CARE HOMES FOR OLDER PEOPLE
Cranmer House Cranmer House Norwich Road Fakenham Norfolk NR21 8HR Lead Inspector
Mrs Geraldine Allen Unannounced Inspection 14th March 2006 09:30 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 House DS0000035495.V285164.R01.S.doc Version 5.1 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 House DS0000035495.V285164.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cranmer House Address Cranmer House Norwich Road Fakenham Norfolk NR21 8HR 01328 862734 01328 856228 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) Norfolk County Council-Community Care Kirsty Dianne Grand Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered to accommodate 21 service users who are older people not falling within any other category. 20th December 2005 Date of last inspection Brief Description of the Service: Cranmer House is a 21-bedded home, run by the Local Authority in conjunction with the Local Health Trust as a joint provider Unit( JPU). The residential portion of the building only is subject to inspection by the Commission for Social Care Inspection. The Home is situated close to the centre of Fakenham and all local amenities. The home consists of a two-storey building, with the residential care unit being located on the first floor. All bedrooms provide single occupancy with en-suite facilities. Some communal facilities, including the dining room, are located on the ground floor that is accessed via a shaft lift. The home has a newly resurfaced car park, gardens to the front and an enclosed garden. All are accessible to residents. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. Not all of the National Minimum Standards were inspected on this occasion. Where a standard has been inspected, not all of the sub elements, as set out in the National Minimum Standards, may have been assessed. Cranmer House is gradually changing how it provides care, with a move towards mainly short-term care being provided in the future. The home is at a very early stage in this process and staff described some of the issues they are facing as a result of these changes. The manager, Ms Grand, was not available for much of the inspection but was seen once the main part of the inspection was completed. Information was provided on her behalf by Ms Janet Bidewell and Ms Linda Shaul, both care coordinators at the home. Information was also obtained from looking at records. On the day of inspection there were 6 permanent residents living at the home. In addition, there were 6 people receiving short-term care, with a further 2 people due to be admitted during the day of inspection. Overall, this inspection found that the care provided at this home is good. What the service does well: What has improved since the last inspection?
A great deal of work has been done over recent months to improve the environment of this home. The results are very good, with areas of the home seen during this inspection being decorated and furnished to a good standard. Gradual changes are taking place to the client group cared for at this home. Currently, 9 short-stay residents are at the home, but this will eventually increase to 15. Staff are working very hard to improve records and procedures
Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 6 so that they can deal with the significant turnaround of residents efficiently and sensitively. 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. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 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 Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 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): 3 Most residents have an assessment of their needs conducted prior to admission to the home. This is not always possible where an emergency admission is required. EVIDENCE: The care plans for 2 residents were looked at in detail. One was for a planned admission to the home and the other was based on an emergency admission. In both cases it was found that good information had been obtained at an early stage to ensure staff were able to provide appropriate care. The home uses an admission checklist, to ensure that all staff are aware what information has been given and/or received by the resident. This is essential in view of the home’s move towards short-term care provision. There was some discussion with Ms Shaul and Ms Bidewell about their plans to improve this document further so that it acts as a good aid. For the resident who had entered the home as a planned admission, the file revealed a good admission process. This included the completion of a preadmission assessment that highlighted care dependency levels. There was also information from healthcare professionals.
Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 9 For the resident who had been admitted via the emergency procedures, information was seen on file that had been faxed by the social worker and GP. A telephone assessment had also been completed. There was some discussion about how information from social workers particularly could be better sent to the home. It was agreed that the use of emails might be a better medium for the home. A recommendation has been made that the use of emails, particularly from social workers, is considered in order that the receipt of information about residents prior to their admission is available to the home in a timely way. See recommendations. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 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&9 Each resident has a care plan that clearly sets out the persons needs and how they can be met. The home has safe procedures in place for the administration of medicines. However, the storage arrangements are inadequate and need to be improved without undue delay. EVIDENCE: As stated above, 2 care plans were looked at in some detail. These demonstrated good information for staff to ensure the needs of each person are understood and met appropriately. The care plans include risk assessments around daily living activity and health & safety matters such as manual handling. There was evidence that residents are involved in the planning and review of their care. There was also evidence that care plans are kept under regular review. The arrangements for the storage, administration and recording of medicines were inspected. All senior staff that have a responsibility for the administration of medicines have attended certified medication training. The GP regularly reviews the prescribed medicines for the permanent residents at the home.
Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 11 The medicines for all permanent residents are provided and stored in a Monitored Dosage System, set up by the pharmacist. The medicines for shortstay residents come in separate packs as dispensed by their own pharmacist. Some residents have considerable quantities of prescribed medicines and these are kept together in small plastic baskets. As a result, the storage of medicines is becoming problematic. The medicine trolley is not large enough to contain all the medicines safely and the configuration of the shelving does not allow for easy access and identification of medicines held for each resident. These concerns were discussed with Ms Grand, who was aware of the difficulties and was looking into obtaining a new, more appropriate trolley. This matter needs to be resolved without delay. See requirements. The Medicine Administration Record (MAR) was inspected. This revealed that, because some residents have substantial quantities of medicines, the MAR continuation sheets were not being completed fully in all circumstances when new sheets were started. As a result, continuation sheets did not include the name or the dose of the medicine prescribed. Although the MAR continuation sheet is stapled to the original sheet, there is a danger that this may become loose. It was suggested that the problem may be resolved by photocopying the MAR original and a blank continuation sheet together to make a large sheet that contains all the relevant information. See recommendations. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 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 the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 13 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): These standards were not inspected on this occasion. EVIDENCE: Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 14 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): 26 The home was clean and tidy. EVIDENCE: Those areas of the home seen during this inspection were clean and tidy. There were no unpleasant odours detected. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 15 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 Although the home is currently employing staff in sufficient numbers to exceed minimum levels, staffing arrangements need to be kept under review as the client group gradually changes. EVIDENCE: A staff rota for the week of inspection was provided and this showed that sufficient care staff hours are provided to meet the needs of the residents at the home. However, discussion with the care co-ordinators revealed that their workload has significantly increased since the gradual implementation of shortstay was commenced. The time taken to complete the admission process, from initial assessment through to admission and development of the care plan is substantial. Care co-ordinators are also responsible for ensuring each discharge home goes smoothly. The expectation that care co-ordinators are able to spend 50 of their time providing direct care is currently unrealistic as procedures have still not been finalised. Currently the home is accommodating 9 short-stay clients, but this will increase to 15 over time. Care co-ordinators stated that they do some work in their own time, including scheduled days off, to ensure that residents’ care is not affected. It is recommended that staff hours, including those of the care co-ordinators, is kept under close review to ensure the provision of hours is realistic. See recommendations. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 16 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): 38 Practice at the home supports the health, welfare and safety of residents, staff and visitors to the home. EVIDENCE: A recommendation was made at the inspection on 20 December 2005, regarding the storage of alcohol gel. This has been met in full. Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 17 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement The registered person must ensure that adequate and safe storage arrangements are in place with regard to medicines kept at the home. Timescale for action 14/04/06 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 OP3 Good Practice Recommendations It is recommended that the use of emails, particularly from social workers, is considered in order that the receipt of information about residents prior to their admission is available in a timely way. It is recommended that the MAR original and continuation sheets are photocopied together to ensure all relevant information about the medicine prescribed and the dose to be given are clearly recorded. It is recommended that staff hours, including those of the care co-ordinators, is kept under close review to ensure the provision of hours is realistic 2 OP9 3 OP27 Cranmer House DS0000035495.V285164.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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