was at a premium even though occupancy levels were low. Consideration could be given to changing the medication trolley of which there was two, one on each floor, for larger ones. Observations and feedback from service users confirmed delivery of nursing, personal and medical care in private. Service users stated that staff respected the privacy of their rooms, knocking before entering. Also they confirmed that letters were brought to their rooms by staff unopened. Bedrooms were fitted with telephones to enable service users to use the phone in private. Currently visitors met service users in their bedrooms if they required privacy. They could also use the activity suite if not occupied. It was the intention to build two sun lounges later this year that will enhance the home’s facilities for visitors’ to meet service users in private. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 15 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, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to choose their lifestyle, social activities and maintain contact with family and friends. Social, cultural and recreational activities are a developing area of the home’s operation. Service users receive a healthy, varied diet according to assessed requirements and are offered choice of meals. EVIDENCE: Service users’ individual autonomy and independence was promoted within individual levels of capacity in the day-to-day operation of the home. There was autonomy for service users in the management of their financial affairs. Service users could choose to bring with them by agreement, items of furniture and other personal possessions for personalising private space. Service users had choice in use of the dining room or could have meals served in their rooms. Observations concluded commitment of staff to maximising service users capacity for control over their lives. There was an activities programme in operation a copy of which was displayed in the home and in each bedroom. A qualified support worker who also possessed certificated expertise in provision of gentle armchair exercise for
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 16 older people and had expressed interest in coordinating the home’s activity programme was delegated this responsibility. She combined this with the role of care assistant. The activity programme was subject to constant review and continuously evolving with effort made to incorporate service users interests and ideas. The activity suite was equipped with computers designated for service users use, also a microwave and tea making facilities. The activity programme was varied offering music appreciation, discussion groups, and flower arranging and glass decoration opportunities. Fitness and cookery sessions were available and indoor games of bowls, basketball and darts. There were board games, bingo, quizzes and film nights on the wide screen television in the lounge. Records of social care confirmed due recognition given to the therapeutic value of 1:1 conversation with service users to promote social stimulation. One service user was encouraged to continue her hobby of woodcarving. Comments from service users included “ there are numerous activities but I did not take part”. Service users had a choice of spending time with others in communal rooms or on their own in their rooms. There was no pressure on them to engage in the activities programme. The home had large wide screen televisions and music centres in communal areas. All bedrooms had personal televisions fitted as standard, which included satellite channels and radio stations. They also had access to outside telephone lines and private telephones can be fitted in bedrooms by request. Books were available and newspapers delivered by arrangement at additional cost. Service users and their relatives/friends stated that visitors were made welcome by staff. The home’s Concierge on their arrival at reception greeted visitors on the day of the inspection. They received assistance in locating the person they were visiting and were offered refreshments. By arrangement and at an additional charge, visitors were welcome to dine with service users. Hairdressing services were available in the hairdressing salon on the second floor. There was also opportunity to book complimentary therapies from a qualified visiting therapist. Formal arrangements were noted for a national charity for carers to use the activity suite once a week for most of the day. The suite was used for up to 12 older people living in the community supported by the charity’s own staff. They organised activities and any necessary care and support whilst carers had a break from their caring responsibilities. The guests purchased lunch, which they ate in the dining room. No adverse comments were received from the service users of Cranmer Court in relation to this arrangement. The home manager stated that she had evidenced that staff employed by this charity had been fully vetted. Two places were open to service users living at Cranmer Court to join in the group activities organised by this charity. The manager confirmed these arrangements were working well. It was stated that some service users now living at the home had previous involvement with staff and service users of this charity and enjoyed this weekly contact with ‘old friends’.
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 17 At the time of the inspection outings had not yet been organised using the home’s vehicle, which was wheelchair accessible. The manager stated there were plans to arrange excursions and to use community facilities as the activity programme further developed. A service user was observed to attend a sheltered workshop one day a week where she met up with acquaintances known to her prior to admission. There she made poppies and planned to do this work at the home on other days. Dial – A – Ride transport was used to transport her to and from the workshop. Another respite user was noted to continue attendance at a day centre whilst accommodated at the home. The Service Users Guide included contact details of the local Church of England and Roman Catholic Churches. A communion service was now taking place at the home. It was stated by management that visits could be arranged by ministers of all denominations. Where a service user is not from a Christian faith procedures required an active plan to be agreed on admission with the service user and as appropriate their relatives and sponsoring authority. This was to agree how the individual would be enabled to celebrate his/her religion and culture. At the time of the inspection there were no service users of none Christian faith accommodated. . The catering team comprised of a head chef, second chef and general kitchen assistants. Observations confirmed that the kitchen was well equipped and there were no outstanding requirements from the recent inspection by the Environmental Health Officer. Food storage and catering records were satisfactory and all area of the kitchen was clean and hygienic. There was a rotating menu, which was stated to have been produced taking into account service users needs and expressed preferences. The menus afforded choice of a second meal option and additionally other alternatives were always available on request. Special diets were accommodated. Feedback from service users indicated that they usually were satisfied with provision for meals though it was noted that some individuals would like specific menu changes. Comments included “ meals are varied and appetising”. The presentation of food and of the dining tables was excellent at the time of the inspection. Staff were observed to assist service users with meals appropriately and sensitively. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 18 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, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to a robust, effective complaint procedure. Their legal rights are protected and they are safeguarded from abuse. EVIDENCE: The complaints procedure was included in the Service Users Guide and contracts, which were also on display. A complaints and compliments file was maintained. There had been no complaints about the home since registration. A conversation with a relative confirmed that staff and management were responsive to any concerns reported. This individual felt listened to and expressed confidence in the effectiveness of the complaint procedure. Service users stated that they would complain to the manager of the home without fear of recriminations. Policies and procedures safeguarded vulnerable adults from abuse. They promoted a robust response to any allegations, suspicions or evidence of abuse. Multi-agency safeguarding vulnerable adults procedure were available in the home. All staff had received safeguarding vulnerable adults training as part of their induction and further training was planned for all the team. There had been no allegations or incidences of abuse since the home’s registration. Staff were informed of the organisation’s whistle blowing procedure and a copy was displayed in the staff room. It was suggested that telephone contact details for all relevant agencies be also displayed as part of the whistle blowing procedure.
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 19 Financial systems and procedures for administering service users personal money by the home protected service users from financial abuse. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 20 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, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enabled service uses to live in a safe, suitably equipped, well-maintained and comfortable environment, which promoted independence. EVIDENCE: The home has been designed and built to a high specification that exceeds national minimum standards and ensures the facilities are fit for purpose. The building complies with requirements of the local fire and rescue service and environmental health department. The décor and furnishings throughout the home afforded a quality environment that ensured the comfort and wellbeing of service users. Bedroom accommodation is all single occupancy with en-suite facilities and has been tastefully decorated and furnished. A range of adaptations and equipment was available to meet nursing needs and support service users with physical and sensory impairments.
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 21 A high standard of cleanliness, hygiene and odour control was evident. The safety and security of the environment was assured through compliance with relevant regulations. Robust systems were in place for auditing and monitoring safety. A programme of routine maintenance was in place. The home employed maintenance staff comprising of maintenance operative designated to work solely at Cranmer Court. A senior maintenance operative shared his time between this home and a second home operated by the same organisation. The grounds and car park were well maintained with suitable pathways and lighting. The front garden and part of the rear garden had been landscaped. Planning consent had been obtained to add on two sun lounges later this year, which will provide additional lounge and activity facilities. Estimates had been sought to complete landscaping work in the grounds. Garden furniture, sunshades and a shed were on order. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 22 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 this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of service users. Based on feedback from service users however it is necessary to review staff practice, routines and deployment to ensure accessibility to service users to meet needs and expectations. EVIDENCE: The staff rota was inspected and staffing levels were two nurses and two care staff on duty throughout the waking day for twelve service users, accommodated on ground floor wings. Two waking staff comprising of a nurse and a care assistant were deployed on night duty. Feedback from service users at the time of the inspection and direct observations indicated that staffing levels were adequate. Also four out of five service users who returned comment cards confirmed that they always received the care and support they needed. Feedback from relatives of some service users however base on their observations and information reported to them by service users was less favourable. This information highlighted the need for management to review staffing priorities, routines and practices. One comment received referred specifically to night staff taking a long time to respond to the call bell. Another expressed the opinion that staffing levels were insufficient, particularly at weekends.
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 23 Housekeeping staff were employed in numbers adequate to maintain standards of cleanliness and ensure laundry systems promote good hygiene practices. All interactions observed between staff and service users during the inspection were caring and respectful. Staff personnel files were sampled and recruitment and vetting procedures found to protect service users. CRB Disclosures for staff were stored confidentially in a separate file with access restricted to the home manager. The CRB record inspected confirmed that all staff had CRB Disclosures. The manager was reminded of requirements relating to disposal of Disclosures. Noting that ID documents for staff were maintained on the CRB file it was suggested these be transferred to personnel files to ensure these were not inadvertently destroyed. Staff training records confirmed induction, statutory and mandatory training provided for staff. The home employed three staff with NVQ in care level 3 qualifications and 3 with NVQ in care level 2 qualifications. At the time of the inspection the requirement to employ 50 of staff with NVQ in care qualifications at least Level 2 or equivalent was met. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 24 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, 33, 34, 35, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was observed to be efficient and competent. Effective quality assurance and monitoring systems were in place. Accounting and financial systems were demonstrated to ensure efficient business management and safeguarded service users’ financial interests. Service users best interests were safeguarded by the home’s policies and procedures and record keeping. The health, safety and welfare of service users and staff was promoted and protected. EVIDENCE: The organisational structure supporting Cranmer Court comprised of the home manager, head of care, chef manager, and hotel services manager, administrator, maintenance manager and housekeeper.
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 25 The home manager was registered by the CSCI and had a relevant nursing qualification. She was currently studying for an NVQ Level 4 management in care qualification and the registered managers award. An efficient senior staff team supported the manager. The head of care was a registered general nurse with twelve years experience in care home management. Registered nurses all held current registration with the Nursing and Midwifery Council and the senior nurse also had attained the registered managers award. The management of the home was observed to be efficient and competent. The administrator ensured efficient support to the management of the home and ensured financial procedures and records were well maintained. Record keeping was secure. Discussed with the manager was the need for all nursing and care staff to be informed of the recent change to ensure records were confidentially stored in the nursing station. A nurse who had been in this area was observed to significantly delay responding to an emergency call bell. This was owing to priority given to first locating the senior nurse who had the key to the nurses’ station. The nurse explained it was against the home’s policy to leave the door to the nurses’ station unlocked. It was noted that no confidential documents were on the desk in the nurses’ station at the time and these were secured in large lockable cabinet. When later raised with the manager it was confirmed that this was not the policy since installing the lockable cabinet in the nursing station. Records were well organised relating to accounting and financial practices. Insurance cover was in place for employers and public liability and for service users personal possessions. Arrangements were made for carrying out health and safety and fire safety audits. An action plan was generated from the health and safety audit carried out in February and remedial action taken as necessary. Fire records confirmed a fire risk assessment had been carried out and effective fire procedures and maintenance practices noted. Though a number of staff confirmed arrangements for regular fire practices records of these had been mislaid. A recent minor fire incident attended by the fire & rescue service had generated additional staff fire training and improved fire safety and prevention procedures. There had been an oversight in notification to CSCI of this incident. First aid procedures and practices were satisfactory and a programme of first aid appointed person training was in progress for staff. Quality assurance systems ensured quality audits at the home. A financial audit and health and safety audit had been carried out since the home’s registration. Clinical audits were stated to be imminent by the clinical service director. Monthly unannounced visits were carried out by the regional manager on behalf of the responsible individual in accordance with statutory requirements. Reports of these visits were available in the home and the regional manager agreed to supply a copy of reports of future visits to the
Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 26 CSCI. The regional manager was stated by the manager to be supportive and was present for part of the inspection. Monthly management reviews of the total operation of the home took place and reports of these were available in the home. Senior management at head office then follows up any outstanding action. The home was stated to have just achieved the Hospitality Assured quality award. The corporate quality assurance systems were consultative with service users and their representatives. Owing to the short time that the home had been operation some of these systems had yet to be implemented. The Responsible Individual was observed to take an active interest in the home’s progress and was present to receive feedback on the inspection outcomes at the end of the inspection. Cranmer Court DS0000065906.V296810.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 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 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 4 4 3 4 4 3 4 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 x 3 3 Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 14(2)(a)(b) 15(2)(b)(d) Requirement For further assessment of needs and development of care plans for the named service user discussed at the time of the inspection to ensure needs are fully met. Also for assessment of needs and provision of a more suitable lockable facility for the use of this individual who is visually impaired. For review of staff practice, routines and deployment to ensure good practice and adequate availability of staff to meet service users needs and expectations. Timescale for action 30/06/06 2 OP27 12(1)(a) 18(1)(a) 30/06/06 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 OP1 Good Practice Recommendations For the statement of purpose, service users guide, fire procedure, activity programme and menu to be produced
DS0000065906.V296810.R01.S.doc Version 5.2 Page 29 Cranmer Court 2 3 OP2 OP4 in suitable formats for service users with a severe visual impairment. For service users sponsored by other agencies to receive a statement of terms and conditions. To obtain an assessment of the environment from SAVI or other suitably qualified professionals to ensure suitability of the environment to meet the needs of the service user with severe visual impairment. It is also essential to ensure appropriate arrangements in place for this individual to access call bell facilities. Cranmer Court DS0000065906.V296810.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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