Care Home: Craighaven Residential Home

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What the care home does well All prospective residents are assessed prior to them living at the home so that their needs can be identified and a decision can be made on whether these can be met.Craighaven Residential HomeDS0000063561.V376857.R01.S.docVersion 5.2The staff are friendly, caring, approachable and have a good rapport with people living in the home. A comment card received from a visiting professional stated: “They provide excellent care always contact me appropriately, always carry out my instructions, follow my advice. It’s a happy, lively, caring environment”. Relatives are happy with the care and services being provided and were positive in their comments about the home. One relative stated in a letter to us:- “Mum was certainly happy there as she could be, we also know from personal observation on many visits that each resident is treated very much as an individual”. Another stated “it looks after the residents extremely well, they always look neat and clean” People receive a choice of meals which are appetising and which they enjoy. One person spoken to said the food was “marvellous”. The home is comfortable and homely and people enjoy the freedom of being able to access different lounges as well as a sensory room which provides a quiet and more relaxing environment. Staff try to ensure that a social activity is provided every day so that people get the social stimulation they need. One relative stated in a comment card to us “always things to keep residents busy ie videos, exercises, dancing, quiz. Lots of special celebrations, birthdays, anniversary, Mothers day, Saints day etc”. Over 50% of the care staff have achieved a National Vocational Qualification (NVQ) in care to help them provide more effective care to the people living in the home. What has improved since the last inspection? Medication management has been reviewed and care records are now much clearer in demonstrating that medication has been given as prescribed. Menus have been changed to contain more detail and include pictures of food items so that it is clearer for people to identify food choices available to them. Some of the bedrooms have been redecorated to improve the environment for people living in the home. A key worker system has been introduced which links each person who lives in the home to an identified member of staff. The member of staff is responsible for monitoring their ongoing needs and following up any matters with the manager or family as appropriate to make sure their care is delivered effectively.Craighaven Residential HomeDS0000063561.V376857.R01.S.docVersion 5.2Systems for monitoring the amount of food people are eating have improved so that staff can identify those people who may be at risk of poor nutrition, weight loss and ill health. New door locking mechanisms have been fitted to bedroom and bathroom doors so that people can easily exit these rooms without the risk of locking themselves in. Some of the sash windows to the rear of the building have been replaced to a more user friendly design as well as improve the environment for people living in the home. What the care home could do better: Records relating to the management of dressings for wounds must be clear to ensure professional advice is followed and staff are clear on their responsibilities in meeting the person’s needs. Accidents and incidents resulting in medical intervention or which impact on the wellbeing of people living in the home must be reported to us consistently. This is so we know these are being identified and appropriate actions are being taken to safeguard people. Care records need to be signed and dated and daily records need to be sufficiently detailed so that it is clear care needs identified are being met in a timely manner. A clear system for staff to record any complaints received should be devised so that any concerns can be easily identified and followed up accordingly. The use of door wedges must be reviewed with the fire officer so that people are not placed at risk in the event of a fire. Key inspection report CARE HOMES FOR OLDER PEOPLE Craighaven Residential Home Craighaven 4 Heath Terrace Leamington Spa Warwickshire CV32 5LY Lead Inspector Sandra Wade Key Unannounced Inspection 4th August 2009 08:15 DS0000063561.V376857.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Craighaven Residential Home Address Craighaven 4 Heath Terrace Leamington Spa Warwickshire CV32 5LY 01926 429209 01926 339686 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) Craighaven Limited Elizabeth Joy Heritage Care Home 35 Category(ies) of Dementia (35) registration, with number of places Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) 35 The maximum number of service users who can be accommodated is: 35 5 August 2008 Date of last inspection Brief Description of the Service: Craighaven provides care and accommodation for 35 older people and has dementia care registration. The home is located in a residential street in the Milverton area of Leamington Spa, approximately one mile from the town centre. There are local shops, a post office, pub, hairdressers and churches located within half a mile of the home. Doctors surgeries, dentists, chiropodist etc, are readily available and within easy access of the home. Craighaven provides accommodation on three floors (lower ground, ground and first floor). There are 25 single rooms and five double rooms and all have ensuite facilities. Each area is accessed by a stair lift and some corridor areas and rooms have steps to access the rooms. There is no passenger lift available in this home to accommodate wheelchairs. There are three main lounge areas and a sensory room. The home has a variety of equipment and adaptations including handrails, grab rails, mechanical/electrical hoists, adjustable beds, raised toilet seats and wheelchairs. There is a public telephone available. People can arrange to have a telephone installed in their own private room if they wish. The home is set in its own grounds and has an attractive enclosed paved garden area with various tables and chairs. Some of the doors from the main building used to access the garden have steps but there is a ramp from one of the doors to allow people with wheelchairs to access the garden easily. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 5 The fees for the home are published in the Service User Guide which is made available to people upon admission. At the time of this inspection the fees ranged from £560 up to £600 (private rate) per week. These are subject to change and persons may wish to obtain more up-to-date information from the service. Extra charges are made for chiropody, hairdressing, personal newspapers, some toiletries and social activity projects where appropriate carried out in the home. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 8.15am and 6.20pm. Three people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Comment cards were also sent out to people living in the home, staff and GPs to ascertain their views of the service. We received two responses from GPs, six responses from people living at the home and five responses by staff who work at the home. Information contained within these as well as the AQAA has been included within this report where appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, complaint records, financial records, maintenance records and medication records. Because people with dementia are not always able to tell us about their experiences, time was spent in one of the lounges observing what it is like for people living in the home. Both breakfast and lunchtimes were also observed. A brief tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: All prospective residents are assessed prior to them living at the home so that their needs can be identified and a decision can be made on whether these can be met. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 7 The staff are friendly, caring, approachable and have a good rapport with people living in the home. A comment card received from a visiting professional stated: “They provide excellent care always contact me appropriately, always carry out my instructions, follow my advice. It’s a happy, lively, caring environment”. Relatives are happy with the care and services being provided and were positive in their comments about the home. One relative stated in a letter to us:- “Mum was certainly happy there as she could be, we also know from personal observation on many visits that each resident is treated very much as an individual”. Another stated “it looks after the residents extremely well, they always look neat and clean” People receive a choice of meals which are appetising and which they enjoy. One person spoken to said the food was “marvellous”. The home is comfortable and homely and people enjoy the freedom of being able to access different lounges as well as a sensory room which provides a quiet and more relaxing environment. Staff try to ensure that a social activity is provided every day so that people get the social stimulation they need. One relative stated in a comment card to us “always things to keep residents busy ie videos, exercises, dancing, quiz. Lots of special celebrations, birthdays, anniversary, Mothers day, Saints day etc”. Over 50 of the care staff have achieved a National Vocational Qualification (NVQ) in care to help them provide more effective care to the people living in the home. What has improved since the last inspection? Medication management has been reviewed and care records are now much clearer in demonstrating that medication has been given as prescribed. Menus have been changed to contain more detail and include pictures of food items so that it is clearer for people to identify food choices available to them. Some of the bedrooms have been redecorated to improve the environment for people living in the home. A key worker system has been introduced which links each person who lives in the home to an identified member of staff. The member of staff is responsible for monitoring their ongoing needs and following up any matters with the manager or family as appropriate to make sure their care is delivered effectively. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 8 Systems for monitoring the amount of food people are eating have improved so that staff can identify those people who may be at risk of poor nutrition, weight loss and ill health. New door locking mechanisms have been fitted to bedroom and bathroom doors so that people can easily exit these rooms without the risk of locking themselves in. Some of the sash windows to the rear of the building have been replaced to a more user friendly design as well as improve the environment for people living in the home. 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 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. Craighaven Residential Home DS0000063561.V376857.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 Craighaven Residential Home DS0000063561.V376857.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed at this inspection. People using the service experience good quality outcomes in this area. People have access to written information about the home to help them make an informed decision on whether to stay. An assessment of people’s needs is carried out prior to them staying in the home to ensure these can be met effectively. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a Service User Guide and Resident Handbook containing detailed information about the home which is given out to prospective residents or their representatives. Since the last inspection action has been taken to ensure this contains a copy of our summary inspection report to help people make an informed decision about arranging a placement in the home. However the Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 11 Guide did not contain a standard form of contract which is also helpful in informing people about what can be expected if they choose to stay. The Service User Guide had been produced in small print which could make it difficult for some people to read but the ‘Residents Handbook’ had been produced in larger print and did contain some of the information in the Service User Guide. Our current address had not been updated in case people wanted to contact us. The manager acknowledged this and said arrangements were being made to update these details. The manager confirmed the pre-assessment process which enables the needs of any new person to be assessed before they come to live at the home. The manager said this assessment is usually carried out by herself or a member of the management team who visits the person in their own home or in hospital as appropriate. This assessment ensures the needs of people are identified so that a decision can be made whether these needs can be met by the home. Copies of the pre-assessment records were available to confirm these assessments had been carried out. Information obtained at the assessment stage had been transferred into care plan records to ensure staff support to meet these needs could be arranged. Craighaven Residential Home DS0000063561.V376857.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. People using the service experience good quality outcomes in this area. People living in the home feel well cared for and each person has a detailed care plan to ensure their needs are identified and can be met by staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During the inspection staff were friendly, caring and supportive towards people living in the home. Staff greeted each person as they came into the lounge areas and were seen to interact with people throughout the day. A review of the care and records for three people was undertaken. Care plans contained details about the persons preferences in regards to touch and smell as well as details about their speech, memory, mobility, oral health, washing, bathing and dressing. They also confirmed if the person liked physical contact such as a ‘cuddle’ or holding hands when speaking to them. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 13 Where there were any deficiencies in records, staff were able to explain how they delivered care and what they would do to ensure the person’s needs were met. Since the last inspection care plans detailing the needs of people have been rewritten and updated so that it clear what support they require. The care of a person with a skin problem was reviewed. It was clear that a care plan had been devised showing the symptoms of this and the effects these had on the person. Creams had been prescribed and staff spoken to said that they were applying these daily to treat the condition. Staff also explained other actions they were taking to help relieve this condition including ensuring the person wore their preferred selection of clothing. The only area where some improvements were required was in relation to the daily records that staff complete. These did not always give a picture of the symptoms and problems the person suffered as a result of the skin condition. The manager said this had already been identified and was due to be discussed at a staff meeting. The care of a person with diabetes was viewed. There was a care plan in place for the management of this which said they were to be given sugar free snacks between meals and sugar free squash. It also acknowledged that the person did not eat particularly well. A nutritional risk assessment had been completed showing this person was at risk of poor nutrition. It was evident that the person was being regularly weighed to check any weight loss and records were kept of how much food they were eating each day. Weight records showed slight fluctuations each month with some showing they weighed less and some showing a slight increase. It was not clear what high calorie snacks this person was receiving in between meals. Snacks on the menus only showed biscuits which were not appropriate for this person on a regular basis due to their diabetes. The manager said that they give this person cheese and biscuits but there were no records seen to demonstrate this. The care of a person who had suffered from pressure sores to the skin was viewed. It was evident that staff had devised a suitable care plan for monitoring the skin to ensure any red areas or breakdown of the skin was identified. A risk assessment had also been completed showing this person was at high risk of skin damage. Records stated that a pressure relieving mattress was in place and the person was to sit on a pressure cushion. The person was observed to sit on a pressure cushion and their bed also had a specialist mattress in place. Staff said that they applied creams to this person’s heels on a regular basis and creams were seen to enable this to happen. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 14 The support of the district nurse had been sought when a pressure sore had been identified so that an appropriate dressing could be applied. It was not clear from records in place how often the dressing was actually being changed or how staff were managing this sore in between the district nurse visits. For example there were no instructions to staff to monitor that the dressing did not fall off and what they should do if it did. There were also no instructions to staff on how they should provide personal care such as bathing whilst the dressing was in place. The manager agreed to make the care plan clearer in regards to this. Staff spoken to said that if the dressing did become loose or fall off they would replace it themselves until the district nurse came in. They also said depending on where the pressure sores were they would either protect the area from getting wet or would provide a bed bath. Care plans were not individually dated and signed so there was a clear audit trail of when the care needs had been identified. This is helpful to know particularly when care needs change so that it is possible to see if a person’s health has improved or deteriorated. Falls risk assessments had been carried out for each person whose care file was reviewed. Staff were recording any falls that people had sustained in the daily records and there was also an additional sheet kept on care files for staff to record falls so that these could be monitored on a monthly basis. Some people had pressure mats in use by their beds so that if they got out of bed staff were alerted to this and could go to their assistance to prevent them falling. Positive steps had been taken by the home in terms of identifying those people who may be at risk of deprivation of their liberty. The home had developed a policy so that they can support people in the home appropriately. A deprivation of liberty for example could be linked to a care practice which may prevent someone from doing something they want because it would place them at risk. This could be preventing a person from leaving the care home on their own because there is a risk they would try to cross a road in a dangerous way. The manager was aware that treatment plans needed to be in the best interests of the person and that care professionals needed to be consulted where appropriate. The manager had instigated an assessment for one of the people in the home and actions were in the process of being undertaken following the assessment. One person had poor sight and although the care plan identified this and did state that staff needed to explain things such as what they are wearing or eating it was not clear that large print documentation or talking books had been explored. The manager agreed to follow this up. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 15 People who responded to our comment cards were positive in their responses to us although it should be acknowledged that due to their dementia diagnosis some people had been supported by family to complete these. Comment cards received from all six people stated they “always” receive the care and support they need. One person stated “provides very good care” another stated the home “looks after the residents extremely well, they always look neat and clean”, another stated “very attentive towards my mothers needs”. Two relatives spoken to during the inspection were positive about the care being provided. When asked about the care and if they were happy with this one stated “oh yes very happy” and the other said “wonderful”. Comment cards were received from two professionals. One stated “provides a caring and supportive environment for patients ( their families) suffering from dementia. Providing for both their physical and psychological needs whenever they can”. The other stated “They provide excellent care always contact me appropriately, always carry out my instructions, follow my advice. It’s a happy, lively, caring environment”. A relative had written to us to express how happy they were with the care their relative had received in the home. They stated “I am writing to compliment this home on the excellent care they provided to my elderly mother during her period of stay”. A review of medications was undertaken and these were found to be managed well. It was evident improvements had been made following the last inspection. The home has a medication trolley, a small medication room, a medication fridge and a cupboard to store all medication appropriately. The medications checked were mostly in blister packs known as a ‘monitored dosage system’ (MDS) where staff push out the tablets or capsules from the packs. Some of the medications were in individually named boxes. The amount of medication received at the beginning of the medication cycle was clearly indicated on the medication charts so that it was clear how much medication each person had at the beginning of the medication cycle. All medications checked were accurate in regards to the amount given and remaining. The medication record for one person stated the medication should be given at 7am with food but there was another medication for 7am stating it was to be given half an hour before food. It was not clear from the records how this was being managed. The member of staff assisting with the medications audit stated that one tablet was given half an hour before another and the one to be taken with food was given with a biscuit. This was however for a person with Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 16 diabetes. The manager said that the person could occasionally have sweet items but this was not fully reflected in the diabetes care plan. This is important so that staff know the restrictions in managing the diabetes and can make sure this is effectively managed. The code ‘o’ was being used on some of the medication charts as opposed to a signature which would confirm the medication had been given. The ‘o’ was not defined on the chart so it was not clear how the medication had been managed. There were no people on controlled drugs but appropriate facilities for the storage of these was in place and a register was also available should this be required. There were no concerns with direct care given in regards to the privacy and dignity of people in the home. In the double rooms there was a screen available although it was evident this would provide limited privacy. The manager stated that plans had been agreed to convert the double rooms into single rooms and it was hoped this work would be done by the end of the year. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. People using the service experience good quality outcomes in this area. People have access to social activities and are able to exercise choices regarding their care and meals where appropriate to maintain their independence and wellbeing. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is an Activity Organiser/Welfare Officer who works in the home five days a week usually in the afternoon to organise and provide social activities for people living in the home. The Annual Quality Assurance Assessment (AQAA) completed by the manager states “The wishes of the service user are at the core of everything we do. We have a dedicated activities co-ordinator and offer a choice of daily activities for the service users to choose from. We encourage service users to take part in activities but we do respect their wishes should they not wish to participate”. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 18 This was found to be the case during the inspection. Social activities for the day were detailed on a notice board in the reception area of the home. This included, looking at books, card games and Tai Chi. Pictures of these activities were also on the notice board so that people living in the home could see what the activity involved. There was also a weekly social activity schedule on display which included a pamper day, looking at old photos, radio, poetry and floor games. Records in the home confirmed which activities each person had participated in. The manager said that social activities are provided every day although some people were happy to observe rather than join in. The atmosphere on the day of inspection was a happy and lively one at times as family members and friends came to visit. During the morning easy listening music was being playing while people were assisted to the dining areas for breakfast. Staff greeted people as they entered the lounge and dining areas and they responded. Some people chose to read newspapers, listen to music or sit in the sensory room and chat to staff as they passed by. The sensory room has seating for five people and contains a CD player, pictures of beach scenes, lighting around the top of room, side tables and a call bell lead should staff assistance be needed. Comment cards received by us from people living in the home showed that out of the six responses received, two people felt there were “always” activities they could take part in, three felt there “usually” and one person did not respond. A relative stated “always things to keep residents busy ie videos, exercises, dancing, quiz. Lots of special celebrations, birthdays, anniversary, Mothers day, Saints day etc”. In July the home had organised a Strawberry and Cream Tea afternoon which they reported had gone well. It was advised that money raised was going towards a new minibus so that more regular outings could be organised for people living in the home. Care files contained “Getting to know you” forms and these listed information such as names of family members, significant events, past holidays, past occupations, hobbies and interests etc. This information helps staff to focus their social activities in accordance with the needs and wishes of people living in the home. Staff spoken to were knowledgeable on what people liked to do socially and it was evident when discussing this with them that this information was also reflected in care files. This included for example staff being knowledgeable of family names and family events that had taken place. One person said they were not happy because they could not leave the home they said “every day I get up and have two cups of tea, sit in room and watch television, I want you to let me out”. The manager told us that she had taken Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 19 appropriate actions to follow up this matter with the social worker as there were safety risks involved should this person leave the home. The manager had discussed what could be done to meet the wishes of the person to move to a different home closer to a family member. It was evident the person was happy in other ways but not with the situation they were in. They said “staff are good they are very nice they are and we can have a laugh”. The breakfast time was observed and each of the dining areas were full. Breakfast consisted of cereals, toast or a cooked breakfast. Some people had their breakfast later than others depending on when they got up. Staff were on hand to support those that needed help or prompting. At lunch time the meal was beef stew and dumplings or fish pie followed by lemon sponge and custard or apricots and custard. The meals looked appetising and quantities had been adjusted according to the needs of the people. The AQAA completed by the manager makes reference to people being “free to choose where they sit in the home” as well as having a choice which dining room they wish to dine in. The AQAA also states that people can choose to eat in their own room should they wish to. At lunch time, staff showed each person the two plated meals to see which one they would like. One person said “I don’t know just put one down whatever you like”. When this person started to eat they said “marvellous” All tables had juice for people to drink. In one dining room there was not enough fish pie so a member of staff took the time to go to the kitchen to get some more. Overall the mealtime experience was observed to be a positive one with people enjoying their meals. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 assessed. People using the service experience good quality outcomes in this area. People know how to raise any concern and systems are in place to ensure any allegations of abuse or complaints are investigated and acted upon appropriately to safeguard people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A complaints procedure is in place and this was on display in the reception area of the home and was also detailed in the Service User Guide which is provided to each person upon their admission. The manager states in the Annual Quality Assurance Assessment (AQAA) that the complaints procedure can be provided in large print upon request. The complaints procedure did not detail the Local Authority contact details to enable any person wishing to make a complaint to easily find this information if they are not happy with responses from the home. This will need to be addressed. All comment card responses received by us from people living in the home or their representatives stated they knew who to speak to if they had a concern. Since the last inspection we have received no complaints about this service. Records seen showed that the home also had not received any complaints. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 21 Staff spoken to said that if a complaint was raised with them they would report this to the manager. It was not clear there was a recording system in place to ensure complaints were documented for follow up in the absence of the manager. The manager agreed to address this. Staff spoken to were aware that if they were to observe abuse or receive any allegations of abuse they must report this to the manager. The manager states in the AQAA that staff have been completing a distance learning course run by the Warwickshire Safeguarding Adults Board entitled ‘Recognising and responding to adult abuse and neglect’. This training helps staff understand their responsibilities so they can respond to any allegations of abuse made effectively and ensure people are protected. A ‘Whistleblowing” Policy is in place which sets out some information about what staff can expect should they report an allegation of abuse. It was limited in the finer detail of what protections are in place for staff who report abuse and how this could impact on them. The manager agreed to look at reviewing this. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 and 26 were assessed. People using the service experience good quality outcomes in this area. People live in a comfortable and homely environment which is subject to ongoing maintenance to ensure this remains pleasant and safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Bedrooms are located on three floors (lower ground, ground and first floor). Access around the home is via a variety of staircases, which have stair chairs; there is no shaft lift to support wheelchairs and corridors are not very wide to effectively support residents confined to the use of wheelchairs. There are three main lounge areas and a smaller room which has been adapted to a sensory room. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 23 The home has a variety of equipment and adaptations including handrails, grab rails, hoists, adjustable beds, raised toilet seats, sit on weighing scales and wheelchairs to assist people around the home as required. There are communal toilets located close to the lounge and dining areas so they are easily accessible to people. There is an attractive enclosed paved garden area with various tables and chairs for people to use in finer weather. There is a ramp that is available for those people who use wheelchairs to access the garden and some bedrooms have steps and handrails directly from their room into the garden. The lounge areas are pleasantly decorated with suitable seating to support people living in the home. There are old-time pictures on the walls in all communal lounge and dining areas and a stereo with CDs and a television to make the environment homely. There are also tape recorders available with cassettes. All areas viewed were clean and no unpleasant odours were identified. Some of the bedrooms have been redecorated since the last inspection and those viewed were clean and tidy with personal possessions to make them more homely. New locks had been fitted to bedrooms and bathrooms to prevent the risk of people locking themselves in their rooms. Since the last inspection some of the sash windows at the rear of the building on the ground floor have been replaced. The laundry was viewed and was well organised for managing a dirty to clean flow of washing. Separate containers were available for both clean and dirty laundry and staff have access to gloves and a hand-wash sink with liquid soap to maintain good hygiene practices. There is still only one washing machine to cater for all laundry needs of the home and the manager said should this break down they have a 24hour contract for repair. The manager states in the AQAA that they have changed laundry processes and products to address the problem of stained clothes not being effectively cleaned. No concerns with laundry were noted during the tour of the home. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28, 29 and 30 were assessed. People using the service experience good quality outcomes in this area. The needs of people are met by the numbers and skill mix of staff and staff training is accessed on an ongoing basis to ensure people receive effective care to meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a registered manager and deputy manager at the home and there are dedicated staff that provide laundry, cleaning and catering services. The manager advised there were 33 people in the home and they aimed to have six care assistants on duty during the morning and five in the afternoon. Two carers cover night duty with one additional person on call if required. Duty rotas viewed confirmed these staff numbers are being met although the Social Activity person is counted in with the care numbers during the afternoon. Comment cards received by us from five staff showed that two felt there were “always” enough staff to meet the needs of people, two staff felt there were “usually” enough and one felt there “sometimes” was enough staff. All five Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 25 felt they had enough support, experience and knowledge to meet the different needs of people living in the home. On the day of inspection, no concerns were identified in regards to staffing numbers available to support the needs of people. Staff were observed to be friendly, caring and supportive and shared a good rapport with people. Comment cards received from two visiting professionals stated “staff well trained and manager”, “they have excellent continuity of staff (always a good sign I think)….and all know what is happening with every resident, it’s been like a big family”. Staff training is provided on an ongoing basis and training schedules viewed showed that most staff had completed statutory training such as moving and handling and food hygiene. There were still some staff who needed to complete fire training. The manager had arranged further training sessions for the few staff that were still to complete food hygiene training but it was not clear that further fire training had been arranged. Training in areas relating to the care needs of people living in the home had also been completed to help staff more effectively care for people in the home. This training included dementia awareness, infectious diseases, and ‘end of life’ care. Staff training records confirmed induction training had being completed. It was not clear from individual records viewed what specific training staff had done to demonstrate their competence in each induction area reviewed. These areas had however been signed off by the manager to confirm they had completed training in these areas. Competences should be demonstrated so that it is clear staff have reached an appropriate level of competence to care for people safely. The training schedule seen listed 37 care staff of which 20 had attained a National Vocational Qualification (NVQ) in care or equivalent. This training helps staff to provide more effective care to people living in the home. The manager advised during the inspection that a further seven staff were due to complete this qualification by the end of August 2009 which means the home will further exceed the standard of 50 of staff to complete this training. A review of staff records was undertaken for new staff to confirm that suitable recruitment procedures are in place to ensure the protection of people living in the home. All records viewed contained the required information including a Criminal Records Bureau (CRB) check and two written references. Staff comment cards received by us showed that four out of five staff felt the home had carried out the appropriate checks before they started work. One Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 26 stated that this was not the case because the checks did not come into operation until after they had started. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38 were assessed. People using the service experience good quality outcomes in this area. The home is run by an experienced manager. Systems are in place to ensure the home is run in the best interests of people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has worked in the home for some time and worked as a nurse prior to being employed by the home. She also managed a large nursing agency and in various roles in the caring field. The manager has attained the National Vocational Qualification (NVQ) 4 Managers Award and had accessed other training since the last inspection to keep her skills updated. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 28 Comment cards received from two professionals who visit the home were are very complimentary of the service. One stated “best emi home in the area at present”, the other stated the home is “excellent” and “as a GP I feel lucky that this is one of the homes I care for. I enjoy going there and working in partnership with the staff”. A relative whose mother stayed at the home commented in a letter to us “Mum was certainly happy there as she could be, we also know from personal observation on many visits that each resident is treated very much as an individual”. Staff spoken to were complimentary of the home, one stated “definitely supported by management” and “training is encouraged”. Comment cards received by us from staff also contained positive comments. One stated “Craighaven is a great place to work, we all work together as a team, we all understand our individual responsibilities and have a good relationship with our seniors”. Another stated “training is very good, manager helps and cares about the staff”. The manager had undertaken a quality monitoring exercise in May 2009 to gain views of people who live in the home. Responses were in the process of being returned and those viewed were positive. Staff meetings were being held regularly and issues discussed were clearly documented in notes of meetings. This included safeguarding and what to do, the privacy of people in the home, cleaning of the home, medication and the recording of doctor/nurses visits. The monitoring of the service and discussions at staff meetings helps the management of the home run smoothly in meeting the needs of people. The manager confirmed that they do not hold any monies for people living in the home. She advised that any monies given by relatives are given in cheque format and are paid into a ‘residents account’ so they can be accessed when needed. She advised that receipts are given for any transactions undertaken on behalf of people in the home. Records checked showed that receipts had been obtained for services such as hairdressing and chiropody. Staff undertake health and safety training and there are also regular health and safety checks undertaken to make sure the environment is safe. Records viewed showed that checks had been carried out as required on electrical portable appliances, hoists and gas equipment. An updated fire risk assessment was in place and hot water temperatures were being monitored to make sure they were not too hot to scald people. It was not clear when the next 5 year electrical wiring check was to be done and this should be followed up accordingly. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 29 In some areas of the home door wedges were in use. These prevent doors closing in the event of a fire and could place people at risk. The manager was made aware of this so that alternative options could be considered. A review of accidents and incidents was undertaken to establish if these were being recorded and acted upon appropriately. It was evident that some of these involved medical intervention, repeated falls and injuries which had not been reported to us as required. The manager agreed to address this. Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 31 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 Requirement Care plans must include details of how wounds are to be managed and by whom. They also must indicate what action is to be taken by staff in the event of dressings falling off. This is to help ensure a safe and consistent approach by staff in providing care. Timescale for action 30/11/09 2. OP7 15 30/11/09 Care plans must include how personal care is to be provided to people who are receiving treatment for wounds. This is so that people are not placed at risk of not having their personal care needs met and they can be confident that any action taken by the staff will be appropriate to their needs. Accidents and incidents which require medical intervention or which impact on the well-being of people who use the service must be reported to the Care Quality Commission. This is so the home complies with its statutory responsibility and people can be confident that DS0000063561.V376857.R01.S.doc 3. OP37 37 30/11/09 Craighaven Residential Home Version 5.2 Page 32 appropriate actions are being taken to safeguard people in the home. 4. OP38 23 The service must ensure that where doors are to be left open, suitable door retaining devices are in place which meet with fire precautions. The fire service should be consulted to make sure actions taken are appropriate and safe. This is so people are not placed at risk in the event of a fire. 16/10/09 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 OP1 Good Practice Recommendations The Service User Guide should contain a standard form of contract and consideration should be given to a large print font so that prospective residents and their representatives can easily read this make a fully informed choice about arrangement a placement at the home. Each care plan should be clearly dated and signed so there is an audit trail that shows when care needs have been identified. This is so any progress or deterioration in health can be easily monitored and staff support addressed. Daily records should be completed in sufficient detail to give a reflection of the person’s health so that it is clear care needs identified are being met. Records should be clear as to what high calorie snacks are to be given and when for people who are subject to weight loss due to ill health. This in particular applies to people with diabetes. This is so staff are clear on what is expected and it is clear actions are being taken to support DS0000063561.V376857.R01.S.doc Version 5.2 Page 33 2. OP7 3. OP7 4. OP8 Craighaven Residential Home 5. OP8 the person’s health. People with poor vision/sensory impairments should have access to appropriate aids to support their needs such as large print documents or talking books. Medication records need to be clear in demonstrating how medications have been managed. This includes definitions of any codes used. There should be a clear system in place for staff to record any complaints they may receive in the absence of the manager. This is to ensure these are clearly identified and can be followed up accordingly. The Whistleblowing Policy should be reviewed so that this is sufficiently detailed and clear to staff what will happen if they choose to report an allegation of abuse. 6. OP9 7. OP16 8. OP18 Craighaven Residential Home DS0000063561.V376857.R01.S.doc Version 5.2 Page 34 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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