Inspection on 11/12/06 for Cranwood

This inspection was carried out on 11th December 2006.

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

Cranwood 14/02/06

Cranwood 20/07/05

Cranwood 01/09/04

Cranwood 07/04/04

Cranwood 16/12/03

Cranwood 24/11/03

Cranwood 06/08/03

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

CARE HOMES FOR OLDER PEOPLE Cranwood 100 Woodside Avenue Muswell Hill London N10 3JA Lead Inspector Karen M Malcolm Key Unannounced Inspection 11th December 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 Cranwood DS0000033341.V319084.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. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranwood Address 100 Woodside Avenue Muswell Hill London N10 3JA 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) 020 8883 0563 020 8442 0075 London Borough of Haringey Ms Donna Hamilton Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may provide accommodation and personal care for up to 38 persons of either gender who are over 65 years of age (OP). The provider must undertake a programme of measures that will achieve compliance with National Minimum Standards for Older People Standards 19 to 26 - Environment, or those equivalent standards that may be published at the time, as required by Regulation 23(1)(a); 23(2)(a-p); 23(4)(c); and Regulation 16 (2)(c)(g)(j)(k) - by 1st April 2005. In order to promote the health and safety needs of service users living in Cranwood, the provider must ensure that the home complies with all requirements contained in relevant Health and Safety Legislation and further must undertake a programme of measures that will achieve full compliance with National Minimum Standards, or those equivalent standards that may be published at the time, as required by Regulation 23(1)(a); 23(2)(a-p); 23(4)(c); and regulation 16 (2)(c)(g)(j)(k) - by April 1st 2004. To provide intermediate care to a maximum of 9 of the 34 service users of either gender, seven of whom must be 65 years of age or older. Two of these nine service users may be aged between 60 and 65 years of age. Accommodation for this service is restricted to the dedicated unit on the lower ground floor. The unit must have a team of staff specifically dedicated to it. Any individual service user’s stay within the unit should not be any longer than 6 weeks. 14th February 2006 3. 4. Date of last inspection Brief Description of the Service: Cranwood is a residential home registered to provide care and support to up to 38 older people. Owned and operated by the London Borough of Haringey, and located in a residential area of Muswell Hill in North London, the home is close to local shopping and transport facilities. Cranwood is split into four units Oakwood, Marrett, Rosebank and the ICB unit. The main aim of the home as set out in the statement of purpose is To work with older people and their relatives in order to give advice, care and support The objectives of the home are to: 1. Provide a comfortable/enjoyable residential care home for all service users 2. Create an environment, which enables service users to retain their Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 5 individuality, independence, dignity and privacy, as set out in the Charter of Rights for service users. 3. Encourage service users to maintain their previous friendships, skills, hobbies and interests. 4. Allocate to each service user a key worker, who will have designated responsibility for helping with his/her personal requirements. 5. Provide activities and a lifestyle for all service users, which will operate within a risk assessment system. 6. Offer a service of the highest quality, in a non-discriminatory, equal opportunities environment. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges are from: - £388.50 per week as from the day of the inspection. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over one day. The duration of the inspection was approximately nine hours. The assistant manager and the manager assisted the inspector throughout the inspection. The staff on duty were five carers in the morning and four carers in the afternoon, three domestics, a laundry person, a cook, a kitchen assistant and administrator. There were twenty-five service users in the home at the time of this inspection and two service users were in hospital. This inspection involved sampling a number of care plans and records, a tour of the building, speaking to service users and observing the interaction between staff and service users, observing a handover with staff which was friendly and positive, interviewing four service users, observing one service user being administered their medication and speaking to the assistant manager and manager. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk Four service users were interviewed these questions were based on the four Standards. The Standards used were: • • • • 1 Information 2 Contracts 3 Needs assessment 16 Complaints Feedback was given to the manager on the day, but a full report on the findings is addressed in the main body of this report. Feedback was given to the manager at the end of the inspection. The inspector found the manager, service users and the rest of the staff very open and helpful throughout the inspection and would like to thank them for their time and patients. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: This inspection has identified fourteen areas of improvement and three recommendations. While it’s evident that the staff are experienced and competent, the home has failed to ensure that service users needs are consistently being recorded, reviewed, monitored and up-dated appropriately. It is therefore required that the registered person submits an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The areas of concerns are that PRN medication guidance must be in place, the home’s medication policy must be updated and in place, sufficient information must be recorded on individual service users’ care plans, all complaints made Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 8 must be recorded, investigated and actioned appropriately evidence of this must be on kept on file. Clearer guidance must be in place for two specific service users who’s linguistic and care needs are to be properly addressed. It is also required that an urgent re-review of their care needs is undertaken with the placing authority. Records of supervision must be undertaken and copies kept on file and a legionella test certificate must be in place. Reccomendations addressed in this report are deemed good practice. 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. Cranwood DS0000033341.V319084.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 Cranwood DS0000033341.V319084.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall service users are assured that their assessed needs will be met by the home and first they are receiving appropriate care to meet four individual needs. However, the registered person is not ensuring that the correct support plan is in place prior to a service user being placed in the home. This means that appropriate assessed are not being met. Service users are at risk from harm. EVIDENCE: All service users have their needs assessed prior to admission, and copies of these assessments were seen on the four service users files examined during this inspection. Since the last inspection there has been two deaths and two admissions. The intermediate care (IBC) unit, which can support up to nine service users, is vacant. Prior to this inspection the home’s manager has submitted an Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 11 application to the Commission applying for a major variation to change the ICB unit to support service users with dementia. At the time of this inspection the process of the application had not been completed. One of the two service users whose placement began on the 28/8/06 was admitted under the home’s emergency placement procedure. This procedure clearly stipulates that the placement is reviewed within 72 hours. However, the manager informed the inspector that the specific service user has not had a proper review. Some of the individual’s areas of risk assessment have been addressed with the social worker and the home. These include supporting the individual around their personal safety, supplying the individual with a bus pass and a mobile phone. It was evident that the placing authority had not put in place the appropriate support networks to ensure that the specific service users cultural needs are met within and outside the home. The service user is Congolese and speaks French only. The home has one member of staff who speaks French and they have been the translator for the service user and staff supporting. The care plan although completed did not cover all the aspect of this individual care and how it is being supported by the home. At the time of the inspection the manager stated that she had received an email from the placing authority service manager stating that the individual’s placement had been terminated. It was advised that this issue is discussed formally with reasons as to why the placement had broken down the evidence of this must be clearly documented and kept on file. The manager showed the inspector a copy of the newly devised pre-admission assessment form. This was deemed impressive by the inspector. However, it was advised that a section relating to the prospective service user’s sexuality information should be included. Standard 1 Information Overall two out of four service users stated that they had received a copy of the service user’s guide on the day the moved into the home. However, evidence that a copy had been given was not on the files examined. One service user did understand the questions being asked, this interview was abandoned, although a translator supported the inspector. The manager stated each person is given a copy in person. Standard 2 Contract All service users asked, stated, that no information was given to them regarding any changes to their cost of care. This information is kept on individual files with the home’s office administrator. All service users asked stated that no written contract or statement of terms and conditions was given to them after they moved. One service user stated Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 12 their wife deals all their financial affairs and paperwork. The second part of this question was not asked. Standard 3 Needs Assessment One service user out of four stated that before they came into the home some person informed them about the home and the services they offer. One service user stated that moved here as they were becoming progressively depressed and in other service user said they moved to the home because the other home they were living at was closing down. It is the opinion of the inspector that the service users whom were questioned, were very apprehensive and confused as to why these questions were being asked of them. One service user asked the assistant manager why hadn’t anyone else being asked these questions. Older people tend to find finance and contracts discussion a worry, especially if they relate to money issues. The overall findings is that service users do receive a copy of the home’s service user guide on the day of admission, contract of care and any changes are received via a letter addressed to the individual, however, this information is kept with the office administrator on behalf of each service users. Service users are given information about the home prior to moving in, however, some service users may not of remember this due to memory loss of a confused stated of mind. Evidence of this is documented on individual’s care plans. Cranwood DS0000033341.V319084.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. Healthcare needs are addressed by the home, however this is not consistent. Therefore service users are not always confident that their needs are being addressed appropriately. Service users are confident that these are protected by the home policies and procedures. PRN guidance is not in place for staff to ensure PRN medication is administered correctly this could place service users at risk. EVIDENCE: At the previous inspection it was required that the registered person ensures that after each shift daily logs are completed. Monthly summaries address individual’s areas of risks and goals, risk assessments are updated when a incident such as a fall occurs and fall monitoring is maintained. It was also required that the medication policy is updated include a section relating to disguising medication. It was evident that the care plans documentation procedures had improved. This was commented to the manager at the time of the inspection. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 14 Four care plans sampled evidenced that each service users has a named key worker. Healthcare notes are kept in two places for service users, one on the service user’s file and one with the assistant managers. This information pertains more to GP visits or other health matters. It was recommended that documents should be combined, to give a holistic approach towards each individual’s healthcare needs and to ensure that the correct information recorded monthly by key workers is accurate. Weight charts are also completed monthly. However, it was evident that insufficient information was recorded with regards to why an individual had lost or gained weight or if any medical intervention had taken place. The assistant manager’s healthcare notes, it was evident that some of detailed information regarding one individual’s health, for example weight loss was written up. As stated above this information should be combined. The daily logs seen had improved. The manager stated that a part of her overall monitoring and reviewing of documents she undertakes an ad hoc spot check. Evidence of this was on file. The home’s overall recording system had improved from the last inspection and the inspector commended this during the feedback at the end of the inspection. The last review dates undertaken by the placing authority were recorded on the notice board under each a service users’ name in the office area. However, on one care plan files seen, not all copies of the most recent reviews were on file. The registered person must ensure that the service users’ outstanding review notes are obtained, to ensure that any actions identified can be followed through in care plan. These requirements are all restated in this report. It was evident that all service users care plans were kept securely in the home. The manager informed the inspector that two of the service users first language is not English. The manager explained that their linguistic needs are supported by one of the part time domestic staff. However, information regarding this support need was not documented on either of the service users files. During the inspection the inspector tried to interview one of the service users with the domestic support. The interview was difficult because the service user was unhappy about the care. The manager stated that the night before the inspection the specific service user’s relatives visited and generally after each visit the service user becomes slightly depressed. It was advised that the manager liaises with the placing authority to look at the suitability of the placement with the relatives. A copy of the information and action plan is to be clearly documented on file. The manager ensures all Regulation 37 reports are submitted to the Commission within the timescale required under the Regulation. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 15 The medication policy in place was, but dated 2001 ‘Administration and Control of Medicines in Care Homes’. This document was a general one relating to all care homes. However, a copy of the organisation’s updated version of the medication policy was submitted to the inspector by email. This was not in the home on the day of the inspection. The inspector was able to observe the assistant manager completing the medication rounds. One batch of medication prescribed was administered to one of the specific service user whose first language was not English. The medication administration records (MAR) highlighted that the specific service user had nine tablets to take that morning. It was observed that the specific service user was struggling to swallow each tablet. The assistant manager appropriately supported the individual. However, it was the opinion of the inspector that this could have been less stressful. It was advised that a review of the individual medication was in order as the paracetmol tablets prescribed as PRN ‘as an when required’ was given to the individual daily upon request. It was also advised that the service user’s medication could be administered in two batches throughout the morning or whether or not the GP could prescribe some of the medication in liquid form. The manager agreed that on her agenda this specific service user’s medication does need reviewing. It was also required that any service user who is prescribed PRN medication must have in place clear and precise guidance as to when the medication can be given. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 16 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. Service users benefit from the provision of good entertainment and have a satisfactory social life within the home. Service users maintain family contact and participate in various planned activities in house and in the community on a weekly basis. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The home employs one part time activities co-ordinator who also works parttime as a carer within the home. Weekly and monthly activity events are displayed clearly in the home. Over the past year the home has had several parties most recently a Bonfire night party and a Caribbean evening. Those who are able are taken to the pub for lunch and recently to see the Christmas lights in London. In preparation for Christmas each unit was fully decorated and a copy of the Christmas Day menu was displayed. The main notice board outside the assistant manager’s office displays the daily information, such as staff on duty and the day’s event/s. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 17 During the afternoon of the inspection a number of service users were watching and listening to the children from the local school carol singing. It was observed by the inspector that individual service users were enjoying this activity. This was indicated by their participation and the facial expressions. Activities that service users have partcipated are logged on each service user’s information sheet their care plans. However, the information recorded was insufficient to detail whether or not the individual enjoyed the activity or what activity they participated in. In some cases no information was recorded. It was advised that the activity sheet must be consistently recorded. The home has a visitor’s book at the front entrance and all visitors are required to sign in. Next of kin names and address are recorded on individual’s care plans. The home has a cook on each day of the week. Meals are cook in the main kitchen and then sent in hot trolleys to each unit. During the tour of the kitchen, each area of the kitchen was found to be very clean and well maintained. Staff wore appropriate protective clothing. The dry stores, fridges and freezers were well-stocked and record temperatures of food, fridge and freezer checks were recorded. Service users’ spoken to state that the food in the home was good, ‘one service user stated that it was not like their own cooking but it was enjoyable and had no complaints’. Service users are offered a variety of choices including a vegetarian option. A record of individual’s choices is kept on file by the kitchen staff. Cranwood DS0000033341.V319084.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home promotes an open culture where service users feel safe and are supported to share any concerns in relation to their protection and safety. However, records of complaints are not always actioned once received therefore there is the potential for service users concerns not to be taken seriously. Service users are protected with the knowledge that staff are well trained and understand the procedures with regards to abuse. EVIDENCE: The home has a Protection of Vulnerable Adults policy (PoVA), a copy of the local authority’s PoVA procedures and complaints policy in place. Since the last inspection three PoVA (Protection of Vulnerable Adults) referral have been made to the local authority. All have been thoroughly investigated. One of the PoVA referrals related to a service user’s sexuality and this was discussed with the manager. A copy of The Age Concern ‘The whole of me…’ was given to the manager. It was evident that this is a huge subject and needs addressing with staff, service users and their relatives. One suggestion given by the inspector was that a part of the home’s new devised pre-admission questionnaire should have a section relating to sexuality around individual’s needs, preference, support, advice and guidance, assist to the prospective service user moving in. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 19 On each of the service users care plan there is a separate sheet for complaints, compliments and concerns to be recorded. However, on each sheet examined no information was recorded. The manager stated that this has not been an issue. However, in one of the ‘resident’s meeting minutes’ it clearly stated that service users were asked if they have any complaints they would like addressing. A number of complaints were recorded, relating to noise levels, food and laundry going missing. One specific service user complained that care staff had led them to the toilet by their little finger and this hurts. It was difficult for the inspector to clear track whether or not each complaint had been addressed by the manager. Residents’ meetings are held once a month and led by the one person from the management team. The inspector was able to speak to one of the service users who complained about the menu. However, it was not clear as to whether the individual had this issue addressed. It was advised that complaints, concerns or compliments raised in the ‘Resident’s Meetings’ or any other forum, must be addressed straightaway. Evidence of the action taken must be recorded clearly and communicated with the individual service user appropriately. Due to a number of the service users’ who may suffer from short term memory loss or confused it is important that feedback is appropriately managed by the home to ensure that the individual clearly understands what is being said and why. It is good practice to have on the agenda of each meeting a section from the last meeting titled ‘matters arising’. This would ensure clear documentation is recorded following the outcome of a concern or event from the last meeting. Standard 16 Complaints It was evident from the interview that two out of four service users had not been given a written copy of the home’s complaint procedures. One service user stated that if they were unhappy about the service they would contact their social worker; another service user stated that they were unhappy with one specific member of staff who seems to always get upset with them when they were incontinent. The service user expressed that they were made to feel worst, as they already felt bad when this happens. This complaint was shared with the manager was asked to investigate the matter. The third service user stated that they had no problems and one service was not able to communicate their answers effectively and the interview was abandoned. The findings from this part of the Thematic Probe questioning were that service users were more confident in sharing this information with the inspector. Service users were aware of how to complaint and who to complain to. However, these did not always feel that their complaints would be acted upon. Cranwood DS0000033341.V319084.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is decorated to a high standard and service users benefit from a home that meets their personal needs, style and taste, creating a comfortable and safe environment for those service users living and visiting Cranwood. EVIDENCE: Since the last inspection it was evident that the home has improved environmentally. All the major refurbishment work has been completed and is beautifully presented. Each unit is defined and has it own identity within a large establishment consisting of a number of single bedrooms, a kitchenette, lounge/dining area, bathrooms and separate toilets. All the bedrooms examined are individualised to meet each service users’ personality and taste. The bedrooms have all the amenities as required in the Standard 23 of Care Homes for Older People NMS. Each bedroom has a washbasin and magnetic closures on the doors. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 21 During the tour of the building the home was found to be comfortable. Service users were either in their bedroom reading, sleeping, watching TV or sitting in the lounge listening to music. Each unit had a fresh bowl of fruit and tables were set neatly set for lunch. Call point in bedrooms were accessible when needed. However, the call point in the lounge/dining room were not accessible for service users as they were all positioned near doors and none were near where service users were comfortably sitting. The assistant manager stated that at all times there is a member of staff in the lounge/dining areas. It was advised that these call points must be a part of the home’s environmental risk assessment. The home is a large home with a number of quiet areas for individuals to relax at their own leisure. The inspector did observe this on the day. The home on the day was found to be very clean and hygienic. The home employs domestic staff daily. The laundry room is in the basement and houses three washing machines and two dryers. Cranwood DS0000033341.V319084.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. 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. Staffing levels are satisfactory to support service users needs. Service users also benefit from a competent staff team. The home’s recruitment procedures are robust enough to protect service users from harm. EVIDENCE: The home recruits and selects staff in accordance with the London Borough of Haringey policies and procedures. These procedures are based on principles of equal opportunity to ensure that nobody begins work without appropriate references and satisfactory appropriate CRB checks. The rota was available and it was a clear reflection of the care staff present on the day. The staff team consists of a manager, three assistant managers, twenty-two residential care workers, one handyperson three cooks, two kitchen assistant and three domestics, one of the domestic assistant is rota’d to undertaken their duties during the afternoon. At present the home has four staff vacancies and one member of staff is on suspension. The manager informed the inspector that a Regulation 37 report is to follow regarding this matter. Three staffing records were examined. Records of staff induction were not present on two of the three staff records examined. A copy of the new format and guidance was shown to the inspector. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 23 Staff know and support the main aims and values of the home. Staff job descriptions are linked to achieving service users’ individual goals as set out in the service user plan. As part of the inspection procedure, the inspector observed the staff handover. The process was very detailed. After the handover the inspector asked a number of questions regarding supervision, service users care plan information, changes to individual service users healthcare needs, training and staff morale. It was evident that care staff were knowledgeable about individual service users care needs and all stated they had received regular supervision and training, however, these sessions had not been recorded. A copy of the local authority’s training manual for late 2006 to 2007 was on file. Any specialist training is organised by the manager with the training department. The manager has arranged some specialist training with regards to intensive dementia awareness. The manager state that the management team will be trained first followed by the remaining staff team. This training is in preparation for the change to the home’s Conditions of Registration. It was advised that the first training session should include the activity co-ordinator. Cranwood DS0000033341.V319084.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is supported well by the senior staff providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. Record keeping is good. Staff supervision is not always consistent; therefore service users cannot be confident that the staff team supporting them are well supported and supervised. Health and safety is maintained and in good order, therefore ensuring that service users are safeguarded by policies and procedures with regards to their care and support needs. EVIDENCE: On the day of the inspection the manager was at one of the Commission for Social Care Inspection’s Head Offices having her registered manager’s Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 25 interview. No feedback with regards to the result of the interview was given on the day. Throughout the inspection manager displayed an open and positive approach to the way she managed the home and this was reflected in the general atmosphere within the home. Discussions with staff indicated that the manager in the home was seen as approachable and supportive. There is evidence that the registered person has ensured that regular monthly visits are being made by senior staff within Haringey Social Services to monitor and review the running of the home and the standard of care provided. There was evidence on file that policies and procedures within Haringey affecting the running of Cranwood are regularly reviewed. Same records of supervision notes were recorded however, these were sporadic and therefore not consistently practice. Quality Assurance was discussed with the manager. The manager stated that the Annual Quality Assessment is due this month. However, throughout the year the manager has ensured Quality Assurance Monitoring is high on the home’s agenda. Four times a year the home holds relatives’ meetings, however, the turnout is usually poor. The last quarter the relatives’ meeting was combined with the home’s annual Bonfire Night Party the turnout was good and feedback was productive. The manager stated that this meeting was held prior to the fireworks display. One of the comments raised in the meeting was that the relative’s proposed future meetings to be held on Sunday. Resident’s meetings’ are held monthly and are also productive. Records of each meeting held are kept on file. The home’s record keeping is well maintained. All information held is easily accessible. All service users files gives clear comprehensive guidance to understanding individuals needs within the home. The service users care plans are very well maintained by the manager and care staff. However, it was the view of the inspector that there is still room for improvement. A number of records relating to the running of the home were examined. Most were found to be detailed, accurate and up to date. The accident book was examined and indicated that accidents were being recorded appropriately and with the outcome noted. However, under health and safety no Legionella testing certificate had been undertaken. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 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 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 X 2 Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 12(1) & 13(4)(b) Requirement Timescale for action 30/01/07 2. OP9 13(2) 3. OP3 15(2)(c) The registered person must ensure that risk assessments are to be updated accordingly when any changes occur. (For instance a fall). This is to be recorded in full with outcome and support needs and reviewed monthly. The plans must be signed and dated when completed. (Previous timescale of 30/04/06 not met) The registered person must 30/01/07 update the medicines policy and include a section dealing with the possibility of disguising the medication, if non-administration will seriously endanger a service user’s health. (Previous timescale of 30/04/06 not met) The registered person must liaise 30/01/07 with the placing authority to arrange a review of this specific service user who has complex culture needs. If the specific service user placement is to be terminated then under the home’s duty of care a clear plan of action prior to the individual leaving this service must be in DS0000033341.V319084.R01.S.doc Version 5.2 Cranwood Page 28 4. OP8 17(1)(a)S sch 3.3(m) 5. OP7 17 6. OP7 15(2)(b) 7. OP9 13(2) place. The registered person must ensure that monthly weight charts specifically records why a service user may have lost or gained weight. This information must then be summarised in the monthly summary report to ensure that the service user’s needs in monitored and reviewed appropriately. The registered person must ensure that copies of the most recent service users reviews undertaken by the placing authority are obtained. The registered person must liaise with the specific service user’s social worker to organise a further review regarding the individual’s care and linguistic needs and whether or not that Cranwood is a suitable placement. Evidence of this must be clearly documented on the care plan with action/s taken. The registered person must have in place clear and precise PRN guidelines for the specific service user who is prescribed Paracetomol. An appointment is to be made with the GP to review this medication to ensure whether or not the medicaiton remains PRN. 30/01/07 20/02/07 20/02/07 30/01/07 8. OP12 17 The registered person must ensure that all service users who are prescribed PRN medication have in place clear and precise guidance notes on when this is given. The registered person must 30/01/07 ensure that sufficient information is recorded on each service user file pertaining to activities. The information must be detailed and concise stating whether or not DS0000033341.V319084.R01.S.doc Version 5.2 Page 29 Cranwood 9. OP16 22 10. OP16 22 11. OP19 13(4) 12. OP30 13. OP36 18(2) 18 14. OP38 13(4) the individual had enjoyed the activity The registered person must ensure that all complaint or concerns raised in the ‘Resident’s Meetings’ or any other forum, must be addressed straightaway. Evidence of the action taken must be recorded clearly and communicated with the individual service user appropriately. The registered person must ensure that the complaint raised by the specific service user who complained to the inspector on the day must be fully investigated. A copy of the outcome and action taken must submitted to CSCI. The registered person must amend the current home’s enviromental risk assesement to include a section relating to the location of Call points. The registered person must ensure that induction training undertaken is recorded on file. The registered person must ensure that staff have regular and recorded supervision at least six times a year and that supervision records are kept in individual staff files. The registered person must ensure that Legionella testing is undertaken and a copy of the certificate is kept on file. 30/01/07 30/01/07 20/02/07 30/01/07 30/01/07 20/02/07 Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 30 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. 2. 3. Refer to Standard OP9 OP19 OP30 Good Practice Recommendations It is recommended that the registered person should combine the two healthcare reports held in separate places. It is recommended that the registered person seek advice and guidance with other professional with regards to sexuality training, support or advice. It is recommended that the first batch of dementia training include the home’s activity co-ordinator. Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Cranwood DS0000033341.V319084.R01.S.doc Version 5.2 Page 32 - 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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