Inspection on 04/06/08 for Cravenside

This inspection was carried out on 4th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cravenside 11/07/07

Cravenside 02/05/06

Cravenside 22/09/05

Cravenside 20/04/05

Cravenside 07/10/04

Cravenside 05/04/04

Cravenside 09/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cravenside Lower North Avenue Barnoldswick Lancashire BB18 6DP Lead Inspector Mrs Julie Playfer Unannounced Inspection 4th June 2008 09:00 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.V361421.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.V361421.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 Burns 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.V361421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the overall total of 44 the service is registered to accommodate: up to 20 service users over the age of 65 years (OP); up to 15 service users in the dementia (DE) category; 2 named service users in the category Mental Disorder over the age of 65 years (MD(E)); 6 service users in the category of Physical Disability (PD) for intermediate care only 11th July 2007 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 £332.00 - £433.00 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 and each unit. 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 lounge/hairdressing salon. There is a passenger lift. Each Unit has single bedrooms, a bathroom, toilets and communal lounge/dining area with an integral kitchen (for light meals and snacks). 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.V361421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Cravenside on 4th June 2008. At the time of the inspection there were 43 people accommodated in the home. The inspection comprised of spending time with the residents, looking round the home, reading some of the residents’ care records and other documents and discussion with the staff and the registered manager. As part of the inspection process we (the commission) used “case tracking” as a means of gathering information. This process allows us to focus on a small group of people living at the home, to assess the quality of the service provided. Prior to the inspection, the registered manager completed an Annual Quality Assurance Assessment known as AQAA, which is a detailed self assessment questionnaire covering all aspects of the management of the home. This provided useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff, the residents and their relatives. Nine questionnaires were returned from relatives/visitors to the home and five questionnaires were received from people living in the home. In addition eleven questionnaires were received from staff. The responses from the questionnaires were collated and used for evidence purposes throughout the inspection process. What the service does well: Current and prospective residents were provided with appropriate written information, which was presented in an easy read format. This ensured the residents were aware of the services and facilities available in the home. The residents were able to exercise choice and control over their lives. The daily routines were flexible and designed to meet the wishes and preferences of the residents. As such the residents could decide when they wished to get up and go to bed. The residents spoken to felt that the staff respected their rights to privacy and personal care was delivered appropriately. Further to this, a resident who completed a questionnaire commented, “I am very happy to be at Cravenside from all aspects”. Visitors were welcome in the home at any time and residents were supported to maintain good contact with their family and friends. The relatives who completed a questionnaire were satisfied with the quality of care provided, one person commented, “The provision of overall care is very satisfactory and the Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 6 staff work hard to establish good relationships with the residents and their relatives”. The residents were aware of the complaints procedure and knew who to talk to in the event of a concern. This meant they had the opportunity to resolve any queries at an early stage. Information was available to staff about the protection of vulnerable adults, which included a clear procedure to be used in the event of an alert. The residents were provided with clean comfortable bedrooms. The residents could personalise their rooms, with their own belongings. The sitting and dining areas were decorated in a homely fashion, with a variety of armchairs, footstools, side tables, ornaments and pictures. A good percentage of staff had achieved NVQ level 2 or above. This qualification provided the staff with the necessary knowledge to carry out their role effectively. There were effective systems to monitor the quality of the service to ensure the home was run in the best interests of the residents. What has improved since the last inspection? Since the last inspection, the management team had undertaken training on implementing the computerised care planning system known as “Saturn”. The system is designed to store all information electronically and provide a more detailed picture of the residents’ needs. The cook had rewritten the menus after discussions with the residents to incorporate their suggestions and choices. Several improvements had been made to the premises, in order to promote the welfare and comfort of the residents. A new fire alarm and detector system had been installed, six automatic door closures had been fitted to fire doors and a new bathroom had been installed on Dean Unit. In addition the laundry room had been reorganised and three pressure mats had been purchased. The latter were used for residents with a history of falls to alert staff if they got up during the night. The induction training for new staff had been up dated, to ensure the staff completed their initial training to a recognised national standard. The time of the staff handover meeting had been changed from 8 am to 10 am. This gave the staff more time on the units before starting breakfast allowing them to spend time assisting the residents to get up in a more relaxed manner. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 8 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.V361421.R01.S.doc Version 5.2 Page 9 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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home were provided with appropriate written information to enable them to make an informed choice about where to live. However, there was sometimes a lack of information gathered during the assessment process. This meant staff had limited information about people’s needs at the point of admission. EVIDENCE: Written information was available for the residents in the form of a statement of purpose and service users guide. The guide had been distributed to each resident and was available for reference on each unit. People spoken to confirmed they had received a copy of the service users guide and said that it was easy to read and understand. A brochure had also been produced which offered current and prospective residents with a useful overview of the services and facilities available in the home. All the residents who completed a Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 10 questionnaire indicated they received enough information prior to moving into the home. Copies of the last inspection report were available for reference on each unit and in the entrance hall. All residents were issued with a statement of terms and conditions of residence or contract and an individual placement agreement. However, it was noted that one person’s contract had not been signed or dated. The ‘case tracking’ process demonstrated that the residents had their needs assessed prior to admission by a social worker and/or the senior staff in the home. Copies of the preadmission assessments were seen on the residents’ files. The assessment format covered a range of individual needs, however, it was noted that one person’s assessment only contained brief information and some sections weren’t completed. This meant that staff had limited information about the person’s needs and preferences, when she moved into home. The registered manager confirmed that admissions were not made to the home in the absence of a needs assessment. This meant the registered manager was confident that the staff had the necessary skills and knowledge to meet the assessed needs of the prospective resident. Residents receiving intermediate care were accommodated in a designated unit on the ground floor. The unit was equipped with specialist facilities and equipment to promote activities for daily living and mobility. The residents were supported to rebuild skills in order to return their own home. Residents were admitted to the unit following an assessment of needs by a social worker. Care plans were developed by the occupational therapist. The plans focussed on the person’s level of skills and rehabilitation, which meant the staff might not have detailed information about other important areas of need and how best to meet these needs. Staff were specifically deployed in the unit and residents had full access to specialist services from relevant professions, including occupational and physiotherapists. Residents living on the unit, said they were well supported by the majority of staff, who they described as “excellent” and “very kind”. However, two residents made comments about the approach taken by two members of staff, who they said were not as helpful and supportive as other staff. This matter was discussed with the registered manager during the inspection. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans were not always reviewed regularly and did not provide clear information about how best to meet the residents’ healthcare needs. Appropriate systems were in place to manage medication. EVIDENCE: Three people’s files were looked at in detail as part of the case tracking process. All three people’s files contained a care plan based on their assessment of needs. Two people’s plans had been developed using a computerised care planning system known as “Saturn”. The other person’s plan had been devised by the occupational therapist to assist with the person’s rehabilitation. The “Saturn” plans covered people’s physical, personal and social needs and were supported by risk assessments. Since the last inspection the management team had completed training on implementing the “Saturn” care plans. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 12 The plans were available on each unit to facilitate ease of reference, however, the staff spoken to said the plans were time consuming to complete and some of the contents were confusing. When staff were asked what were the essential pieces of documentation to refer to when caring for a resident, they referred to the daily notes and risk assessments, none made reference to the Saturn plans. This would suggest that the plans have limited use and application in the daily care of the residents. It was noted that one person’s plan had not been reviewed and updated for three months. This meant that staff would have limited information if the resident’s needs changed during this time. These findings were reflected in comments made in the questionnaires completed by staff, one person wrote, “Care plans need to be reviewed more frequently” and another person commented, “Most care plans are up to date, but staff sometimes are very busy and do not always have enough time to complete them”. Staff were given verbal updates about the residents’ well-being at the daily handover meetings. This meant that important information was passed to staff quickly and staff were aware of any changing conditions. However, should a member of staff be absent from the meetings there was a risk that key information could be missed. The plans were supported by daily records of personal care, which provided information on changing needs and any recurring difficulties. These records were detailed and the residents’ needs were described in respectful and sensitive terms. The residents confirmed they were involved in the care planning process and recalled discussing their care needs with a member of staff. This gave the residents the opportunity to have an active input into the delivery of the care. Healthcare needs were appropriately assessed, however, there was no designated section within the care plans, which provided information on healthcare needs and staff therefore had limited guidance on how best to meet these needs. There was evidence within the records of personal care to indicate the residents had access to NHS services and advice from specialist services had been sought as necessary, for instance the District Nursing Team. Risk assessments in respect to moving and handling, pressure sores and nutrition had been incorporated, where necessary, into the care plan documentation. The assessments included management strategies to manage, reduce or eliminate an identified risk. However, some of the management strategies were brief and provided little detail in order for staff to manage the risks in a consistent manner. For instance one risk assessment advised the use of “distraction methods” but there were no further details as to what methods were the most effective and meaningful for the person. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 13 The residents spoken to felt the staff respected their rights to privacy and dignity and all made complimentary remarks about the staff, for instance one person said, “The staff always treat me well and always knock on the bedroom door before entering”. All the residents, who completed a questionnaire, indicated that they “always” received the care and support they needed. The staff were observed to interact with the residents in a positive manner and they referred to the residents in their preferred term of address. During discussions staff demonstrated an awareness of treating people with respect and considering their dignity when providing personal care. Policies and procedures were in place to cover all aspects of the management of medicines and these were readily available for staff reference. The home operated a monitored dosage system of medication, which was dispensed into individual blister packs by a local pharmacist. Appropriate records were maintained in respect to the receipt, administration and disposal of medication and all staff designated to administer medication had received accredited training. However, it was noted there were several omissions on the medication administration record where staff had not signed the record to indicate the medication had been given and there were no records seen relating to the application of prescribed creams. Appropriate arrangements were in place for the management of controlled drugs, however, there was a slight numerical error in the controlled drugs register. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were supported to maintain good contact with their family and friends; however, the frequency of activities did not always meet the residents’ expectations. Residents were provided with a nutritious diet. EVIDENCE: The residents’ preferences in respect of social activities were recorded and considered as part of the assessment process. However, the arrangements for activities within the home were a source of comment for the staff and relatives who had completed a questionnaire. One relative wrote, “There are no social activities organised and the home does not provide enough stimulation for it’s residents, our relative just sits and watches television”. Similarly, a member of staff commented, “We do not have enough staff to be able to offer structured activities at all times” and another member staff wrote, “The home should offer more activities and outings”. The residents spoken to had mixed views about the activities, one person said she was very well supported to continue her interest in sewing and knitting, but other residents said there was “not a lot Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 15 going on and it’s a long day”. Another person commented, “I’ve walked round the garden so many times”. Activity records were available on each unit but these had not been fully completed by the staff. However, the registered manager said that many of the residents had enjoyed recent trips out to Blackpool, Hollingworth Lake and the Lake District. In addition people visited the home to initiate armchair exercises once a week and massage once a fortnight. Information contained in the AQAA indicated that activities were being reviewed in line with the needs of the residents. Two students on placements were observed to play with a beach ball with the residents, during the morning of the inspection. The residents were supported to follow their chosen religion and representatives from the local church visited the residents for communion and prayers and an ecumenical service was held every other week. The routines were flexible and were primarily designed to meet the needs of the residents. The residents spoken to said they had a choice in the times they got up and went to bed. One person said “I often stay up to watch the television and sometimes I have breakfast in bed”. The staff were observed to seek the residents’ views throughout the inspection and most of the residents spoken to said they felt comfortable to comment on life in the home. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in the privacy of their own rooms, should they wish to do so. The relatives who completed the questionnaires indicated they were satisfied with the overall quality of care provided, one person wrote, the home “provides safe and comfortable care”. Similar comments were received from relatives seen during the inspection, one person said, “I am very impressed with all aspects of care”. All the residents spoken to said they liked the food provided. However, one resident who completed a questionnaire commented, “The meals do not look appetising and are not to my appeal at all”. There was a choice of food each mealtime and residents were asked prior to each meal what choice they wished to make. On the day of the visit, the residents and staff were aware of the forthcoming meal and this generated a general discussion at lunchtime. Since the last inspection the cook had rewritten the menus after discussions with the residents to incorporate their suggestions and choices. The meal served on the day inspection was plentiful and well presented. Residents were given sensitive and appropriate support to eat their meals. Drinks and snacks were served throughout the day and at other times on request. Residents were observed asking for drinks during the inspection and were promptly served by staff. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were able to express their views and had access to a clear complaints procedure. Policies and procedures were in place to respond effectively to any allegations or suspicions of abuse. EVIDENCE: Both informal and formal arrangements were in place to ensure the registered manager and staff listened to and acted on the views and concerns of residents. This was achieved during daily conversation, one to one discussion, satisfaction questionnaires and residents’ meetings. The residents spoken to said they felt comfortable expressing their views and were aware of whom to speak to in the event of a concern. A copy of the complaints procedure was included in the service users guide, which was available in each of the bedrooms and on display in each unit and in the reception. The procedure contained the necessary information should a resident or their representative wish to raise a complaint with the home or direct to the Commission. According to information supplied in the AQAA the registered manager had received two complaints. A record had been maintained of the investigations Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 17 and the subsequent outcomes. Both complaints had been resolved within 28 days. The registered manager had access to a copy of “No Secrets in Lancashire” (The Joint Strategy for the Safeguarding of Vulnerable Adults), along with a specific procedure setting out the required response in the event of any allegation, suspicion or evidence of abuse. These issues were incorporated into the induction training and staff received specific training as part of their mandatory training programme. Staff spoken to were aware of the procedure and whom to refer any incident to as well as the various agencies involved. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were provided with a clean, pleasant and well-maintained environment, which promoted their comfort and independence. EVIDENCE: Cravenside is a purpose built premises comprising of three ground and three first floor units, each accommodating between 6 to 8 people. Each unit is self contained and provides lounges and dining areas along with bedrooms and bathrooms. A passenger lift eases access to the first floor. Accommodation is provided in single bedrooms. There is an enclosed garden for the use of all residents, which has raised flowerbeds and benches. Residents were observed to use the garden on the day of the visit. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 19 Since the last inspection, several improvements had been made to the premises. A new fire alarm and detector system had been installed, six automatic door closures had been fitted to fire doors and a new bathroom had been installed on Dean Unit. In addition the laundry room had been reorganised and three pressure mats had been purchased. The latter were used for residents who had a history of falls, in order to alert staff if they got up during the night. Established arrangements were in place to report repairs and routine maintenance appropriate records were maintained of the work completed. It was evident on a partial tour of the building that the residents had personalised their rooms with their own belongings and decoration was good throughout. The residents spoken to said they liked their rooms, which they described as comfortable and warm. The bedroom doors had been fitted with appropriate locks and keys had been distributed as appropriate. The locking mechanism allowed staff to gain entry in the event of an emergency call. The home was clean and odour free at the time of the inspection. The residents spoken to said that a good level of hygiene was maintained at all times. The laundry was located on the first floor. All the residents spoken to said their clothes were laundered properly and were returned to them in a timely manner. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents benefited from well trained staff, however, current staffing levels had an impact on the amount time staff could spend with the residents. EVIDENCE: The registered manager maintained a staff rota, which indicated, which staff were on duty and how many hours they had worked. All staff providing personal care were aged over 18 and all staff left in charge of the building were aged over 21. Whilst all the residents who completed a questionnaire indicated that they “always” received the care and support they needed and staff “always” listened and acted upon what they said, the level of staffing was a contentious issue for many of the staff and relatives who completed a questionnaire. One relative wrote, “At times I think they are understaffed, more staff would help” and a member of staff commented, “The service provides a good standard of care, but this could be greatly improved if staffing levels were increased. New residents are becoming more fragile and need more care”. The staff allocated to care for the residents on the first floor, also had to carry out the laundry duties for the whole home. One staff member who completed a questionnaire said, “We do not have staff in the laundry room, so care staff Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 21 have to go in and do the washing, drying and putting away. This gives us less time to spend with the residents”. Staff were observed on the day of inspection, to be breaking off caring for the residents and checking the laundry room at regular intervals. This meant that the staff were not able to spend a sustained period of time with the residents. At the time of the inspection the organisation had made proposals about reducing the level of night staff and was carrying out a consultation exercise with all interested parties. This proposal had provoked widespread concerns for the health and safety of the residents. One member of staff wrote on a questionnaire, “At the moment there are 3 night staff and a sleeping in officer on duty, but I am very worried that there will be 2 night staff and no sleeper and it will be unsafe. It is an accident waiting to happen”. Pre arranged meetings were held on the day of the visit with staff and relatives in order to gather their views and comments. At the end of the consultation period, any changes in staffing levels would have to fully safeguard the health and welfare of the residents. Since the last inspection, the time of the staff handover meeting had been changed from 8 am to 10 am. This gave the staff more time on the units before starting breakfast allowing them to spend time assisting the residents to get up in a more relaxed manner. Lancashire County Care Services operated a recruitment and selection procedure, which was underpinned by an Equal Opportunities Policy. The files of two members of staff, who had recently commenced working in the home, were seen during the inspection. It was evident from viewing these files that the procedure had been appropriately followed and all relevant checks had been carried out. Since the last inspection, new staff undertook a “Skills for Care” induction in addition to an in house induction. This provided underpinning knowledge for NVQ training. At the time of the visit, 80 of the care staff were trained to NVQ level 2 or above. All staff had a training portfolio and were provided with training relevant to their role. Staff who completed a questionnaire indicated that the training kept them up to date with new ways of working. Staff spoken to were committed to increasing their knowledge and welcomed the training opportunities afforded to them. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management and administration practices were effective in ensuring the home was run in the best interests of the residents. EVIDENCE: The registered manager held the Registered Manager’s Award as well as other relevant qualifications such as NVQ level 4 in Management and an HNC in Social Care. The registered manager had also undertaken periodic training to update her knowledge and skills, which included updates in moving and handling, fire safety and risk assessment. The manager had a good understanding of the needs of older people and this was communicated to the staff team. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 23 The management approach was consultative and there were established ways of working to consult the staff and residents on an ongoing basis. Relationships within the home were positive and staff spoke to and about the residents with respect. Further to this, one member of staff commented on a questionnaire, “All visitors and staff feel that the home is a very warm welcoming environment. All residents are given choices regards their care and encouraged to make decisions themselves”. Arrangements were in place for the supervision of staff, however, not all staff had received formal supervision six times a year. This meant that staff had limited opportunities to individually discuss their experiences at work on a formal basis. The service had been awarded an Investors in People Award. Residents’ and staff meetings were held on a regular basis and from the minutes seen it was evident both the staff and residents were encouraged to express their views about life in the home. The registered manager had also developed a business plan for the home, which highlighted the planned developments for the forthcoming year. This document linked with the AQAA questionnaire submitted to the Commission. All sections of the AQAA were fully completed and the information provided gave a clear picture of the current situation within the service and the planned areas for development. Satisfaction questionnaires had been distributed to the residents in December 2007. The forms had been sent to a central office and the registered manager reported the collated results were not yet available. Care audits were carried out by the Area Manager and the registered manager monitored the management of medication and all aspects of health and safety. Such systems ensured that the quality of the service was continually checked. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of monies was found to be correct. Records were maintained centrally, in respect to the amount of fees charged and received. There was a set of health and safety procedures available, which included the safe storage of hazardous substances. Staff received health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Documentation seen during the inspection and information supplied by the registered manager indicated the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated the staff had received instruction about the fire procures during their induction. However, it was noted that the last fire drill entered in the fire log was dated February 2007. Risk assessments had been completed in respect to safe working practice topics. Arrangements were in place to record accidents and incidents in the home and the Commission had been notified as appropriate of any significant event in the home. Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 24 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 3 2 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 2 Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 15 (2) (b) Requirement The care plans must be kept under review, to ensure staff have up to date written information about the residents’ needs. The care plans must cover the residents’ healthcare needs and provide clear guidance for staff on how best to meet these needs. Staff must sign the medication administration record immediately following the administration of medication. This is to avoid omissions in the records. A record must be maintained of the application of prescribed creams. The controlled drugs register must accurate at all times, to ensure a clear audit path can be followed. Following consultation with the residents a programme of meaningful activities must be established, to ensure the residents enjoy a full and stimulating lifestyle. DS0000035008.V361421.R01.S.doc Timescale for action 15/07/08 2. OP8 15 (1) 15/07/08 3. OP9 13(2) 04/06/08 4. OP12 16 (2) (m) 15/07/08 Cravenside Version 5.2 Page 26 5. OP27 18 (1) (a) A review of staffing levels must undertaken and completed to ensure the number of staff is appropriate for the health and welfare of the residents. 01/08/08 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 OP2 OP3 OP6 Good Practice Recommendations Residents or their representatives should be asked to sign and date the contract, to ensure they are aware they of the terms and conditions of residence. The registered manager should ensure that detailed information is gathered during the assessment process, to ensure staff are aware of the residents’ needs. Care plans developed for residents living on the intermediate care unit, should cover all aspects of need, to ensure staff have information about how best to meet the residents needs. Staff should be supervised on the intermediate care unit to ensure they are supportive and helpful to the residents at all times. The risk assessment management strategies should include more detail to ensure staff have guidance on how to manage risks in a safe and consistent manner. 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 registered manager should ensure all care staff receive formal supervision at least 6 times a year. This gives staff the opportunity to discuss their work performance and identify future training needs. Advice should be sought from the Fire and Rescue Authority in respect to the frequency of fire drills and drills should be carried out in line with this advice. This is to ensure staff and residents are familiar with the fire emergency procedures. 4. 5. OP8 OP27 6. OP36 7. OP38 Cravenside DS0000035008.V361421.R01.S.doc Version 5.2 Page 27 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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