Care Home: Craigielea Nursing Home

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What the care home does well The home is well managed and run in the best interests of residents. Checks are in place including the use of questionnaires to monitor the standards of care provided. There is a stable staff team of experienced mature carers that provide a good standard of care for residents. There is a thorough assessment of residents needs to ensure that appropriate care is provided. Residents are treated with great warmth and respect. Positive comments from people were; Everything is very good, there are activities in the afternoon, there are church services and magazines to read. I am well cared for. I feel safe and happy. Everything is good. The home is old but well maintained. What has improved since the last inspection? This home was assessed as excellent at the last inspection and many of the systems in place ensure this continues. Maintenance and renewal works are ongoing. Training of staff to ensure that care practices are good continues and the Manager and Chief Executive constantly look at how care can be improved. No requirements were made at the last inspection. What the care home could do better: Consideration should be given as to how storage facilities may be improved. Staff should be reminded of the importance of maintaining accurate recordings with the medication system to ensure peoples health needs are met. Ensure that identity photographs are in place for all staff and that when recruiting staff, a record is made of any gaps in employment and the associated reason. Key inspection report Care homes for older people Name: Address: Craigielea Nursing Home 739 Durham Road South Low Fell Gateshead Tyne & Wear NE9 6AT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Allan Helmrich     Date: 0 2 0 2 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Craigielea Nursing Home 739 Durham Road South Low Fell Gateshead Tyne & Wear NE9 6AT 01914874121 01914870639 susan@craigieleacare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Gateshead Dispensary Nursing Home (Craigielea Limited) care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered peson may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 27 Physical Disability - Code PD, maximum number of places: 3 Date of last inspection Brief description of the care home This home is a three storey, stone built building with a slate roof. It is a converted building. A sympathetically styled extension has provided additional communal and bedroom space. It is located in a residential area, close by the A167 in the Low Fell area. It has 27 places and is registered to provider care, including nursing care, to elderly persons. The home is run on a not for profit basis by a registered charity. It is Care Homes for Older People Page 4 of 25 Over 65 27 0 0 3 Brief description of the care home close to local facilities and main bus routes. It stands in its own grounds. These are well kept and planted, and are easily accessible to service users. There is limited parking in the home but street parking is possible in the area around the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at: Information we have received since the last visit on 26th March 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of Care Homes for Older People Page 6 of 25 residents, their relatives and other professionals who visit the service. The inspection was unannounced and was undertaken by an inspector over two days. During the visit we: Talked with people who use the service and their visitors. Talked with the registered manager and staff on duty. Looked at information about the people who use the service and how well their needs are met. Looked at case records for four people and other records which must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with sufficient information to make an informed choice about the home before moving in and they are fully assessed by a competent person to ensure their needs can be met by the staff team. Evidence: Visitors to the home are greeted at reception. The reception area of the home contains information about the home and the service provided. There was a newsletter to review and a summary of the surveys received from people over the previous three months, stating any action taken to address the issues identified. Prospective visitors are provided with an information pack that can be made available in large print or audio for those who require it. It contains the necessary information about the staff and management of the home. People spoken to said that their move into the home was well managed and that they were provided with enough information before they decided to move in. People have Care Homes for Older People Page 10 of 25 Evidence: contracts and examples of these were seen. The manger confirmed that the placing authority did their own assessment and that the home did their own assessment of needs independent to this. Records contained both assessments and this provided a comprehensive picture of peoples needs, including social, spiritual and aspirational needs. The manager said that service users were encouraged to provide information for their own profile or life history and examples of these were also seen. Care intended to rehabilitate people to return home is not provided. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect their health and personal care needs to be provided in a way that meets their needs. Evidence: Following admission to the home, the initial assessment information obtained is reviewed and improved before a range of care plans are produced. The care plans of four people were reviewed. These were well written and contained all the information necessary to ensure their needs are met. This includes nutritional assessments, information on pressure damage risk, moving and handling, personal care and social needs. Where appropriate, external health care professionals are involved and necessary information from them is recorded on a professional communication record. There were good risk assessments documented and evidence that these were carried out in practice. The home is well equipped and all rooms have variable height beds. Many beds showed evidence of alternative strategies to bed rails, such as foam wedges. There are a number of pressure relieving cushions and mattresses in use and the home has Care Homes for Older People Page 12 of 25 Evidence: a variety of hoists and other moving and handling equipment. The home has appropriate policies relating to the safe handling of medicines and staff involved in the provision of medicines have received training. The system for storage and administration was reviewed. Medicines are appropriately stored and a system of recording is in place. The records were generally of a good standard, however some blank spaces were noted, an error in description had occurred and a medication on the controlled register was confirmed by only one signature. These are against good practice. The manager regularly audits the medication system and did demonstrate that errors found are addressed appropriately. Staff were seen to talk respectfully to service users and listened attentively to what they said. Staff knocked before entering service users rooms and gave support in a way that was unhurried and focused on the individual they were dealing with. People spoken to were appreciative of the care provided by the staff team. Peoples comments included: Everything is good. I feel safe and happy. I am well cared for. The relative of one person felt that care could be improved and that the bedroom did not enable a good standard of care to be provided. The manager was meeting with this person to discuss their concerns. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can choose what to do and there are a range of activities for people to choose from. Meals are varied and wholesome. Evidence: The manager in an assessment document, provided prior to the inspection, commented that residents are free to choose what to do and that they are encouraged to join in with organised daytime activities. However, at the time of the inspection a lift in the home had been out of operation for three weeks. This had disrupted the normal schedules and placed extra burden on the staff team. People living in the home and their visitors generally accepted that this situation was outside the control of the home. The activities organiser was spending more time with those people isolated in their bedrooms and staff were bringing those people together, who enjoyed each others company, in individual bedrooms. People spoken to stated there were sufficient staff available and some confirmed they have been visited by the activities person. The notice board identified the activities of the week as mainly oneto-one sessions with some sing-a-longs and bingo. During the inspection people were involved with staff making music with small percussion instruments and singing. Care Homes for Older People Page 14 of 25 Evidence: The home obtains a daily news paper for people and church services by Church of England and Catholic lay people are held to meet the needs of those people who wish to attend. The Salvation Army visit the home occasionally. The home has large screen televisions in the lounges and a Sky package and Wii console of games. The large screen television was welcomed by those people spoken to in a lounge. The home has a bus capable of taking up to four people and a wheelchair out on day trips. The manager stated people have access to a phone but their is not a cordless phone to promote privacy by enabling people to use it in their own rooms. Visitors spoken with stated they could come and go freely and that they were always made welcome. The lunchtime meal was observed. People in the ground floor dining area were supported by staff in a quiet professional way. Menu choices were detailed on a board in the home and everyone spoken to had enjoyed their meal. People on the second floor were catered for in their bedrooms due to the lift problem. One visitor who regularly assists there relative at lunchtime stated the meals are quite good. The kitchen contained a good range of foods so that people could choose alternatives to the menu choices and there was fresh fruit and juices available. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that any concerns they have will be taken seriously and investigated. They are supported by a well trained staff team. Evidence: The home has a complaints procedure, in a service guide, that is presented to each person when they enter the home. The procedure is also on a wall in the reception area for the benefit of visitors and complaints are solicited at the regular meetings held in the home. There are also feedback forms available on the reception counter that may be used. There is a log for recording complaints and their outcomes. Everyone spoken to stated they felt able to discuss any issues they have with management and those who commented said that they feel safe in the home and are well supported by the staff team. The manager is aware of safeguarding procedures to ensure vulnerable people are well supported. Staff receive training and currently the manager is reviewing the need for refresher training. Staff spoken to were confident that they would support people in the home and protect them from any form of abuse. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This well maintained home can meet the needs of people living there. Although storage could be improved to avoid bathrooms being used for storage. Evidence: The home is converted from a substantial family residence and retains much character of a home of quality. However some corridors and turns are difficult to negotiate and storage is at a premium. At the time of inspection a lift in the home was temporarily out of order causing people who reside on the second floor to be cared for on that floor only. People on the first floor were able to use a lift in the adjacent residential home to gain access to the ground floor facilities. The manager was using her best endeavors to have the lift repaired. The home was clean, tidy, well ventilated and maintained to a good standard. Heating is provided from a safe, low surface temperature source. No extremes of temperatures were experienced during the inspection. The home has good levels of natural and artificial light in all areas. All communal areas are homely in appearance, are tastefully decorated and furnished with co ordinating furnishings and curtains that are domestic and varied in style. Care Homes for Older People Page 17 of 25 Evidence: The home has a loop induction coil system, for hearing aid users, in the lounge. There is a large screen television in the main lounge connected to the Sky service and a WII console that provides games for people to use. The home has a dedicated hairdressing facility that is bright and modern. The home has aids and adaptations, and provides a suitable environment that will meet peoples needs and safeguard staff. Bedrooms were of different sizes and some people spoken to were offered larger bedrooms to suit their needs. Others in smaller rooms were content and others were awaiting larger rooms to become available. The rooms seen were personalised with small items of furniture and memorabilia. People spoken to were generally satisfied with their private space. Bathrooms and toilets were sufficient to meet peoples needs and contained bathing facilities to assist people with reduced mobility. Many bathrooms however were used as temporary storage for hoisting equipment and laundry trolleys. These items had to be removed before the bathroom was usable. The kitchen is a good size and equipped with equipment necessary to provide appropriate meals and snacks. The laundry also contains appropriate equipment to ensure disinfection standards can be met. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a competent well trained workforce, employed in sufficient numbers to ensure their needs are met. Evidence: The manager who works in a supernumerary capacity from Monday to Friday is normally supported by two nurses during the day then one nurse through the night. There are six care staff on duty between 7-45am and 1-15pm then five care staff between 1-15pm and 8-00pm then three care staff during the night. In addition an administrator, activities organiser, handyman, domestic and catering staff are employed. Additional staff hours are provided to ensure people are escorted to health care appointments and when outside activities are organised. Staff spoken to felt under pressure currently due to the extra work of ensuring people are well supported while the lift is being repaired, however all stated they are well supported by management and that training to meet their needs is provided and meetings and supervision enabling them to meet with management takes place. The home has high levels of staff that have achieved NVQ level 2 or above. Staff spoke of being encouraged to take up National Vocational Qualification (NVQ) training and on the achievement of level two they take part in an award ceremony that includes a gift of champagne. The company also offers an increase in the hourly rate Care Homes for Older People Page 19 of 25 Evidence: as an incentive for staff to achieve the required levels of training and staff feel valued by the home because of this. Currently 100 staff have achieved NVQ level 2 and one person has achieved NVQ level 4. All new staff undertake a full induction and this is followed by a newly created competency assessment. The manager is currently reviewing the files of longstanding members of staff who may not have undertaken the new comprehensive induction and this is now being provided for them. Recruitment files for three recent recruits were reviewed and found to contain information to demonstrate suitable employment checks are carried so that vulnerable people are protected. Recruitment checklists are used but these do not demonstrate gaps in employment have been investigated. Also one file did not contain a photograph for identity purposes. The files did contain; an interview assessment form, references, CRB checks, terms and conditions of employment and induction information. People who come with qualifications must also provide certificated information of this training. Details of supervisions carried out by the manager are in place and a programme of future supervision dates informs the manager. Good records are in place to demonstrate the manager is aware of who requires training and when these require updating. A good level of training is provided for staff in the home and staff confirmed this during the inspection. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and systems are in place to ensure the quality of care is monitored and safe working practices are promoted. Evidence: The Registered Manager is an experienced Registered Nurse who in 2008 completed the Registered Managers Award to demonstrate her ability to manage a home for vulnerable people. She has managed the home successfully for over ten years and is respected by the staff team. As part of her continuous professional development she has completed a three month course related to the Care of Older People with Sunderland University and a three month course with Gateshead Council related to Health and Safety. She is in day to day control of the care provided and works closely with the Chief Executive in other matters. A comprehensive quality assurance programme is in place and this is supported by regular audits of medication systems, infection control and maintenance systems. Each week there are managers meetings followed by quality assessment meetings. Care Homes for Older People Page 21 of 25 Evidence: Feedback sheets are freely available on the reception counter and quarterly audits are produced and made available to residents and visitors to the home. There is a quarterly Trustees report and a monthly newsletter to provide information. A system is in place to hold monies for people should this be required. Monies are held securely and each transaction is witnessed and receipts are retained when appropriate. Regular health and safety audits are done by the manager and maintenance certificates are retained to demonstrate people are safe. Certificates for the servicing of the heating system and checking of the homes internal wiring system were inspected and found to be in order. The homes maintenance person checks all electrical items brought into the home and any failures are removed to ensure safety is maintained. The records kept of these checks did not identify this fact. The manager demonstrated with information provided prior to the inspection that appropriate policies and procedures for management of health and safety are in place and that staff are provided with this training to maintain a safe environment. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 Make staff aware of the importance of ensuring the medication administration records are accurate. And that any errors they find are immediately addressed and corrected. Consider how additional permanent storage may be provided in the home. Record in the homes recruitment checklist if gaps in employment have been investigated. Ensure a photograph of staff is held in the home for identification purposes. Record to disposal of electrical items that fail the portable appliance testing system used in the home. 2 3 19 29 4 38 Care Homes for Older People Page 24 of 25 Helpline: 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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