Care Home: Cartmel Grange Care Home

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What the care home does well People living in the home and their relatives gave very positive feedback on the service and care provided. One relative said it would be "difficult to find a fault in the care" and another commented that "they make resident`s feel they are part of one big family". One relative said, " We have been very pleased with the standard of care and quality of staff, it takes a weight off my mind". The manager and staff take time to help people settle into the home and make sure it suits them and detailed information is easily available to help people decide about living in the home. One person living there told us that the home, " has lived up to every expectation I had". Care planning and care practice is person centred and supports people`s choice and independence. The service does regular audit work across all systems in the home to monitor the quality of the service and makes changes if needed. The environment is homely, clean, fresh smelling and comfortable and relatives and residents commented on the high standard of cleanliness. There are good systems for handling medication to make sure that medicines are managed safely and that residents receive the correct treatment. There is good communication with residents` doctors so that health care needs are met promptly. The management team and owners of the home present a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and quality of life of residents living in the home. The service includes residents and families in how the home is run and supports residents to achieve what is important to them. The home works hard at, and is creative in, providing leisure and recreational opportunities for residents. The activities coordinator organises and provides a varied activities programme based on individual preferences and capabilities. These are designed to appeal to different groups of residents and on an individual basis with one to one support where that is wanted to improve choice and quality of life. Staff are motivated to work to a high standard, and are well supported and supervised. Training and staff development is given a high priority in the home. Consequently staff morale and enthusiasm is high benefiting those who live there and their families. Staff are aware of the needs of residents and work well with relevant health care professionals to maintain an appropriate service for residents. The service has robust recruitment systems to ensure they get the right staff and promote the safety and wellbeing of people living there. What has improved since the last inspection? All records relating to medication are well kept and accurately show the treatment administered to residents. Where it is necessary to crush medication before administration this is done in residents` best interests and after proper consultation. Internally the providers continue to improve and update the home and equipment and adaptations to help residents get around the home according to their needs. New hoists have been provided to meet a range of moving and handling needs and additional pressure relieving mattresses for people who need them. New catering equipment has been bought to continue to improve in that department and new furniture as needed. A new lift is to be installed in and this is on order. This will be in addition to the existing small lift to make access easier and quicker between floors for residents especially at busy meal times. Bathing facilities on the ground floor have been upgraded to the same good standard as the others in the home. Improvements have been made in facilities for relatives to stay overnight where residents are poorly and need their family close by. There is now a flat available for people to stay in. The grounds have been greatly improved, developed and made tidy and residents have seating out there and some wheelchair access. The manager plans to further improve the outdoor space and make areas of the garden easier for wheelchair users to access. The manager is continuing to develop and improve the staff training programme and especially in relation to palliative and terminal care for residents. The number of staff with at least NVQ level 2 training in care continues to increase to develop the staff skills. The quality assurance systems continue to be improved to measure their success in meeting their aims and to promote resident choice and interests. Good practice in recruitment and staff checks has been improved to promote resident`s safety and welfare. The manager now renews staff criminal record bureau checks after three years to make sure nothing has changed. This home has previously worked hard at achieving the National Minimum Standards and providing good, safe care. Some of the improvements noted during this visit are not the kind that are less quantifiable but about atmosphere, and a culture of awareness of the individual resident and their aspirations. What the care home could do better: The service should review the use of loose medicine labels that are attached to medication administration records to reduce the risk from them becoming attached to the wrong record. The manager uses the quality monitoring systems to identify and address areas that can be improved and had already identified and begun to address areas of good practice in respect of additional assistance at mealtimes. CARE HOMES FOR OLDER PEOPLE Cartmel Grange Care Home Cartmel Grange Care Home Allithwaite Road Grange over Sands Cumbria LA11 7EL Lead Inspector Marian Whittam Unannounced Inspection 09:15 10 December 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 Cartmel Grange Care Home DS0000064543.V352517.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. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cartmel Grange Care Home Address Cartmel Grange Care Home Allithwaite Road Grange over Sands Cumbria LA11 7EL 015395 32028 015395 35438 valerie.kendall@brancastercarehomes.co.uk 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) Brancaster Care Homes Ltd Ms Valerie Kendall Care Home 61 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (61), Physical disability (2) Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 61 service users to include: up to 61 service users in the category of OP (Older people not falling within any other category) 2 named service users in the category of PD (Adults with physical disabilities) up to 23 service users in the category DE(E) (Dementia over 65 years of age) up to 5 service users in the category DE (Dementia under 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st August 2006 2. Date of last inspection Brief Description of the Service: Cartmel Grange Nursing Home is a care home with nursing, registered to offer nursing care for up to 61 residents including people with dementia. It is a large Victorian building extended and adapted to its current use and retaining many of its period features. It is on the on the edge of town of Grange-Over-Sands, overlooking the surrounding countryside and with extensive views across Morecambe Bay. The home is set in large gardens within walking distance of the town and local amenities, including the local railway station. The Home is on three floors, Bay View on the ground floor, Arnside on the first floor accommodating residents with dementia and Ingleborough View on the second floor. All floors have a separate lounge and one large main communal dining room on the ground floor. There is a passenger lift to allow residents access to all three floors. Brancaster Care Homes Limited owns and runs the home. Information is available to prospective residents in the Statement of purpose and service users guide; this is available and displayed in the home and the service user guide/welcome pack is in all bedrooms. A copy of the last inspection report is on display. The fees charged by the home range from £407.30 to £575.00 per week as at the date of the inspection. An additional charge is made for personal toiletries, newspapers, magazines, also hairdressing and chiropody services and any personal travel expenses, according to information provided during the inspection. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit to Cartmel Grange Nursing Home forms part of a key inspection. It took place over two days with a pharmacy inspection on 29.11.07 and we (The Commission for Social Care Inspection, CSCI) visited the home on 10.12.07 and two of us were in the home for five and a half hours. We conducted a short observational exercise lasting 2 hours (Short Observational Framework for Inspection, SOFI) to provide insight into people’s state of well being and staff interaction with them. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service does well and what could be improved. This was returned to CSCI in good time before the visit. • The service history. • Interviews with residents and staff on the day of the visit. • Observations made by us in the home during the visit. • SOFI, an inspection tool for directly observing and reporting on the quality of care people experience especially those who have communication difficulties. • Completed questionnaire survey forms from nursing and care staff and people using or coming into contact with the service. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. The CSCI pharmacist inspector assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager other staff and residents. The pharmacy inspection took four hours. What the service does well: People living in the home and their relatives gave very positive feedback on the service and care provided. One relative said it would be “difficult to find a fault in the care” and another commented that “they make resident’s feel they are part of one big family”. One relative said, “ We have been very pleased with the standard of care and quality of staff, it takes a weight off my mind”. The manager and staff take time to help people settle into the home and make Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 6 sure it suits them and detailed information is easily available to help people decide about living in the home. One person living there told us that the home, “ has lived up to every expectation I had”. Care planning and care practice is person centred and supports people’s choice and independence. The service does regular audit work across all systems in the home to monitor the quality of the service and makes changes if needed. The environment is homely, clean, fresh smelling and comfortable and relatives and residents commented on the high standard of cleanliness. There are good systems for handling medication to make sure that medicines are managed safely and that residents receive the correct treatment. There is good communication with residents’ doctors so that health care needs are met promptly. The management team and owners of the home present a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and quality of life of residents living in the home. The service includes residents and families in how the home is run and supports residents to achieve what is important to them. The home works hard at, and is creative in, providing leisure and recreational opportunities for residents. The activities coordinator organises and provides a varied activities programme based on individual preferences and capabilities. These are designed to appeal to different groups of residents and on an individual basis with one to one support where that is wanted to improve choice and quality of life. Staff are motivated to work to a high standard, and are well supported and supervised. Training and staff development is given a high priority in the home. Consequently staff morale and enthusiasm is high benefiting those who live there and their families. Staff are aware of the needs of residents and work well with relevant health care professionals to maintain an appropriate service for residents. The service has robust recruitment systems to ensure they get the right staff and promote the safety and wellbeing of people living there. What has improved since the last inspection? All records relating to medication are well kept and accurately show the treatment administered to residents. Where it is necessary to crush medication before administration this is done in residents’ best interests and after proper consultation. Internally the providers continue to improve and update the home and equipment and adaptations to help residents get around the home according to their needs. New hoists have been provided to meet a range of moving and handling needs and additional pressure relieving mattresses for people who Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 7 need them. New catering equipment has been bought to continue to improve in that department and new furniture as needed. A new lift is to be installed in and this is on order. This will be in addition to the existing small lift to make access easier and quicker between floors for residents especially at busy meal times. Bathing facilities on the ground floor have been upgraded to the same good standard as the others in the home. Improvements have been made in facilities for relatives to stay overnight where residents are poorly and need their family close by. There is now a flat available for people to stay in. The grounds have been greatly improved, developed and made tidy and residents have seating out there and some wheelchair access. The manager plans to further improve the outdoor space and make areas of the garden easier for wheelchair users to access. The manager is continuing to develop and improve the staff training programme and especially in relation to palliative and terminal care for residents. The number of staff with at least NVQ level 2 training in care continues to increase to develop the staff skills. The quality assurance systems continue to be improved to measure their success in meeting their aims and to promote resident choice and interests. Good practice in recruitment and staff checks has been improved to promote resident’s safety and welfare. The manager now renews staff criminal record bureau checks after three years to make sure nothing has changed. This home has previously worked hard at achieving the National Minimum Standards and providing good, safe care. Some of the improvements noted during this visit are not the kind that are less quantifiable but about atmosphere, and a culture of awareness of the individual resident and their aspirations. What they could do better: The service should review the use of loose medicine labels that are attached to medication administration records to reduce the risk from them becoming attached to the wrong record. The manager uses the quality monitoring systems to identify and address areas that can be improved and had already identified and begun to address areas of good practice in respect of additional assistance at mealtimes. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 8 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. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and facilities is clear and easily available before and following admission so people have useful information and are able to make an informed choice. EVIDENCE: Information is available about the home for prospective residents and their families in the statement of purpose and service users guide so they know what the home can provide. There is also information available about moving into care from other agencies such as those published by CSCI about choosing a care home and from Age Concern and Help the Aged. The notice boards in the foyer and corridors of the home give clear information of what is going on Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 11 in the home on a daily basis including quality monitoring as well as the information found in the regular newsletter “the Porthole”. A detailed information/welcome pack is provided for all residents in their bedrooms with useful information about the home and life there, what to expect when they come in, the services on offer and about settling into their new home. The home operates a named nurse and key worker system so when people come to live in the home they are able to spend time with them helping them feel comfortable with their new home. The admission process is led by the individual’s needs and includes the family in the support offered. One newer resident said “ the staff have enabled me to settle in well here and encouraged me to talk to others and make friends”. This time is also spent gathering information with new residents and their families for developing their individual personal profiles with them. All residents have an individual plan of care and resident’s needs have been assessed in detail before and following admission and their individual care plans developed from this. The home manager or senior nursing staff do an individual assessment of needs to ensure that the home can meet the needs before residents came to live there. The assessments seen were detailed and clear and, where appropriate, assessments undertaken by social services are obtained. Where appropriate families, specialised care agencies and professionals have been involved in providing information on the health, social, cultural and personal care needs to be met for residents. All prospective residents and/or their families are invited and encouraged to visit the home prior to admission to speak to staff and ask questions. This gives them an opportunity to assess the quality and suitability of the home. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9, 10 and 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a comprehensive person centred care planning and assessment system in place to provide information for staff. People living in the home are protected by safe systems for handling medicines that are continually assessed for quality. EVIDENCE: People using the service are supported using a person centred approach to be involved in planning their care. All residents have an individual plan/profile of care, based on initial assessments and the individual plans set out their health, personal and social care needs and personal and clinical risk assessments. All plans and assessments are evaluated, reviewed, updated and audited regularly to make sure procedures are being followed and individual needs met. For one person a review of nutritional needs had led to a review by a dietician and a plan put in place to make sure appropriate nutritional support was provided. Changes identified at evaluation are incorporated into care plans and needs Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 13 assessments and the plans are focused on outcomes for people. Care plans were in place for medicines prescribed, “when required” to make sure that they were given only when needed to prevent unnecessary treatment and is safe practice. People nursed in bed or with communication difficulties also have ‘advanced care plans’ where the objective is to develop an individualised guide to promote better communication and understanding of people’s feelings needs and preferences. This helps improve their quality of life and asks questions, such as “what do you want to happen”. This was very evident for one person with communication difficulties who had been supported to express some important personal wishes in their care. Residents spoken with were happy with their care and survey responses supported that view. One resident said, “I am very happy here, they always act on my requests promptly”. Another said, “Everyone helps me and listens”. The home also uses the ‘Liverpool Care Pathway’ for care homes for terminally ill residents, setting goals in their care and giving a clear pathway for assessment and management of pain and situations arising at the end of life. There is evidence of timely referral to health care services and the actions taken following their involvement. Resident’s health care needs and reviews are being promptly attended to and the home works well with other agencies and health professionals to meet identified needs. This was evident for one person where pain levels were being monitored and doctors involved for the timely review of pain relief. Doctors from the local surgeries do a weekly visit to the home to monitor and see residents promptly. Residents spoken with said their privacy was respected and felt their dignity upheld. Observation during the inspection, including moving and handling and assistance with eating and drinking suggests that resident’s dignity is being promoted and independence promoted in accordance with their plans. We observed that all the staff addressed the residents in a respectful manner and that the staff at the home showed a good understanding of the residents and their needs and communicated well. We looked at medication handling and practices and found there were good systems in place for ordering and double-checking medication to make sure that any errors are found and dealt with quickly and before administration to residents. Medication that was looked after on behalf of residents was handled safely and administered accurately to protect their health. Residents who are able to are supported to administer their own medication and this allowed them to remain as independent as possible Medicines, with only rare exceptions, could be accounted for at all times and this showed that residents received treatment in the prescribed doses. All records relating to medicines were well kept and accurately showed the treatment that had been administered. However, the practice of using loose medicines labels printed by the pharmacy is not recommended in case the label becomes attached to the wrong record that could result the medicine being given to the wrong person. Cartmel Grange Care Home DS0000064543.V352517.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): NMS 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A full and varied programme of well organised activities is provided that takes into account resident’s individual preferences, capabilities, and cultural and religious expectations. The dietary needs of the residents are well catered for. EVIDENCE: The home has an activities coordinator who along with staff provides a range of advertised group and one to one activities. The activities programme is reviewed each week and the programme reflects what people living there say they want to do want to do. This includes concerts, theatre groups musical groups, art sessions, film club, various games, discussion groups, monthly Tai Chi and social and religious events. There is a separate television lounge with a large flat screen digital television used for the film club. Staff also put on events for residents such as traditional Indian and Philippino dancing. The newsletter has all the dates for outings and activities and resident shopping days in Kendal and church services. Resident’s former hobbies and current interests and ‘life maps’ are recorded in detail and individual abilities and capabilities are given consideration in planning and carrying out activities. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 15 For example one person nursed in bed has more one to one activities such as ‘pamper sessions’ as they could not join in the group activities. The home also provides a useful correspondence session for people to help them keep up personal correspondence with family and friends and help them with letter writing and sending cards to keep in touch with family and friends. The pictures provided by the social assessments are clear and give a person centred background to residents as individuals and to what is important to them and what has or has had significance in their lives. An activity record shows what people have enjoyed doing and valued. Resident’s surveys confirm that there are a variety of activities on offer but that residents do not have to join in if they do not want to. Relatives commented positively on activities saying there was “a good range of activities in the afternoon. ”Relative’s comments indicate that they feel involved in the life of the home and one said “there is always a word of care and welcome to visitors and residents alike”. The service has a group of local volunteers who take a trolley around weekly with toiletries, sweets and everyday items that residents may need. People told us they found this a useful service and also had a chat at the same time. The service encourages and promotes local community involvement in the home and local community groups visit the home such as the bowls and croquet club and the Alzheimer’s Society hold their monthly support group meeting in the home. The manager wants to extend this to hold meetings for the residents with the Age Concern advocacy/advice service on a regular structured basis. Information on advocacy is displayed and the service made available to residents along with useful contact information. Menus are displayed on the dining room tables and were varied and nutritious People told us there is always a choice of food each day and that there are drinks provided throughout the day. Residents said that they could have alternatives to the choices on the menu and mealtimes were flexible. This was very important for one person who told us that when their knees were bothering them “they bring my meals to me, which is great”. . Another person told us their only complaint about the food was that “portions can be over generous”. We spoke with the chef and visited the kitchen. The kitchen was clean and well equipped, with appropriate records maintained. Residents spoken with all said the quality and choice of food was good. We observed the residents for part of the lunch period. Lunch was served in a relaxed, unhurried manner with the residents chatting with each other and the staff. There were a lot of residents who needed assistance with eating and staff provided this. However it could make the meal time experience better for the more restless residents if more staff were assisting to both help people with their meal so some people did not became restless. We discussed this with the manager who was already trying to address this through consulting with residents and families about what changes they felt would help improve meal times. Cartmel Grange Care Home DS0000064543.V352517.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): NMS 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective complaints system and procedures to promote residents safety that both residents and staff are aware of and have confidence in. EVIDENCE: The home has received 2 complaints in the last year and both were fully investigated and addressed using the home’s procedures. There is a complaints logging system that records all complaints and the details of the investigation and the actions taken to prevent it happening again. The manager copies CSCI into all its responses to complaints and the actions it has taken. Complaints monitoring is linked to the home’s quality assurance system for quality checking. The home has a clear complaint procedure that is displayed and available throughout the home. Additionally the complaints procedure is in the information packs in resident’s rooms. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 17 We talked with the manager and looked at complaints records and the changes that had been made as a result of matters people raise formally and informally. The service had a positive approach to complaints and concerns and what could be learned from them and improved upon. Surveys received from residents and relatives indicate that they are aware of the complaints systems and that they felt confident that they would be listened to and their concerns properly dealt with. Nursing and care staff have had training on recognising abuse and adult protection procedures. Staff spoken with were aware of the procedure to follow and told us what they would do if they suspected abuse. The home has its own policies and procedures in place for adult protection; identifying and reporting abuse and whistle blowing. These are in line with the current multi agency guidance and this is also available in the home. Information on advocacy is provided for residents in the home and the service is obtained on request. Cartmel Grange Care Home DS0000064543.V352517.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): NMS 19, 20, 21,22, 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 environment within the home is of a consistently high standard providing residents with a well maintained, well equipped, clean, attractive and homely place to live. EVIDENCE: The home is well maintained with a high standard of decoration throughout that provides a clean, tidy and homely environment for residents. Attention is paid to detail and making the environment welcoming and homely, lounges are arranged in a way that promotes groups rather than being institutional. The lounge and dining areas are spacious, comfortable and well furnished with good lighting and seating. The home has a rolling programme of redecoration and upgrading of bedrooms and communal areas. The homes own Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 19 maintenance person does small daily maintenance jobs promptly. One relative who visits the home regularly commented that the home is “always beautifully clean and nicely furnished”. Another relative told us “Bedrooms and bathrooms are clean and there is no smell when you go in”. Resident’s bedrooms that we saw had a high standard of décor, and furnishings. Many residents had brought some of their own possessions in with them and this made their bedrooms more personal and homely. Bedrooms are all single occupancy, are light and naturally ventilated with domestic type lighting. Many rooms have extensive views over Morecambe Bay and the surrounding hills. Several people told us how much they enjoyed being able to see these from their rooms. The grounds have been greatly improved and made tidy and residents have seating out there and some wheelchair access. The manager plans to further improve the outdoor space and make areas of the garden easier for wheelchair users to access. There is a range of equipment, nursing beds, and adaptations to help residents make the most of their independence and to get about the home and call bells are accessible in areas used by residents. A new lift is planned to be installed and is on order. This will be in addition to the existing small lift to make access easier and quicker between floors for residents. New hoists have also been purchased, additional pressure relieving mattresses and more catering equipment to meet needs as they have arisen. Staff have been trained in the use of such equipment and residents are assessed for its safe use. There are clear infection control procedures and we saw staff using gloves and aprons during care and using appropriate clinical waste disposal. Staff have been given training on infection control and this is recorded in their training records. Bathing facilities on the ground floor have been upgraded to the same good standard as the others in the home. As part of the ongoing development of palliative and terminal nursing care in the home there is now a flat available on the premises for relatives to use. This will allow family and friends so to remain close to and spend time with family members who are approaching the end of their lives. Cartmel Grange Care Home DS0000064543.V352517.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): NMS 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has robust recruitment processes and sufficient nursing and care staff on duty day and night. Comprehensive and person centred training programmes ensure that staff have the skills and knowledge to give a consistently high standard of care to people living there. EVIDENCE: Staff rotas and observation during the visit indicate the home has sufficient staff on duty with a range of skills and experience to provide a consistently high level of individual care. This and low staff turnover provides continuity for residents during the day and night. Staff spoken with enjoyed their work, felt valued and supported by their manager and the organisation they worked for. Consequently morale was good in the home with staff feeling very motivated to maintain high care standards and develop professionally and personally. One resident told us, “ I know the staff are doing their job but it’s the way they do it, they don’t make you feel embarrassed, they keep your dignity and I am very happy to be here” One relative survey response commented that” I think the home is well managed so that all staff including the cleaners and gardener are respectful and caring towards residents and visitors”. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 21 The home has a high percentage of care staff with NVQ Level 2 in care or above and encourages staff to undertake a range of training beyond the mandatory. Three members of nursing staff are doing the Registered Managers Award to increase their management skills and develop professionally. The home has a specific training programme for all care staff so they are properly prepared for their roles. Staff training and development for nursing and care staff is promoted, including palliative care and equality and diversity and dementia care training. There is an annual training plan covering mandatory training and training specific to the resident groups. Individual training files identifying staff training needs and induction records are kept for all staff. A senior member of the care staff works as a training coordinator to make sure all training is fully organised and takes place as planned. Different members of nursing staff undertake additional training to act as an expert resource in areas such as continence, wound care, terminal care and activities provision for those with dementia. The manager promotes a ‘learning culture’, that can be seen from the monthly training day that all staff attend to improve good practice. The last one was given by an occupational therapist to raise staff awareness on activities. The organisation emphasises its commitment to training by ensuring staff are paid for all their training sessions, have access to distance learning and provides a separate training room for external trainers to use. Robust recruitment procedures and practices are in place and are being observed. Records of recent staff recruitment show that all necessary checks to safeguard residents are being done prior to staff starting work there. Staff have clear job descriptions and terms and conditions of employment. Registered nurses personal identification numbers are checked on recruitment and periodically to make sure no changes have taken place to further protect resident’s interests. The home has implemented a policy of three yearly CRB checks for all staff and is currently renewing the CRB checks for all staff in post over three years. This demonstrates good practice and the importance given to safeguarding people living in the home. Cartmel Grange Care Home DS0000064543.V352517.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): NMS 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Effective management safeguards people using the service and procedures are in place to safeguard resident’s interests and promote their health and safety. EVIDENCE: The registered manager is well qualified and experienced for her role and is well supported by the deputy and an enthusiastic and highly effective nursing team to provide a well run service. The manager is also well supported by the owners of the home to identify and work to improve services where they can. The home has clear development plans outlining annual objectives. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 23 The management team has a clear vision for the home of continued improvement. Staff confirm that formal and daily supervision is being done and regular staff meetings are held with staff contributing to the agenda. This allows staff feedback as well as internal reviews of policies and procedures, audits and information sharing. Staff supervision systems have been improved, following audit, to better reflect practices through observations of staff undertaking care. This is to ensure staff are clear about the high standard of care in practice that is required by the organisation. Supervision looks at core values of the home, procedures, training needs and personal issues that may need support. Staff told us they were well supported and knew what was expected of them. Staff, residents and relatives confirm that the manager has an ‘open door policy’ for anyone who want to speak with her and we saw this in practice. Record keeping is in good order with clear up to date documentation that is kept securely. Much audit work is being done to make sure that systems are frequently monitored for quality and effectiveness for example, medication practices and care plans, complaints, and supervision to identify and correct any problems quickly. Accidents and falls are subject to analysis and using audit and analysis the staff have been able to reduce the number of falls residents have. There are residents and relatives’ and visiting professional’s satisfaction surveys to gauge satisfaction with the service provided. There are regular resident and relatives meetings for feedback and suggestions. Records and servicing contracts indicate that the home has systems in operation and training to promote resident health and safety. The home has three moving and handling trainers to act as a resource in the home and ensure all staff have this training. There is evidence that appropriate testing and cleaning is being carried out to reduce the risk of Legionella and water temperature testing to reduce the risk of scalds to residents. Records showed that servicing and maintenance of equipment is being done. Cartmel Grange Care Home DS0000064543.V352517.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 4 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 4 X 3 3 3 3 Cartmel Grange Care Home DS0000064543.V352517.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that the practice of attaching loose dispensing labels to medicines administration records be reviewed with the supplying pharmacist to prevent potential errors. Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cartmel Grange Care Home DS0000064543.V352517.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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