CARE HOMES FOR OLDER PEOPLE
Cravenside Lower North Avenue Barnoldswick Lancashire BB18 6DP Lead Inspector
Mrs Jennifer M Turner Key Unannounced Inspection 10:30 11 and 12th July 2007
th 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 Cravenside DS0000035008.V337136.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. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cravenside Address Lower North Avenue Barnoldswick Lancashire BB18 6DP 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) 01282 816790 01282 853620 JulieBurns@careservices.lancscc.gov.uk Lancashire County Care Services Mrs Julie Ann Cowgill Care Home 44 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (21), Physical disability (6), Physical disability over 65 years of age (6) Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The service should at all times employ a suitably qualified manager who is registered with the Commission for Social Care Inspection Within the overall total of 44, a maximum of 20 service users requiring personal care who fall into the category of OP (either sex). Within the overall total of 44, a maximum of 15 service users requiring personal care who fall uinto the category of DE(E) (either sex). Within the overall total of 44, a maximum of 2 (named) service users requiring personal care who fall into the category of MD(E) (female) Within the overall total of 44, a maximum of 6 service users requiring personal care who fall into the category of PD(E) for intermediate care only (either sex). Within the overall total of 44, a maximum of 6 service users requiring personal care who fall into the category of PD for intermediate care only (either sex). 2nd May 2006 6. Date of last inspection Brief Description of the Service: Cravenside is registered to provide personal care and accommodation to a total of 44 people in the categories of older people; older people who also have dementia and people needing rehabilitation care. The home is owned and managed by Lancashire County Care Services, which is a Lancashire County Council direct services organisation. At the time of the inspection visit the fees charged were £320.00 - £392.00 per week. Additional charges were made for hairdressing; private chiropody; toiletries; newspapers; dry cleaning and part contributions to outings. The home has a booklet about ‘service details’ to give to prospective residents and displays a copy of the most recent CSCI inspection report by the front door. Cravenside is located near to Barnoldswick town centre, with footpath access to the town centre shops and other amenities. The home looks out onto a green and has an enclosed protected garden at the front. There are sitting areas and a car park by the front entrance. The premises are purpose-built, comprising three ground and three first floor residential units (each accommodating between 6 to 8 people) and a first floor day care lounge/hairdressing salon. There is a passenger lift. Each Unit has single bedrooms, a bathroom, toilets and communal lounge/dining area with an
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 5 integral kitchen (for light meals and snacks). The home has separate smoking rooms on both floors. The main kitchen and pay telephone are located on the ground floor. The home provides limited car and mini-bus transport (booked in advance). Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, including a visit to the home, took place on the 11th and 12th July 2007 over a twelve and three quarter hour period. At the time of the inspection the occupancy level was forty-four. The manager, administrator, care staff, domestic staff, the cook, a number of residents and relatives were spoken to. During the course of the inspection, a number of residents and staff files were examined, procedures and records were also examined, lunch was taken with the residents, activities were observed and the premises were viewed. Feedback was offered to the manager at the end of the inspection. Information from an Annual Quality Assurance Assessment document, seven survey forms received from residents, two survey forms received from health professionals and two survey forms received from relatives contributed towards the findings. Requirements and recommendations made from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well:
Cravenside has a welcoming and supportive atmosphere and was being managed by a competent, experienced person. A comment made by a health professional was that “Cravenside has friendly, caring staff”. Residents said they “liked living at Cravenside” and several commented the “girls are good”. People said they “liked the home very much”. It was “always clean and nicely decorated”. The residents personal privacy needs were being dealt with sensitively and they were being treated with respect and as individuals. A health professional commented, “ People are treated with dignity and care”. Staff were qualified and enthusiastic about meeting residents’ needs. They treated and spoke to residents with kindness and respect. Staff had a good understanding of the needs of people who had dementia and helped residents to be as independent as possible. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 7 Everyone spoken to enjoyed the meals, which were well prepared by qualified cooks. Menus had choices, variety and good nutritional content. Meal times were pleasant, unhurried and staff were attentive to need. Residents were appreciative of the activities provided, such as movement to music, games and quizzes and the entertainers who visited from time to time. Visiting times were flexible so friends and relatives could call at different times, the residents could see people in private. Relatives spoken with said they were always felt welcome at the home and made very positive comments about the care and attention provided. The home was clean, warm and generally in good order. The residents had been encouraged to personalise their rooms, by bringing with them their own belongings, such as pictures and ornaments. This had helped create a sense of home and belonging. What has improved since the last inspection?
Following the pre admission assessment of long-term residents, the manager sends a letter to them confirming the outcome. A new format for care plans has recently been introduced, which the manager said would give a more detailed picture of peoples needs. Many bedrooms have been refurbished since the last inspection. This provides comfortable and safe surroundings for the residents. Bathing facilities in the dementia units have bee improved. This ensures safety for residents and staff. The complaints procedure has been reviewed. This ensures that people making a complaint are fully aware of how it will be dealt with. The manager informs the Commission of any events that may adversely affect the well-being or safety of the residents. The manager has made arrangements for some fire doors to be fitted with mechanical devices. This ensures the health and safety of the residents when negotiating the doors and promotes their independence. A new fire alarm and detectors have been installed. number of false alarms. This has reduced the Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 8 What they could do better:
The Statement of Purpose and Service Users Guide should be reviewed on an annual basis. This ensures that new residents have up to date information about the home. The manager should be involved with the assessments of people using the Intermediate Care Unit so that she can tell them about the Unit, its purpose and to give them written information about it. In respect of the Intermediate Care Unit, in addition to an up to date Service Users Guide, people should receive some written information relating to the purpose of their stay at Cravenside. Following a detailed health and welfare needs assessment, the manager must write to people who will be using the Intermediate Care Unit to confirm whether or not their needs can be met. The manager must only admit people within the conditions of registration on the Intermediate Care Unit. This will ensure that staff are appropriately trained to deal with their needs. The shower in the Intermediate Care Unit needed to be repaired and the bath needed to be raised to accommodate a hoist. This will ensure that people have a choice of bathing facilities. All staff must adhere to policies and procedures for safely administering medicines. This will ensure that both residents and staff are protected by safe practices. In the interest of security the medication cabinet should be secured to an immovable object. Entries in the Controlled Drugs register should have two signatures to ensure that medication has been properly administered. The strength of medication should be recorded in the Controlled drugs register. This ensures that the correct amount of medication is being administered. Care plans should be reviewed at least once a month and should include, if possible, residents and their relatives. This ensures that people are aware of decisions taken about their life. The registered person should take into account the layout of home, laundry and domestic duties, and the needs of some residents for assistance from 2 staff, when planning for staffing numbers to meet residents’ needs. The converting of casual hours to contracted hours may assist with this.
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 9 Although some form of induction training was being carried out, the manager was advised that the “Skills for Care” organisation, which encompasses National Training Organisation targets, should be used. This will ensure that staff receive induction to a recognised national standard. The manager should ensure all staff receive formal supervision at least 6 times a year. This will ensure that their training and self-development needs are identified and met. 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. Cravenside DS0000035008.V337136.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 Cravenside DS0000035008.V337136.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): 1:3:6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment procedure was carried out prior to people moving into the home for either long term or respite care. This meant that their diverse needs were known and met. In the Intermediate Care Unit, people were usually accommodated without the manager carrying out an assessment, so it was not clear how their needs were to be met. EVIDENCE: Although there was a file, on the music centre in the entrance area, which provided an information leaflet about the home, the Statement of Purpose and Service Users Guide had not been reviewed within the previous 12 months. A copy of the complaints procedure was also available. It was suggested that up to date information be displayed on the notice boards in each of the Units
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 12 within the home. The manager indicated that information could be made available in large print. Information written on a pre assessment form, completed by the manager, included all the required details and included various health and social care needs and abilities. This information was obtained during a pre admission visit to Cravenside or when the manager visited people in their own home or in hospital. Relatives spoken with said they had previously visited Cravenside prior to a placement being accepted. There was evidence that, following the pre admission assessment, a letter was sent to people confirming the outcome. Although the Service Users Guide was available for people on the Intermediate Care Unit (Rehabilitation Unit), there was no specific information available for them explaining about the unit and the purpose of their stay. The manager commented that the health professionals did not like what she had produced, but had not offered an alternative. The manager also explained that she did not always have the opportunity to be involved with a pre admission assessment of people entering the unit. People were admitted following an assessment by social workers and the manager and care staff felt that they were not always suitable. She said that there was one person presently in the unit since 03/05/07 that was in the wrong category for the unit. During the inspection a social worker visited the unit to carry out a re-assessment and stated that the person involved “would be moved as soon as a suitable placement was found”. This issue has been raised in previous inspection reports. Letters confirming the suitability of the home were not sent to people using the unit. People spoken to in the unit were happy with the care offered. They said that they had “good support from trained and competent staff”. One person commented, “I don’t know when I’ll go home but I am improving each day”. Another said, “I’ve not been home yet, but they are taking me to see my new flat”. Cravenside DS0000035008.V337136.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. Care plans need to be reviewed on a regular basis to ensure that the care being provided is current and beneficial to the residents. Shortfalls were identified in medication practices that had the potential to place people at risk. EVIDENCE: Three people’s care plans were examined. A variety of risk assessments were completed in response to individual needs and circumstances, and information was included in the care plan. A new format for care plans had recently been introduced, which the manager said would give a more detailed picture of peoples needs. Staff were still attempting to address the changes. They said that there was “not enough time to do reviews regularly”. Relatives and staff spoken with indicated that people received appropriate medical and health support when required. Records showed that moving and
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 14 handling assessments were carried out as appropriate and that people received attention from a variety of health care professionals. All contact was recorded in residents’ files. Various health care policies and procedures were available. The medication and records were checked for five residents. Generally the records were correct but there were some discrepancies. Sometimes no medication was given and no reason was recorded. On two occasions records were signed but there was no record of anything being given. People completed and signed an agreement upon admission stating who they wished to be responsible for administering their medication. Separate medication storage cupboards were sited between the two units they served and were secured appropriately. People on the Intermediate Care Unit were responsible for their own medication, but controlled drugs were stored centrally. Only staff who were appropriately trained administered medication. The trolley containing the controlled drugs was not secured to an immovable object. In the controlled Drugs register only one signature was made against some entries and the strengths of the drugs were not always listed in the controlled drugs register. Residents were very happy with staff attention, saying that the “girls are good”. The staff team were committed to providing the best service they could and were seen to treat and speak to residents with respect. People confirmed that personal care was conducted in private. Staff felt that a domestic washing machine on each unit would help to ensure an improved service in respect of the washing of people’s clothes and they felt there would be less opportunity for clothes to go missing. A number of mechanical release devices had been fitted to lounge doors. People said it was easier now for them to be able to walk from one place to another without asking staff to open the doors for them. More devices are to be fitted using money from the “Care and Dignity” Grant. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Residents’ dietary, social, cultural and spiritual needs were being met. They were able to make choices and decisions about their life at the home so that their lifestyle met their preferences. EVIDENCE: From the questionnaires received from residents there was a mixed reaction to the activities that were arranged. One lady did not involve herself with what was offered as she “had her own interests”. One person was involved with making teddy bears and was awaiting the return of a new member of staff who helped her with them. Staff said that whenever a trip was arranged they tried to involve someone from each unit. Sometimes residents “want a nap” or “sometimes residents take themselves off somewhere else”. People spoken to appreciated the activities on offer. They said the different activities suited different tastes and abilities and they enjoyed singing, quizzes and ‘keep-fit’ classes. They also said they liked “reading and had books and newspapers”.
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 16 Staff on the dementia care units continued to arrange video afternoons, sing songs, ‘pamper days’ and baking. Records showed that staff record in the unit what activities have taken place and on resident’s individual files. Several people said they liked to go out with family, friends or staff on outings. They said their relatives were made welcome at any time and offered refreshment. They could receive visitors in the privacy of their own room. Clergy of various denominations visited the home to hold services and see individual people. Visiting arrangements were outlined in the Service Users Guide. Relatives spoken with said they were always felt welcome at the home and made very positive comments about the care and attention provided. Policies and procedures promoted residents’ choice and independence. Residents said that they made lifestyle choices such as when to get up/go to bed, preferred time to bathe and how to occupy their time. A tour of the home showed that residents were encouraged to bring personal possessions with them to make their rooms personal and homely. Lunch was nicely presented and well cooked, with a choice of two dishes or an alternative. People said the “food is good” and it is “always nice and hot”. Staff were seen to ask people what they wished for their meals the following day. The menus were displayed within each unit. The records of meals served was seen and showed that meals were balanced and catered for health needs (such as diabetic and soft diets) and residents’ preferences. Residents could choose to have meals in their bedrooms. The unit kitchens provided facilities for people to make their own drinks and snacks. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Residents were protected from abuse and had access to the homes complaints procedure. EVIDENCE: A Complaints Procedure was available in the reception area of the home. It was also included in the Service Users Guide. Appropriate information was included. Residents said that they were “confident to approach a member of the management team if they had any concerns” and they “would contact their family or a Social Worker if the home did not sort things out”. A complaints book was available and there had been one complaint raised about the laundry since the last inspection that had been dealt with satisfactorily. Staff spoken with commented that there were “many complaints about the laundry”. The manager said that any concerns of an internal nature were dealt with quickly and proficiently. Relatives said that “they knew who to talk to” if they had any concerns. Compliments and letters of appreciation were directed toward the members of staff concerned. Residents said they felt safe from abuse at the home. There were good adult protection procedures. Staff were knowledgeable about how to recognise
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 18 abuse, how to protect residents and how to respond to suspicion or evidence of abuse. Records showed that appropriate training had taken place. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 19 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): 19:21:26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was warm, clean and comfortable with a good standard of hygiene being achieved. EVIDENCE: The home was well maintained, with appropriate aids, adaptations and equipment to promote independence. Maintenance records were seen. Staff said that some new carpets had not been provided as the home had been “under threat of closure”. Several residents said they “liked the home very much” and it was “always clean and nicely decorated” and they “liked living here”. Bedrooms were viewed with the consent of residents. They were personalised and clean. Décor was in a good condition. Some staff felt that a washing machine supplied on each unit would help to solve some of the problems of missing laundry and a dish washer would save time.
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 20 Alterations had been carried out on the bathrooms on the dementia care units. The shower in the Intermediate Care Unit needed attention, as it was not working. The bath needed to be raised in order for a hoist to be used. The manager said that she hoped to be able to provide improved facilities from monies recently obtained from a Care and Dignity Grant. Residents and relatives completing surveys indicated the home was always clean and fresh. Domestic cleaning records were seen. Cleaning materials were kept securely. Appropriate laundry equipment was available. An appointment was seen in the diary for “high cleaning” of walls, ceilings, fly screens and cooker hoods to be carried out in the kitchen. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 21 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. The allocation of staff, needs to make residents feel safe and confident that their diverse needs are being met. Staff were recruited using current guidance but induction training needed to encompass National Training Organisation targets. This will ensure that staff receive induction relating to a national standard. EVIDENCE: Residents spoken with were complimentary about the staff team. Staff were seen to provide support and interact with the residents in a positive and sensitive manner. Comments on questionnaires received from residents stated that “staff listened and acted on what they were asked” and staff were “generally available when needed”. However one relative commented that “Due to staff shortages ………….feels lonely sometimes when here is nobody there” Staff rotas and records showed that previously agreed staffing levels were in place. Although one staff member was allocated to each unit, several residents needed the attention of two staff, which necessitated calling staff from another unit. The manager stated that “casual cover” provided some hours. Arrangements were in place to cover catering and cleaning duties. Domestic staff were allocated to carry out kitchen domestic duties.
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 22 According to information provided by the manager and from the training records, 28 of the 43 care staff (67 ) had achieved a National Vocational Qualification (NVQ) at level 2 and several had achieved NVQ level 3, so exceeding this standard. The home had a robust recruitment procedure, which records and discussion with staff, showed was followed satisfactorily. Staff spoken to were enthusiastic about training. The training matrix showed completed basic training (including moving and handling, medicines awareness, health & safety, basic food hygiene, first aid, adult protection, challenging behaviour and dementia care). Records of induction training were not available. An orientation checklist was used for new staff and casual staff. Induction relating to the “Skills for Care” organisation which encompasses National Training Organisation targets were discussed, and the manager was offered advice about obtaining information about this off the appropriate website. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 23 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): 31:33:35:36:37:38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration arrangements promoted the smooth running of Cravenside for the benefit of the residents, staff and visitors. EVIDENCE: An experienced and qualified manager, whom residents, staff and relatives considered approachable, ran Cravenside with the support of a management team and external managers. She had completed dementia care training via distance learning. There were various strategies in place to communicate with residents and other stakeholders. Questionnaires were sent out on an annual basis to
Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 24 residents, relatives and staff. Information was collated and passed back at meetings on units. Staff meetings were held every two months and agendas and minutes were seen. Records of management team meetings were seen and residents meetings were carried out on each unit. The Investors in People award was also in place. The manager operated an ‘open door’ policy and throughout the inspection days, the views of residents, relatives, visitors and professionals were welcomed. Records of two residents seen indicated that systems were in place to manage their personal allowances. Records and monies were correct. Secure storage was available. Usually two weeks spending money was kept in a residents account. The manager said that residents’ monies were banked into a Lancashire County Council account with names of every resident on the account. The money was then “transferred into individual bank accounts when so much money was accrued”. It was suggested that residents’ monies be paid into their own bank accounts at the time it was received. Staff spoken with said that “formal supervision was lacking” although they received appropriate support from the manager and senior staff. There was a list on the back of the office door outlining the dates of supervision sessions However records indicated that although formal supervision was held, this was less than six times a year. Appraisals were also held. The requirement made following the previous inspection relating to the manager notifying the Commission of certain events was now taking place. Information in the Annual Quality Assurance Assessment indicated that equipment had been serviced and that installations and maintenance checks were ongoing. Records were seen of various checks. Records showed that the fire alarm system was tested weekly. The annual fire risk assessment had been reviewed. Health and Safety risk assessments had been completed and health and safety policies were available. Training in safe working practices was ongoing. The annual Gas Safety inspection was completed. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 25 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 X X 1 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 2 3 3 Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 26 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 OP6 Regulation S.24 Care Standards Act (2000) Timescale for action The manager must only admit 30/09/07 people within the conditions of registration (i.e. Condition numbers 5 and 6: Within the overall total of 44, a maximum of 6 service users requiring personal care who fall into the categories of PD or PD(E) for intermediate care only).(Previous timescale of 04/05/06 not met) Following a detailed health and 30/09/07 welfare needs assessment, the manager must write to people who will be using the Intermediate Care Unit to confirm whether or not their needs can be met. (Timescales of 22/09/05 and 04/05/06 not met) All staff must adhere to policies 30/09/07 and procedures for safely administering medicines. Medicines Administration Charts (MAR) must be completed correctly. (This refers to discrepancies in Controlled Drugs Register) (Previous timescale of 04/05/06 not met)
DS0000035008.V337136.R01.S.doc Version 5.2 Page 27 Requirement 2. OP6 14(1)(d) 3. OP9 13(2) Cravenside 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. Refer to Standard OP1 OP6 Good Practice Recommendations The Statement of Purpose and Service Users Guide should be reviewed on an annual basis. This ensures that new residents have up to date information about the home. In addition to an up to date Service Users Guide, people who are accommodated in the Intermediate Care Unit should receive some written information relating to the purpose of their stay at Cravenside. The manager should be involved with the assessments of people using the Intermediate Care Unit so that she can tell them about the Unit, its purpose and to give them written information about it. Care plans should reviewed at least once a month and should include, if possible, residents and their relatives. This ensures that people are aware of decisions taken about their life. The medication cabinet should be secured to an immovable object. Entries in the Controlled Drugs register should have two signatures to ensure that medication has been properly administered. The strength of medication should be recorded in the Controlled drugs register. This ensures that the correct amount of medication is being administered. The shower in the Intermediate Care Unit needed to be repaired and the bath needed to be raised to accommodate a hoist. This will ensure that people have a choice of bathing facilities. The registered person should take into account the layout of home, laundry and domestic duties, and the needs of some residents for assistance from 2 staff when planning for staffing numbers to meet residents’ needs. The converting of casual hours to contracted hours may assist with this. Although some form of induction training was being carried out, the manager was advised that the “Skills for Care” organisation, which encompasses National Training
DS0000035008.V337136.R01.S.doc Version 5.2 Page 28 3. OP6 4. OP7 5. 6. 7. 8. OP9 OP9 OP9 OP21 9. OP27 10. OP30 Cravenside 11. OP36 Organisation targets, should be used. This will ensure that staff receive induction relating to a national standard. The manager should ensure all care staff receive formal supervision at least 6 times a year. Cravenside DS0000035008.V337136.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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