Inspection on 12/06/07 for Cranmore House

This inspection was carried out on 12th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cranmore House 25/05/06

Cranmore House 15/02/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Cranmore House 107 Sutton Road Erdington Birmingham West Midlands B23 5XB Lead Inspector Amanda Lyndon Key Unannounced Inspection 12th June 2007 08:10 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 Cranmore House DS0000064262.V342481.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. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranmore House Address 107 Sutton Road Erdington Birmingham West Midlands B23 5XB 0121 373 9784 F/P 0121 373 9784 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) none Dr Jayshree N Patel Mrs Hemlata Patel, Mr Ullas Ambalal Patel, Mr Mukesh Patel, Mrs Dipika Patel, Mr Kirit Patel, Dr Jivantika Patel, Mr Narendra Patel Mrs Tina Joyce Boyland Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the home can accommodate up to 22 residents for reasons of old age (OP). The home may accommodate three named service users under 65 years of age. The home may accommodate three named service users who have dementia. 25th May 2006 Date of last inspection Brief Description of the Service: Cranmore House is registered to provide residential care for up to twenty two people for reasons of old age and this includes three people who are under sixty five years of age and three people for reasons of dementia care. It is situated on a main road in Erdington close to a shopping centre and public house. Public bus services run past the home and a railway station is within easy walking distance. The Home is within a large Victorian property and an extension has been added. Accommodation is provided on the groundand first floor and the second floor is used for administration purposes. A passenger lift provides access to all floors. Bedrooms are of varying sizes offering both single and shared occupancy and none of the bedrooms have en suite facilities. There are currently two bathing facilities provided at the Home and staff are available to provide assistance in these areas. There are two lounges and smoking is permitted within one of these. Off road parking is available at the front of the building, and a large secure garden is at the rear, and this is accessible to wheelchair users and people with physical disabilities. There are notice boards throughout the Home displaying any forthcoming events and other information of interest to residents and their visitors. There is a variety of “in house” activities available for residents to participate in should they choose. A copy of the most recent CSCI report was on display in the Home for residents and other interested parties to refer to. The weekly fee to live at the Home is between £320 and £355. Items excluded from this fee include personal toiletries, hairdressing, private chiropody and dry cleaning. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A random visit was undertaken at the Home on 7th November 2006 in order to monitor the progress made since the previous key visit dated 25th May 2006. The outcome of this was that there was a number of ongoing complaints about care delivery and staff attitude at this time however it was evident that the recently appointed Home Manager was striving to address these issues in order to improve outcomes for people living at the Home. Additional requirements were made during the random visit regarding improvements to be made regarding the living environment so that residents are provided with a clean and comfortable place to live in where their privacy is respected. This information was taken in to consideration when planning for this visit. Other information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving people using the service and complaints received by CSCI since the last key visit at the Home. In addition, the Registered Manager had completed a self assessment document, giving some information about the Home, residents and staff which was also taken into consideration. Following the visit eight completed questionnaires were returned to CSCI from people using the service and their families and these included positive comments about the service provided including: “I am quite happy with all the support I receive here” “If I need a Doctor the staff will send for a Doctor” “ The care is quite good” “The Home is always clean and tidy” “The staff liaise very well with other professional agencies” Two negative comments were received about the lack of activities provided at the Home including “ I would like to get involved with more indoor activity” The unannounced key field work visit referred to in this report was undertaken over one day by one Inspector when there were twenty two residents living there. Information was gathered by speaking with ten residents, three visitors, five staff members, the Registered Manager and Registered Provider. Two residents were “case tracked” during the visit in order to assess what it would be like to live there. This involved speaking with these people and examining care, medication, staffing and health and safety records. A partial tour of the Home was undertaken and staff were observed performing their duties. Two residents were “case tracked” during the visit in order to assess what it would be like to live there. No immediate requirements were made on the day of the visit Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 6 What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to make informed decisions about whether they would like to live there and are encouraged to sample what life would be like to live at the Home. One resident who had recently come to live at the Home said “I have seen a brochure and it had lots of information in about this place. I’m looking forward to going into the garden”. Another resident said “I have come to live here permanently. I came to look around before and thought it was very nice here”. Any information of interest to residents can be made available in other formats for example large print, audio tape or in other languages so that everybody can access this information. Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any instructions are carried out and this ensures that any health care needs are met. One resident said “ If I need the Doctor the staff get him straight away”. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained. One resident said “The staff always knock my door before they enter my room”. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. One resident said “The staff get the Ring and Ride and I go to the local club”. Residents are supported to form friendships with each other so that they can share their experiences. One resident said “I like living here, I like the people” Residents are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. Visitors are made to feel welcome and a good rapport had built up between people using the service, staff and their visitors. One visitor met during the visit said “The staff always ask if we would like a drink, it makes the residents feel like it is their home”. There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. One resident said “The food is very good here, I love the salmon with vegetables”. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 7 Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. One resident said “I would speak to the Manager if I wasn’t happy but I have never had to complain”. There are systems in place to protect residents from harm. Residents are provided with a clean and homely living environment in which they are safe and secure and their privacy is respected. Residents are encouraged to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Staff training is provided so that staff have the appropriate skills and knowledge to work safely and effectively and provide a good standard of care to residents. Residents have the option of using the Home’s facility for the safekeeping of small amounts of money. What has improved since the last inspection? Each resident has a written plan about the support that they require from the staff team so that their care needs are met. These are reviewed each month to ensure that they are up to date and are stored securely so that residents’ confidentiality is maintained. An activity team is being developed and a variety of “in house” activities are being arranged. These are on display so that residents can choose which activities they would like or would not like to participate in. Appropriate screening has been provided in double occupancy rooms so that the privacy and dignity of each resident is maintained. A lockable storage facility is provided in each resident’s bedroom for the safekeeping of valuable and private items. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 8 Improvements had also been made within the internal environment of the home including the purchasing of curtains, lounge tables, carpets in some areas and lamps for residents’ use. The Home has been cleaned thoroughly and extra cleaning staff are employed to ensure that it is clean at all times. Liquid hand soap and hand paper towels are now provided in all bathrooms and toilets and a dishwasher has been obtained in order to prevent the spread of infection at the Home. A programme of redecoration within the Home has commenced so that it is a more attractive place in which to live. A grab rail had recently been fitted to the ramp leading in to the garden and this ensures the safety of and promotes the independence of residents using it so that residents had easy access to the garden. More than 50 of care staff had achieved a minimum of NVQ level 2 and this should ensure that they have the appropriate knowledge to provide a good standard of care for residents. The Registered Manager is now in post and it was evident that she had worked hard to improve the services provided for residents. One resident said “You can’t get anyone nicer than the Manager, anything you ask for you can get, she is a real lady”. Service satisfaction questionnaires have been distributed to residents, visitors and health/social care professionals in order to obtain their views about the service provided. This is in order to monitor the quality of services provided and make improvements as necessary. What they could do better: The systems in place for the management of medication must be improved and staff require further training in this area so that residents receive their medication as prescribed by their Doctor. One resident said “I do my own medication and lock it in my bedroom” Opportunities for residents to participate in trips outside of the Home must be provided so that the interests of residents are maintained. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 9 Adequate ventilation must be provided within the area of the Home in which residents are permitted to smoke in order to promote the health and wellbeing of all residents and staff. The bathing facilities do not meet the needs of some residents living at the Home and there is no shower facility provided. Residents must be offered a choice of bathing and shower facilities that are fit for purpose and need. A mechanical commode pot washer must be provided in order to clean commode pots in a hygienic manner and prevent the spread of infection in the Home. New workers must not commence employment at the Home until satisfactory relevant references have been obtained in order to safeguard residents. New workers must undertake appropriate induction training so that they have the opportunity to acquire the necessary skills and knowledge to work in a competent and safe manner. 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. The summary of this inspection report can be made available in other formats on request. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 10 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 Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough so that prospective residents are able to make informed decisions about whether they would like to live at the Home. Residents know before admission that their care/support needs could be met at the Home. EVIDENCE: A revised statement of purpose had recently been produced and this included the majority of information required so that prospective residents had information about the services provided at the Home. The Registered Manager stated that these could be produced in other formats and languages on request so that all prospective residents had access to the information included within this. One of the Partners involved in the ownership of the Home is the Pharmacist used to dispense medications at the Home. This must be reflected within the statement of purpose so that residents are aware of this. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 12 The service user guide was produced in a large print format and included residents’ views about living at the Home. This document was easy to read and included interesting information about what it would be like to live at the Home. With his agreement, staff had read this document to one resident who had poor eyesight. During the visit one person who had recently come to live at the Home expressed his satisfaction about the service user guide and the usefulness of the information include within it. He said “I have seen a brochure and it had lots of information in about this place. I’m looking forward to going into the garden”. Prospective residents are encouraged to visit the Home and have lunch in order to sample what it would be like to live there. One resident who had recently come to live at the Home stated that he had enjoyed visiting the Home prior to coming to live there and that the staff and residents had welcomed him. He said “I have come to live here permanently. I came to look around before and thought it was very nice here”. It was pleasing to observe that fellow residents had taken the time to have conversations with him as this will help him to settle in to his new life at the Home. A comprehensive pre admission assessment had been undertaken using an updated assessment tool in order to assess whether his care needs could be met at the Home. This included good information about his preferences in respect of his daily life so that his daily routines could be maintained whilst living there. On the day of the random visit a gentleman had come to spend the day at the Home in order to sample what life would be like to live there and it was evident that he was being welcomed by staff and residents. Residents come to live at the Home on a month’s trial period and following this time a care review is undertaken involving the resident, their social worker, family and Home’s staff so that all present have the opportunity to discuss whether the resident would like to continue to live there and whether their care needs were being met. Intermediate care is not provided at the Home. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are good promoting residents’ health and well–being however residents are at risk of receiving the wrong medication due to poor work practices. Residents are supported in a respectful manner by staff and this ensures that their dignity and self-esteem are maintained. EVIDENCE: On admission to the Home comprehensive assessments of residents’ individual care needs are undertaken and care plans are derived from this information. These are written plans that identify the individual care needs of residents and the support required by staff in order to meet these needs. Since the random visit improvements had been made regarding the content recorded within care plans and a number of new assessment documents have recently been introduced into the Home in order to identify the specific support needs of residents. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 14 Care plans sampled included the personal preferences of individual residents in respect of their daily lives for example their preferred times of waking and going to bed, hobbies/interests and dietary preferences. Physical and mental health care needs, communication needs and social care needs were identified so that they could receive the required support in these areas. It was pleasing that reference was made to the things/people that were important to the individual as this ensures that person centred care could be provided. A “typical daily routine” had been written for each person based on their preferences however not all of these had been signed by the resident as confirmation that they agreed to the content of these. Care plans were evaluated each month and these included comprehensive written reviews of residents’ individual care needs to ensure that these were still being met. There was evidence that residents were involved in this process and this ensures that they have the opportunity to put forward their views about the care provided. Daily reports included good detail about the care provided to residents and any activities that they had engaged and these were used whilst evaluating the care needs of residents. Personal risk assessments had been undertaken including the risk of falls, oral hygiene and any specialist equipment used for this person. Moving and handling risk assessments identified the specific support and equipment required in order to safeguard residents and staff. Residents have the option of retaining their own Doctors on admission to the Home (if the Doctors were in agreement) so that residents had continuity of health care. Residents have access to a range of health and social care professionals including dentists, opticians, continence advisors, social workers, community psychiatric nurses, district nurses and podiatrists. One resident said “ If I need the Doctor the staff get him straight away”. One recent comment obtained by the Home from a social care professional stated “Whenever I have had dealings with staff I have felt listened to and staff have gone out of their way to deal with issues”. None of the residents living at the Home had complex communication needs, English is the preferred language of all residents and staff provide support to residents who wear spectacles and hearing aids. Pressure relieving equipment could be obtained as required and a number of residents sat on special cushions in order to reduce the risk of developing sore skin. The Home’s staff stated that none of the residents currently living at the Home had sore skin. Residents are weighed regularly so that any concerns in this area can be reported to the relevant health care professionals. One resident confirmed that she enjoyed having a bath three times a week and the Home’s staff provided support to do this. She also confirmed that the staff team came promptly in response to her using the call bell facility in her bedroom. One resident said “The staff have moved my call bell socket so that it is easier for me to reach which is good”. On the day of the visit a staff member was providing support Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 15 to a resident whilst attending a hospital appointment and this ensured that she felt supported and safe during this time. Individual care reviews involving residents, their representatives, social workers, relevant health care professionals and the Home’s staff are undertaken each year and at any time that residents’ care needs should change. This provides all involved with the opportunity to assess whether the current care/support regime meets the needs of the individual resident or whether alternative/additional support is required. One visitor said “We have seen the care plan”. The vast majority of the residents had chosen for the staff to store and administer their medication on their behalf however following risk assessments residents have the opportunity to self administer their own medication and this ensures that their independence is promoted whilst maintaining their safety. Appropriate lockable facilities are provided in residents’ bedrooms so that they can store their medication safely if they choose to do so. One resident said “I do my own medication and lock it in my bedroom” Medication administration charts (MAR) were generally well maintained and organised and photographs of residents were provided so that residents could be identified during the medication round. The Registered Manager currently had the responsibility for the ordering and receiving of new prescriptions/medications into the Home and copies of prescriptions were kept so that any prescribing errors/dosage changes could be identified prior to administration. Since the last random visit prescription creams were now stored safely so that vulnerable residents could not access these. There was however, evidence of a number of poor practice issues regarding the administration of medication identified prior to and during the visit: • During the visit the Registered Manager stated that their had been a discrepancy regarding the stock balance of a controlled drug held at the Home. CSCI were not informed of this at the time of the incident and an internal investigation had been undertaken, the outcome being that the unaccounted for medication was due to spillage. Work practices had been reviewed as a result of this so that liquid medications were measured and poured without wastage. • Since the random visit there had been two separate incidents in which residents have received the wrong medication. At the time of the incidents it was established that the errors had been due to two staff members undertaking the medication round at the same time, one person being responsible for dispensing the medication and the second person being responsible for the administration of the medication and poor communication between these two people. This is considered to be poor practice and despite this being discussed with the Home’s staff it was of concern to observe on the day of the visit that this poor practice continues at the Home. This was brought to the attention of the Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 16 Registered Manager who stated that she would address this and arrange for further staff training in this area. • Medication administered had been signed for on the wrong day and one medicine administered had not been signed for at all. This prevents an accurate audit trail from being followed and the monitoring of the effectiveness of treatments prescribed from being undertaken. This will cause confusion and may result in medicines being administered more than once or not at all. Countersignatures were not obtained for all handwritten entries on to MAR charts and staff had manually added an extra column on to a MAR chart that had expired. This is considered to be poor practice and may result in medication administration errors. An ointment had not been signed for as being applied therefore there was no evidence whether the resident had received this treatment as prescribed. • • Residents had been supported to choose clothing, make-up and jewellery that were appropriate for their age, gender, culture and the time of year. It was pleasing that staff were complimenting residents about their appearances as this ensures that their self esteem and self confidence are promoted. Staff were supporting residents in a respectful manner and residents confirmed that they receive any post unopened ensuring that their privacy is maintained. Residents have the option of having a key for their bedroom door and a number of residents choose to do this. One resident said “I lock my room if I go out”. The payphone for residents’ use was located by the front door and did not afford privacy, however the Home Manager stated that residents could use the Home’s portable phone in order to make or receive calls in private. Care files containing personal information about residents were stored securely and this ensures that residents’ confidentiality is maintained. Care plans included detail about the preferred names of residents and during the visit staff were greeting residents using these preferred names. This ensures that residents’ individual identities, dignity and preferences are respected. One resident said “The staff always knock my door before they enter my room”. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 17 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. 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. Additional activities including opportunities for residents to participate in organised trips outside of the Home should meet the needs and expectations of all people living at there. Residents exercise control over their daily lives and staff respect their personal preferences in respect of this so that their independence and individuality are maintained. Residents have a choice of healthy meals that meet any special dietary requirements for reasons of health, taste and cultural/religious preferences. EVIDENCE: Prior to the visit two negative comments were received about the lack of activities provided at the Home. This had also been identified through the Home’s own service satisfaction questionnaires and as a result of this all residents had been consulted about the activities on offer to them. This provided residents with the opportunity to put forward their suggestions for activities to be arranged on their behalf. For example, one resident expressed a wish to attend a day centre and this was promptly arranged on her behalf to start this week. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 18 An “activity team” was being developed consisting of three staff members that had a particular interest in this and activity equipment was currently being ordered in order to provide more opportunities for residents to be involved in activities. Some residents met during the visit expressed their satisfaction about the activities that had been introduced in to the Home, for example, musical entertainers, bingo, quizzes, “Therapets” and progressive mobility. Residents had the option of choosing whether they would like to participate in an activity or not and activity records held identified who had attended. Since the random visit the activity board in the dining room was being used and on the day of the visit this displayed activities arranged for the week so that residents could choose whether they wished to participate or not. There were currently no trips arranged for residents outside of the Home however the activity team will be looking in to this. Residents have the opportunity to participate in individual activities outside the Home where they can meet with other people of similar ages and interests. One resident said “The staff get the Ring and Ride and I go to the local club”. Three residents regularly attend a day centre. A number of residents chose to have a newspaper of their choice delivered. One resident said “I have the paper delivered here every day and it comes straight away”. Large print library books were available for residents to borrow if interested. A hair dresser visits the Home every fortnight so that residents have the opportunity to have their hair cut and styled. It was evident that good friendships had formed between residents and residents’ birthdays are celebrated. This ensures that individuals have companionship and feel involved in life at the Home. One resident said “I like living here, I like the people” All of the residents currently living at the Home were of a white British origin however people of other cultural backgrounds were welcomed. Opportunities were provided for residents to continue to practice their religious beliefs whilst living at the Home including Holy Communion that is held at the Home each month. A number of residents chose to visit the local Abbey in order to practice their chosen faith. All of the residents were of Christian faiths however people of non-Christian faiths were welcomed at the Home and support would be given to these people to continue to follow their religious beliefs. Residents confirmed that their visitors were made to feel welcome at the Home. One visitor met during the visit said “The staff always ask if we would like a drink, it makes the residents feel like it is their home”. Another visitor met during the visit said “We are very lucky to have found this place”. Menus identified a variety of wholesome/home made meals and residents confirmed that they were offered a choice of these on a daily basis. There was evidence that residents were involved in the planning of new menus so that Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 19 they were served food that they enjoyed. One resident said “The food is very good here, I love the salmon with vegetables”. The lunch time meal options on the day of the visit were roast chicken and fresh vegetables or a tuna salad with semolina pudding or fresh fruit for dessert and resident expressed their satisfaction about these. A cooked breakfast is available at weekends. The menu options of the day were on display in the dining room for residents to refer to. Alternative diets could be arranged for reasons of health, cultural/religious preferences or taste and a diabetic diet was being prepared at the current time. Residents have the choice of where their meals are served, the majority of residents chose to have their breakfast in the dining room and a few residents chose to be served their breakfast in their bedrooms. Residents were welcomed in to the dining room and it was apparent that they came for breakfast at their own pace so that they were not rushed. Breakfast was observed and there were good social interactions between residents and between residents and staff during this time. The dining tables were new and were laid attractively and plans were in place to replace a number of the dining chairs with more appropriate chairs with arms that were fit for purpose and the needs of residents. If required staff assisted residents with their meals in a sensitive manner so that their independence and dignity were maintained. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 20 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. 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. Residents and their visitors are confident that their views are listened to any issues raised are dealt with in an appropriate and timely manner. There are systems in place that should protect residents from harm. EVIDENCE: Since the last key visit CSCI had been made aware of three allegations of an adult protection nature regarding the Home, one of these is currently ongoing. Issues raised included poor care delivery and staff attitude. In addition there had been one complaint received by the Home and this was regarding a number of issues about the care provided and the living environment. This was referred to the Registered Providers for investigation and the outcome was that regulations were being met for the benefit of the residents living there. The Registered Manager had amended the complaints procedure and this was on display in the reception area of the Home in a large print format. A “complaints and suggestions book” was located on the reception desk and this included a recent compliment received about the care provided at the Home. Residents met during the visit stated that they were confident that any concerns raised would be acted upon. One resident said “I would speak to the Manager if I wasn’t happy but I have never had to complain”. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 21 Staff had recently undertaken training about the protection of vulnerable adults and it was apparent that improvements had been made regarding staff’s knowledge about adult protection procedures. There was evidence that the appropriate authorities are informed and prompt action is taken regarding adult protection issues in order to safeguard residents. The adult protection policy included local multi agency guidelines so that staff were aware of who to contact in the event of alleged or actual abuse thus safeguard residents. It was pleasing that the Registered Manager had recently arranged for an advocacy service to visit the Home and speak with residents who may require this service. This provides residents with the opportunity to obtain additional support regarding their daily lives and personal finances so that they maintain control over their personal matters. Information about this was accessible to residents in the reception area of the Home should they choose to use this service. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely, clean and comfortable environment in which they feel safe and secure and their privacy is maintained. The bathing facilities provided do not offer residents and choice and are not fit for the purpose and needs of all residents living at the Home. Other aids and adaptations meet the needs of residents. Infection control measures are good with the exception of the lack of an appropriate facility to hygienically clean commode pots and this may result in the spread of infection. Inadequate ventilation in the smoking area of the Home and neighbouring vicinty will affect the health and well-being of residents. EVIDENCE: Residents stated that they felt safe and secure living at the Home. The external appearance of the Home had improved as windows had been replaced and Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 23 hanging baskets were on display. The secure back garden was accessible through the lounge and residents had to negotiate a small step on to the ramp leading on to the patio area. A grab rail had recently been fitted to the ramp ensuring the safety and promoting the independence of residents using it. The garden, including the grassed area was level making it suitable for all residents, including wheelchair users to enjoy. Improvements had also been made within the internal environment making it a more pleasant environment in which residents live. This included the purchasing of curtains, lounge tables, carpets in some areas and lamps for residents’ use. A programme of re decoration was due to be commenced so that residents had an attractive environment in which to live. Plans were in place to purchase a new television, garden furniture and seated weighing scales so that people with physical disabilities could be weighed safely. There were currently two baths available for residents’ use, one located on each floor. There was no working shower facility. The bath located on the ground floor was not fit for purpose as most of the residents were not able to raise their legs high enough to use the facility. Plans were in place to install a new assisted bath and shower facility within the next six months so that residents had the choice of facilities that were fit for purpose and need. Since the random visit the toilet roll holders located in the bathrooms had been re positioned so that they were easily accessible to residents thus promoting their independence, safety, and dignity. Liquid hand soap and hand paper towels were now provided in all bathrooms and toilets so that residents could wash their hands in a hygienic manner. The majority of residents currently living at the Home were mobile either independently or following assessment with the assistance of a walking aid. Other aids and adaptations provided to ensure the safety of residents whilst maintaining their independence included grab rails in corridors and near to toilets, raised toilet seats and transfer hoists. Since the last CSCI visit the Health Promotion team had undertaken an audit of the premises following a request for advice being made by the Registered Manager. As a result of this the original plans to relocate the laundry had been discarded and one bathroom was taken out of action and had been designated as a temporary sluice area. An interim risk assessment and infection control procedure had been written about the manual cleaning of commode pots in order to safeguard staff and reduce the spread of infection at the Home. Quotes were being obtained in order to purchase a mechanical commode pot washer so that soiled commode pots could be cleaned in a hygienic manner. Since the random visit a dishwasher had been obtained in order to ensure that cooking and eating equipment was cleaned at the appropriate temperature. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 24 Residents’ bedrooms were decorated in a homely style and contained their personal possessions that reflected their age, gender and interests in order for them to feel comfortable in their surroundings. Residents met during the visit expressed their satisfaction about their bedrooms. It was pleasing that an occupational therapy assessment had been undertaken and an appropriate grab rail had been fitted to the bed of a resident in order for her independence to be maintained. Since the random visit lockable storage facilities were provided in residents’ bedrooms for the safekeeping of valuable and private items. Appropriate screening had recently been purchased and was now available in all double occupancy bedrooms so that residents’ privacy was upheld. There is a designated lounge in which residents are permitted to smoke and this is located on the ground floor next to the kitchen and dining room. Despite the extractor fan being in use and the window being open, this did not provide adequate ventilation in this area of the Home. The door to this lounge had been left open and the smell of cigarette smoke was very evident within the kitchen and dining room and this may affect the health and well-being of other residents living there. Since the last visit a cleaning schedule had been implemented and the Home was found to be clean on the day of the visit. A new washing machine had recently been purchased so that residents’ personal clothing and bed linen is washed in a hygienic manner. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive support from an adequate number of staff and the implementation of comprehensive training should ensure that residents are cared for by appropriately trained staff. Failure to follow recruitment procedures does not safe guard residents from harm. EVIDENCE: Residents, staff and the Registered Manager stated that they were satisfied with the current care staffing levels. There are three care staff including a senior staff member on duty during day time hours with kitchen and housekeeping staff providing ancillary support. There are two members of staff on duty during night- time hours with “on call” managerial support. The Registered Manager’s working hours are in addition to these staffing levels and as identified further in this report, additional managerial support is recommended in order to ensure the best possible outcomes for residents. Staff met during the visit were enthusiastic about their job roles and had a good knowledge of the individual care needs of residents. The gender mix of staff did not reflect the gender mix of residents currently living at the Home. The Registered Manager had identified the need for male care staff within the staff team and in the interim all residents had been consulted about any preferences in respect of the gender of staff assisting with their personal care Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 26 needs. Agency staff are used to cover periods of staff sickness, absence and holidays so that the staffing levels are not depleted. It was pleasing that the Home staff strive to use the same agency staff members in order to promote continuity of care for residents. There were currently staff vacancies for a Deputy Manager and a part time cleaner. Two staff recruitment files were sampled for people that had recently commenced employment at the Home. Prior to starting at the home new workers were deemed to be safe to work with vulnerable people thus safeguarding residents. It was evident, however, that two satisfactory references had not been obtained for either person prior to commencing employment and this does not safeguard residents. All new workers receive a “staff handbook” and undertake an “in house” induction covering health and safety issues so that they should have the necessary knowledge to work in a safe manner. One induction document sampled on the day of the visit was not completed in full and this will prevent the staff member from obtaining all information required to work safely. On the day of the visit, the Registered Manager registered with “Skills For Care” so that all new workers could train towards obtaining the appropriate skills and knowledge to provide a good standard of care for residents. This must be implemented within the Home. Staff had recently undertaken a wide range of training including moving and handling, first aid awareness, fire safety, dementia care awareness and infection control. A fire drill had been held recently so that staff and residents had the appropriate knowledge to respond in a safe manner in the event of an emergency. 69 of staff have achieved a NVQ level 2 qualification in care and a number of care staff are currently working towards NVQ level 2 and 3. This should ensure that residents are supported by a competent and appropriately skilled staff team. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the residents living there however there is a need for additional managerial support to ensure the best possible outcomes for residents living there. Systems in place for quality monitoring and resident consultation are good and residents are confident that their views are acted upon. The arrangements for health and safety are good and this safeguards residents. EVIDENCE: The Home has been run by it’s current owners since early 2006 and it was evident that improvements had been made regarding the services provided Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 28 there and the living environment for residents since this time. The Registered Manager has been in post since August 2006 and had successfully registered with CSCI. The Registered Manager has achieved the Registered Managers’ Award so that she has the appropriate skills and knowledge to lead the staff team in a competent manner. It was evident that the Registered Manager had worked hard to improve the outcomes for residents living at the Home and positive comments were received about her management style. One resident said “You can’t get anyone nicer than the Manager, anything you ask for you can get, she is a real lady”. The Deputy Manager had left employment at the Home two months prior to the visit and it was evident that in the absence of “in house” management/administration support, the Registered Manager was unable to delegate/share tasks for example, the ordering of medications, the writing of care plans, staff supervision and training, staff recruitment and the ordering of food supplies. This was brought to the attention of the Registered Provider who advised that they were actively recruiting for a Deputy Manager and an Administrator was allocated to the Home approximately once a week at the current time. Quality monitoring visits are undertaken by the Registered Providers each week and reports of the findings of these were produced. Residents and staff were consulted during these visits so that they are involved in this process. The systems in place for resident consultation had improved since the last visit and a residents’ meeting had been held recently. The purpose of the meetings is to discuss the services provided and whether residents felt that they were provided with enough choices regarding their daily lives at the Home. It is an opportunity for residents to put forward their suggestions for improvements regarding their lives at the Home. The Home Manager had asked the residents whether they would be interested in forming a Residents’ Committee, however this suggestion was declined. A staff meeting had been held very recently and this included information about key worker roles and responsibilities, training opportunities and environmental issues including plans for creating a staff room. Staff meetings provide staff with the opportunity to put forward their suggestions about the services provided at the Home and this enhances staff moral. Service satisfaction questionnaires had recently been distributed to residents, visitors and health and social care professionals in order to obtain their views about the services provided at the Home. This included their views on privacy and dignity issues, care delivery, food and activities provided at the Home. Feedback was predominantly positive and the Home Manager stated that any negative comments were received in a constructive manner in order to improve the services provided. Following the collection of all information the Registered Manager stated that she would produce a report based on the findings of the questionnaires and this would be accessible to residents and Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 29 anyone else interested in this. A previous report produced included detail of actions to be taken based on the comments received and there was evidence that these had been acted upon for the benefit of the residents living at the Home. There was a facility for the safe keeping of small amounts of residents’ money and written records regarding this were well maintained. Individual residents’ money was stored separately and receipts of items purchased out of this were kept as evidence of purchases made. Balances of money held sampled during the visit were found to be correct however the monies held had not been audited for the last five months. It is recommended that the monies held be audited more frequently by external managerial staff who do not have day to day control over this system. It is also recommended that consideration be given to residents’ access to their money should the Registered Manager be away from the Home including “last minute” situations. Accident records were well maintained and were audited regularly by the Registered Manager in order to identify any trends or patterns in accidents thus reduce the risk of further accidents of the same nature. For example, one resident had been identified as having experienced numerous falls and a referral to appropriate health care professionals had been made in order to implement measures to reduce the risk of further falls for this person. It was evident that medical advice is sought promptly by staff in the event of a resident being involved in an accident in order to ensure that they had not been injured. Maintenance checks of equipment used at the Home are undertaken so that they are safe to use. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 30 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 2 x 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 2 3 x 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 2 x x 3 Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? yes 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 37 Requirement Timescale for action 17/07/07 2 OP9 13(2) 3 OP9 13(2) 4 OP21 23(2)(c) (j) CSCI must be informed about any incidents regarding medication that may affect the health and welfare of residents. Current work practices regarding 31/07/07 the administration and recording of medication must be reviewed and amended in order to ensure that residents receive their medication in a safe manner. Opportunities for staff to 01/09/07 undertake training about the safe administration of medication must be provided so that staff are aware of their responsibilities regarding this, residents receive their medication as prescribed by their Doctor and so that medication administration charts are well maintained. Assisted bathing and shower 01/11/07 facilities must be in good working order and fit for purpose (timescale of 01/12/06 not met) Adequate ventilation must be provided within the area of the Home in which residents are permitted to smoke in order to DS0000064262.V342481.R01.S.doc 5 OP25 23(2)(p) 01/08/07 Cranmore House Version 5.2 Page 32 6 OP26 16(2)(j) 7 OP29 19(1) 8 OP30 18(1) promote the health and welfare of all residents and staff. Appropriate equipment must be 01/11/07 provided designed to clean commode pots in a hygienic manner in order to protect staff and prevent the spread of infection within the Home. New workers must not 17/07/07 commence employment at the Home until two satisfactory references have been obtained in order to safeguard residents. New workers must undertake 01/09/07 appropriate induction training so that they have the opportunity to acquire the necessary skills and knowledge to work in a competent and safe manner. (timescale of 15/11/06 not met) 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 The statement of purpose should identify that the dispensing Pharmacist is one of the Partners in ownership of the Home so that residents are aware of this information. Residents should be involved in the writing and reviewing of their “typical daily routine” so that their personal preferences in respect of this are maintained whilst living at the Home. Consideration should be given to provide opportunities for residents to participate in organised trips outside of the Home so that their interests are maintained. Additional managerial support should be provided in the interim until a Deputy Manager is recruited at the Home in order to ensure the best outcomes for residents living at DS0000064262.V342481.R01.S.doc Version 5.2 Page 33 2 OP7 3 4 OP12 OP31 Cranmore House the Home. 5 OP35 It is recommended that auditing of the system used for the safekeeping of residents’ money be undertaken more regularly by external Managers in order to safeguard both residents and the Registered Manager. It is recommended that consideration be given to residents’ access to their money should the Registered Manager be away from the Home including “last minute” situations so that residents can access their money at any reasonable times. Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cranmore House DS0000064262.V342481.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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