CARE HOMES FOR OLDER PEOPLE
Craven Nursing Home Keighley Road Skipton North Yorkshire BD23 2TA Lead Inspector
Wendy Dixon Unannounced 22 June 2005 10:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Craven Nursing Home Address Keighley Road, Skipton, North Yorkshire, BD23 2TA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01756 700994 01756 790925 Craven Nursing Home Ltd Mrs Felicity Coleman Care Home 48 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (28) Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 30/11/04 Brief Description of the Service: The Craven Nursing Home is situated in semi rural settings on the outskirts of the market town of Skipton. The home is a large traditional detached twostorey building, which has been extended towards the rear, which is currently undergoing a major renovation program. It has long distance views, views to the front overlooking the Skipton to Keighley road and the Leeds/Liverpool Canal at the rear. There are well laid out gardens and private parking facilities. Service users accommodation is on both floors accessed by a shaft lift.The home is registered for 48 service users who require nursing care. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to the short notice inspection (4 days) that took place on Wednesday 22nd June 2005.The inspection lasted 5 .25 hours (10.30am to 3.45pm). The reason that the inspection was announced was to ensure the registered provider would be present to discuss the ongoing major renovation and proposed changes at the home There were 42 service users resident in the home, all requiring nursing care. The inspection focused on a number of key standards and on the areas of concern identified at the last inspection. An inspection of the premises took place, including a number of bedrooms, the homes kitchen, lounges and parts of the new build. The care records of five service users were examined in detail and where possible these service users were spoken with about the care they receive. There were also discussions with members of staff, the manager and owner of the home. What the service does well:
The Craven continues to provide a comfortable home to service users where they are well cared for by a well-trained and motivated team of staff. Service users plans of care were detailed and up to date ensuring that the staff delivering the care knew what each service user needed, liked and disliked. Staffed were observed speaking to and caring for service users in a kind and respectful way. The meal served during the inspection was lunch, this looked very appetising and much enjoyed by the service users. The homes kitchen was clean and well organised and the menus showed meals are varied. The home was clean and fresh smelling throughout, helping to prevent the spread of infection and making the home a pleasant place for service users to live and staff to work. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 Information obtained about service users before they are admitted to the home should be more detailed. EVIDENCE: Service users are assessed prior to admission to the home by a member of the qualified nursing staff to ensure that the home has the appropriately trained staff and facilities to meet their needs. The service user who was most recently admitted to the home had visited prior to admission with members of his family to look at his proposed room and meet staff. A qualified nurse carried out assessments of his care needs however information about his past and any current medical problems was not included. This information needs to be included to ensure service users obtain the correct treatment as quickly as possible. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 The health needs of service users are well met, but some improvement in the monitoring of medication is needed EVIDENCE: The care plans of five service users were inspected and found to be of good quality. These contained detailed information about how service users needed to be cared for and showed any health problems were quickly and appropriately dealt with, consulting with other professionals where necessary. These were up dated on a regular basis. Where these service users were spoken to they confirmed that the information recorded was correct and up to date. Care plans were signed by the service users or where more appropriate their relatives showing they were aware of the contents. Staff were observed speaking to service users in a kind and respectful manner.
Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 10 Five service users medication was inspected. There were a number of errors with regards to the way the numbers of medication was recorded. The stock balances of 4 service users were incorrect. Also one service user was on medication that needed to be counted every time it was administered, this had been signed for but the number was incorrect on closer investigation it was apparent that the medication had not gone missing but the medication had not been properly counted or administered. Also certain medications require 2 signatures only one was present. The medication system will be re inspected on an unannounced basis to ensure appropriate action has been taken by the registered` manger and qualified nurses to ensure the system is safe. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The meals provided are varied and of good quality EVIDENCE: The homes kitchen was clean and well organised. The menus were varied, service users are offered a cooked breakfast and the main meal of the day of the day is lunch. The majority of the service users tend to eat in one of the homes dining rooms. The current building works has affected these but the interim arrangements put in place ensure service users can still eat their meals in comfortable pleasant surroundings. The meal being served during the inspection was lunch and looked very appetising and was much enjoyed by the service users. Freshly made cakes were being prepared for tea. The cook had an excellent knowledge of service users dietary requirements as well as their likes and dislikes. The kitchen had recently been inspected by the local environmental health officer and no requirements were made. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were inspected on this occasion EVIDENCE: Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The current building works are causing some disruption however the home continues to provide service users with a clean comfortable and safe place for them to live. EVIDENCE: There are major changes being made to the home and will greatly improve the facilities in the home. These have been underway for about six months and works are due to be completed in March 2006. The work completed has been done to a high standard and service users rooms are bright and airy with large ensuite toilets. Service users can personalise their rooms as they wish with photographs and mementoes to make feel as much like there own home as possible. Efforts have been made to minimise the disruption to service users as much as possible and the home has temporarily reduced the number of service users, as rooms need to be refurbished/taken out of use.
Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 14 The home was clean and fresh smelling throughout and gloves and aprons were in good supply to help prevent the spread of infection. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home provides enough suitably qualified and trained staff to meet service users needs. EVIDENCE: There were 42 service users in the home on the day of inspection. The minimum number of qualified nurse hours needed to care for these service users is 337hours per week the home provided 347 week commencing 20/06/05 and the minimum number of care assistant hours needed is 594 the home provided 854 week commencing 20/06/05. The registered provider employs 2 full time nurses with specialist qualifications to care for service users with mental health problems and dementia who live in the home. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The home is well managed and provides a safe place for service users to live and staff to work. EVIDENCE: The registered manager has recently obtained the NVQ4 in care management in addition to her first level nurse qualification, these qualifications help ensure the home is well managed and service users, relatives and staffs problems/concerns are properly dealt with. The registered manager and or her deputy are available in the home on a daily basis to deal with issues as they arise. The home is well maintained, the registered provider has consulted with other agencies (fire officer) to ensure that service users continue to be protected from the risk of fire while the building works take place and disruption to service users is being kept to a minimum.
Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x 3 Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 2 Requirement The registered manager must ensure medication is safely administered and accurately recorded Timescale for action On Receipt of this report and maintained thereafter RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Service users medical history should be documented as part of the preadmission assessment. Craven Nursing Home J53_J04_S61132_Craven NH_V233746_060705_Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection York Area Office Unit 4, Triune Court Monks Cross York, YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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