Care Home: 1 Cranwell Grove

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Cranwell Grove 1 Cranwell Grove Whitchurch Bristol BS14 9QR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 0 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 1 Cranwell Grove 1 Cranwell Grove Whitchurch Bristol BS14 9QR 01275540115 01179699000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Brandon Trust care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is 4 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 1 Cranwell Grove is a residential care home registered with the Commission for Social Care Inspection to provide accommodation and personal care to four residents with a learning disability. Currently there are four men living at the home - they have all lived together for 18 years and there are no plans for any of them to be moving to alternative accommodation. The home is situated in a residential area of the city, close to local amenities and bus routes. The Brandon Trust operates the home. The home has access to major bus routes into the city centre and the surrounding areas. Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We did an unannounced inspection of this service as part of our annual inspection programme. This is to ensure that the quality of the service remains good and that the people who live in the home experience good quality outcomes. The inspection took place over one day and five hours were spent in the home. We met with one person who lives in the home and two staff members. Prior to the inspection we had sent survey forms to the home and two were returned. The staff had helped these two people to complete the forms. Care Homes for Adults (18-65 years) Page 5 of 27 Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can expect to have their individual needs met because of the assessment processes that are followed. Evidence: There have been no new admissions into Cranwell Grove since the last inspection therefore it is not possible to assess the homes pre-admission assessment procedures. We did look at the homes admission policy though and this stated that there would a graduated series of visits to the home by any prospective person after a full assessment of needs had been undertaken, and the impact of any admission on the existing people in the home would remain paramount at all times. Of the four people who are living in the home, the care files of two of them were looked at. We saw that in both cases the care needs had recently been reviewed and re-assessed. This measure will ensure that the care delivered remains appropriate to a persons needs and any new needs will have been identified and planned for. Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: A statement of terms and conditions called A Place to Live Agreement is placed in each persons file along with The Brandon Trusts Mission Statement - supporting people to live the life they choose. The first document is in written format but the mission statement is in pictoral form. We were told that none of the people who live in the home have the capacity to understand the information in the statement of terms and conditions. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning and risk assessment processes ensure that each person is able to live their lives as they want and they have the opportunity to try new experiences. Evidence: Two care files were looked at to see how assessed needs are identified and then met. Each person had a detailed plan of care that was evidently based upon an extensive knowledge of the persons individual care and support needs. The plans state how much assistance each person needed with specific tasks. Both plans had recently been fully reviewed. For one person there were plans written showing the morning routine, one on day centre attendance days and the other on non-attendance days. The plans include in-depth information about When I do this, it means I want/I am and Staff need to..... This means that people will be cared for in a consistent way and the staff team are always aware of how to support the person. Most decision making is made based upon the knowledge that the staff team have Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: about each persons likes and dislikes. None of the people have good verbal communication skills but staff said that they are able to pick up on mood, behavioural changes and facial expressions. This level of awareness of each persons satisfaction was observed during the inspection. Risk assessments are completed about money management, safe bathing, eating and drinking and using transport for example. For one person, although the risk assessments had been reviewed on at least a yearly basis, they had been prepared many years previously. Some of the assessments needed to be tidied up - it would be good practice if these were rewritten. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are supported to have a good lifestyle. They are able to choose what they do, and how they spend their time. Evidence: Each person has a programme of activities for the week but there are times during the week when all four people will spend time together in the home. Each person attends a local authority day care centre but this provision is being reviewed at the moment because the facility is due for closure later in the year. People would be supported to attend any college course as appropriate - we saw that one person attends an arts and crafts college course and is supported by a learning support worker. People will be supported to use community facilities as they wish. One person regularly uses the local swimming pool, the cinema and likes to go to nearby Weston-superCare Homes for Adults (18-65 years) Page 13 of 27 Evidence: Mare. The other person liked to visit Clevedon and go shopping in Asda. People will be supported by the staff team to visit their family and other relatives. Holidays are arranged on a yearly basis. There were photos around the home of previous holiday and last year they went to Weymouth. Individual holidays may be arranged, or for two, three or four of the gentleman. The four people have lived together for many years, and we were told that they are dependent upon each other and are comfortable in each others company. People will be provided with a healthy and well balanced diet. In the evenings when all four are together they will have the main meal - they tend to all eat the same meals. During the day when they 1:1 time with a key worker they will be able to choose what they have to eat, or go out to eat. When they go to the day centre each person will take a packed lunch with them Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will receive the support with their personal and healthcare needs that they require, and the homes medication procedures are safe. Evidence: The two staff members who were on duty demonstrated a good knowledge of each persons healthcare and personal care needs. This knowledge is based upon the longterm relationship that has developed between them and the people they are looking after. Specific details regarding each persons care needs are recorded along with instructions of what action the staff team are to take. One persons plan provided detailed information about how the person could be supported to relax, whilst the other referred to the persons deteriorating mental health and the safeguards the staff needed to take. People will be supported as necessary, to attend any appointments with healthcare professionals. The homes medication systems are safe. Responsibility for the days medications is allocated to a particular staff member on a duty by duty basis. Staff spoken with during the inspection said that they had done safe administration of medication Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: training. The medication policy was last reviewed in July 2008. The storage arrangments are satisfactory. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home will be safeguarded from harm and can be assured that the staff team will ensure they are happy with the care and support they are receiving. Evidence: The homes Complaints Procedure is included in the Statement of Purpose but is also produced in pictoral format despite the fact that the four gentleman living in the home, are unable to understand the complaints procedure. The last complaint recorded in the homes complaints book was in 2006 but there was a good record of action taken, further action needed and the outcome of the complaint was recorded. We have received no complaints about this service. The staff team are able to determine when people are unhappy or are not comfortable with something. The interaction noted between one person and their support worker evidenced that this person was very comfortable with that member of staff. The support worker showed genuine care and compassion towards the person. All staff will do adult protection training and those spoken with demonstrated good awareness of safeguarding issues. They are aware of their responsibilities and would know how to report bad practice, if it became necessary. Care Homes for Adults (18-65 years) Page 17 of 27 Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cranwell Grove is a comfortable and safe home, and it meets the needs of the current people who live there. Evidence: Cranwell Grove has existed as a care home since 1990. It is a large detached property situated in a residential housing estate, surrounded by family homes, and areas of communal open spaces. From the outside there is no indication that the property is a care home and it remains in keeping with the local community. There is a small garden area to the rear of the property. The home is generally well maintained. Some parts of the home have already been redecorated and further works are planned. The large lounge room is due to be done fairly soon. The hallway is tatty and we were told that this will also be redecorated. The home is safe, comfortable, clean tidy and fresh smelling. The front door has an alarm fitted so that staff can be alerted if either of the four people try to leave the building. There are three communal areas in the house - a large lounge, separate dining room and a quiet room. Since the last inspection, new slding doors have been fitted in the Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: lounge, but grab rails are needed to make going in and out easier. We were told that the installation of rails by this door is already planned and will be done soon. A tour of the home was made and each persons bedroom seen. The bedrooms are large and each have a wash handbasin installed. The rooms are furnished to meet that persons needs. There is one main bathroom upstairs and a cloakroom on the ground floor. A grab rail is fitted to the side of the bath so that one person in particular can get in and out of the bath. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are looked after by well trained staff who are familiar with their individual needs and this means that their physical and emotional needs will be met. Evidence: A team of seven support workers including the interim home manager make up the staff team that support the four gentlemen who live at Cranwell Grove. Each staff member has a job specification that sets out the terms and conditions of their job. During the day there are always two support workers on duty and over night there is one sleep-in night staff. There is a team of Brandon Trust bank staff who would be used to cover any vacant shifts - this ensures that people will be looked after by staff that know how they like to do things, and are aware of their individual needs. Both support workers who were present for the inspection had worked at the home for many years. There has been one new member of staff recruited recently. Induction training is arranged for all new staff and this will involve attendance at the corporate headquarters and includes going through fire safety, food hygiene and learning disability training. All other staff have completed the NVQ Level 2 award in Care. This means that the support workers will be competent to look after the gentlemen who live at Cranwell Grove. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Observations of staff practice and interaction with the one person who was at home that day demonstrated that the staff were approachable, the person was comfortable and at ease in the company of the staff and that what was happening was arranged around their needs and not the staff. It was not possible to look at staff recruitment files however Brandon Trust have consistently demonstrated that they follow safe and robust recruitment procedures and ensure that they always recruit suitable staff. Previous to this visit we have visited the Brandon Trust offices and are satisfied that the recruitment procedures followed are good. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Cranwell Grove live in a home that is well run and run with their best interests in mind at all times. Evidence: The home manager post is currently vacant but the task of overseeing the running of the home has been delegated to an interim home manager. Brandon Trust are in the process of reorganising the home managers post in all of their community homes, and it is likely that in the future, one home manager will be registered with the Commission to cover up to three services, plus there will be a senior support worker in each home. Members of the senior management team from Brandon Trust visit the home on a monthly basis and audit arrangments at the home. Care plan reviews for each person have recently been undertaken, along with an advocate, for each person. This has been done because of the proposed closure of day care services and to enable plans for the future to be made. These measures will ensure that the service provided Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: always remains appropriate for the individual concerned. The fire log was up to date with all environmental checks completed on a regular basis. Drills for both staff and the people who live in the home are carried out on an almost monthly basis. The homes fire procedure states that the four people would not react to the fire alarm and therefore staff need to ensure that the four gentleman are evacuated in the order as per prioritised risk assessment. The Fire Risk Assessment was last reviewed in 2007 and therefore needs to be relooked at to make sure that it is still appropriate. The home is well maintained and safe. A door alarm is fitted to the front door, and staff are alerted if any one opens the door. Staff receive training in health and safety, infection control, fire safety, food hygiene and first aid - this means that they all follow safe working practices. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Those risk assessments that were written many years ago would benefit from being tidied up so the information they contain is clearer to read. The Fire Risk Assessment should be reviewed to ensure that it is still appropriate. 2 42 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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